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Medical reform in Ukraine: pay or die

2015-02-07  Tatiana Matsokha  Версия для печати

Medical reform in Ukraine: pay or die

Everybody knows health is one of the most important things in our life.  At the same time a lot of people including even doctors don't understand the matter of these words.  For most people it means only individual measures to be healthy.   Usually doctors give some advice how to prevent some diseases, but they don't say that this problem must be solved at the public level. It is very important to understand that individual health depends on the society health in general.  Health of all the citizens depends on the government health policy and its results.

Now in Ukraine reformation of the current system of health services is being carried.  However, there are a lot of doubts concerning these changes and their correctness.  Before beginning the reforms and changes the situation analysis should be performed.  If we don't know a real situation, we can't propose any changes.

According to the state statistic service the average life expectancy in Ukraine is 70.4 years: for men-65.2 years and for women- 75.5 years. It is a very low life expectancy for a developed country with free health care.  There is addition information that can reveal serious health problems.  This information was revealed at Kyiv press conference "Medicine in Ukraine".  According to the results of Gorshenin Institute survey, about 80 percent of Ukrainian people are not satisfied with the quality of health services.  According to the result public opinion poll, 40.3 % of respondents are absolutely unsatisfied and 39.7 % of respondents are satisfied a little. Only 18.3 % of respondents are satisfied.  Among them 15.1 % are satisfied, 3.2 % are absolutely satisfied and 1.7% could answer this question.

Most of the respondents (93.3%) think that the health reform must be carried in Ukraine.  At the same time most of them don't know how to do it.

Changing of the health services will impact each citizen in the country.  That why it is very important to discuss this problem publically, not only in professional sphere, before making any strategic decision.

To study and improve health care scientists all over the world have tried many times to analyze and compare different systems of health services in different countries.  All existing systems of health services in the world are usually divided by specialists into four types.  The first three of them received names after their creators.  The first one is German (Otto fon Bismark), the second one  is Soviet (Nikolai Semashko), the third one is English ( William Beveridge), and the last one is American (market).

Before in Soviet Ukraine there was Semashko system of health services, which gave a high level and quality of health services in spite of a lack of budget fund.  It was an excellent example to be followed. All the inhabitants from a baby till a grown- up were served free. It gave good results.  But with the advent of capitalism times have changed. And now this system like others in the world does not correspond to the current conditions.

Transparence and openness are needed in medical activities.  It is necessary to reveal our problems and needs at the modern stage.  It is necessary to understand what we need and what we can do.  It will shut the door for corruption. 

For example, E.V. Komorowskiy (candidate of medical sciences, doctor of the highest category) has repeatedly said that the main question which must be solved is what fund can be used to cover heath expenses.  If we think that health care is free in our country (by the way, as it is declared in our Constitution), it is a mistake. We should be frank and say that we need a new clear model of financial relationships in the medical branch. In any case, it is necessary to declare at the legislative level the amount of funds for heath needs.   For example, health expenses require 5% of the Gross Domestic Product (GDP).  After it is desired the rate and terms should be determined.  For example, we want to expend 9 percent of the GDP for health services.  It means we need 8 years to reach the planned level (annually increasing expenses by 0.5%).  And, of course, it must be declared legislatively.  As a result, it will give us a good opportunity to develop strategic planning of expenses basing on the economic situation in the country.

Nowadays the health expenses account for only 2.8 % of the GDP.  It means only  3 - 7 dollars  per capita.  So Ukraine takes position 96among 176 countries in the world (according to the WHO data).  Thus, it is doubtless, the participation of the government in organization and providing of the system of health services plays an important role in relationships between the government and the society.

However, now experts claim that the government will decrease health expenses.  It is impossible to avoid it.  As a result, the quality of health services will be decreased too.  It will lead to a serious problem, in particular, in small towns and villages, where a lot of hospitals and policlinics will have to be shut down.  At the beginning of 2015 the health expenses in Ukraine were cut down, so a lot of health establishments have no funds to support their activities.  There is no alternative.

The next principal thing is how to share health expenses.  It is impossible to get correct information because we have a lot of problems with domestic health statistic information in general and, especially, information about activities of specific health establishments.

For example, correct information concerning diseases is often hidden.  Some patients spend too much time in hospital. So we cannot make a right conclusion how many beds we need to satisfy our demand.  We have no information about cost of treatment of any patient from any disease.  Sometimes a patient who is treated in hospital can be treated at home.  Sometimes doctors prescribe a lot of medicine etc.

