Medical reform: it seems that we are going back to bed …
Ukraine does not need to restrict medical reform, but to improve it, recognize and correct errors. What are you talking about?
The management of the Ministry of Health and the relevant committee have announced their intention to work on the errors in promoting medical reform. And the above is perceived differently by the medical community and the public – from full approval to protests. Society still cannot understand how the health care sector should be reformed and where it is evolving. The industry passed the first stage without success and found itself stuck on the threshold of the second. No one expected the implementation of the second phase of medical reform to coincide with a pandemic, unprecedented security measures and an economic crisis. It is clear that in these times, the resources necessary to pursue structural change are not enough. But the problem is that those responsible are changing, and each has their own vision of reform. And why at the same time there is no agreement on the path chosen. Is it really impossible to finally sit down and agree on the model of medicine to be built so that everyone – patients, doctors and the state can benefit from it? For immediately reflected and error-free. If, for this, you have to listen again to the arguments “for” and “against”, then please, to your attention.
Lawmakers: Correcting Mistakes – Giving Everyone More Money
The truth is that reform has both great advantages and obvious disadvantages. And state leadership is now faced with the task of preserving the benefits and urgently correcting the mistakes, said Mikhail Radutsky, chairman of the Verkhovna Rada Committee on National Health, Medical Assistance and medical insurance:
– So the first mistake that we start immediately to correct is insufficient funding. Given the lack of funding, no reform will succeed! Therefore, the National Health Committee insists on the need to double funding for the health system next year – up to 6% of GDP. The budgeting process for 2021 has already started and we urge the government and parliament to review the amount of funding for medicines.
As for this year, in an economic crisis and a pandemic, the priority is the question of maintaining medical personnel and medical equipment. Therefore, we are amending the law “On State Financial Guarantees of Medical Services for the Population”, which will allow all medical institutions to receive funding at a level not lower than that of 2019. In addition, care emergency medical services, treatment for coronavirus infections, heart attacks and strokes will be funded by medical guarantees.
Our second task is to immediately and urgently support all of our medical workers. After all, they are all at the forefront of the fight against coronavirus infection! The government will also find more than 11 billion UAH. on doctors’ salaries. For many categories of health workers, the increase will be 50%. As legislators, we will do our best to get changes to the budget approved as quickly as possible. And the salary increase went as planned!
The third task is to immediately begin the process of amending legislation that will allow the Ministry of Health to develop and approve national treatment protocols and quality standards. It is on the basis of national protocols and standards that the prices of medical service packages will be calculated. And from next year, our medical institutions will start receiving from the state for services rendered to patients exactly as much as these services actually cost on the market, and not as they cost now.
And the fourth direction – increasing funding, we must simultaneously increase the level of responsibility of medical institutions towards patients. The physician liability insurance system will help solve this problem. In many countries of the world, professional medical liability insurance is compulsory. And, according to the Committee, the introduction of such a system in Ukraine should be part of medical reform.
Chief Doctors: “We were not prepared for such a drug”
During the discussion at the Ukrainian Crisis Media Center on “Why health care reform should not be reduced”, representatives of the medical community expressed their position.
Igor Zmyslya, director of the Sumy regional children’s hospital:
“Until April, many (leaders of the institutions. – Editor’s note) did nothing in anticipation of the fact that the reform would not take place. Unfortunately, the time lost for the leaders of these institutions is becoming critical. Delaying reform at this point, in my opinion, is generally impossible under these conditions, when we switched to new funding from the National Health Service. We started to work as companies and with new powers as companies, which gives us new opportunities – to spend money on development. The big problem is that with the transition to the new health care system, many problems have yet to be resolved. But in the reform process, these issues are not resolved simultaneously. Cancellation is not possible, the postponement makes no sense, so we are for reform and we are working. “
Elena Kolodenko, Director of the Primary Health Care Center # 3, Odessa:
“If before the start of the reform, our institution received 2 million UAH per month, today about 3 million. This allowed us to invest in the material and technical base and to increase the salaries of doctors and medical staff. But the bottom line is that we were able to receive not only funds from the NSZU, but also from other sources of funding for the institution. It is very important to cooperate with the Ministry of Health with the finance department of the city council in order to formulate local programs so that the delivery of medical care is truly of high quality. When we talk about the health care system, we cannot reform one link and forget the other. “
Vladimir Krasyokha, chief doctor of the multidisciplinary Ascension hospital (Nikolaev region):
“Today they are trying to return to financial institutions under the old Soviet system. Unsuccessful establishments with ineffective managers knew they could close or needed to be optimized. We talked to them about it – become planned treatment hospitals, diagnostic centers, and don’t keep empty buildings without patients who haven’t been there in years. We looked for grants, projects and all possible measures to increase funding, buy equipment and raise doctors’ salaries. Now after that, as we received a million more funding in the first month than before, we paid bonuses to employees of infectious disease departments and mobile teams to fight COVID-19, without waiting for funding. the state. We have approved paid services and see the need for these official paid services that are economically viable and accessible to patients. We want to work honestly and in the legal field, and not return to the Soviet system, where lists are written and charitable contributions are taken. It is not a medicine. We were not preparing for such drugs. “
Information from NSZU: who worked how – he received it
The second phase of the transformation of the health system began on April 1. According to the NSZU, contracts have already been concluded with 1,645 specialized agencies. 64 are individuals and individuals. Under these agreements, the NHA has already paid more than 5 billion hryvnias. 954 institutions received more under the agreement with the NZZU than with the grant.
