Across the globe, the pandemic has struck social compacts no less than individual lives. Falling incomes and escalating healthcare needs have amplified public concerns over government choices in healthcare financing, stimulating new research on what could be realistically done to increase the perceived fairness of these decisions. This case study is part of a series of case studies contributing to development of guidance for policy makers on procedural fairness in health financing. The study examines applicability of the newly proposed criteria to the experience of the 2016-2017 health reform in Ukraine, focusing on the decisions of the Government to choose general taxation as the funding source for a newly established benefit package and the decision to replace a highly decentralized health financing system with a single-purchaser model.

The study is based on qualitative methods. Using a desk review, it examines the evolution of regulations and supportive documents, expert analysis and media content. This is supplemented by semi-structured interviews with the reform stakeholders, deliberately covering respondents with diverse opinions on the process and outcomes of the reform. The analysis shows both reform decisions are in line with global lessons and evidence on UHC reforms. They were also based on advanced procedural regulations with considerable transparency throughout the process. However, the changes were perceived as unfair by major and influential stakeholders, leading to ressentiment, and creating risks for reform sustainability. The study sheds light on how this outcome could have been pre-empted with a fairer process. The reform process was focused on technical accuracy, transparency and reasons-giving but underinvested in meaningful public participation. It makes a case for using the new procedural fairness criteria as an ex-ante diagnostic tool to support sustainable changes in health financing, especially if stakeholders are not well organized and lack coordination platforms.