Top 10 Consequences of Medical Reform for Ukrainians

Translated by Ollie Richardson & Angelina Siard

22:55:03
08/02/2019

strana.ua

Ulana Suprun has been absent for a couple of days, and all of domestic medicine has started collapsing. At least, the Ministry of Healthcare tries to convince Ukrainians that this is what happened.

The deputy of the acting minister Olga Stefanishina wrote on her Facebook page that the delivery of medicines and vaccines to regions is being disrupted because of the absence of Ulana Suprun on her workplace, and several dozens of difficult patients can’t go abroad for treatment. Following her, the first deputy of Suprun Pavel Kovtonyuk delivered a new portion of “betrayal”.

“The National Health Service paid all establishments for their services for January. But not everything can be solved at the operational level. Tomorrow we planned to submit for coordination drafts of resolutions for the transition of ‘Available Medicines’ to the National Health Service and the launching of the electrode ticket, and also about the piloting of the third stage of reform in the Poltava region. But we can’t. The submission of the three-year budgetary declaration for 2020-2022 is under threat because of a judicial decision ,” wrote Kovtonyuk on his Facebook page.

As a reminder, on February 5th the District administrative court of Kiev temporarily discharged Ulana Suprun in accordance with the claim of the people’s deputy – the radical Igor Mosiychuk.

The Ministry of Justice will challenge this decision on February 11th. And, according to the logic of the Ministry of Healthcare, if Suprun loses the legal battle, medical reform in Ukraine will definitively stop.

But the main issue lies elsewhere: is there anything good about this reform that justifies worrying about its destiny and the destiny of Suprun?

“Strana” highlighted the top-10 consequences of medical reform for patients, doctors, and pharmacists.

1. Many were left without a doctor

One of the main innovations of the medical reform is the choice of a family doctor. In an ideal scenario every Ukrainian would sign a declaration with their doctor (the norm for one doctor is 1,800-2,000 patients).

The National Health Service pays 370 hryvnia per year for every declaration plus the increasing rates for pensioners, children, and so on. The maximum sum is about 1,400 hryvnia, which is paid for children.

At the moment, declarations were signed by about 25 million Ukrainians. The rest are now paid on the so-called “red list” (about 240 hryvnia per year). But from July 1st the “red list” will cease to be financed.

“Even taking into account the fact that we are no longer 42 million people – many left on earnings etc. – 10-14 million Ukrainians risk being left without medical care. In Kiev, for example, less than half of the actual residents of the city concluded a declaration. Theoretically they should receive at least free emergency aid. But, for example, vaccination, screening for tuberculosis, treatment of hypertension, etc. don’t apply here. This means that they can be treated only for money,” said Konstantin Naduty, the Deputy Chairman of the Ukrainian Medical Association.

Many Ukrainians stubbornly don’t want to sign a declaration since there are no guarantees of the security and confidentiality of medical information.

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Plus, many rather high quality doctors scrutinise patients and refuse the most “unpromising” ones – in terms of money and health. “As a result pensioners remain without a general practitioner, and they aren’t able to go to a doctor at the other end of the city,” said the CEO of “Alliance 4M” and the head of the board of the Expert Council of Public Research and Projects in the sphere of National Health and Social Protection Inna Berezyuk to “Strana”.

2. The quality of medical care decreased

At the beginning of the reform the Ministry of Healthcare decided on quotas for doctors – 1,800-2,000 patients for each one. Later it was permitted to take even more, but for “superfluous” patients the coefficient of payment is lowered.

“But 2,000 patients is quite a lot. After all, it is necessary to consider that people who worry about their health make an appointment with the doctor and will come often. As a result the load on doctors increased, which affects quality. Now queues in policlinics are larger than before, the family doctor does home visits at their own discretion. In Spain, for example, it was already understood that with 1,500 patients per family doctor, doctors are overloaded and can’t give patients the due attention, so the standard was lowered to 1,200. But in Ukraine with such a standard there won’t be enough doctors for everyone. So it means that the quality suffers in advance,” noted Konstantin Naduty.

3. The ambulance ceased to come

The reform of the ambulance is one of the “freshest”. It started only in the autumn of last year, and at the first stage Ukrainians shouldn’t have felt any affects at all.

It was planned to create a dispatching system, to bring protocols of emergency aid into accord with the international standards, and to train personnel and so on. But in parallel doctors started to receive instructions to not go to “trifles” – high temperature, high pressure, and so on. As a result Ukrainians were left alone with their illnesses. The head of the Ministry of Healthcare Ulana Suprun advised: even if you fall ill, bring down your temperature and go to a policlinic instead of calling an ambulance.

“At the height of the epidemic of measles and flu, such advice is simply a mockery. People will start being ill twice more often,” summed up doctors. And the head of the public organisation “National Interest of Ukraine” Vasily Apasov says that people will thus be reoriented towards paid medicine.

“If the child has a temperature, and the family has some savings, they will call a private ambulance or a private doctor”

he explained to “Strana”

4. Narrow specialists cost money

So far the Ministry of Healthcare has reformed only primary medical aid. The authorities want to undertake the reform of secondary aid – and this is narrow specialists, diagnostics, hospitalisation, and so on – from July of this year.

The ministry already published a list of quotations outlining the services from clinics that the National Service is prepared to buy.

For a X-ray, for example, about 80 hryvnia is offered, for a blood test – 50-150 hryvnia, endoscopic inspections – 600-800 hryvnia, and so on.