For example, the city of Uman hospital received 26.5 million hryvnias per grant, nearly 110 million hryvnias under a contract with the NSZU; The Chernihiv Center for Modern Oncology under the contract received 52 million more than the grant. Kiev City Hospital No. 8 – 20 million more. More funds have been received by hospitals that are better equipped and have the best specialists. Who will be able to provide better patient care. And this is the meaning of the changes that take place from 01.04. So that a person who will need medical care can benefit from it, without financial difficulties. The tariffs now reflect the funding allocated.
ASN also supported the growth of funds for the health system. But also for the rational use of available resources. So that patients receive better care. And efficient hospitals have more money. Today, 100,000 electronic instructions have already been written in the electronic health system, electronic medical records are kept for more than 2 million patients. This is electronic data, on the basis of which the system decisions will be taken during the formation of the next stages of transformation.
Opposition: all power claims are a bluff
Recent Minister’s Statements And Actions Of Officials Indicate They Want To Cancel Health Care Reform And Take It Back To The Past, Said Voice Party MPP Olga Stefanyshina, Member Of Ukraine’s Verkhovna Rada Health Committee health care and medical insurance in a commentary on Ukrinform.
– They want to bring the funding system back to the one that has been in Ukraine for 30 years. It is a destructive system, and it will only complete home medicine. Of course, it is necessary to refinance the industry, but the reform cannot be stopped for this. Stepanov’s words “reform does not collapse, but requires major changes” – a bluff. Because these are not just changes, the Department of Health is proposing to revert to the old funding system. And it is a murder of reform. I thank the colleagues on the committee who defended the medical reform, among them also the doctors by profession. I once again hope that members will not allow the reform to be destroyed.
Critics of the reform: new power proposals – what we expected
Konstantin Naduty, chairman of the board of the All-Ukrainian Medical Society, is pleased that the community has finally heard much of what critics have said and warned for several years in a row.
– Not without “strong point” – “professional liability insurance for doctors”. You should understand that this is not a gift, but an integral part of the cost of the services. And without the introduction of medical autonomy, the “climax” looks like a new high-margin diet, because the cases in which doctors are called upon to assume such responsibility today are in the fingers of one hand.
But overall, clear progress. Certainly, for what we call condescending “errors”, legal states punish them by law, because the cost of these errors is billions of funding shortfalls by industry and countless human losses, both in because of the non-receipt of the necessary help and because of escapes from such prospects.
The Minister can be dismissed. Most of those who stood on the stage next to him a month ago were excited about the reform and dragged us into the abyss. He had the courage and the conviction to open the president’s eyes and publicly call a spade a spade. What will happen next – wait and see.
The ideologues of the reform: on the possible mechanisms for its abolition
The statement by Minister of Health Maxim Stepanov on the review of the funding reform means the effective rejection of the reform, said former Deputy Minister of Health Pavel Kovtonyuk.
– They leave the National Health Service of Ukraine (NHA), but in fact they transform it into a grant transmitter, return to funding on the principle of “give money to everyone”. This will not improve the situation of medicine and will only lead to a reduction in the funding of clinics which, thanks to better preparation and efforts, have been able to increase their funding. Clinics that have tried to do something, have prepared, have worked well and received more funding, now they will receive less. We always have those who work better, pay for populism, to pay those who have not prepared and have not tried.
At the same time, there are mechanisms to reverse the reform, which can be applied in the presence of consolidated political will. They can in particular modify the law on state financial guarantees (on medical reform. – Editor’s note) of the law on the state budget. Under the two previous ministers, there was no such consolidation, the ministers did not take an obvious position, the reform therefore continued. Now I see that the minister has the support.
Today, the budget has no funds for the changes announced by Minister Stepanov, in particular, there is no funds to allocate an additional 11 billion UAH to increase the salary of doctors. Authorities will hide behind the fact that now COVID-19, that we are spending additional resources, but so far, it is unclear where to obtain additional resources. You don’t even have to be a finance minister to understand that in April our economy fell 4%, that it will fall in May and fall all summer. Not only will there not be an additional 11 billion UAH, but perhaps they will also withdraw something from the drugs at the end of the year in order to pay pensions. These are all pretexts to cancel the reforms.
Julia Gorban, Oksana Polishchuk, Kiev
According to the materials: ukrinform.ru