Medical system “made in Ukraine”: the thorny path of reform
Andrey Dotsenko – entrepreneur, founder of the NGO “Foundation for Innovative Development”, chairman of the ICF “MANUS DEI”, head of the company “Sky Building”
This article is devoted to some of the problems of medical reform that are not discussed in the “victory reports”
For Ukrainians , who did not have time to really deal with the intermediate results of the medical reform and loud theses about “money for the patient” or “choose your own doctor” – was announced the start of the second stage.
With the first, he is related by the vague wording, extremely weak information policy, the lack of free access to official data of the Ministry of Health and the very streamlined figures for which the acting Minister of Health Ulyana Suprun refers in her social networks.
According to the media, almost 17 million Ukrainians have signed a declaration with primary care physicians today, and more than 25 million have become owners of prescriptions for free medicines for chronic diseases.
With an increase in the number of patients who signed declarations with doctors, the salaries of employees of primary health care institutions increase significantly, the Cabinet of Ministers reports. For example, in August, a doctor at a primary health care center in the Kharkiv region, after signing declarations with 1,600 patients, received UAH 14,160 in salary, against UAH 9,752 in June.
Sounds reassuring, but not everyone is as lucky as he is.
It’s not just a matter of salary.
For more than a month, a loud scandal connected with the dismissal of doctors at Okhmatdet and the possible closure of the bone marrow transplantation department has been discussed. Parents of children who are in the hospital after transplantation are rightly worried that they may be left without medical assistance and their children will die.
While helping medical institutions, both Kiev and regional, in different regions of Ukraine, I faced with the fact that the threat of closure hung over both regional hospitals and specialized ones. In addition to “Okhmatdet”, the Ukrainian Medical Center for Rehabilitation of Children with Organic Damage to the Nervous System of the Ministry of Health of Ukraine is concerned about the future of their patients.Scandals around the dismissal of doctors at the National Cancer Institute are not abating in the media, and doctors from remote district hospitals are reasonably afraid of becoming “unemployed.”
All this works against medical reform and its acceptance by the population, because it does not provide intelligible answers to the most pressing questions for people: who will make the correct diagnosis? How long will it take to get to the nearest hospital? Will it provide timely and competent medical care? What tests and analyzes will you have to pay for? How much money will it cost if you get sick?
According to statistics, in 2017, there were 1,700 hospitals in Ukraine, while in 2012 their number was 2,500. The number of hospital beds also decreased by almost a third: in 2017, there were 309 thousand hospital beds in Ukrainian hospitals, and in 2012 – 404 thousand.
The numbers speak for themselves – even if we take into account the rapidly declining population and make an inevitable error in the statistics. According to the State Statistics Service, over the past five years, the number of hospitals in Ukraine has decreased by almost a third, and it will continue to decrease. In order not to aggravate the situation around the stages of reform, not only the population, but also the medical workers themselves, need clear comments, explanations and a detailed plan for further steps from the leaders of the Ministry of Health.
In my understanding, medical reform is a change in the system as a whole, a change in views and approaches. First of all, it is the strategy, program and systemic vision of the reform. Secondly, a timely, competent and balanced information and explanatory policy at absolutely all levels. Thirdly – modern equipment in the required quantity, which doctors know how to work with; wards with the necessary conditions and operating rooms with the necessary equipment.
Medical reform in Ukraine is not just loud statements on paper, but the life and health of every person.
The biggest problem today is, oddly enough, the lack of an information campaign. Neither doctors, nor patients, nor citizens themselves understand what exactly will change as a result of the reform and are afraid that healthcare will become even worse than it was before the reforms.
Regularly facing the pressing problems of hospitals, rehabilitation centers and patients, I understand that there are much more questions now than the answers themselves. But there is already a certain understanding of the “basics” of innovations:
1. For now the primary link (prevention and diagnosis) is in the process of reforming. Patients choose their own doctor, sign declarations with the therapist and, thus, a “money follows the patient” system is formed. From 2020, the Ministry of Health promises to launch a “program of medical guarantees”, that is, a package of free medical care.
2. The number of doctors and hospitals directly depends on the size of the population – therefore, the competent implementation of the medical reform directly depends on the territorial-administrative reform. Hospital districts are formed within the region. The constituency must include: at least one first and / or second level intensive care hospital, a rehabilitation treatment hospital and consultative and diagnostic centers.
3. A first-level hospital must provide medical care for at least 100 thousand people, a second-level hospital – at least 200 thousand. The perimeter of the hospital district’s service is determined by the “timeliness” of travel to intensive care hospitals (no more than 60 minutes) or the radius of the service area of 60 kilometers (subject to the availability of paved roads).
It must be remembered that any reforms do not pass quickly and painlessly; patience and strength are needed in order to accept innovations and adapt to them.
This is a natural process.
But it will be greatly accelerated by the explanation of the nuances and main components – therefore, I promise to understand and share clear and comprehensive information with each “letter of the document”. Now, wading through all the nuances of legislation and regulations, listening to diametrically different opinions of experts and political scientists on the same articles, I have a persistent feeling that the representatives of the Ministry of Health are categorically not ready to give detailed and understandable explanations about the essence of the reform, its main goals and advantages , not just for representatives of the commercial segment of the medical field but to ordinary citizens as well. I write “not ready”, so as not to write – “they do not want”.
And one more question, which lies much wider than the plane of reforming domestic medicine, is hanging in the air: what to do with the moral principles of people and the peculiarities of our mentality, how to increase the responsibility of doctors for their patients and how to wean them from taking “gratitude” into their pockets?
We will seek clarifications and answers!
We, Ukrainians, have the right to know what is happening in our country.
https://blog.liga.net/user/adotsenko/article/31028