Healthcare reform in Ukraine: Illusiveness of the changes

Author : Andriy Shypko

Source : 112 Ukraine

At the end of January, the Law on State Financial Guarantees for Medical Services came into force
11:28, 23 February 2018

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At the end of January, the Law on State Financial Guarantees for Medical Services came into force. Following the schedule of the medical reform, the official signing of the service declarations with doctors at the primary level would begin in April, and in July the National Health Service should start its work.

All of us have repeatedly heard about the benefits as a consequence of the reform promised by the Ministry of Health, but these changes are illusory. Unfortunately, eloquent declarations do not have real possibilities for their implementation.

Concerning the primary level of the medical care, the reform package of the adopted bills provides that during March-June, every citizen of Ukraine must on his family doctor and conclude a service agreement with him. At the same time, it can be any doctor working at the primary level, regardless of the region in which he works; he can be both a staff unit in a polyclinic and a private entrepreneur.

So what are the traps and pitfalls here?

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First, there is no objective information on the qualifications of individual doctors, most patients will be affected by the distorted and biased "advertising."

Secondly, those of the doctors who are "faster" will consciously sort the citizens in the nearby houses, as a result of which the most problematic and complex will be distributed according to the "residual" principle.

It is also difficult to imagine a situation when the doctor will carry out visits to patients from remote areas of the settlement or a village.

In addition, it should be noted that the entire contractual process is likely to take place under the pressure of the leadership of the Primary Health Care Centers (polyclinics, dispensaries), which will not be interested in creating a new order. It would be much easier to preserve the current one when the residents are attached to the doctors by the micro districts order; the wages do not vary greatly not to create competition within the team.

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Here we should remember about the suggested limitation – 2000 patients per family doctor. If we divide the population of Ukraine (which according to the State Statistics Service is 42 million 603 thousand people), we will face a shortage of slightly more than 17 thousand family doctors. According to the tentative data, we actually have less than 10 thousand. In the coming years, this amount is unlikely to increase significantly; rather the doctors are one of the leading groups of labor immigration.

The next direction is a guaranteed service package of the primary level.

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The documents really provide for a wide range of examinations, analyzes, and diagnostic procedures that might be necessary for a person to consult a doctor. Even in Soviet times, district therapists should perform almost all the positions indicated in the latest developments of the Ministry of Health, so here is the question: do we have the necessary diagnostic and procedural-manipulative base to ensure the prescriptions of the family doctor?

It should be noted that the state's guarantee of free provision of medicines on the primary level is gradually not mentioned, although this was one of the brightest "brands" of those concepts from the new Ministry of Health team that preceded the adopted bills. Now, this important promise for the population has been replaced by a modest phrase - "provision of medicines in accordance with state and municipal programs." But how many such programs really work at the primary level? Unfortunately, we have a package to which we cannot add the word "guaranteed" yet.

And one more question from the sphere of "cunning" figures comes to mind. If the standard of financing at the level of 370 hryvnias (13 USD) is established for each person in a year, what can they be enough for?

Taking into account the fact that today people quite justifiably do not trust the results of the research in the state laboratories and have neither the desire nor the time to sit in the morning queues, they will choose paid diagnostic centers where the total blood test costs at least UAH 100 (4 USD).

In general, the new model of the funding system is not clear: who will receive the funds - to the doctor's account or to the institution's account?

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Speaking about the out-patient department, then, apparently, this institution itself will divide the received in calculation per one doctor 60 thousand hryvnias per month. Part will go to the doctor for quantitative and qualitative results, and the rest of the funds will go to the maintenance of the device, purchases, salaries to junior staff and non-medical workers. Everything is clear here, but the question arises: what is new in this mechanism, apart from the beautiful signboard about the regulatory funding, this is approximately the same.

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Otherwise, the doctor will distribute funds for the maintenance of other medical and non-medical workers - the administration of institutions, nurses, as well as to finance diagnostics, laboratory research, prevention, physiotherapy, vaccinations, droppers, day hospital stay and so on. And among all this, he must allocate something for his own salary. But in order to implement this approach, a very complex legal and financial mechanism should be prescribed: how to divide these funds, what is the order of their redistribution. It is important to realize that the Treasury will not give a penny without this. This mechanism just does not exist...

In fact, there are a lot of questions, and all of them should have a clear answer, otherwise, it turns out that Ukraine has crossed the line of the "humanitarian catastrophe." Therefore, it is necessary to bring to the attention of the Ministry of Health's leadership that before laying the walls, it is important to lay the foundation for reforms, which are absent today.

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This column does not necessarily reflect the opinion of the editorial board or 112.International and its owners.

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