In late February, Ukraine’s Ex-Minister of Health Zoryana Skaletska promised Ukrainians free treatment from Covid-19 in state medical institutions. However, some patients with coronavirus say that they have to pay thousands of dollars for treatment. In addition, insured citizens complain that companies are massively refusing to compensate for treatment for Covid-19.
If a person feels unwell, he or she can go to the doctor and do an express test for coronavirus. If a result is positive, this person will be isolated in the same hospital. The Ministry of Health has clearly established a list of institutions that accept patients.
The patient cannot be treated in a private clinic, this is the prescription of the Ministry of Health. Private health facilities can only consult the patients. If the private clinics find the coronavirus, they must immediately transfer this patient to the public hospital.
Such a strict prohibition could be rarely found abroad, clinic departments are even re-profiled into infectious disease hospitals, and they are divided into “clean” and “dirty” areas where patients can walk.
Since state institutions treat the person with coronavirus patients, the state must pay for it. According to the deputy head of the healthcare strategic development department of the Donetsk Regional State Administration, Oleksandr Pedenko, one day of treatment for such a patient costs the budget 50 USD. According to WHO recommendations, the average hospitalization lasts 21 days. That is, about 1-1,125 USD have to be spent per patient.
But the main cost item is the treatment of severe pneumonia caused by a coronavirus. The Ministry of Health says that it costs at least 3,550 USD. Is this a lot?
The Czech Republic has not yet billed people, but the average cost there is about the same as in Ukraine. Treatment of a patient can cost from 800 to 5,500 USD. In China, clear prices are not called, but they also talk about several thousand dollars. In Russian St. Petersburg, the state pays about 760 USD per day for patients with a mild form of the disease, with an average of almost 2,000 USD, and severe with 2,500 USD.
Many Americans have to put off medical care due to the high cost of treatment in the absence of insurance. The treatment of seriously ill patients with pneumonia, according to the Kaiser Family Foundation, costs 20,000 USD. However, there are even higher bills: one American was sent an invoice for the treatment of coronavirus in a mild form for almost 35,000 USD.
It is difficult to assess whether the amounts allocated for the treatment of Ukrainians are fair. The level of our healthcare system is far from the foreign one. If we consider the statements of doctors and patients about what the coronavirus is treated with, then these are mainly antiviral and antimalarial drugs. There is no specific treatment for the disease.
Antiviral "Ribavirin" costs 4-8 USD. Ukrainian and Italian hospitals are also actively using anti-malarial "Plaquenil" in treatment (23 USD per pack). It blocks the receptors through which the virus enters the lungs.
China called Arbidol one of the drugs that could help in curing coronavirus. This drug was developed half a century ago at the Soviet Institute of Pharmacology. But there are serious doubts about its effectiveness, so WHO does not list it in the recommendations for the treatment of influenza. The price of packaging varies 2,5 – 3,5 USD.
But other drugs, especially immunomodulators, are more expensive. The price of Interferon can reach 3,500 USD.
Of course, it all depends on the dosages of the drugs that the doctors will prescribe. But it is necessary, in addition to medicines, to take into account the cost of catheters, as well as the fact that doctors use masks, overalls, glasses, and gloves that must be disposed of after each examination. In addition, vitamins and antipyretics are needed. The amount is also affected by the payment of food. So the "price tag" per patient can theoretically really reach up to 50 USD.
But, despite state funding, Ukrainians still have to pay for part of the treatment on their own.
Ex-head of the Ministry of Health Zoryana Skaletskaya said: medicines are not specific, medical facilities do have them. But patient of Odesa City Infectious Diseases Hospital Shahin Asadov says that he had to spend almost 900 USD only for the first 2 days of hospitalization.
He paid for bathrobes for medical workers and medicines, and did not buy them personally, but simply gave the money to doctors.
The lack of drugs in hospitals can be explained by increased demand (not only Ukraine but also other countries of the world faced this situation), it is not entirely clear why Odesa residents were forced to purchase gloves, plasters, catheters, syringes, and tubes. After all, they definitely should be available in the hospital.
MP Serhiy Shakhov, who had already recovered from coronavirus, told 112.ua that he had spent more than about 80 USD. He bought "Plaquenil," he has got pneumonia because of the coronavirus.
Not everything was so rosy for Oleksandr from Chernivtsi, first Ukrainian, who has got cured of coronavirus. According to him, the treatment was paid by approximately 70%. In the first week, his family bought everything they needed on their own, and only after the medical institution intervened financially, and then not completely. By what criteria in institutions show such a selective approach to hospitalized is unknown.
The absence of towels, toilet paper, cutlery, and water is often also a problem for the patient.
