On October 19, the Verkhovna Rada of Ukraine adopted bills on medical reform in the second reading. 240 MPs supported draft law 6327. It was adopted after considering about 900 amendments to the reform, about half of which were adopted. MPs canceled the clause about partial payment of medical services by the state. Now services must be paid completely either by the state or by the patient. Besides, the direct introduction of international protocols was also abolished. Now the protocols must be revised by respective national structures.
“This is a historic event for Ukraine, as the changes in the healthcare system will start for the first time in 26 years. (…) What we have done today is a start to a new medical system, where every Ukrainian will have free access and state guarantees of financing for quality medical services,” emphasized Dr. Ulana Suprun, Acting Minister of Healthcare of Ukraine, during a press briefing at Ukraine Crisis Media Center.
What changes for doctors?
One of the key changes is the system of accounting doctor’s earnings. Thanks to the reform, a doctor gets the freedom to choose the form and place of work. He can be either a payroll employee through a collective labor contract or a doctor in private practice. Besides, there will be no fixed remuneration. The doctor’s income will depend on the number of patients visiting him and receiving quality services. Revenues of those with many patients will increase substantially. “According to our calculations, if a doctor works efficiently in private practice he will be able to earn more than UAH 15 thousand (about $600 dollars, as compared with the current $150-200 – UCMC),” assured Pavlo Kovtoniuk, Deputy Minister of Healthcare of Ukraine.
To implement the reform, the Government has planned three years of gradual changes. From the beginning of 2018, the primary link of medical services will be changed completely – namely the work of family physicians, physicians, and pediatricians. International medical protocols are being translated into Ukrainian for them. The adoption of a presidential law on computerization of rural medicine is also of great importance. The possibility of connection to the e-health system and provision of some medical advice remotely will allow rural doctors to have access to their patients identical with that of their colleagues in densely populated cities.
Other levels of medical services will change gradually, first in the test mode on the example of separate hospitals. The Ministry of Health does not consider it possible to make a shock transition to a new system because it is necessary to first see whether the new rules are actually effective in Ukraine, or they need to be changed.
What changes for patients?
As a result of medical reform, from the beginning of the next year, a patient will be able to choose an outpatient clinic and an individual physician regardless of the place of registration. The state-allocated money is secured for the patient. The patient will not pay for medical care, as it was before, neither officially in private clinics, nor unofficially in state hospitals. The hospital will keep records of all services provided and invoice the National Health Service. “There will be a tariff for every service, and the National Health Service shall pay every hospital for the medical services provided,” said Pavlo Kovtoniuk. In accordance with the approved bill, top priority medical services will be paid at the expense of the state budget; if a patient wants to undergo a procedure at his own discretion, without a doctor’s recommendation, then he has to pay on his own.
Starting in 2019, the state will annually update a list of health services that are to be paid for by the patient. This list will depend on budget opportunities. The state will not cover uncritical services such as planned dentistry or aesthetic medicine.
Medical education as a prerequisite for change
Oleksandr Linchevskyi, Deputy Minister of Healthcare, noted that sound academic background is a prerequisite for changes in medicine. The reform envisages a higher passing grade of the External Independent Testing and more rigorous graduation exams for medical specialties.
Medical education has traditionally been one of the most corrupt since it opened the way to equally corrupt medical practices. “Changes in medical education will change the image of medicine,” assured the deputy minister.
Public responsibility of the patient
Now much depends not only on doctors but also on patients. “Patients should have the courage not to bribe; to figure out which services are really free; to write a request or complaint if asked or demanded to pay; not to visit an incompetent doctor or follow the instructions you do not understand,” said Iryna Lytovchenko, Co-founder of International Charity Fund “Tabletochki”. “This cannot be a one-way movement. Doctors will change and we should change as patients.”
Read more about the changes that health care reform will bring in our explainer.