Key Steps to Transforming Ukrainian Healthcare
Ukraine inherited the Soviet system of free public medicine for all. But reality turned out to be completely different: budget deficits, economic crises, and a lack of reform resulted in a “parallel world” where one had to solve healthcare problems through out-of-pocket informal payments and bribes. Ukrainian patients often paid for everything from medical services to supplies, as doctors claimed that “there are no budget funds”. For example, patients were forced to buy medicines or vaccines, which had already been purchased for them with funds from the state budget. Moreover, despite the high price paid by Ukrainians for medical treatment, the results were rather disappointing.
This Soviet system has decayed, and both patients and medical professionals have already realized this. For a better future, we must change the situation and build a new, safe and caring healthcare system.
The current team of reformers at the Ministry of Health of Ukraine, headed by Dr. Ulana Suprun, has personally experienced Ukraine’s old medical system and studied its numerous problems. They travelled to all parts of the country and listened to many Ukrainians, both patients and doctors, who told them personal stories about experiencing the worst aspects of this system. Having analyzed numerous issues and studied the expertise of world health organizations, the Ministry of Health took a democratic and evidence-based path to healthcare reform in Ukraine. After 22 failed attempts, over 25 years by predecessors, they have secured the support of Ukraine’s Parliament to reform the old system and in late 2017 formal laws were passed to build a new patient-oriented healthcare service.
- The key to transforming the Ukraine's old healthcare system is to focus on patient needs. The first step is the implementation of the new healthcare financing mechanism - “money follows the patient”. The state will now allocate money for the specific needs of a patient instead of financing hospitals, doctors, and inpatient beds.
- Secondly, the reform introduces “family” doctors. Patients now have legal rights to choose their own family doctor based on his/her skills (and regardless of the place of registration) and sign a transparent agreement with him/her based on quality and respect. Family doctors should constantly take care of the patient’s health, and receive salaries depending on the number of patients who have contracted with him/her. Therefore, doctors have incentives to ensure that patients are healthy and satisfied with their services.
- Next, primary care, palliative care, and emergency medical care are 100% funded by the state. Besides, the state provides reimbursement for medicines for cardiovascular diseases, asthma, and type 2 diabetes (in the near future, patients will be able to get prescriptions filled online).
- New methods for procuring and distributing vaccines are being introduced to eliminate shortages, to ensure the highest quality, and to reduce corruption at the local level. Instead of the current ad hoc approach, this process involves a three-year planning and better monitoring.
- To restore confidence in the regions, patients will soon have access to new modernized medical centers with new diagnostic equipment for doctors, built or restored in full compliance with the latest sanitary standards. Moreover, patients will be able to book doctors’ appointments on-line or by telephone.
- To restore confidence across the country, doctors’ qualifications will be secured through new licensing and educational standards. In fact, medical education has traditionally been one of the most corrupting areas in Ukrainian healthcare, since it opened the way to equally corrupt medical practices, which is why ensuring a sound academic background is one of key prerequisites for healthcare transformation. Therefore, the reform envisages requiring higher passing grades for External Independent Testing and more rigorous graduation exams for medical specialties.
- Finally, Ukrainian doctors are now obliged to adhere to international treatment protocols in their everyday practice. There used to be thousands of domestic treatment protocols in Ukraine, most of which were out-of-date and inconsistent with current medical progress. In addition, the use of evidence-based medicine and the exclusion of corrupting components should make treatment cheaper for patients.
Now much depends not only on doctors, but also on patients. Patients should have the courage not to give bribes; to figure out which services are free; to write a request or a complaint if a bribe is asked or demanded of them; and to not visit an incompetent doctor or follow instructions they do not understand.
At the same time, doctors should get what they have long dreamed of: respect, high standards and appropriate financial compensation.