Medical Reforms 2017: A Health Revolution or a Management Failure?
Medical Reforms 2017: A Health Revolution or a Management Failure?
The Ministry of Health of Ukraine presented a package of legislative initiatives, which provides for a number of fundamental changes in Ukrainian medicine. Among them are the provision of a guaranteed package of medical services and medicines, which will be covered by public funds every year, personalization of payments, introduction of international medical protocols for treatment and diagnosis, return of pediatrics to the primary level. The key bill is "On state financial guarantees for the provision of medical services and medicines." We asked the representatives of the medical community, people’s deputies, as well as representatives of local self-government whether new approaches to the organization of the healthcare sector have a bright future.
Irina Sysoenko, Deputy Chairman of the Verkhovna Rada Committee on Health: Currently, only everything that needs to be changed in the legislation for real improvements is being prepared. From mid-2017, the government promises to improve the work of primary care physicians - pediatricians, therapists, family doctors. But I’m not sure it will be implemented in time.
Also, according to the Prime Minister, from April 1, patients will be able to receive free medication for cardiovascular disease, type II diabetes and bronchial asthma, but to date, this opportunity is not yet realized. And I demand from the government, first to make sure that the state program really worked and "breathes", and then go out on TV and talk about it. But not the other way around, as is being done now. In addition, the transition of public funding to the payment of medical services, in particular, the receipt by the doctor of payment for a specific patient, is on the agenda. The issue of remuneration of medical workers is still acute. The level of the minimum wage was increased on January 1, but no one changed the tariff grid for doctors. So we have a situation where the doctor gets the same salary, as well as the guard. And this leads to the fact that medical workers refuse to work in such conditions.
Dmitry Vernigor, Chief Physician of the First Volunteer Mobile Hospital named after N. Pirogov, ex-head of the Health Department of the Desnyanskaya RGA of Kyiv: Today, everything that the Ministry of Health provides to the press regarding the reform of medicine is the right ideas, which have been around for many years. These theses have been proposed since 2010. Now the Cabinet of Ministers of Ukraine is engaged in creation of by-law base - adoption of resolutions, management mechanisms. However, many declarations of the Ministry of Health can be appealed in court with reference to the law. Thus, most of the announced reforms contradict the Constitution and the existing legal framework. The Cabinet is trying to find some mechanisms, but it is more like a large-scale PR campaign than real reform. I repeat, the ideas are not new or supernatural, but how they are going to be implemented within the framework of the Law and what the mechanism is is unknown. In addition, the Ministry of Health is constantly postponing project implementation dates, changing deadlines (for example, the beginning of a new system of selling available drugs is postponed for the second time). That is, the government is showing the unwillingness of the authorities to implement their own declarations.
Oksana Korchinskaya, First Deputy Chairman of the Verkhovna Rada Committee on Health: Many governments, as far as I understand, were guided by the advice of their political technologists and never engaged in real medical reforms, because it is very painful for the population and can lead to loss of ratings. And professional doctors often oppose any changes, as they are satisfied with the salary they receive in addition to salary. Medicine and the Ministry of Health have been corrupt for decades. Ivan Soroka, President of the Ukrainian Medical Club: I hope that the reforms of the Ministry of Health will still have a future even in our reality. All the previous teams of the Ministry of Health came to pretend to be violent, not to reform. Endless pilot projects were offered without a detailed analysis of these pilots. Yes, they were useful, but no one ever analyzed them for further use. No audit was conducted, and the pilots themselves did not proceed with the planned reform.
The first thing the Ministry of Health should do is to announce to patients and the medical community the concept and strategy for the development of the industry for the coming years. Talk clearly about your goals and how those goals will be achieved. Goals must be realistic, reasonable and achievable. Ask any doctor where the medical industry is going now - you are unlikely to get an understandable answer ...
