It’s been six months since I’ve seen Ukraine’s most energetic minister, Dr. Ulana Suprun, and she’s been busy. Her comprehensive efforts to overhaul Ukraine’s dysfunctional health system are going well, she assures me.
It’s the first time I’ve heard this statement about any reform anywhere in Kyiv.
On April 1, Ukraine’s Ministry of Health launched its new health care system. It’s revolutionary, addressing a wide range of policies that determine how medicine is practiced in the country, from drug procurement to billing to medical education.
Most important, individuals can finally choose their own doctors. But there are many smaller improvements, as well. For example, the new system is digitized. During a visit, a health aide or nurse takes the information on a computer rather than writing notes by hand, as in the past; the new practice increases patient confidentiality, eliminates the possibility of lost records, and better enables the collection of health-related statistics. In the past, employers had access to individual health records, but under the new system, a patient’s record belongs to them.
The World Health Organization told Suprun they would consider the reform successful if 10 percent of the country had signed up by the year’s end. Less than three months after the system was launched, more than 10 million people—or 24 percent of Ukrainians—have signed up. The Ministry of Health estimates that 180,000-200,000 people are signing up every day.
As usual, Suprun is over-performing. “Health care reform. There’s no turning back,” she says with a note of pride in her voice. “We have gone past the point of no return.”
More than 22,000 doctors have signed on, as well as 1,200 medical care facilities.
A screenshot from the Ministry of Health’s eHealth Portal shows that more than 1,200 medical care facilities, 22,000 doctors, and 10 million patients have signed up.
Suprun says that primary care doctors are happy with the new system and that there’s been a huge attitude shift. At first, doctors were skeptical and pushed back. But now, patients’ rights organizations tell Suprun that hospitals and medical offices have become much more service-oriented.
Everything changes on July 1 with staggered deadlines to gradually move medical institutions, specialists, and hospitals to the new system.
Starting then, doctors and facilities will be paid per patient, and this should double the salary of the average primary care physician, from about $200 to $400 per month.
In October, there will a second sign up for medical institutions, and a third in December. By the end of 2018, they will all have switched over. By the beginning of 2019, if medical institutions haven’t done this for primary care, they won’t get paid. In 2019, the financing will change for specialists, and in 2020 for hospitalizations.
Also on April 1, the National Health Service of Ukraine was established. It’s led by Oleh Petrenko, a physician, director of a private hospital, and author of the health care reform bill.
The Ministry of Health also rolled out clinical protocols on May 15, which may have a revolutionary impact on how doctors practice medicine in Ukraine. Suprun, an American-born physician from a Ukrainian family in Michigan, said she used protocols in her Manhattan practice and that doctors can easily access them on their phones or laptops.
Clinical protocols are internationally-recognized guidelines that define a disease, specify how to treat it, and list the appropriate tests and treatments. The Ministry of Health bought the Finnish Medical Society Duodecim’s international protocols and the World Health Organization is paying to have them translated into Ukrainian. The protocols for the 100 most common diseases a primary doctor sees are currently available on the Ministry of Health’s website, although they are currently only available in English. The Ministry says that 5,800 doctors have signed up for the protocols in the month since the free service became available.
The protocols will help standardize care, determine that a patient receives the right specialized care at the right hospital, and eliminate fraud. After 2020, a physician must follow the protocols in order to get paid for the services rendered. The National Health Service will not reimburse a physician if he or she orders a test that doesn’t follow the protocol.
Suprun admits that with 100,000 doctors in Ukraine, a protocols-based system cannot be implemented overnight. “We don’t have all the medicines and equipment in the protocols. We need some time to adapt,” she said.
The ministry is also working to fix drug procurement, which has long been a target for corruption. After the Maidan, reformers teamed up with three international nongovernmental organizations to outsource the procurement of drugs for immunizations, HIV, and tuberculosis, saving the state 40 percent of its budget. They are still doing this, but it’s only a temporary fix. On January 16, Olga Stefanyshyna, an outspoken advocate for patients’ rights, joined the Ministry of Health as a deputy minister. Stefanyshyna is setting up a national drug procurement agency to cut out the middleman.
For three diseases that are treated at home, the Ministry of Health launched the “Accessible Medicines” program in April 2017 to make medicines for cardiovascular disease, type 2 diabetes, and bronchial asthma available at pharmacies. A doctor writes a prescription, and then a patient takes it to a participating pharmacy to fill, receiving the medicine at no cost or a small co-pay, depending on the brand. Every third pharmacy participates voluntarily, Suprun said, and participation is growing.
Each time I speak with Suprun, she emphasizes the need to improve medical education, which is poor, and establish a system of professional licensing, which Ukraine doesn’t have. The ministry is making progress on both. It is working to increase standardized requirements for prospective medical students and those already in medical school, and is establishing professional licenses for doctors in Ukraine. Starting in 2020, licenses will require residency, recommendations, and continuing medical education, and must be renewed every three years.
If Suprun and her team manage to put these changes into place, the health system will be markedly better. But she is under constant attack in parliament, and Ukraine’s presidential and parliamentary elections are right around the corner. Suprun knows that time is running short. She says she needs to stay in the job until 2020 to make the changes lasting.
Let’s hope she does.
Melinda Haring is the editor of the UkraineAlert blog at the Atlantic Council and a fellow at the Foreign Policy Research Institute. She tweets @melindaharing.
Image: After Ukraine launched a new health care system on April 1, patients have noticed a difference. Doctors and medical staff are more service-oriented, Acting Health Minister Ulana Suprun said. Credit: UNICEF Ukraine