The Ministry of Health of Ukraine presented the plan of healthcare reform in 2017. There are nine main areas of work, each of them includes adoption of new regulations and practical steps. Transition to “money follow the patient” model will start in spring, said Pavlo Kovnoniuk, Deputy Minister of Health of Ukraine, at a press briefing at Ukraine Crisis Media Center.
The reforms include preparation and adoption of legislation necessary to launch the new model of funding. Public healthcare facilities will receive more autonomy and will sign agreements on healthcare services with the state. A new institution called the National Health Service will be created to order the services, sign agreements with healthcare facilities and pay for providing services to patients. Moreover, an e-register of patients will be created. The Ministry will also start preparation to transition of secondary and tertiary care to a new model of funding. This includes creation of hospital district and calculation of service cost. Other areas of work include revision of clinical protocols for the most frequent medical conditions, simplification of printed reporting, introduction of the national system of reimbursement of medicines’ cost for a defined list of medical conditions and introduction of reference pricing for medicines.
Legislative changes
The first novelty is ability for all types of primary care facilities to sign agreement with the state. “At present, this is possible only for primary care centers. We would like to provide this opportunity to clinics and private practices – all medical facilities in the community. Communities should have right to make their own decision how to form their facilities network,” Pavlo Kovtoniuk noted. The second novelty is that pediatricians will have right to practice as primary care doctors. “We have already noted that there will be three types of specialists in primary care: family doctors, pediatricians and general practitioners. We don’t want to create artificial barriers. If people want choose them as their doctors, they should have such opportunity,” Deputy Minister explained.
The Ministry also prepared a number of by-laws, including regulations on agreements with doctors, agreements between primary care facility and the state, a detailed “package” of assured primary care services and healthcare services guidelines. “This document prescribes the general tasks of primary care doctors, such as prevention and treatment of basic medical conditions according to clinical protocols. It also prescribes details, such as analysis included into primary care package and a detailed guideline on screening procedures. Requirements to technical equipment are also prescribed there,” Pavlo Kovtoniuk noted.
On February 8-9 draft documents will be discussed with experts and regions representatives. After this they will be passed for approval to the Cabinet of Ministers and the Parliament.
Doctors salaries
Doctors’ salary will not be fixed, it will depend on the number of his patients. “The suggested amount is 2 thousand patients. It may depend on circumstances, as in several cases it isn’t possible. The doctor shall not refuse the patient who wants to choose him as doctor,” Deputy Minister noted.
Pay rates per patient will depend on patient’s age. “UAH 210 is the average pay. It will be two times more for children under 5 years and elderly people 65+. There will be also intermediate rates for children aged 5-18 etc.,” Pavlo Kovtoniuk explained. The full pay scale will be published in a month. In the next year the Ministry will consider possibility to introduce particular rates for patients with chronic conditions etc.
The model of funds distribution inside a hospital will be defined by the director, but the doctor is free to choose the hospital. In such way, directors of hospitals and local communities will have motivation to offer better conditions for the doctors.
Why Ukraine needs a unified e-register
The e-register is designed as a united system for exchange of medical data. It will contain information about all patients, and budget funds will be distributed according to this data. “This mechanism will help us avoid cases when one patient is registered in three different hospitals. If the patient goes to a new hospital and signs up there, the previous agreement will be cancelled,” explained Deputy Minister. He added that this rule does not apply to emergency conditions.
To work with the register, the hospitals do not need special software. Most of programs that are currently present in the market will be suitable.
Hospital Districts advantages
In Ukraine, especially in the regions, there is a problem that the number of hospitals is sometimes significantly bigger than the number of those able to provide the service that the patient needs. Hospital districts are aimed to solve this problem and “bring the service closer to the patient”, Pavlo Kovtoniuk explained. The Councils of Hospital Districts will have to select hospitals for their network in such way that the patients would have access to all services as close to their homes as possible. One of the requirements is that the trip to primary care clinic would take no more than one hour.
When the new system will start its work?
By the beginning of spring we will adopt all the documents necessary to launch this system. It will start its work in spring in those regions which will be ready for transition, then in summer in those which will be ready by the summer. In 2018, it will be compulsory,” Deputy Minister said. The main criteria of region readiness are awareness of patients and doctors, ability to work with e-register and hospitals’ ability to sign agreements.