Some citizens with suspected coronavirus are sent for self-isolation - mainly with a mild form of the disease. Yelyzaveta Romanchuk, who was in the Kyiv Oleksandrivska hospital, switched to self-isolation because she did not receive any protective equipment, including shoe covers, and the doctors did not come to visit her for two days. Romanchuk told us that after discharge for several days her temperature rose to 37.4, but no pills were needed. Unless painkillers, but she has already had them.
Maksym Golovkin also remained on self-isolation, who became the first person in the Odesa region with a confirmed diagnosis of Covid-19. He was taken a smear on March 14, and the doctors offered him to either stay in the hospital or stay at home. The Ukrainian considered that it was safer for him to go home, so he was prescribed drugs for 1,500 USD.
The patient’s smear test came only on March 25th and he is still waiting for a second test.
As already mentioned, treatment in government clinics is free. The hospital should be provided with all the necessary medicines and products. Their absence is not the responsibility of the doctors, but of the institution’s management. Often, doctors also have to ask patients to purchase something at their own expense, as the state covers poor-quality consumables. Lawyers advise not to blame healthcare workers.
“It’s clear that bribes might take place because doctors and nurses are not appreciated financially in our country. The salary of a doctor in the highest category is 250 USD. Is there any evidence of such payment outside the box office, for example, video or audio recording?” lawyer Rostyslav Kravets states.
According to him, most often the matter is still in the underfunding of institutions, as local healthcare official Oksana Rokunets-Sorochan assures. According to her, the lion's share of assistance falls on the volunteers.
Kravets considers what is happening a big failure of medical reform.
"Unfortunately, the "reformers" bring any industry they are engaged into a complete collapse. This was the case with judicial, law enforcement, and medical reform. There are no treatment protocols, the doctors themselves, and no understanding of what to do next," he says.
“Under the Constitution, everyone has the right to receive free medical care in state institutions. But medical reform has narrowed this right to a certain amount of care, its specific types and a certain list of medications. In addition, treatment costs do not specifically stipulate coronavirus treatment costs. Theoretically, I can come to the hospital and ask for free treatment, otherwise, I would contact the law enforcement agencies. But the laws in our country are selective,” said Maksym Baryshnikov, medical lawyer.
It would seem that everything is simple: if your health is insured, the company must pay for treatment for the disease. In the USA, insurance really matters a lot, but in Ukraine, it is not so simple.
Facebook user Kateryna Kukhar wrote that her friend had a high fever, and a doctor at a private clinic refused to come to the call. The insurance company explained to the client that the case might be related to a pandemic, which means that this is not the competence of the company. This post caused a storm of indignation in social networks. Are the actions of the clinic and insurance legal?
As we already mentioned, private clinics really have the right to refuse consultation. Now the demand for private doctors is increased. Marina Avdeeva, one of the founders of Arsenal Insurance, says that even those citizens with whom an insurance contract has not been signed turn to her and ask her to call a doctor for a fee. She has to refuse, as this can “lengthen the line” for the insured.
Basically, insurance is valid until a coronavirus is diagnosed. Since on March 11, the WHO recognized the situation with the Covid-19 pandemic, and according to our legislation it is considered force majeure, this is not an insured event. In fact, insurance has all the legal circumstances to refuse payment, National Financial Services Commission states.
“Our private insurance medicine is in an embryonic state. If the state had listened to medical law specialists and introduced a viable private health insurance system not only for individual insurers over the past 15-20 years, then it would be possible to add to the general list of diseases, the treatment of which is covered by insurance, such viruses,” Baryshnikov shares his opinion.
To make sure that the insurance will provide you with assistance in case of illness, you need to check the section "Exclusions from insurance cases" in your contract. Some companies may also refuse to help those traveling to countries with coronavirus.
"A general conclusion cannot be drawn: everything depends on the specific insurance contract. You need to check whether compensation is provided for in your case, at least for medicines. Staying in a state hospital is free," says Rostyslav Kravets.
The insurers can provide the patient with medicines, which the hospital cannot provide, and generally treat the client after his hospitalization. If this is provided by your company, when buying a drug, ask for a sales receipt or receipt in addition to the cashier's check. These documents will need to be submitted to the insurance along with an application for compensation. If a person purchases the medicine on her own, without a doctor’s prescription, the money will not be reimbursed.
Testing for the virus in a private clinic is unlikely to be reimbursed since it is necessary to obtain referrals from doctors of state hospitals for its passage. They do not prescribe them to everyone who has symptoms.
In China, the second wave of the disease has already begun, and in Ukraine, only according to official reports, the number of patients has reached almost one thousand people. Ukraine already suffers from a lack of drugs and doctors. It is possible that soon patients will have to pay extra out of their pocket.
Now, every fourth Ukrainians lives below the poverty line. Do citizens, and especially pensioners, have enough money to buy all the necessary drugs? The question is rhetorical.