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Procedural fairness and the resilience of health financing reforms in Ukraine
In 2017, Ukraine’s Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principle...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645049/ https://www.ncbi.nlm.nih.gov/pubmed/37963081 http://dx.doi.org/10.1093/heapol/czad062 |
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author | Dzhygyr, Yuriy Dale, Elina Voorhoeve, Alex Gopinathan, Unni Maynzyuk, Kateryna |
author_facet | Dzhygyr, Yuriy Dale, Elina Voorhoeve, Alex Gopinathan, Unni Maynzyuk, Kateryna |
author_sort | Dzhygyr, Yuriy |
collection | PubMed |
description | In 2017, Ukraine’s Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders’ participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform’s design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty. |
format | Online Article Text |
id | pubmed-10645049 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106450492023-11-15 Procedural fairness and the resilience of health financing reforms in Ukraine Dzhygyr, Yuriy Dale, Elina Voorhoeve, Alex Gopinathan, Unni Maynzyuk, Kateryna Health Policy Plan Case Study In 2017, Ukraine’s Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders’ participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform’s design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty. Oxford University Press 2023-11-14 /pmc/articles/PMC10645049/ /pubmed/37963081 http://dx.doi.org/10.1093/heapol/czad062 Text en © The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Case Study Dzhygyr, Yuriy Dale, Elina Voorhoeve, Alex Gopinathan, Unni Maynzyuk, Kateryna Procedural fairness and the resilience of health financing reforms in Ukraine |
title | Procedural fairness and the resilience of health financing reforms in Ukraine |
title_full | Procedural fairness and the resilience of health financing reforms in Ukraine |
title_fullStr | Procedural fairness and the resilience of health financing reforms in Ukraine |
title_full_unstemmed | Procedural fairness and the resilience of health financing reforms in Ukraine |
title_short | Procedural fairness and the resilience of health financing reforms in Ukraine |
title_sort | procedural fairness and the resilience of health financing reforms in ukraine |
topic | Case Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645049/ https://www.ncbi.nlm.nih.gov/pubmed/37963081 http://dx.doi.org/10.1093/heapol/czad062 |
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