Healthcare reform, which is promoted by the administration, finally dismantles shareware medicine in the country.
Article 49 of the Constitution of Ukraine stipulates that the state creates conditions for effective and accessible for all citizens medical care in state and communal health protection institutions provide medical care free of charge. But anyone who has ever been treated in Ukraine agree that the government is unable to cope with the provision of free medicine, says Valery Litvinski to No. 22 the magazine Reporter.
To recognize that in Ukraine there is no free medicine urges and acting Minister of health Suprun – the main ideologue of health reform. “We say that in our country medicine is free, which it isn’t, we all pay for everything… We need to stop lying and tell the truth. We should create a system where people won’t sell cars and apartments because they got sick,” says Suprun.
Medical reform in Ukraine is already a kind of “byword”. During the years of independence have been developed 21 the draft law on health insurance has changed more than 20 Ministers of health, and the Ukrainians, meanwhile, was 10 million less – the population declined from 52 to 42 million people. According to the state statistics service in Ukraine every day from various diseases kills about 1,600 people. That is, every hour of life out of 67 Ukrainians. But, according to the world health organization, the number of beds in hospitals Ukraine ranks fourth in the world. Only here, in this life we are only 130. the Ministry of health assured that if you reform the system, the day could save an additional 440 Ukrainians.
To promote the reform of the Ministry of health enlisted the support of numerous activists and Western partners, which is not surprising given the personality of the Minister. Thus, the reform supported by the ambassadors of the Great seven countries in Ukraine and the World Bank. Activists posing as corpses under the Verkhovna Rada and has launched a social media flashmob with the hashtag #wymaganiom, as part of it users shared the problems faced in the Ukrainian medicine.
But all these efforts did not really get members. In the end, the violation of procedures and only at the second attempt MPs still voted in the first reading for the bill No. 6327, which changes the approach to public funding of medical services. A second bill as part of the reform is about changing the Budget code, the Parliament failed.
We pay, but officially
The Ministry zdravookhranenyie to install the state-guaranteed package of medical services. They will be provided free of charge. The list of such services will be determined by the government and reviewed every year. At the moment it is assumed that is completely free for patients will remain primary care services, family physicians, internists, pediatricians. Emergency assistance – that is, if you get to the hospital as the result of a sharp deterioration in health (heart attack, stroke, acute appendicitis, etc.), after an accident or personal injury. And palliative care support to terminally ill. Also, the state will pay for prenatal care, childbirth and treatment of children.
For services in excess of this guaranteed package, the patient will have to pay, or to pay for certain operations entirely. Free will is a specialized and highly specialized medical care, so – called secondary and tertiary.
If such changes are implemented, for example, an emergency surgery to remove the Appendix, you will be free, but for elective surgery on the kidney, or the knee will have to pay. Pay will be diagnosis and visits to specialists, ophthalmologist, dentist and so on. The government will set fixed prices for every medical service, they will be in the public domain.
The health Ministry promises that the fee for patients for secondary and tertiary health care will not be significant, there will be some subsidies and incentives. But really at the moment, the tariff surcharges are not calculated and announced benefits only for participants of the Antiterrorist operation.
The need for a formal co-payment for certain medical services or payment for these items the reform of the most critical. Chief expert of the medical group of the Reanimation package of reforms Zoryana Chernenko notes that guaranteed package should include a number of services to secondary care. According to her, if now patients can wait for free planned operations and such operations do quite a lot, after the medical reform will work this will not be a free testing. “Do not think that patients will be able to pay 1-2 thousand for each visit to the secondary. Today the solvency of citizens does not allow to think so. To make a co-payment is not something that meets the needs and opportunities of the population,” – said Chernenko.
The Ministry of health indicate that free medicine in our country and so does not exist. 90% of medicines are purchased with the personal funds of citizens, and every second patient is refusing treatment or delaying it because of lack of money. So, to say that medical care will be paid and a very expensive wrong, because it is now expensive.“Now all medical care for the money. All patients or pay, or die. And pay is not known how many, no one knows where this money is going, there are no uniform tariffs. Your doctor may tell you that the operation will cost 10 000, your friend that 5 thousand because you have expensive shoes, and in his opinion you can more to pay … Where is the money going. View the electronic register of chief doctors, and you will see Lexus, land, houses, cash. And this despite the meager official salary”, – said the Executive Director of the charitable Foundation “Patients of Ukraine” Olga Stefanyshyn. She emphasizes on the contrary the reform introduces new strict rules in the medical system, it is the same for every citizen.
Family doctor – our all
When talking about medical reform, you can often hear the phrase “money follows the patient”. Describe the innovation, according to which at the primary level, every citizen, regardless of age, chronic diseases, place of residence will sign a contract with any family doctor, who will choose himself. Family doctor services will pay the state. In case of illness first need to go to him, and he will direct you to a more specialised doctor. However, the patient can immediately go to a specialist at the secondary level of care.
