Translated by Ollie Richardson & Angelina Siard
On April 1, 2018, the first stage of healthcare reform in Ukraine began. Ukrainians will now be able to see a specific expert only after seeing the family doctor first, who will issue a referral. A child with a high temperature now won’t get a free ambulance. The reform will be completed in three years most services – for example, planned childbirth, operations, research or analysis – will require payment. The State will finance from the budget only reception at a doctor and emergency first aid. RT found out whether Ukrainians are ready for such medical innovations.
Saving the dying is dying work
As of April 1st the citizens of Ukraine will receive medical services in accordance with the new rules. Patients will have to sign a contract on cooperation with the family doctor, who will refer them to specialised experts. It will become impossible to see a ENT specialist, surgeon, ophthalmologist, or a stomatologist independently.
According to the source of RT in the Ministry of Healthcare, it will be possible to sign a contract with any family doctor in the country, irrespective of their place of registration. And not just with one. For example, if a patient is registered in Kherson, and they live in Kiev, they will be able to visit a doctor in the Ukrainian capital. And if, having come to see relatives in Kherson they fall ill, then they can sign a contract with any Kherson doctor. “The idea is that the Ukrainian will be able to choose a doctor themselves. The only condition is that such a doctor will serve no more than 2,000 patients,” explained the interlocutor of RT.
It is planned that the family doctor will be paid 370 hryvnia ($14) a year to serve one patient, regardless of the number of their calls. In order to get the advice of a surgeon, ENT specialist, or another doctor of a narrow specialisation Ukrainians will be obliged to firstly stand in the queue at the policlinic to see the family doctor and to then receive a referral.
It is supposed that healthcare reform in Ukraine will start to work fully from 2020. By this time the State will guarantee to patients only first-aid treatment — seeing the family doctor, the calling of an ambulance, and urgent hospitalisation. For all other services — for example, planned childbirth, an operation, treatment of chronic diseases — it is necessary to pay. However the Ministry of Healthcare hasn’t yet determined the size of the payment for medical services.
Changes will be brought also to the work of ambulance crews. Instead of doctors, paramedics who will be able to give only first aid will come to patients.
It will be possible to call them free of charge only in emergencies — for example, loss of consciousness, epilepsy, or heart attacks. High temperature and an allergy (except anaphylactic shock) isn’t included in the list of reasons for a free ambulance call. But the population has an alternative — at any sign of a deterioration in health it is possible to call a paid ambulance that will cost (on average across Kiev) 2,000 hryvnia ($80).
In some years Ukrainians will face the other innovations that the Ministry of Healthcare is now working on. The acting Minister Ulana Suprun suggests to cancel fluorography exams, which every Ukrainian currently has once a year.
Help for only those who are well-off
Healthcare reform in Ukraine started after the Verkhovna Rada approved bill No. 6327 in October of last year. Suprun’s proposals caused a lot of debate in the government, and it was succeeded to approve the bill only at the fourth attempt. During voting the head of committee of Rada concerning healthcare Olga Bogomolets called Suprun’s proposals anti-people and anti-constitutional since, according to the 49th Article of the Constitution of Ukraine, healthcare in the country is free. But under the pressure of President Petro Poroshenko the bill nevertheless was adopted.
According to the source of RT in the Ministry of Economics, the government couldn’t not adopt the bill — it had no choice. “The State has no money to provide the population with a full range of medical services free of charge, that’s why we are compelled to be limited only to basic services. People will be obliged to pay for the other services,” explained the interlocutor of RT.
But the heads of hospitals don’t agree with this. According to them, the State increases expenses on healthcare annually.
In 2018, 86.9 billion hryvnia ($3.3 billion) from the State budget was allocated for the functioning of healthcare, which is 15% more in comparison with last year. This is about $78 per person per year.
“The money allocated for medicine is enough, but most of it is simply plundered,” said one of the doctors of the Kiev central hospital to RT. “Medicines are delivered to us only in the resuscitation unit, and all other patients are forced to get them independently. In hospitals there is no bed linen, nobody repairs the rooms, and patients have been fed with only the cheapest porridges for a long time”.
At the same time the salaries of highly skilled surgeons who save the lives of Ukrainians every day is about 7,000-8,000 hryvnia ($270-300) per month. According to the doctor, fighting against corruption effectively would allow more funds to be allocated for hospitals for purchasing drugs, repairing rooms, and increasing the salary of personnel. However instead of this the government decided to economise on patients.
But the population doesn’t have the money for fully-fledged treatment. According to the doctor, a week’s treatment in a hospital costs patients 3,000-4,000 hryvnia ($113-150), whereas the average salary in the country is 7,300 hryvnia ($265) per month.
Doctors are often told to prescribe only the most necessary drugs because patients don’t have enough money for a full course of treatment. “I was diagnosed with ‘diabetes’, and each drip feed costs 200 hryvnia ($7.5) per day. My money was enough only for two doses of medicines, it is my relatives and friends who helped me to purchase the other drugs. I have no money to buy food in the dining room on the first floor of the hospital, that’s why during the week I eat the pearl barley and porridge that is given free of charge in the hospital,” said the inhabitant of Kiev Igor Nesmeshny to RT.
In October, 2017 Ulana Suprun recognised that about 70% of Ukrainians self-medicate because of a shortage of funds for analysis and hospitalisation.
But healthcare reform will nevertheless be introduced, insisted RT’s source in the Ministry of Healthcare. “Ulana Suprun will finish this reform being the acting minister, because the Verkhovna Rada won’t appoint her as minister — there aren’t enough votes for this. Besides this, Suprun didn’t refuse American nationality, so it means that she can’t work in State bodies”. According to the interlocutor of RT, Suprun constantly clashes with the management of hospitals, deputies, and governors, but she is supported by the President Petro Poroshenko and the Prime Minister Vladimir Groysman.
At the beginning of 2018 there was a serious conflict between the Acting Minister of Healthcare and the leaders of the Transcarpathian region. Ukraine has endured an epidemic of measles for the second year and regularly faces a shortage of vaccines, that’s why the leaders of regions try to solve the problem independently and appeals to countries of Eastern Europe to provide drugs free of charge.
This time, when measles in Transcarpathia reached an epidemic scale, and the Minister of Healthcare didn’t organise the delivery of medicines to the region, the Transcarpathian authorities independently contacted their Hungarian colleagues, and in some days the vaccine came to the region as humanitarian aid. This helped to stop the serious illness spreading, but Suprun accused the Transcarpathian authorities of violating the law by using a vaccine that hadn’t been cleared.
The director of a large private clinic in conversation with RT recognised that with such reforms most of the population will lose access to healthcare services in a few years — only wealthy people will be able to receive the help.
“If a pensioner breaks their leg — how will they get to hospital? The ambulance won’t come, and they have no money for a taxi. What to do in this case?” he said. According to him, hope remains only for charity foundations that are involved in fund-raising for the diseased.
“In Ukraine Ulana Suprun is called Doctor Death,” said the President of the Center for System Analysis and Forecasting Rostislav Ishchenko to RT. “And this best characterises healthcare reform in Ukraine”.
In turn, RT’s source in the Ministry of Economics reported that the government of Ukraine plans to introduce an insurance that should cover the cost of services that the population have to pay for. “Most likely employers will pay for it. But we are afraid that business will deduct this cost from the salary of the population. We still don’t know at all what to do with pensioners and how the most needy will survive,” noted the interlocutor of RT.
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