Kyiv, November 25, 2015. All controversial points in the draft laws on medical sector reform (№2309a, 2310, 2311), which prevented MPs from voting, have been eliminated. Parliament has therefore to launch the reforms which are important for society, said Igor Pereginets, Deputy Minister of Health Care of Ukraine at a press briefing at Ukraine Crisis Media Center. “We cannot put off voting on these draft laws any longer. We can also continue seeking the least risky options and lose everything. And we may take a chance and correct the shortcoming while still moving ahead. We are ready any day to present the draft laws to MPs together with a development strategy and action plan for every direction,” said Pereginets.
The Deputy Minister reminded that autonomization of medical institutions implies a radical change in the management approaches: refusal to allocate funds on principal of beds (paying for maintaining a number of spots for those who may potentially need medical treatment – UCMC note) in favor of payment for the actually provided services, greater involvement of employees in the management of institutions. Medical institutions will receive the status of non-profit public companies with their own accounts in a state bank; supervisory board will carry out strategic management; the head doctor will be elected on a competitive basis; there will be an opportunity to select staff independently.
However, these changes do not mean the state will refuse to financially sustain medicine. “The government will allocate money from the state budget but it will not be used according to the Soviet principle “take as much as you need” and then we will see what happens. The funds will be allocated according to the principle of providing services, fulfilling orders and contract agreements,” said Pereginets.
Zoryana Chernenko, senior expert at the healthcare system reform group, Reanimation Package of Reforms (RPR), reminded that a number of regions have already implemented pilot projects on reforming healthcare institutions. According to the plan, their implementation should result in greater affordability, better quality of medical services and more effective distribution of money. The project suggests dividing healthcare into primary and secondary. Primary healthcare includes family doctors; secondary – consists of narrow medical specialist. Patients can see specialists only after visiting a family doctor. Financing the latter has increased by 35 percent and their facilities have improved. All the regions, involved in the pilot projects on healthcare reform have re-organized medical institutions in municipal non-profit enterprises. According to RPR experts, Vinnytsia and Dnipropetrovsk regions have had the best experience so far. “In Vinnytsia, for example, they organized training centers for quality training of family doctors. In Dnipropetrovsk public reaction motivated organizing a media center which gives citizens information about the project, and what changes they can expect. The result can be achieved by explaining changes and implementing them effectively,” said Chernenko. According to her, the pilots demonstrated that a mere increase of doctors’ salaries, not on the basis of clear charging system and the system of allowances does not change the doctor and patient relationship.
Anatoliy Holunov, director at the Center of computing social and medical technologies “Ukraine”, described “cost/quality” ratio experiment held in some cities to improve healthcare. The healthcare sphere of Voznesensk yielded the best results. Among these results are a well-developed network of family medicine clinics and a powerful computer system which allowed for personalization of data on services and medications and thus made possible real-time management of both costs and quality of health care. Besides, patients made agreements with family doctors, which stipulate that not only a doctor is responsible for the patient’s health, but also a patient himself. “The key point is that we managed to move to a real ‘individual’ financing primary healthcare. It’s not just funding based on a family doctor’s salary, it is a possibility to pay a surcharge for services and for the outcome.” According to Mr. Holunov, this flexible reallocation of services from secondary to primary level on the principle “money follows the patient,” enables a flexible control of costs.
Oleksandr Yabchanka, manager in the healthcare system reform group, RPR, conclude that centralized management is ineffective. According to him, patients and not bureaucrats should allocate budgetary funds and choose both doctors and hospitals, while the communities should manage hospitals. “In frames of current implementation of decentralization across Ukraine, the responsibility for healthcare is handed over to the municipalities. However, there is no way in which the community could use its ownership of healthcare institutions,” underlined Oleksandr Yabchanka. It is precisely this mechanism that should be provided in a package of draft laws that have been registered in the parliament on July 7. “If the Verkhovna Rada does not adopt the necessary changes, the Cabinet of Ministries is authorized to give the regions opportunity to decide on the healthcare system on the spot,” emphasized the manager in the healthcare system reform group, RPR.