Health care reform: what should be done for building a fully-fledged health system in Ukraine
Medicine in Ukraine. Health care reform: what doctors and patients should expect from. National strategy of health care reform. Changing the distribution of funds. Decentralization. The introduction of health insurance. Public-private partnership (PPP).
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Міністерство освіти і науки України
Національний університет «Києво-Могилянська академія»
Факультет правничих наук
Кафедра міжнародного права і спеціальних правових наук
з курсу «Право та суспільство (англійською мовою)»
на тему: “Health care reform: what should be done for building a fully-fledged health system in Ukraine”
Виконав студент 2 р.н.
2 групи ФПвН:
Григоров Денис Володимирович
Крахмальова Катерина Олексіївна
Medicine in Ukraine is a successor of Soviet medicine, which was created in 1930-s and reached its peak after World War II, in 1970-s. . In Soviet era, national healthcare system was mostly able to carry out its responsibilities, such as combating infectious diseases, providing medical services to remote regions, etc., but nowadays it is certainly outdated and very ineffective. The fact that 87% of Ukrainians are unsatisfied or poorly satisfied with quality of medical services speaks for itself . Moreover, doctors themselves are discontented with our medical system: average doctor salary is lower than 300$. Even our closest neighbors are better in this perspective - average doctor salary is 800$ in Russia, 700-800$ in Lithuania, 1.500$ in Poland. . Therefore, we can assume that existent healthcare system has proven to be ineffective, as suggested by discontent from both doctors and patients.
We need a profound systematic upgrade to change things for better. However, now, our country is in a middle of great political and economic crisis, and we have limited resources to spare for our healthcare system. Thus, the financial question remains the most difficult - where to get money? How to get enough money? How to spend them efficiently? In order to answer these questions, let us discuss main points of the health reform.
Changing the distribution of funds
We have inherited so called “bed system” from Soviet medicine. It means that hospitals are funded in accordance with the number of bed-places for patients. Such method has led to cases, when two hospitals, one overcrowded, second half-empty, but having the same number of bed-places receive the same amount of funding. Moreover, the number of bed-places per one hundred thousand citizens in Ukraine is twice bigger than in EU (950 and 500, respectively) . This should certainly be changed. Funds should be allocated primarily not for the maintenance of hospitals, but for treatment of the patients. To spend these resources more efficiently, half-empty hospitals should fire some employees or even close. Saved money can be used, for example, to purchase expensive drugs for patients or to increase salaries of medical workers.
Back in the 1987, Madrid Declaration regarding professional (medical) autonomy and self-government reaffirmed the need for the medical profession to be self-governed. Consequently, EU adopted a series of laws, which allowed self-regulation and self-government of healthcare system. These laws outline organizational principles of professional doctors. In Ukraine, there is a law draft to the Law on medical authorities on 10/01/2014, which is still in discussion . This bill introduces registry of medical staff, compulsory licensing of doctors, which would significantly increase the level of skills of our physicians and therefore increase the security level of the patient. In addition, implementation of medical self-government authority could really improve legal, social, financial and moral protection of the doctor and the medical profession.
The introduction of health insurance
According to the part 3 of article 49 of the Constitution of Ukraine, in state and municipal hospitals medical care is available free of charge. However, according to former Deputy Health Minister Volodymyr Zagorodny in 2014 the government spent 53 billion UAH on health care. Meanwhile, Ukrainians paid 30 billion UAH for medications and 9.8 billion - for unofficial, corrupt charges. This once again proves that the state "free of charge" medicine de facto does not exist.
Therefore, to prevent corruption and improve the quality of health services, health insurance should be introduced. Compulsory health insurance will allow all citizens of the country to receive high quality medical care. In case of complicated diseases, which require significant financial costs, and if the state, unfortunately, will not be able to provide the necessary funds for patient treatment, additional medical insurance institutions may help. It is with this combination of these two insurance systems that Ukraine will be able to build high quality modern medical system, so you will not have to bribe the doctor in order to be treated properly anymore. We must know what we are paying for. That is the main purpose of this reform.
Thus, Ukrainian healthcare system, which is in the transition from a centralized command system to democratic, is in need of profound transformation. During this process, it is important to adopt positive international experience and take into account the mistakes that were made by other countries.
Public-private partnership (PPP)
National health care system is characterized with existence of serious problem and requires deep institutional, structural and functional reform. However, the possibility of change in this area is substantially limited with available financial resources of the state. The need to find new tools, methods and mechanisms of health care that can help deal with problems .
Development of new sound management decisions, implementing new quality tools for their functioning, particular mechanisms, including public-private partnerships in health sector, will help reaching long-term development priorities of the state, create necessary conditions for increase in growth rate of national economy. Cooperation development of public and private sector in health care will provide an opportunity to improve situation by optimizing spending, investing efficiency, resource use and management, creation of conditions for sustainable improvement of health services, stability of entire system .
