Healthcare reform in Ukrainian

What are the risks of medical reform in Ukraine? What it must change? Will the industry be funded as stated? Will insurance medicine work and how the market for medical services will be?

Medicine established on authorities VS medicine established on evidence

In November 2016, the Cabinet of Ministers of Ukraine approved the Concept of health care financing reform, which is the basis of the all- Ukrainian reform. The general essence of reform is the modernization of the whole system in order to make it qualitative and effective both for the state and for doctors and patients. There was a so-called “Patient Bills” package, which
was developed for its realization in life. The key is the draft “On State Financial Guarantees for the Provision of Medical Services and Medicines”, which introduces the principle of “money walking on the patient”. This means that for each patient, the insurance will be paid to the hospital. On June 8, the bill was passed in the first reading.

The main accents of the Law are:

• Guarantees do not depend on additional criteria
MEANS: Guaranteed medical services to citizens, foreigners, stateless persons permanently residing in Ukraine, persons recognized as refugees.

• Transition to international treatment protocols
MEANS: Will allow health care institutions and doctors to switch from outdated Soviet treatment protocols (algorithms) to modern and effective diagnostic and treatment methods.

• Equal access to a single state guaranteed package
MEANS: Guaranteed package consists of three
service lists

• Green list is a service that is covered by the state 100 % (covers up to 80 % of all appeals of citizens to medical institutions: emergency care, primary health care, palliative care);
• Blue list means that services are partially covered by the state;
• Red list means that services are NOT covered (aesthetic dentistry etc.)

• Payment for medical services and medicines through the mechanism of state joint-stock insurance
MEANS: Insurance is realized at the expense of the state budget, no additional contributions are foreseen. In case of partial coverage of the cost of services, an official co-payment by the state and insured at the expense of other sources person (voluntary health insurance, funds of local budgets) is introduced.

• Ensured persons will be able to receive medical services in health care institutions of any form of ownership and from natural personsentrepreneurs who have a license for medical practice and have entered into contracts on medical care of the population.

• A single strategic customer of healthcare services is introduced, a new centralized body is a National Health Service of Ukraine, which will be accountable only to the Cabinet of Ministers of Ukraine, bypassing the Ministry of Health to avoid the corruption risks.

• The system of family doctors is introduced
MEANS: Family doctor is a general practitioner who will be the primary link in the health care system. This post can be occupied by a doctor who has passed internship training in the specialty “General practice- family medicine” or doctors in the specialties “Therapeutic” and “Pediatrics”, prepared in higher medical institutions postgraduate education in the specialty of family
medicine and who has a certificate. Each patient will choose a family doctor and each family doctor will receive a payment according to the tariff. The size of the tariff will depend on the age of patient and it is assumed that the average tariff will be 210 UAH per year for every person. The first-link doctor’s case is to do a primary review and resolve the issue of referring a patient to a specialist in case that he can not solve the patient’s problem by himself. First-link doctors may also be a doctorsole proprietor. If the patient is not satisfied with his family doctor, he can change him. In this case, the patient’s insurance cover will go to another doctor.

• Launching the reimbursement system
MEANS: The purpose is to make any drugs available to all social layers of population. Patient receives medicines by a doctor’s prescription in s pharmacy, which receives reimbursement for these.

In addition, hospital districts are introduced by reform. This is functional association of medical institutions in the respective territory, providing secondary (specialized) assistance to residents of this territory. All medical institutions in the district are united in a single network. One or several hospitals chosen by residents considerably increases, while others are re-profiled. Requirements for such hospital districts are: to serve at least 200 thousand residents, and the length of time for any resident to get to a hospital from any part of the district is no more than 60 minutes. As a result of reform, state-owned medical institutions will receive status of unprofitable utility companies and will in fact enjoy all the rights and opportunities of private enterprises and not to pay profit tax. Medical institutions will have a space for self-regulation.

On the other hand, own patient’s ID is introduced (electronic register in the E-Health), in which history of medical care of the patient by any medical institutions and doctors will be fixed, and under which the state will control providing specific services in the system to a particular patient. The state pays for a single system of tariffs for the provided service, which was provided qualitatively, to a real patient according to international protocols for treatment and diagnosis.

Pharma did not stay aside

Reforming of the pharmaceutical sector by changing the pricing system for medicines and simplifying the drug registration system. The government also plans to implement the idea of purchasing medicines through international organizations. There is a work on developing a new National List of Essential Medicines, which will include about 300 names of drugs. The reference pricing
system and the procedure for calculating the marginal prices for medicines are introduced.

Expert opinions

In spite of such large-scale plans, the reform in fact tales place quite slowly, not even having time to plan. In addition, many experts have a fear that the introduction of financing medicine through the National Service will become a new corruption basis, and in general, there are doubts as to the appropriateness of establishing an analogue of the Ministry of Health.

There are also fears about the sufficient competence of family doctors and creation of a double payment for medicine. If patient has anyway to pay separately in a pocket for the quality and urgency of services, for certificates and referrals.

By a separate item, experts point out doubts whether the financial obligation of the state about the payment of a guaranteed set of medical care and medical services at several reformed levels will be taken. It should be also taken into account that funding is foreseen in total, to cover the tax due, including VAT. Where to get funds, if now the budget actually provides no more than 7% of medicines. In particular, for the current system of reimbursement of certain category medicines, there is already a state debt for reimbursement.

Experts also note lack of the mechanism for the purchase of medical services. There is a question remained: what will happen to those local healthcare institutions that will remain without government order and budget funding under the control of local authorities. And, in general, all functions that should remain with local authorities in healthcare questions.
In fact- everyone is waiting for not a conceptual but practical vision of reform, including the funding of the industry. The new model contains many contradictions, so we look forward to a practical implementation, which will definitely make point corrections, it will show if the positive predictions of the reformers were true.