At present, the non-systematic implementation of sometimes good and necessary changes in the health care system raises a lot of questions. Patients do not understand why drugs for patients with hypertension, type 2 diabetes mellitus, and bronchial asthma have been identified for reimbursement from the budget. Such groups of drugs are not so expensive that patients cannot buy them on their own. At the same time, in very rare cases, people with cancer can find money for outpatient chemotherapy on their own. At the very least, there must be social justice. All over the world, the state first tries to help in the most financially unsustainable cases. There are a lot of technical issues regarding the implementation of the project. Only a few days before the start of the campaign, pharmacies began to receive information how they will be able to receive compensation for drugs from the reimbursement list. Practitioners have many questions for the list itself. According to them, many of the molecules are chronically obsolete, there are no modern drugs that are included in international protocols and standards of treatment. The result of the wrong communication policy was the leaching of many vital drugs from the range of pharmacies. Patients’ expectations may not be met, which is a minus for reform and reformers. The result of the wrong communication policy was the leaching of many vital drugs from the range of pharmacies. Patients’ expectations may not be met, which is a minus for reform and reformers. The result of the wrong communication policy was the leaching of many vital drugs from the range of pharmacies. Patients’ expectations may not be met, which is a minus for reform and reformers.
Having not yet implemented one project - we start advertising the second, third .... We have not yet implemented reimbursement, and we are talking about changes in the financing system, although we all understand that there is no money and the industry is chronically underfunded. We publicly declare that we have many doctors in the country, but in reality we cannot provide all of them with family doctors. There is barely enough money to pay salaries and utilities, but not for development. This is especially felt in depressed areas, rural areas. But even in Kyiv, where the budget situation is better and the mayor’s office can afford to make more investments in medicine, well-thought-out and well-tested management decisions are needed.
One of the most important issues that remains unresolved is how will the Ministry of Health resolve the issue of adequate remuneration of health workers, who have less than the average in the economy? How can Ukraine maintain its rich medical and scientific potential?
It must be understood that any reform is a well-defined, scientifically sound plan, a specially trained professional team of managers and practitioners, a package of well-designed and agreed bills and an adequate economic platform, not just ideas and declarations.
Natalia Bigari, Head of the Commission on Health, Maternity, Childhood, Social Protection and Retirees: Everything that the Ministry of Health has been proposing in its strategy since the middle of last year is more like theses and appeals, and we do not see the implementation mechanism itself. In fact, we, the doctors, know these goals ourselves, and we support them, but we expect specific mechanisms from the Ministry of Health. Show us the road map! We need a vertical understanding of reforms. Then there will be a team, and everyone will understand what to do, at their level. Alla Shlapak, deputy of the Kyiv City Council:
When there was no clear reform for 25 years, it was painful for all physicians and the general public. It is much harder to work now than before. If you take the experience of other countries - in Britain, when health care reform was carried out, the Queen needed cavalry police. People went out to protest. We need political will, certain rules of the game, and then there will be a result. In addition, there is a clear interpretation of the reforms from the center, as in our country all the initiatives of the Ministry of Health are interpreted differently.
By their nature, many things initiated by the Ministry of Health have a right to exist, but, unfortunately, not in today’s legal field. In the long run, medical reform may have more policy than managerial decisions. The main stumbling block that will always provoke discussion is the inconsistency of reforms to Article 49 of the Constitution of Ukraine. And this discussion will be constructive. If the state, represented by the Cabinet of Ministers, leads processes that contradict the Constitution, it is wrong.
St. 49 on free medicine - this is exactly what is not subject to change today. The population is rapidly depleting. The majority of the population does not have access to quality medical care. Proper administration of existing resources and the creation of alternative sources, such as private medicine, as well as the creation of a strategy for the development of the medical industry for the next 5 years. As a representative of the local government, I can say that there are no changes on the ground in terms of ensuring the implementation of the concept of the Ministry of Health, there are simply no changes in the medical field.
Most of all, it is needed by people who are ill, who receive support from the budget, medicines, financial assistance. The concept of the Ministry of Health does not answer many questions about funding. It also raises the question of whether regional concepts correspond to national ones, and this should sound in unison.
Pavel Kovtonyuk, Deputy Minister of Health: I cannot agree with the fact that at this stage the rhetoric of the Ministry of Health is provoking social resistance. Yes, there is an active discussion, and that’s normal. Some topics have support in society (and most are now), some are problematic for perception in our realities.
In the course of reform, it will be really difficult for some, easy for others. First of all, it will be difficult for those people who are interested in not changing anything. It will be difficult for chief physicians who are not interested in sound cost management. Those who "stuffed" the list of drugs for reimbursement with "fuflomycin". But it will be much easier for business people who know how to effectively manage the hospital’s funds, and for doctors who prescribe good medicines. than under the current system.
