The money will go to the patient.
In December, the Ukrainian Relief Fund, together with our partners, sums up the year. In Ukraine, 2015 was held under the slogan of reforms, one of the most important was to concern health care. The Fund works very closely with domestic doctors and clinics, and is very well aware of the problems of the entire health care system. In addition, the interaction of charitable foundations and medical institutions is still associated with many obstacles. Ufond correspondent Svetlana Khisamova found out in an interview with the head of the board of the public organization "Patients of Ukraine" Dmitry Sherembey what changes have already taken place in the industry and which are yet to be implemented.
- In 2015, a major healthcare reform was announced. Recently, Deputy Minister Alexander Pavlenko presented to the public a report on the work done and information on plans for 2016. How do you assess what was done and what was not?
- The project of health care reform in Ukraine was proposed and developed by the organization "Patients of Ukraine". Out of 120 experts, we selected 12 from Ukraine, Georgia and Poland. They wrote a draft of the reform. Today it is an official strategy. Unfortunately, the reforms that were planned for 2015 have not been implemented, except for one. At the beginning of the year, the priorities were: international procurement, liberalization of the pharmaceutical market and the autonomy of hospitals. Only international purchases were made. The Ministry of Health, to put it mildly, took a passive position and even slowed down the process. As a result, only in December contracts were signed and money was received for purchases.
- Are we talking about all public procurement?
- We planned that would be all. At this stage, 2.4 billion hryvnias have been transferred to international organizations, which is about 65%. This is a significant amount. We plan that in 2016 all 100% of the funds will be transferred for the purchase of drugs under government programs. But this became possible only under public pressure, as a result of protests, BP pressure, threats to remove the Minister of Health.
- What does the liberalization of the pharmaceutical market mean and why was it not possible to implement it?
- Liberalization of the pharmaceutical market will lead to cheaper medicines in pharmacies by 25-35%. The range of available drugs is becoming wider. The concept for the implementation of this plan was ready, all that was needed was to remove bureaucratic obstacles and the corruption component. In Ukraine, drug prices are more expensive than in the EU.
- At the expense of what reduction in price is possible?
- Increasing competition, simplifying the registration process for medicines that are registered in the EU, destroying the system of state-owned enterprises (pharmacies). Only these three points would lead to cheaper. Competition would increase, doing business would be simplified, quality would be higher.
- As for the reform of the hospital sector, it is planned for 2016. The reform assumes that "money will follow the patient." I understand how it works in the conditions of compulsory health insurance, but we do not have it. What do you mean?
- The meaning is very simple. We want hospitals to manage their budgets on their own, based on a tariff list of services. And hospitals would receive funding not for the maintenance of beds, but commensurate with the number of services provided. This makes it possible to spend money more rationally, which is not enough, and makes it possible to assess the result of the money spent. Hospitals will also be able to manage their staff and costs so that efficiency is obvious. There will be healthy competition among hospitals that will fight for the patient, offering better quality services. Insurance companies that pay for the medical services provided to their clients will be able to work legally with these hospitals. Simplify everything.
- And charitable foundations will also be able to cooperate legally, which is a problem today, because not everyone provides transparent reporting?
"Of course." This is a very simple idea. She was overwhelmed by the Ministry of Health.
- But this norm has always rested on the article from the Constitution, which states that our medicine is free.
- This provision of the Constitution is not an obstacle to the autonomy of hospitals. This is a lie. Of course, we are in favor of changing this provision of the Constitution, it is long out of date and does not work. It does not take much work to implement this idea, it is necessary to adopt a separate law.
"Is this Law 2309a?" It will be considered by the Council next year. What are the prospects for its adoption?
- Yes, this is law 2309a. We expect that the composition of the Ministry of Health will change and new communications with the parliament will be established. We will make every effort to pass the law, Ukraine needs it. This will be the most significant step in health care reform. Any reform is a reform of money. Hospital autonomy is a change in the flow of funds. They will be subject to a different calculation principle, and thus we will be able to easily assess the efficiency of the hospital. And of course, we expect clinics to reduce the area of vacant premises that are heated and serviced by utilities. This savings will help hospitals. We want this money to stay in the clinics.
- Is the issue of introducing compulsory health insurance still relevant?
- In any case, Ukraine must move to a new form of obtaining resources for the health sector. The insurance system - mandatory or voluntary - will be in any case. Not much money will appear in the country at once. And we need to find other financial instruments. We exist in illegal paid medicine, where the quality of services is low and the price is unreasonably high. We want the commercial relationship between the health sector and the patient to be legalized, but at the same time the quality and responsibility to be high. So insurance companies are the third participant in the process that controls the quality of medical services. Insurers do not benefit from people being ill for a long time, they benefit from effectively treating patients. And the state, for its part, must offer a minimum package of services that will pay (ambulance, pediatrics, childbirth, etc.) It is necessary to honestly state for society that the state assumes compensation for the cost of these services, they will be of high quality. Everything else - people can buy more on the policy. We all actually go to paid hospitals, we just don’t admit it. So this hallucination must be stopped.
22.01.2016