| Summary: | Ukraine provides an illuminating example of a health system that has responded to a health shock in a way that both builds health system resilience and advances health system reforms. When the COVID-19 pandemic broke out in Ukraine in early 2020, a set of major health financing and provider payment reforms were under way. The capacity of the National Health Services of Ukraine (NHSU) and collaboration with the Ministry of Health (MOH) of Ukraine offered considerable flexibility to make quick adjustments in purchasing arrangements toward changing COVID-19 health care needs. The NHSU is entitled to purchase program of medical guarantees (PMG) services through packages defined on an annual basis with regular adjustments to accommodate evolving needs. The ongoing reforms involved a transition from historical line-item budgeting toward output-based purchasing arrangements through which resources were channeled to selected health providers, conditional on confirmed provider capacity and using new payment mechanisms (capitation, global budgets, fees for service, per-case payment, and so on) that incentivize efficiency. It is an opportune time to reflect on how Ukraine's pandemic response affected the health system reforms and the extent to which adjustments made helped them progress or set them back. The lessons from this experience may be important during the current health sector emergency caused by the Russian invasion in Ukraine, which started on February 24, 2022
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