“Many quotations are below cost. If it isn’t increased, we won’t sign contracts for secondary aid”

explained the co-owner of the “Boris” clinic Mikhail Radutsky (they thus work with the National Health Service for rendering primary aid)

“There obviously isn’t enough money in the budget, they don’t want to add. If nothing changes, by October secondary aid can remain even without salaries. For patients this means that, like before, they will be obliged to buy everything at their own expense (medicine, exams, and so on),” said Naduty.

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5. Inaccessible “Available Medicines”

According to the “Available Medicines” program, Ukrainians have to be compensated for the cost of medicines for cardiovascular diseases, diabetes, and bronchial asthma. But this year only 1 billion hryvnia was allocated for the program from the state budget. This money obviously won’t be enough for everyone.

“Hypertensive persons alone need about 5-6 billion hryvnia”

calculated Konstantin Naduty

Pharmacists massively complain that it isn’t profitable for them to sell “Available Medicines” – we have to keep additional records, but money comes irregularly. Many pharmacists complain that they were forced to participate in the program by the local authorities, and, whenever possible, they leave it. In many villages there is no place where such “Available Medicines” can be received.

6. Disruption of government purchases of medicines

Even before Suprun’s arrival to the Ministry of Healthcare, her predecessor, the-then Minister of Healthcare Kvitashvili, transfered government purchases to a foreign organisation – UNICEF, the UN, and Crown Agency.

This was considered to be the first step of the medical reform and was done, allegedly, to combat the pharmaceutical mafia. These structures still buy medicines for Ukraine using budgetary funds. But, as Vasily Apasov said, the schedule of purchases is constantly disrupted.

“For example, the program for 2016 still hasn’t been implemented. Concerning immunoprophylaxis – it is underfulfiled by 4.15%, concerning AIDS – by 5.8%, concerning oncology – by 0.6%, concerning children’s oncology and haemato-oncology – by 0.75%, and concerning tuberculosis – by 20.3%. Behind even the smallest percentage there is a citizen who needs this medicine. By the way, the situation for 2017 was even worse,” notes Apasov.

It turns out that Ministry of Healthcare transfers budget money to contractors for the years ahead. “But even worse is the fact that medicines are bought are on the verge of their expiration dates. Some producers usually give them very cheaply, almost for free, because disposing of them costs a lot, especially for vaccines. That’s why victorious official reports about a reduction of prices with such a purchase is a fiction,” added Konstantin Naduty.

Experts also note the increasing deficiency of free medicines in hospitals. In oncology only 3 of 10 patients are being treated at the state’s expense, and in children’s oncology – a half.

7. Idle state programs

Some strategic programs being financed at the state’s expense was traditional in Ukraine. They covered various directions of medicines – oncology, tuberculosis, cardiovascular diseases, and so on. But no place was found for them in the medical reform.

Formally such programs weren’t canceled, but in fact they work extremely poorly. Patients are obliged to almost pay for everything from their own pocket. Moreover, the Ministry of Healthcare constantly looks for what else can be cut. For example, they in all seriousness discuss the possibility of treating patients with tuberculosis at home, and not in closed hospitals. They explain this by saying that, allegedly, this is how it is done in Europe.

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8. “Excessive” dentistry

Concerning dentistry, the state will completely remove financing from July 1st of this year. Dental clinics that currently treat children, pensioners, and disabled people free of charge, and for others they use rather low tariffs at the expense of budgetary grants, will be obliged to either switch to the maintenance of local authorities, or become completely commercial. But private dentistry in Ukraine is expensive and not everyone can afford it, but local budgets are also not eager to pay for the fillings and implants of their compatriots.

9. Elimination of rural medicine

Commenting on the discharging of Suprun, doctors told “Strana”: this is Lyashko earning points before elections by bringing the rural electorate to his side. Allegedly, Suprun is especially not loved in villages – after all, she, in fact, deprived them of medical aid. Feldsher-obstetric points (FOPs) were recognised by the new team of the Ministry of Healthcare as “remnants of the past” and were removed from state financing.

Some of them are supported by the local authorities via their own money, but the majority was simply closed. Rural out-patient clinics had to be built in their place, for which 5 billion hryvnia was allocated from the budget. But only a few of these appeared. The telemedicine that was promised to villagers was even more so postponed for an indefinite period of time.

“With our off road terrain and with such a transport service, liquidating FOPs is categorically inadmissible to, this deprives millions of Ukrainians of elementary medical aid”

said Naduty

10. Deficiency of doctors

Formally, doctors are supposed to benefit from medical reform. They were promised many-fold higher salaries. And after the first wave of declaration signing the Ministry of Healthcare reported that successful doctors started receiving 20,000 hryvnia instead of the previous 6,000.

“Such cases indeed exist, but they not mass in character. In some clinics it was decided to use the received financing for their own needs. And only the most advanced managed to both increase personnel salaries and invest money in development. But most doctors didn’t feel changes,” said Konstantin Naduty.

For many salaries still remained at the minimum level, but the work load grew. After all, medical staff are leaving the profession in large quantities. For example, in Kiev alone the deficiency of doctors and nurses is 30%.

Obviously, the Ministry of Healthcare plans to compensate for this shortage with the regular advice of Suprun concerning a healthy lifestyle and treatment. Her debunking of myths about the danger of sitting on a cold surface and that your arm must be kept dry after a tuberculosis skin test, and the recommendation to Ukrainians to switch from black caviar to red caviar are already worth a lot here.

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