If we talk about the problematic issue of free medical care, Article 49 of the Constitution states that "medical care is provided free of charge in state and municipal health care institutions." But this is a declaration that is not supported by any implementation mechanism. That is, a person has the right to free medical care, but how to exercise it, to what extent this right applies - is unknown. Is there a right to peaceful assembly? There is. And to him there is a procedure for holding these peaceful assemblies.
The "free" nature of medicine in the current legislation is a play on words. In 2002, the Constitutional Court of Ukraine (CCU decision of 29.05.2002) ruled that the work of a medical worker is free for the patient, but the medical service may be paid. The scope of paid services, their list, the procedure for approval and the procedure for payment are determined by law. That is, 15 years ago the Constitutional Court determined that a new law was needed in order for the norm on free medical care to be met. For medical services that the state will not be able to provide - to determine the order of payment, and for an open guarantee - the order of implementation. We are working on such a law. And we do not violate the Constitution, but we implement it.
Vladimir Grishin, Deputy Chairman of the Board of NGO "Physicians of Good Will":Sooner or later, the reforms of the Ministry of Health will work, but it depends not only on the leadership of the Ministry of Health, but to a greater extent on society. The uniqueness of our reform process is that the transition to market health care does not come from the traditional way of life, but from the 70-year type of "socialist health care". It should be understood that these features are defined as the main problems of reform. Due to the constant look back at the previous stage and the lack of will, it is impossible to quickly replace some forms and relationships with new ones. Especially - blind copying of other people’s models without taking into account our features. This phenomenon explains the preservation of the remnants of old relationships for a long period of time and the rejection of "copied" new ones. One thing is gratifying that the process of change cannot be stopped,
On April 14
, 2017, the Fund began in 2010 with letters to Kommersant-Ukraine. Everyone had a request, and often a cry for help.
Since then, all our activities have been working with your letters of appeal. But if we publish requests for help on the site’s pages and in partner media, then here, in the "Direct Speech" section, the main topic is Ufond’s dialogue with readers, friends and partners who ask us questions, make comments, suggestions - in general, conversation on a variety of topics. Ask! help@ufond.ua
Ufond’s wards can be helped here: http://ufond.ua/7
The Ministry of Health of Ukraine presented a package of legislative initiatives, which provides for a number of fundamental changes in Ukrainian medicine. Among them are the provision of a guaranteed package of medical services and medicines, which will be covered by public funds every year, personalization of payments, introduction of international medical protocols for treatment and diagnosis, return of pediatrics to the primary level. The key bill is "On state financial guarantees for the provision of medical services and medicines." We asked the representatives of the medical community, people’s deputies, as well as representatives of local self-government whether new approaches to the organization of the healthcare sector have a bright future.
Irina Sysoenko, Deputy Chairman of the Verkhovna Rada Committee on Health: Currently, only everything that needs to be changed in the legislation for real improvements is being prepared. From mid-2017, the government promises to improve the work of primary care physicians - pediatricians, therapists, family doctors. But I’m not sure it will be implemented in time.Also, according to the Prime Minister, from April 1, patients will be able to receive free medication for cardiovascular disease, type II diabetes and bronchial asthma, but to date, this opportunity is not yet realized. And I demand from the government, first to make sure that the state program really worked and "breathes", and then go out on TV and talk about it. But not the other way around, as is being done now. In addition, the transition of public funding to the payment of medical services, in particular, the receipt by the doctor of payment for a specific patient, is on the agenda. The issue of remuneration of medical workers is still acute. The level of the minimum wage was increased on January 1, but no one changed the tariff grid for doctors. So we have a situation where the doctor gets the same salary, as well as the guard. And this leads to the fact that medical workers refuse to work in such conditions.
