In a landmark move that aims to usher in a new era in Ukraine’s health care services, the Cabinet of Ministers recently adopted a series of decrees that would radically overhaul the country’s dismal medical services and corrupt business practices.
Hailed as a major step towards streamlining Ukraine’s notoriously bureaucratic health care system, the new measures will also take aim at the widespread practice of under-the-table payments that poorly paid doctors accept in exchange for better care.
Since the 1991 Soviet collapse, Ukraine’s health care system has been crippled by the government’s inability to properly finance the public’s medical services or pay country’s thousands of doctors a liveable wage has left the healthcare system in tatters.
Compounding the problem is the level of graft by the byzantine web of bureaucrats who line their own pockets with huge sums of state funds that were originally earmarked for health services, leaving medical staff with few resources to care for patients.
The new measures – which are set to come into force in January – are designed to eliminate any interference by crooked state intermediaries by requiring doctors to enter into a contract with their patients, whereby they will be paid directly for the type of services provided and the number of patients treated.
Launching a state medical insurance body
Family physicians and emergency services will be the first targeted under the ambitious three-year plan.
The government is currently determining the minimum set of health services, which will be covered by a state-mandated insurance and available to all citizens.
Through a newly formed state medical insurance body – modeled on the United Kingdom’s National Health Service – doctors will be paid directly, receiving more in proportion to the number of patients they have signed on and services provided.
A family physician in Ukraine will receive an average of Hr 210 or $8 for every patient per year (on top of their salary), while hospitals will be given more financial freedom to use unused funds to purchase medication or new equipment.
Introduction of health insurance
According to the National Health Reform Strategy, the new health insurance will be funded by the state and will be provided regardless of an individual’s place of residence or financial status.
Internally displaced persons, labor migrants and others traveling around Ukraine will be fully covered regardless of their status, according to the health ministry.
“If a displaced person receives treatment in a hospital away from (his or her) home, payment for this service will be provided automatically via the National Health Service,” Ulana Suprun, Ukraine’s acting health minister, told the Kyiv Post.
The insurance will also cover patients with tuberculosis, HIV/AIDS, drug addiction and hepatitis.
The government is going to introduce mandatory insurance coverage for the children under three years old.
Patients will be responsible for an undecided copayment that will be revised each year for specialized treatments, complex or expensive surgeries or specific types of therapy, according to Suprun.
“Purchases of specialized care via the new system will start in 2018 and will be gradually rolled out to specific services (such as complex surgeries),” Suprun explained. “Defining co-payment levels for this type of care is a mid-term agenda. However, the first estimates are likely to be produced in 2017.”
Stimulating healthy competition
Starting in early 2017, all patients will be able to choose amongst a list of primary care doctors with whom they will be required to sign a contract. Officials hope that by stimulating competition between individual care providers will drastically improve the quality of medical services and allow doctors to earn higher salaries of between $500-600 each month as well additional bonuses for the services provided.
The government also plans to strictly monitor all hospitals in order to guarantee that the most efficient clinics receive the lion’s share of patients and greater revenue for the staff.
“The less effective a hospital’s services are, the more expensive it will be to get treatment there. We’ll be keeping a close eye on the most efficient hospitals and come up with a nationwide tariff,” said Deputy Health Minister Pavlo Kovtonyuk.
Creation of tertiary-care hospitals
Ukraine’s regions will also receive tertiary-care facilities that will provide services to all residents who live within 60 km radius of the center.
Located mainly in the country’s administrative centers, and no more than an hour from a patient, the hospitals will provide intensive care treatments and emergency services to seriously ill individuals.
Reimbursement program
Ukrainians living with type-2 diabetes, asthma and cardiovascular diseases will soon have free access to some 25 different medications through the national program for reimbursement.
“These medications will be provided free of charge,” Olga Stefanyshyna, an acting head of the Patients of Ukraine, an anti-corruption initiative, explained. “The patients will get a receipt from the doctor and will be able to obtain the type of medication they need in any pharmacy…the government will then reimburse the pharmacies.”
According to Stefanyshyna, patients benefit of the program by being able to choose between pharmacies and the type of medication they want or need.
The government plans to allocate Hr 500 million or $19.5 million for the reimbursement program that will start in Apr. 2017.
There is a risk, however, that the government may opt to reimburse only certain brands of pharmaceuticals.
“They can use the median and calculate the average price of medicine that will be covered by the reimbursement program. For example, only varieties made in Ukraine. Everything else that is more expensive than the set price won’t be covered,” said Stefanyshyna.
Suprun added that the state will be forced to stop paying for the bare minimum of “walls and beds.”
“Hospitals will no longer be paid, just because they exist. This kind of direct purchasing of services (rather than automatic maintenance of facilities and jobs) should help us dramatically increase the quality of care.”
Critical of government’s selection process
Despite her optimism for the new healthcare package, Suprun has been highly critical of the government’s competition committee for top public service jobs
Suprun has publicly accused the committee of stocking the ministries with incompetent and corrupt civil servants, who are incapable of carrying out much-needed reforms.
“This procedure (the selection process)…allows people who were in Yanukovych’s government and fired for their lack of professionalism during his administration to apply for posts as state secretaries. We need the committee to properly and openly audit these individuals,” Suprun said at a joint press conference with Omelyan on Dec. 5.
The committee’s selection of Andriy Galushchak as a state secretary for the infrascturcture ministry garnered a sharp rebuke from Suprun and Infrastructure Minister Volodymyr Omelyan, who accused the committee of tipping the selection process in favor of those with questionable practical experience and ties to Yanukovych.
Galushchak’s alleged connections to the Yanukovych-era state investment agency chief, Vladyslav Kaskiv, appears to have raised a few eyebrows in the government and prompted Energy and Mining Minister Ihor Nasalyk to call for a review of Galushchak’s appointment.
Kaskiv has been on Ukraine’s most wanted list since March 2016. He has been accused of embezzling huge sums of public funds in the dying days of the Yanukovych regime.
Suprun and Omelyan refused to work with with the newly elected state secretaries until all of the candidates are forced to undergo a proper vetting process.
Both have adamently defended the teams of young reformers that have already been assembled in the ministries and stressed that, “they will continue to work towards improving the system and carrying out reforms as soon as qualified candidates fill the keystate secretary posts.”
