“What’s Up With the Economy?” is a podcast by the Centre for Economic Strategy in cooperation with Hromadske Radio, supported by PrivatBank.
Every week, hosts Anhelina Zavadetska and Maksym Samoiliuk talk with experts, entrepreneurs, analysts, and government officials about what is happening with Ukraine’s economy.
While the podcast is held in Ukrainian, we decided to summarise each issue with the most important insights.
In the new episode, we talk with Maksym Obrizan, a leading Ukrainian economist and Associate Professor at the Kyiv School of Economics, about the economics of health during wartime.
We discuss how Ukrainians’ mental health affects productivity, the state budget, and GDP; why self-medication harms not only individuals but also public finances; and how the healthcare system could be reformed after the war.
How the war affected Ukrainians’ mental health
In May 2025, a survey of two thousand Ukrainians found that around 30% of respondents likely experience anxiety, and 28% — depression. These figures are nearly six times higher than pre-war estimates, indicating a serious decline in the nation’s mental health. According to Maksym Obrizan, mental well-being largely depends on financial stability:
“There is a certain group of people who do not even have enough money for food. Compared to this basic category, other households are much less likely to suffer from both depression and anxiety.”
Financial instability and uncertainty about the future significantly increase the risk of mental disorders. People lacking basic resources are the most vulnerable to anxiety and depression, while households with at least minimal economic stability are less exposed to these risks. Thus, material security has become a key factor shaping the mental health of Ukrainians.
The more money, the less anxiety
Depression and anxiety affect not only individual well-being but also the economy as a whole. Mental disorders reduce productivity, increase sick leave, and create indirect costs for businesses.
“A person suffering from depression may not be able to go to work because their mental state prevents them from doing so. In many countries, losses from depression are measured in billions of dollars,” Obrizan notes.
For Ukraine, where a third of the population lives in a state of constant stress, this has become not only a humanitarian but also an economic challenge for development.
When healthcare becomes inaccessible
Even before the full-scale invasion, Ukrainians paid over 46% of their medical expenses out of pocket — one of the highest rates in Europe. This reflects not only the inefficiency of public programs but also a lack of trust in the healthcare system.
Self-medication is common: many Ukrainians buy medicines without consulting a doctor. In the short term, it may seem cheaper, but for the system overall it leads to rising “catastrophic” health expenditures — when the cost of treating a serious illness falls entirely on families and pushes them into poverty.
The war has destroyed hundreds of hospitals and deepened the shortage of medical personnel. According to surveys, 16% of Ukrainians have lost access to medical services. The most vulnerable are those who lost property or were displaced — their likelihood of being left without treatment is 18% higher.
Despite this, as Obrizan notes, the Ukrainian healthcare system continues to function.
In 2010, half of patients paid doctors “under the table,” whereas by 2023 this figure had dropped to 17%. On the one hand, this shows progress; on the other, it partly reflects a shift toward private healthcare. While the primary care level has improved significantly, secondary and specialized medicine remain in a “grey zone” — with informal payments and low transparency in financing.
Why the insurance model doesn’t work yet
Many countries have mixed healthcare systems — for instance, Germany has adopted an insurance-based model, while the United Kingdom finances its system through taxes. In both cases, the state has mechanisms to collect and redistribute funds, but for Ukraine such a model remains difficult to implement due to the high level of the shadow economy.
A large share of wages remains off the books, complicating the formation of stable healthcare funding. Therefore, the key challenge is not only collecting funds but also using them effectively — with proper control, transparency, and minimal corruption risks. The ability of Ukraine’s healthcare system to operate sustainably and meet people’s real needs depends on this efficiency.
Gender inequality in healthcare
Like most healthcare systems worldwide, Ukraine’s relies heavily on the invisible labor of women — mothers, daughters, and wives who provide unpaid care for the sick, children, or the elderly. This work is not compensated but has a real economic cost: women spend time that could otherwise be used for paid work and often leave the labor market to take care of family members.
“In most countries, it’s women who bear the burden of caregiving. They spend dozens of hours doing unpaid work, yet it is not reflected in GDP,” the economist reminds.
During the war, this inequality has deepened: women are more likely to stay behind the frontlines, care for relatives, and combine employment with household responsibilities. For the healthcare system to remain resilient after the war, it is important to recognize this work as economically significant and to create mechanisms of compensation — for example, through social benefits or tax incentives.
“What’s Up With the Economy?” is a podcast by the Centre for Economic Strategy in cooperation with Hromadske Radio, supported by PrivatBank.
The podcast is available in Ukrainian on different platforms by the link.
