One year without MSEK: How the disability determination system has changed in Ukraine

The first year since the launch of the new electronic system for Assessing a Person's Everyday Functioning has passed as part of a large-scale reform of the outdated process. During this time, the process of establishing disability has become electronic, more transparent, and faster: case reviews no longer take months, and in its first year, the new system covered over 550,000 cases.

The reform changes the very approach to disability determination — making it less bureaucratic and more focused on human needs. The system allows doctors of any specialty working with adult patients to create electronic referrals. All subsequent steps — the formation of expert teams, case review, and decision-making — take place in an electronic format. This is one of the most significant transformations in healthcare and social policy in recent years. The project was carried out with the support of the Swiss-Ukrainian EGAP Program, implemented by East Europe Foundation.

Why changes were needed

The old MSEK (Medical and Social Expert Commission) system had remained almost unchanged since independence. To get MSEK clearance, a person, together with a doctor, had to collect a package of documents - in hard copies - and often provide additional certificates later. Extra examinations were frequently demanded without clear explanation, and the process itself dragged on for months.

Patients did not know when their case would be reviewed or how long they would have to wait. This was compounded by corruption risks and high-profile scandals. The full-scale war exacerbated the problem: the number of people requiring assessment increased, while the system remained slow and opaque.

What has changed

The core idea of Electronic Assessment of a Person's Everyday Functioning is to evaluate not just the diagnosis, but how a person’s condition affects their daily life: their ability to move, work, and care for themselves.

The system has become:

• electronic — hard copies of the documents no longer need to be submitted;
• more transparent — the patient can see the status of their case review, and the medical team is assigned automatically;
• more accessible — assessments are conducted in multidisciplinary hospitals rather than by separate commissions.

What the patient journey looks like now

Previously, the patient journey looked like this: doctor → hospitalisation → Medical Advisory Commission → MSEK.

Now, it is simpler: attending physician → electronic referral → expert team.

During the first year of operation, the system demonstrated its scale:

• 554,757 decisions were made by expert teams in 2025.
• Disability was established in 85% of cases.
• More than 220,000 people received disability status for the first time.
• 638,000 patients applied for assessment.

Importantly, waiting times have been reduced: previously, it took months or even half a year, with no way to track or control deadlines; now, it takes less than 19 days.

The system has expanded significantly and become more accessible: assessments are conducted in over 300 hospitals instead of 328 MSEK offices, and the number of doctors involved in the process has increased more than fivefold — from 1,267 to over 7,000.

For the first time, the reform has systematically anchored human rights within the process of obtaining disability status. This includes access to information about one's case, the opportunity to undergo assessment with a representative, the right to record audio and video, and the ability to appeal the expert team's decision.

Plans for 2026

The next stage of the reform involves its deepening and practical refinement. This includes clarifying the criteria for establishing disability to make decisions more objective and understandable. In parallel, there are plans to introduce a questionnaire that will help better determine a person's individual needs.

The system will also evolve in terms of oversight — risk-oriented mechanisms will be introduced to identify potential violations. An essential part will be the expansion of digital data exchange so that information between different institutions is transferred faster and without unnecessary certificates for the individual.

The first year of the reform has shown that a system that remained closed and complex for years can be made more transparent, fast, and clear. The next challenge is to make it as responsive as possible to the needs of every individual.

The reform of the Electronic Assessment of a Person's Everyday Functioning processes is being implemented by the Ministry of Health of Ukraine in cooperation with state authorities, healthcare facilities, specialised experts, and civil society. Partners who supported the preparation and implementation of the reform: The Rehabilitation for Ukraine (Rehab4U) project, made possible by the generous support of the U.S. Government and implemented by Momentum Wheels for Humanity; and EGAP Programme, implemented by East Europe Foundation with the support of Switzerland.