Dmitry Vernigor, Chief Physician of the First Volunteer Mobile Hospital named after N. Pirogov, ex-head of the Health Department of the Desnyanskaya RGA of Kyiv: Today, everything that the Ministry of Health provides to the press regarding the reform of medicine is the right ideas, which have been around for many years. These theses have been proposed since 2010. Now the Cabinet of Ministers of Ukraine is engaged in creation of by-law base - adoption of resolutions, management mechanisms. However, many declarations of the Ministry of Health can be appealed in court with reference to the law. Thus, most of the announced reforms contradict the Constitution and the existing legal framework. The Cabinet is trying to find some mechanisms, but it is more like a large-scale PR campaign than real reform. I repeat, the ideas are not new or supernatural, but how they are going to be implemented within the framework of the Law and what the mechanism is is unknown. In addition, the Ministry of Health is constantly postponing project implementation dates, changing deadlines (for example, the beginning of a new system of selling available drugs is postponed for the second time). That is, the government is showing the unwillingness of the authorities to implement their own declarations.Oksana Korchinskaya, First Deputy Chairman of the Verkhovna Rada Committee on Health: Many governments, as far as I understand, were guided by the advice of their political technologists and never engaged in real medical reforms, because it is very painful for the population and can lead to loss of ratings. And professional doctors often oppose any changes, as they are satisfied with the salary they receive in addition to salary. Medicine and the Ministry of Health have been corrupt for decades. Ivan Soroka, President of the Ukrainian Medical Club: I hope that the reforms of the Ministry of Health will still have a future even in our reality. All the previous teams of the Ministry of Health came to pretend to be violent, not to reform. Endless pilot projects were offered without a detailed analysis of these pilots. Yes, they were useful, but no one ever analyzed them for further use. No audit was conducted, and the pilots themselves did not proceed with the planned reform.The first thing the Ministry of Health should do is to announce to patients and the medical community the concept and strategy for the development of the industry for the coming years. Talk clearly about your goals and how those goals will be achieved. Goals must be realistic, reasonable and achievable. Ask any doctor where the medical industry is going now - you are unlikely to get an understandable answer ...At present, the non-systematic implementation of sometimes good and necessary changes in the health care system raises a lot of questions. Patients do not understand why drugs for patients with hypertension, type 2 diabetes mellitus, and bronchial asthma have been identified for reimbursement from the budget. Such groups of drugs are not so expensive that patients cannot buy them on their own. At the same time, in very rare cases, people with cancer can find money for outpatient chemotherapy on their own. At the very least, there must be social justice. All over the world, the state first tries to help in the most financially unsustainable cases. There are a lot of technical issues regarding the implementation of the project. Only a few days before the start of the campaign, pharmacies began to receive information how they will be able to receive compensation for drugs from the reimbursement list. Practitioners have many questions for the list itself. According to them, many of the molecules are chronically obsolete, there are no modern drugs that are included in international protocols and standards of treatment. The result of the wrong communication policy was the leaching of many vital drugs from the range of pharmacies. Patients’ expectations may not be met, which is a minus for reform and reformers. The result of the wrong communication policy was the leaching of many vital drugs from the range of pharmacies. Patients’ expectations may not be met, which is a minus for reform and reformers. The result of the wrong communication policy was the leaching of many vital drugs from the range of pharmacies. Patients’ expectations may not be met, which is a minus for reform and reformers.
Having not yet implemented one project - we start advertising the second, third .... We have not yet implemented reimbursement, and we are talking about changes in the financing system, although we all understand that there is no money and the industry is chronically underfunded. We publicly declare that we have many doctors in the country, but in reality we cannot provide all of them with family doctors. There is barely enough money to pay salaries and utilities, but not for development. This is especially felt in depressed areas, rural areas. But even in Kyiv, where the budget situation is better and the mayor’s office can afford to make more investments in medicine, well-thought-out and well-tested management decisions are needed.
One of the most important issues that remains unresolved is how will the Ministry of Health resolve the issue of adequate remuneration of health workers, who have less than the average in the economy? How can Ukraine maintain its rich medical and scientific potential?
It must be understood that any reform is a well-defined, scientifically sound plan, a specially trained professional team of managers and practitioners, a package of well-designed and agreed bills and an adequate economic platform, not just ideas and declarations.
Natalia Bigari, Head of the Commission on Health, Maternity, Childhood, Social Protection and Retirees: Everything that the Ministry of Health has been proposing in its strategy since the middle of last year is more like theses and appeals, and we do not see the implementation mechanism itself. In fact, we, the doctors, know these goals ourselves, and we support them, but we expect specific mechanisms from the Ministry of Health. Show us the road map! We need a vertical understanding of reforms. Then there will be a team, and everyone will understand what to do, at their level. Alla Shlapak, deputy of the Kyiv City Council:When there was no clear reform for 25 years, it was painful for all physicians and the general public. It is much harder to work now than before. If you take the experience of other countries - in Britain, when health care reform was carried out, the Queen needed cavalry police. People went out to protest. We need political will, certain rules of the game, and then there will be a result. In addition, there is a clear interpretation of the reforms from the center, as in our country all the initiatives of the Ministry of Health are interpreted differently.