The more patients will gain the family doctor, the higher his salary, which according to supporters of reform, will stimulate to provide quality services. In 2018, the average payout at the primary level will be about 370 hryvnias per patient. “If the family doctor will gain two thousand patients, you will be able to earn the order of 120-150 thousand hryvnias a year”, – predicts Suprun. However, former health Minister and current MP Oleg Musiy I am sure that such statements utopia and manipulation. “In order to enter into agreements with each Ukrainian, we family doctors in the country about 30 thousand, and is now working 6-7 thousand doctors. Where will you take rest?”, says Musy in conversation with the Correspondent. The Ministry of health responsible – the doctors will see that family doctors earn well and will be interested in this work.
The spread of the practice of reference to a family doctor may help fulfill one of the main objectives of the reform is to establish a close contact between doctor and patient, says Zoryana Chernenko. In her opinion, it is extremely important to teach Ukrainians increasingly turn to the doctor and not to self-medicate or treatment via the Internet. “We have the biggest problem is the low credibility of the doctors quoted late to get help, and this means either considerable expense or already a running state until the incurable” – emphasizes the expert.
Structurally, all medical institutions are divided into three segments. The first was to change clinics comes a family clinic. Second level – special services: CT, MRI, ultrasound, lab. The third narrow section of the hospital.
Critics of reform believe – its implementation will lead to mass closure of hospitals and dismissal of doctors. The Ministry of health say: the bill is about madrepore there is no word about the closure of medical institutions or reducing staff. According to the expert of the Reanimation package of reforms, pediatrician Alexander Absence, over time, competition and the principle of “money follows the patient” will lead to the streamlining of the network of medical institutions is ill-equipped and busiest hospitals, which is simply dangerous to be treated, will re, and the best – technically and personnel to grow. Also doctors without work can remain only those who do not want to go people.
“We were in the district hospital, where seven surgeons doing 100 operations a year. That is, a surgeon makes an average of 14 transactions per year is an average of one surgery per month. You can imagine what a professional level of the surgeon? To be treated in such hospitals is unsafe. At another hospital, the surgeon may do the operation 100 per month, and receive a formal salary, they are the same. In a situation of total egalitarianism doctor is not interested to work better,” says Abcence.
Oleg Musiy believes that the main problem of the reform in the creation of the National health service, which will serve as a unified national customer care and dispose of all state funds allocated for medicine. “It will be megacorporations body, it needs to develop a methodology for the provision of medical services, and calculate their cost, and to enter into contracts with health care providers, and to monitor the quality of medical services. Itself install, itself control” – outraged the MP.
The health Ministry promised on a transparent competition to select the head of Dazzleby health and hope that the activities of the new body will monitor anti-corruption bodies established in the country of NABOO and a Specialized anti-corruption Prosecutor’s office.
The legalities of all this?
Musiy I am sure that health reform violates the Constitution because it stipulates free provision of medical care will be no more. According to him, the initiator of the reform should not tell – is this normal practice or not – “if it prevents some ideas of the Constitution, change it, and not harshly’t violate the fundamental law of the state.”
“Healthcare reform is a product of amateurism and incompetence of the government and the Ministry of health. Reform must be systemic and comprehensive, to call what is being proposed by reform I do not dare. This zavualirovannost zalezanie in the pocket to the patient. In fact, this one – like the funding that is available, to reduce all that Sachsische in the health care system,” – said Musy.
In his opinion, while the Ministry of health was promoting, and ought gradually to demonstrate how reform will be implemented in practice. “It was first necessary to establish the full cycle of the emergency ambulance, it was clear to all that worked like clockwork. Then embark on family medicine, to prepare family physicians to provide outpatient clinics and to purchase equipment. Patients to become accustomed to the operation of such a mechanism,” shares his vision for the MP.
Experts who support the reform, wonder why Musi he did not reform when he headed the Ministry of health, and now the parliamentary Committee on health inhibits initiative.
In the Ministry insist that healthcare reform needs to be completely voted on by the Parliament before the end of the current session, which will close in July. This is necessary in order for it to take effect from 1 January 2018. In the parliamentary Committee say that there is no hurry to projects of the Ministry of health there are lot of amendments, and in their current form can not be accepted. “It will be a complete paralysis of even the existing imperfect system. But to reform we want to make it better, and not worse than it is,” – stressed Oleh Musiy.
In the meantime the population is not particularly familiar with the essence of the reform, despite the fact that politicians have long “cross swords” for her. According to opinion polls, only 8.8% of the population are familiar with the basic provisions of health reform, 33.6% were heard of individual norms, and 57.6 per cent – do not know anything about the proposed changes.
Anything you need to do
“We can continue to look for the ideal model, but the ruin we have now, and people are dying,” says Suprun about the debate around health reform. Changes in the national healthcare system is certainly needed, and they are long overdue. However, it is important in the pursuit of quick change has not come to an even more disastrous results.
Although, to postpone madrepora in Ukraine anymore. Famous doctor Yevhen Komarovsky sure that changes in medicine – urgent, while politicians are engaged in speculation, sail human life. “You hope to raise my child and never in the hospital not to get? Will not work! And you will be in a shabby house, in company with the same 5 silent / patient / hope that will carry, watch as your child will prick 4 times a day medicine, which in the world has been long forgotten. And medications these you buy in a personal pharmacy of the physician… You are led to the slaughter, although there is not lead – has already led… our Entire healthcare system is a violation of human dignity… My people do live without social networking and without all that you still decide to ban. But my people will not be able to survive without medicine,” concluded the doctor.