Why introduction of compulsory medical insurance stalled in Ukraine?

Author : News Agency

Source : 112 Ukraine

About ten draft laws on compulsory health insurance are placed in the Parliament committees, and none of them even passed the first hearing. At the same time, the Ministry of Health believes that insurance medicine will start functioning in a year - in 2020. Neither institutional bodies, nor the ordinary Ukrainians are ready for such a turn of events.
21:47, 11 December 2018

Open source

The opportunity to receive medical insurance appeared in Ukraine in the 2000s, when private insurance companies decided to include such a service to their functions. About 50 insurance companies are currently operating in the market, but less than 10% of Ukrainians enjoy the privileges of voluntary medical insurance. At the same time, most of them received insurance not on their own initiative: it is mainly provided by large employing companies that fight for human resources and value their employees.

As part of the medical reform in 2020, compulsory medical insurance, which would cover about 90% of the population, should start. There is no clear model by which it will work. It is assumed that the Special Tariff Service will set certain rates for the basic package of medical services, which should be the same for all medical institutions. Those services that will be included in the list of health insurance fully paid by the state (for retirees, children and the unemployed) and employers (for officially employed citizens). Other services that are not included in the basic list will need to be paid from your own pocket - directly to the cash desk of the medical institution or by issuing additional insurance from a private company. It will be possible to use the insurance in any hospital: both in private and public. Something similar works now. 47 private clinics signed an agreement with the National Health Service, and the services of primary care physicians (general practitioners, pediatricians, family doctors) are paid for by the state (if the patient has entered into an appropriate agreement with the doctor).

However, this approach contains certain risks. Firstly, if employers have to pay additional contributions to the state insurance fund, this will increase the tax burden and, as a result, the business will go into the shadows. Secondly, money from the state budget is not enough for the full provision of citizens with medical services. Now, for example, the medical industry is underfunded by almost half, and the amount of subsidies is about 3% of GDP (according to WHO recommendations, this amount should be at least 6%).

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Meanwhile, it must be said that the Ukrainians themselves are also not ready for such changes. In order to understand why insurance medicine is not popular among our people, I will note three of its principal features:

1. Ukrainians are accustomed to go to the hospital when they already have problems. At the same time, in all European countries, insurance works by the principle of preventive medicine. It includes regular medical examinations to diagnose the disease at an early stage. If a person does not go to them, and then they discover a certain disease that could be prevented, then treatment will have to be paid out of pocket: insurance does not cover such cases. The fear that you will have to pay big money for the operation force people regularly visit doctors.

2. Ukrainians believe that they can solve their problem quickly and cheaply without insurance. While we have all the hospitals open and the doctors are ready to help, we go there only in need. You can solve the situation with a help of friends or give a bribe. After the introduction of compulsory medical insurance, hospitals will not be able to accept a patient without insurance.

3. Ukrainians worry about the quality of services paid by insurance companies. In the interests of the latter - to save on consumables and drugs. In Europe we see the same thing: having insurance, people wait for a planned operation for years, but if you pay the full amount on the spot, then they make the surgery almost the next day.

Finally, it is worth adding that patients do not value those medical services which are 100% paid by the employer or the state. In the west, half the insurance is paid by the employer, and half by the employee, which encourages a more responsible attitude to the issue of health.

However, the need for partial payment of insurance in Ukraine is caused by the economic situation. Ukrainians are not ready for this and will meet this news without enthusiasm. On the eve of the elections, deputies will not vote for decisions unpopular among the public. The first version of the bill from the Ministry of Health, which included the possibility of a partial payment of the insurance by the insured, did not pass the vote in the parliament. But miracles do not happen, money is nowhere to take. Sooner or later, such a bill should still be adopted: if not at the current parliamentary convocation, then at the next. One way or another, medical insurance is operating in almost all countries and helps to develop the medical industry as a whole. After all, now it is not the hospital bed that will be financed, but specific medical services. In the future, this means that the quality of services in private and municipal medical institutions should be equalized and compete with each other.

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