By their nature, many things initiated by the Ministry of Health have a right to exist, but, unfortunately, not in today’s legal field. In the long run, medical reform may have more policy than managerial decisions. The main stumbling block that will always provoke discussion is the inconsistency of reforms to Article 49 of the Constitution of Ukraine. And this discussion will be constructive. If the state, represented by the Cabinet of Ministers, leads processes that contradict the Constitution, it is wrong.St. 49 on free medicine - this is exactly what is not subject to change today. The population is rapidly depleting. The majority of the population does not have access to quality medical care. Proper administration of existing resources and the creation of alternative sources, such as private medicine, as well as the creation of a strategy for the development of the medical industry for the next 5 years. As a representative of the local government, I can say that there are no changes on the ground in terms of ensuring the implementation of the concept of the Ministry of Health, there are simply no changes in the medical field.
Most of all, it is needed by people who are ill, who receive support from the budget, medicines, financial assistance. The concept of the Ministry of Health does not answer many questions about funding. It also raises the question of whether regional concepts correspond to national ones, and this should sound in unison.
Pavel Kovtonyuk, Deputy Minister of Health: I cannot agree with the fact that at this stage the rhetoric of the Ministry of Health is provoking social resistance. Yes, there is an active discussion, and that’s normal. Some topics have support in society (and most are now), some are problematic for perception in our realities.In the course of reform, it will be really difficult for some, easy for others. First of all, it will be difficult for those people who are interested in not changing anything. It will be difficult for chief physicians who are not interested in sound cost management. Those who "stuffed" the list of drugs for reimbursement with "fuflomycin". But it will be much easier for business people who know how to effectively manage the hospital’s funds, and for doctors who prescribe good medicines. than under the current system.
If we talk about the problematic issue of free medical care, Article 49 of the Constitution states that "medical care is provided free of charge in state and municipal health care institutions." But this is a declaration that is not supported by any implementation mechanism. That is, a person has the right to free medical care, but how to exercise it, to what extent this right applies - is unknown. Is there a right to peaceful assembly? There is. And to him there is a procedure for holding these peaceful assemblies.
The "free" nature of medicine in the current legislation is a play on words. In 2002, the Constitutional Court of Ukraine (CCU decision of 29.05.2002) ruled that the work of a medical worker is free for the patient, but the medical service may be paid. The scope of paid services, their list, the procedure for approval and the procedure for payment are determined by law. That is, 15 years ago the Constitutional Court determined that a new law was needed in order for the norm on free medical care to be met. For medical services that the state will not be able to provide - to determine the order of payment, and for an open guarantee - the order of implementation. We are working on such a law. And we do not violate the Constitution, but we implement it.
Vladimir Grishin, Deputy Chairman of the Board of NGO "Physicians of Good Will":Sooner or later, the reforms of the Ministry of Health will work, but it depends not only on the leadership of the Ministry of Health, but to a greater extent on society. The uniqueness of our reform process is that the transition to market health care does not come from the traditional way of life, but from the 70-year type of "socialist health care". It should be understood that these features are defined as the main problems of reform. Due to the constant look back at the previous stage and the lack of will, it is impossible to quickly replace some forms and relationships with new ones. Especially - blind copying of other people’s models without taking into account our features. This phenomenon explains the preservation of the remnants of old relationships for a long period of time and the rejection of "copied" new ones. One thing is gratifying that the process of change cannot be stopped,On April 14
, 2017, the Fund began in 2010 with letters to Kommersant-Ukraine. Everyone had a request, and often a cry for help.
Since then, all our activities have been working with your letters of appeal. But if we publish requests for help on the site’s pages and in partner media, then here, in the "Direct Speech" section, the main topic is Ufond’s dialogue with readers, friends and partners who ask us questions, make comments, suggestions - in general, conversation on a variety of topics. Ask! help@ufond.ua
Ufond’s wards can be helped here: http://ufond.ua/7