At the same time, we understand that appreciation of the system of health services activities plays an important role for any country (according to the WHO).  So, if we want to efficiently improve the system of health services in our country, first of all, we must analyze and find out our current problems in this branch.

It is also necessary to realize that health expenses are limited.  So they must be appreciated basing on their economic efficiency.  At the same time we should not appreciate efficiency of the health measures taking into account only indicators such as quantity of saved lives and life duration.  Life quality becomes more and more important.  The problem of reaching medical and economic efficiency is one of the most important for public health and health services as well as economic science. The further success in improvement of public health is possible if quality medical care is available for population and if it is also profitable.

Experts think the main problem of the current system of health services in Ukraine is the low level of providing the population with medical services.  The free market of health services is proposed to be created to solve this problem.  The participants of this market are supposed to be both state and private ones.  The health establishments will be independent.  However, such an approach will not improve the health services for the population of our country.  Of course, the market of health services will be expanded, but a lot of services will become unavailable for most people.

According to public poll carried by Gorshenin Institute, 40.2 % of the Ukrainians first of all go the state (free) policlinics or hospitals if they are ill.  One third of them (30.1%) prefer to treat themselves.  Only 5.6 % of respondents go to private medical establishments.   About 2.5% of the respondents prefer folk medicine and 5.3 % of the respondents do nothing in a case of disease.

That's why we have a question if it is sensible to expand the market of paid health services if only 5.3 % of the Ukrainians are interested in such a kind of services.

Let's return to opinions of the ordinal citizens of our country.  The Ukrainians think the main problems of our system of health services are a low quality of medical services (18.2%), low salary of doctors (16.2 %), indifference of doctors (15.1%), bribes (12.8%), bad conditions in hospitals (10.8 %), and much workload of doctors (6.2%).  About 5.3% of the respondents think we have other problems and 1.2 % of them could not respond.

The low quality of medical services in our country is connected, first of all, with a high level of corruption, low qualification of medical staff in hospitals. Besides, doctors are not interested to fulfill their work at a high level because their salary is very low and their responsibility is very high.

The key moment in the system of irrational use of funds is ignoring of appropriate payment of medical staff in hospitals.  At the same time a lot of money is spent to build or rebuild hospitals, to buy new equipment etc.  Corruption in the system of health services can explain such a situation.  Some officials are financially interested in it because they receive bribes signing specific agreements.  So, if we want to improve our system of health services, first of all, we must strictly control the financials flows into the health branch and increase salary for medical staff.  It is necessary to realize that education and medicine are the most important foundation for each country.  The further success and achievements depend on them.  Any reforms and changes will be failed unless the inhabitants of our country are well educated and healthy.  Only well-educated and healthy people can be valuable and skilled specialists in different branches.

Returning to E.V.Komarovskiy opinion, it should be noted that the increase of salary for medical staff can be reached owing to the next steps:

After increasing the salary, it is necessary to control strictly any illegal financial relations between a doctor and a patient, between a doctor and a pharmacist, between a doctor and a laboratory, between doctors.

The only fund to live for medical personal must be legal salary, which allows doctors to live properly, but not to survive.

The current system of health services in Ukraine has a lot of problems. The most important of them are:

Everything which was mentioned above is only the top of the iceberg in the system of reforms.  It is necessary to say the problems in the medicine branch have been ignored for ages. There is no doubt that the system of health services must be changed.  Everybody understands it.  At the same time serious steps should not be done now.  First of all, it is necessary to form questions that must be answered during the next year.  The answers must be correct.  It is impossible to begin any health reforms without receiving these answers.  A very strict administrative responsibility for false statistic information and a strict criminal responsibility for false information concerning the biological security of the country (for example, false information concerning vaccination, hiding of information about cases of infections etc.) must be introduced immediately. 

Of course, the health reform must be carried.  However, it must be a different reform.  And we must try a lot to introduce this reform in our disorganized society. Otherwise, our efforts are useless.


Russian version of this article: 



Based on materials from:

1.     http://www.komarovskiy.net/blog/mysli-k-reforme-zdravooxraneniya.html

2.     http://cyberleninka.ru/article/n/kakuyu-sistemu-zdravoohraneniya-vyberet-ukraina

3.     http://glavred.info/archive/2011/09/09/185013-9.html