A new round of healthcare reform has started in Ukraine. The Ministry of Health is formingguaranteed list of services, according to hospital districts, are engaged in reference pricing, reimbursement of drugs, etc. Deputy Minister of Health Pavel Kovtonyuk told Ufond journalist Ofona Melnyk about what awaits the patient and the doctor in the new conditions, whether there is a massive reduction of doctors, who should count the money of hospitals and why the Law on Free Medicine is not implemented in Ukraine.
- Paul, why the new round of reforms of the Ministry of Health of Ukraine causes if not suspicion in society, then social resistance?
-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. For example, the Ministry of Health’s initiatives on international procurement have been criticized, but there is more policy than management. The most problematic issue is the creation of hospital districts. At one time, this provoked protests in the communities.
- What changes await the medical infrastructure after the creation of hospital districts?
- As soon as conversations about hospital districts begin, people have far-fetched fears. But there is nothing in the design of the reform that people should really be afraid of. They talk about the closure of medical institutions, that it will take a very long time to go to the hospital, etc. The truth is that people will get to hospitals faster. It will be possible to get to the Intensive Care Hospital (BIL) of the I level in 1 hour, to the BIL of the II level - in 2 hours. I can explain on the example of Vinnytsia region.
Now there is a possibility of stenting in cases of stroke, only in one regional hospital in Vinnytsia. The average journey to the center of this medical service is about 240 minutes. As a result of creation of hospital districts 3 such centers will be created, travel time will be reduced to 120 minutes. This is the main principle of the formation of hospital districts - on the contrary, services will "come down" from the regional level closer to the people.
- That hospitals will be closed - a myth or reality?
-It will be really hard for some, easy for others. First of all, it will be difficult for those people who are interested in not changing anything. I will give an example. In the town of Slavutych, there is such a medical institution as the “Specialized Medical and Sanitary Unit №5”, which used to work at the nuclear power plant and now serves as a city hospital. The medical unit was designed in Soviet times for a population of 80-100 thousand (then it was thought that many young people would come to the city to work, who would start families and live here). Now there live 25 thousand people. The hospital has many buildings, uses a lot of resources, but its capacity is not fully used. However, the hospital management constantly complains that there is a lack of funding, although the city authorities want to somehow optimize spending. In particular, offer to use empty premises as housing for young doctors who are invited to work in Slavutich. But the chief physician of this unit is against. It receives a large budget and provides few services to the public. In the future, he will have 2 options: either provide more services or reduce capacity. It will be difficult for such businessmen. But where they try to allocate resources rationally, the opposite will be better.
- In this case, the results of the medical institution will depend on the personal factor?
- Soon this norm can be fulfilled after the adoption of the bill № 2309a-d, concerning the autonomy of medical institutions. The Verkhovna Rada Committee on Health has already agreed on its final version. A compromise was reached on this issue after discussions that lasted more than a year and a half. We are waiting for it to be included in the agenda. - How correct is the transfer of obligations to pay for utilities of budgetary institutions from the state to the local level? - On the contrary." Now we have a complete financial "leveling". Everyone is given the same, regardless of how resources are distributed and regardless of the number of patients. This is a purely communist system, in which the quality of medical services depends only on the individual. Most hospitals are owned by local communities (city, district), so they - local communities - must choose their own effective managers. At the same time, be guided by financial incentives, not family or friendships.
Strategically, this is not quite the right step, although temporary. So far, the decision has been made for 2017, it will be reconsidered. In general, energy costs should be included in the cost of medical services. For example, in a restaurant we pay by a single check, not separately for food and heat. So it should be in medicine - the payment of the service on the general account, which includes the communal, and on the basis of which the manager distributes further costs. This stimulates it, including energy efficiency. For example, in the outpatient clinic of one of the villages of Chernivtsi region there is only 1 doctor, and in addition to the doctor - 11 more full-time units: drivers, guards, etc. Even 2 firemen are available at the rate. Why? It turns out that the outpatient clinic is heated by a kind of "antediluvian" furnace, which must be melted in the morning and extinguished in the evening. It would seem it is much easier to buy a modern heating system than to keep two firemen on a salary. But under the current system, people choose this level of management.
- Will the reimbursement program, which forms a new list of affordable (or free) drugs, limit the possibility of obtaining them by prescription?
-Again, in this aspect, there are those who will have a hard time surviving the reform. In particular, those who "stuffed" the list with fuflomycin… But doctors who prescribe drugs that are proven internationally, will feel great. For comparison: today in the List of drugs subject to reimbursement - 1000 names, and in the international list of the World Health Organization (WHO) - 300. The question is whether we need 700 items in our list, which have no proven impact on the world level. human health. Yes, they should be sold in pharmacies. Perhaps someone believes that tincture of oak bark helps - it is a personal human right. But if there is nothing in the international evidence base in this regard,
- Is the law on free medicine in Ukraine a relic of Soviet times or a necessary necessity?
- If we analyze the world experience, we can see an interesting detail: where free medicine is not declared at the state level, it is quite possible to get free quality medical care. But, for example, in the CIS countries, where they still can not part with this communist practice, a person goes to the doctor and pays him out of pocket.
- There is often a message in the media that the legislative initiatives of the Ministry of Health contradict Article 49 of the Constitution of Ukraine, which regulates the human right to free medical care. To what extent are these statements true?
- Article 49 of the Constitution states that
"Medical care is provided free of charge in state and municipal health care institutions." 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. 04/09/2017But 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.
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