Do you know what actually health reform is? It is not only about insurance medicine and not just for the free treatment. During a meeting with journalists and experts in America House, the acting Minister of Health Uliana Suprun reported on the main reform objectives and answered the questions of an audience. We tried to summarize and make the reform explanation more comprehensive.
According to Uliana Suprun, the Ministry of Health is trying to change the current system so that people are confident that in the case of illness they can get free and competent care.
“Doctors think that it is normal to pay the chief physician for his work. Patients think that it is also normal when they express gratitude to a doctor, in his pocket, not via a cash desk. But this is not right “- stated Suprun. To combat this phenomenon, on April 28, the Ministry of Health signed a memorandum with NABU on fighting corruption in the healthcare system.
However, it is obvious that corruption in this area can be overcome only when doctors will receive decent wages and do not wait for patients’ “gratitude”.
Insurance medicine and the new finance system
The most important thing the reform provides is a radical change in the financing of the health care system. “We have submitted four bills on financing to change the system so that it does not support the facilities and infrastructure, but reimburse the patients care. The state should allocate funds for treatment rather than hospitals”, – said Suprun.
Previously the state allocated money for hospitals and patient capacity, but now the funds should go to pay for services provided to patients. For this reason, there will be introduced public insurance related to all who live in Ukraine. This does not mean that now we have to pay any additional costs for insurance because financing of services available at the hospital will be provided at the expense of taxes. “Citizens do not have to look for some kind of insurance, they are automatically insured since living in Ukraine”, – notes Suprun.
Primary care medical services will be absolutely free. Family doctors, pediatricians, doctors of internal medicine, who provide a range of services, will get funds for each patient who signs a contract with them. The patient will not pay the doctor. This includes emergency and palliative care. “This assistance is free because you have already paid taxes for it” – said Suprun.
Secondary and tertiary health care services will be paid as per joint tariff, regardless of residence. Also, there is an opportunity for the partial payment of some services by state and the availability of preferential programs for vulnerable groups.
The budget holder of allocated funds for financing services will be a new structure – the National Health Service. When a patient chooses the doctor and the hospital, the service will allocate funds for his treatment.
With the transition to the new system, the physician’s salary will directly depend on the number of his patients. At an average, the state will allocate for one patient 210 UAH per year. The norm for the physician will be 2 thousand patients.
For pediatricians, the number is 800-900 patients. They will receive more per one patient (for example not 210 UAH, but 270 UAH.) because they have more work and stress. The same applies to doctors who work with the elderly.
The payment will arrive every month. The patient has to sign a contract with a doctor. If the patient does not like the doctor, he may change him once a month and start treatment with another one. Accordingly, the payment will also go to another doctor.
As for nurses, they will be paid by hospital or doctors with whom they work.
As the President has already signed the law 2309a-d, which provides autonomy of hospitals, they’ll become a kind of nonprofit enterprises. This means that they will have another administration within the institution and will not be dependent on its owner, for example, if it is a city or regional hospital. They will be able to obtain financing from other sources.
Appointment of chief doctors
One of the future changes includes the appointment of chief doctors. Now, together with the anti-corruption non-governmental organizations, the Ministry of Health is developing a new system whereby the chief doctors are not simply assigned, but selected by competition.
As explained by Suprun, this should be a system of selection, according to which the best and the most effective managers will become chief physicians. “The person should be appointed to this position not by District Council, but the contest commission, which will consider all candidates, their hospital development plans, talent, and experience. Based on results there will be selected the best one”- stated the Acting Minister.
Another innovation is the emergence of a new position – administrative director of the hospital. This is to ensure that the chief doctor could directly deal with the patients’ treatment and medical affairs. Instead, the individual will deal with administration and financial issues. The separation of these functions should improve management in medical institutions. So the hospital will have two directors – “administrative and medical”.
Electronic system of health care
Another important step will be the introduction of an electronic system of health care, including the registry of patients and doctors. In its turn, the register will contain an electronic card with the medical record of the patient. This innovation will allow doctors to gain access to patient information from any computer connected to the Internet. Also, the single system is designed to connect already existing registers in some cities and hospitals.
Such system is to be developed by a separate unit set up by the Ministry of Health, aiming to make it simple and convenient, so that doctors spend as little time for its completion and reporting as possible. According to the Acting Minister, a base version of the product has already been created, which so far involves only the possibility of registering a doctor and a list of his patients. Also, some doctors tested this system and were trained to use it.
It is clear that to use this system it is necessary to have Internet access. Therefore, funds for investment projects will be included in the budget for 2018. The Ministry of Health hopes that part of these projects will be focused exactly on informatization of hospitals: the purchase of computer equipment and internet connection.
One of the key elements of health care reform is the organization of hospital districts, which should help to arrange the existing network of hospitals. Now, a good specialty care is mostly available only in some regional centers and cities. The reform should contribute to the existence of the one second level hospital of intensive care in each hospital district. “We do not close the hospitals, on the contrary – we want more polyclinics, for patients to have better access to them and not to be forced to go to the regional center to get the services which they should receive at their hospital district” – noted Suprun.
Creation of hospital districts and distribution of functions between hospitals will take place at the local level because they know better the needs of their population. As of today, 15 areas have been creating the hospital districts. They divided the districts and create Hospital Boards, to determine which hospitals will fulfill certain functions.
According to national insurance, even in cases of serious illness, the government will guaranty the patient receiving of the necessary medication. The state will purchase and pay for these drugs as long as it takes, even if the drugs are expensive. It is clear that the state will not pay the full cost of all drugs, but there will be programs to cover part of the cost.
As for purchasing medicines for hospitals, some success has already been achieved, particularly with regard to the transparency of the process, commented Suprun. Also, all hospitals should reveal to the public a list of available free drugs.
According to the Acting Minister of Health, today’s blood donation system is not very secure. This includes the entire process – from blood giving to testing and storage. So now the system is changing to a European model using the experience of Germany and France, which provides free donation.
As explained by Suprun, the work on new system development is at the final stage. The changes will include the way the donor provides the blood, where it is tested and stored, and how it is delivered to hospitals.
Psychiatric care and PTSD
Also, the work on a new strategy for mental health care has recently completed. It offers a fundamentally different vision of psychiatric care. By now, such aid involved the treatment with medical drugs, rather than therapy and social adaptation. The changes should contribute to the treatment of the patients on an ambulatory basis, rather than on a patient basis.
According to Suprun, a separate issue is a wrong approach in helping people with posttraumatic stress disorder (PTSD) diagnose. This is particularly important for combatants in the ATO area. In her opinion, not in all cases, the mental effects are really incurable; they can be overwhelmed through therapy, psychologists care and socialization.
Illustration by Dmytro Zinchuk