Deputy Healthcare Minister explains the changes that the Law on financial guarantees of healthcare services is about to bring in the context of the medical reform.
The Law on financial guarantees of healthcare services needs to be adopted as soon as possible, so that the reform can be implemented before 2019, the elections year. “If we adopt these draft laws in time, we will have an opportunity to introduce the amendments to the state budget and start working with primary healthcare already in mid-2017. In 2018 we need to introduce a new principle for hospitals into the new budget. We need a year to calculate the guaranteed package of healthcare services, so that starting mid-2018 we are able to start the 2019 budget year with a complete guaranteed package,” explained Pavlo Kovtoniuk, Deputy Healthcare Minister of Ukraine at a press-briefing at Ukraine Crisis Media Center.
The draft law “On the state financial guarantees for provision of healthcare services and medicines” is one of the key draft laws required to launch the healthcare reform in full. The draft has already been discussed with the civil society, international experts and has undergone all the required approval stages. It will get registered at one of the nearest sittings of the Cabinet of Ministers.
What exactly is the “guaranteed package of healthcare services”?
The guaranteed package will clearly define which services the patient will be able to get free of charge, which are to be paid partially or in full, and what the tariffs will be. “We aim at switching to the model of healthcare financing in which the state clearly guarantees its citizens provision of healthcare services and medicines, as well as implements the guarantees. It differs from the actual state of play when we allegedly have some guarantees but do not actually feel them,” Kovtoniuk explained. “Each guarantee is supported by the source that covers the costs. It is key for the system.”
The tariffs will be equal all across the country. The Deputy Healthcare Minister reminded that the basic package of services will be completely free of charge (the so-called “green list”), some services will be paid through co-financing (the “blue list”), state financing will not be covering some of the categories. (Check out more detailed information on the lists here). The draft law also introduces a unified standard for services in accordance with international protocols.
The guaranteed package for the next year will be adopted by September 15. If the reform is launched in time, the first full guaranteed package will be calculated on September 15, 2018. The new financing model is planned to be introduced for primary healthcare in mid-2017. Healthcare services for birth will become part of the “green list” already in 2018. “The state will cover costs for regular labor including the services of a medical team that happens to be on the shift, in a standard hospital room, with all the required procedures. If a person wants labor with her doctor, improved hospital room or chooses caesarean delivery, she will be able to officially co-pay the services through the hospital cash desk. The person will have a clear idea of the cost and conditions offered,” Kovtoniuk elaborated.
Will the money be enough?
Each household contributed an average of UAH 4,580 (equivalent of the 1,4 minimum state-established salary) in taxes to the 2017 healthcare budget. The Deputy Healthcare Minister told that should the commercial insurance companies be in possession of the above sum they would be able to cover ambulance and intensive care services, including all the medicines, planned and emergency healthcare as well as primary and secondary healthcare. Oncology coverage would amount to UAH 50 thousand, the coverage related to diseases that may result in disability like a heart attack or a stroke – UAH 96 thousand. “As soon as we switch to the new system even under the current amount of taxes that we’re paying, we will feel considerable difference. Key is how efficiently the money is spent,” Kovtoniuk said.
Who controls the amount and quality of services?
Control over the due implementation of the agreement between a healthcare institution and the state (or conformity of the service to the standard) will be exercised by the National Healthcare Service. Based on these audit results decisions will be made as to whether to cover or not the cost of the service and whether the contract conditions should be revised.
The Healthcare Ministry itself being also the licensing agency will be responsible for cases of medical mistakes until powerful professional associations will emerge and take up these functions from it.
The e-system of healthcare (E-Health) will help the National Healthcare Service to track the process in real time and start more thorough checks should there appear any doubts (abnormally high number of redirections to secondary healthcare institutions etc.).
Who is responsible for the reform at local level?
At local level, local authorities and heads of the medical institutions are responsible for the reform. It’s their personal motivation that defines the success of the reform implementation to a large extent. “There is a big number of cities and newly established amalgamated communities that eagerly respond to the reform call. Part of them don’t. Inertia exists, especially at the level of regional departments. […] However, our primary stakes are at the communities – owners of hospitals, because it will concern their population and their medical institutions, that’s the way it works. I am convinced that we will see a series of communities and regions that will immediately demonstrate the result once the reform starts,” the Deputy Healthcare Minister added.
The challenge that heads of medical institutions are facing is to become efficient managers. “These institutions are currently operating under public financing and respective legislative framework, where they do only what they’ve been tasked with according to the standards. We are shifting towards the commercial law conditions where they will be able to do everything that’s not prohibited and get certain budget for the medical services provided. They will need to learn to be efficient,” Deputy Healthcare Minister explained.