In health Ukraine now made first steps to implement public-private partnership. Specifically, in 2011, the Concept of national program "Health 2020: Ukrainian Dimension" was approved, which indicates need for interaction between public and private sectors. Program of Economic Reforms for 2012-2014 indicates on feasibility of public-private partnership. However, specific projects with use of such mechanism in Ukraine is very small, so study of public-private partnership, its specific forms, patterns and possibilities of their application in Ukraine on basis of international experience is highly relevant..
Analyzing international experience, it is clear that scope of PPP projects can be quite broad. This includes design, construction, operation and infrastructure management of medical institutions, medical services, development, production and dissemination of new medical products (drugs, vaccines, etc.), new medical equipment, and instruments.
World practice of public-private partnership makes it possible to draw conclusion about uniqueness of their application process, due to characteristics of model construction and financing of health care, economic development trends, structure and organization of legal system in country, level of decentralization and autonomy of medical institutions management.
Thus, there is an urgent need to develop and implement institutional instruments, regulatory and methodological support for potential of public-private partnerships. In particular, it is appropriate to develop and implement concept of PPP projects in health care, analysis of structural features of its functioning and to identify those sectors that have the highest potential to implement projects, and most in need of innovation and investment resources.
In legal field of Ukraine we should implement category "public health service" and "low cost medical service", and to develop appropriate lists of medical services required to implement by various medical institutions (especially for vulnerable population groups). Separately we should also develop a list of services that can be transferred to external control and private sector, where is the possible use of public-private partnership.
Complete duplication of global models, forms of public-private partnerships in health care in our country can not give required results. However, functioning of health system is associated with excessively high social as well as commercial and political risks. Therefore, hasty, irregular implementation of PPP projects in this area now in Ukraine may lead to economic losses for government and private sector, as well as welfare loss to society.
Need to improve methods of implementation of public-private partnership in Ukraine requires development and implementation of appropriate models, their objective and standardized evaluation and selection based on risk indicators and efficiency of PPP projects in health sector. This model, which became known as the "comparator" (from English «to compare»), was first introduced in the UK. Then improved versions of comparator PPPs in health sector have been used in other countries, including the Netherlands, Spain, Italy, Australia, Canada, India, Singapore, and USA .
The main purpose of implementing this comparator model is to enable an objective quantitative comparison of PPP projects to the same public sector that would provide same set of services. Comparator helps identify indicators for evaluating results according to funding. Use of this comparator allows the state to distribute and optimize budget for public projects.
In the Netherlands, before deployment of financial crisis all PPP projects that have been implemented at state and regional level could be added to integrated budget model. However, recent PPP projects initiated by local authorities are difficult to be included in this program and get guaranteed by state support for duration of project .
To sum up, it is worth to say, all that measures could change our health system to better. The process of decentralization would increase the doctor's level of education and it could give medical practitioners the opportunity to take show the initiative in health care sphere. The introduction of health insurance is a good way for filling health care budget with more resources that could be used, for instance, for buying expensive medical equipment or drugs for patients. At the same time, changing the distribution of funds would help us to save our money, spending it more effectively. Finally, cooperation development of public and private sector in health care will provide an opportunity to improve situation by optimizing spending, investing efficiency, resource use and management, creation of conditions for sustainable improvement of health services, stability of entire system.
It is worth to mention in conclusion the quotes that was said by the President of U.S Barack Obama: “After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise. It is the law of the land.” As well as United States, our country needs the large-scale health care reform. At the moment, this seems more like an utopia. Nevertheless, united actions of our leaders, medical practitioners and initiative groups of enthusiasts may turn it into reality.
medicine ukraine health reform
1.Vododumur Kurlita. (/25/11/2014). Meduchna reforma: to be or not to be [Health care reform: to be or not to be]. Ukrayinska Pravda Retrivied from: http://life.pravda.com.ua/columns/2014/11/25/184698/. [In Ukrainian]
2.Oksana Shklyarska (22/12/2014).. Meduchna reforma: shcho chekaye na likarya ta patsienta [Health care reform: what doctors and patients should expect from]. Rakurs. Retrivied from: http://ua.racurs.ua/705-medychna-reforma-scho-chekaie-na-likarya-ta-paciienta. [In Ukrainian]
3 The article was taken from the site “posovesti.com.ua” (03/05/2015). Gde vracham zhit horosho [Where the doctors could live well ] Retrieved from: http://posovesti.com.ua/News.aspx?newsID=732. [In Russian]
4.Natsionalna strategia reformuvannya ohoronu zdorovya (2015-2025) [National strategy of health care reform (2015-2025)]. Retrieved from: http://aipm.org.ua/uploads/files/Gromadske-obgovorennya_kurpita.pdf. [In Ukrainian]
5.Proekt Zakonu pro likarske samovryaduvannya [The Bill “On self-regulation of the medical profession”]. Retrieved from: http://w1.c1.rada.gov.ua/pls/zweb2/webproc4_1?pf3511=52254. [In Ukrainian]
6. Health care: trying out the mechanisms of public-private partnership. Nezalezhnuy audutor: Retrieved from: http://nauditor.com.ua/uk/component/na_archive/90.html?view=material. [In English]
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