October 16, 2017
How to Continue the Revolution of Dignity
By Diane Francis
Health care is always a contentious issue in any country and one need only look at the United States as an example. But Ukraine’s corrupt, Soviet system is demonstrably inadequate; witness the fact that Ukrainian lifespans are eleven years shorter than they are in the rest of Europe.
This Thursday, a transformative package of reforms will be voted on in the Verkhovna Rada. These have been months in the making and already demonstrated benefits.
Acting Health Minister Dr. Ulana Suprun is confident that Ukraine’s lawmakers will adopt reforms now.
“The president and prime minister [Groisman] are both 100 percent behind them,” she said in an interview. “The big plus now is that the president is engaging fully, and the prime minister is even going on television and meeting with legislators.”
The president also recently earmarked the use of four billion hryvnia, recovered from money stolen by former President Viktor Yanukovych, to help improve rural medicine in villages. About 30 percent of the populace live in the countryside.
“The money was just recovered,” explained Suprun, “and will be put to good use in villages where often only nurses are there. These funds will help them build facilities and buy devices to provide care, such as computers, telemedicine links for them,” she said.
Some reforms have been implemented, demonstrating the benefits.
“There were suitcases full of cash coming into the Ministry of Health for people to get medical licenses or procurement contracts,” said Suprun who joined the health ministry in July 2016. “Tenders for equipment and pharmaceuticals were rigged so that only one importer and one manufacturer would win.”
In 2015, Ukraine handed over the procurement of drugs and equipment to the United Nations, UNICEF, and the UK nonprofit Crown Agents. This has saved tens of millions of dollars in costs each year because these nonprofit intermediaries buy directly from manufacturers. An example is that a German cancer medication bought in 2014 for $322.60 per unit is obtained now for one-third the price of $104.37.
Suprun proposes a fraud-proof, world class “e-health” system. If reforms are approved, patients will register with a doctor of their choice then doctors will sign contracts with the health ministry to get payments directly based on the patients registered. Doctors and hospitals will also be paid directly by the health ministry for procedures, stays, and recognized services.
“The money will follow the patient and not flow through administrators and municipal bureaucrats, where 30 percent of health expenditures disappear,” she said.
The reforms also will benefit doctors. “Doctors will be paid enough to support their families instead of getting by on whatever the bureaucracies and hospitals gave them,” she said. Physicians currently make up to 5,000 hryvnia per month, but she projects they will make a minimum of 15,000 hryvnia per month, and up to 60,000 hryvnia a month, under the new system.
To keep everyone honest, patients will receive tamper-proof receipts for services they received as will the government. The electronic system will flag questionable procedures or questionable frequencies or those registered with more than one physician.
Some doctors oppose reforms, she said.
“Unfortunately, there are lots of doctors under the current system making a lot of money under the table from patient payments,” she said. “But doctors and health care providers who register for the new system can no longer take cash under the table from a patient. They will sign a contract with us to that effect.”
The system, she said, will improve care and outcomes because doctors and hospitals will compete to register and keep patients satisfied. Coverage will be available to any citizen or permanent resident of Ukraine.
The “e-health” system has already proven its value. For instance, the health ministry required doctors to register all their insulin-dependent diabetics so that pharmacies could issue free drugs to registered patients only then be reimbursed by the government.
“Before we were paying health providers to hand out insulin to 250,000 people. After the registry system, we learned there were only 170,000 insulin-dependent diabetics,” she said. “The figures were inflated and the creation of the registry has saved 500 million hryvnia year.”
Savings will be in the billions and care improved, once reforms are fully implemented. Eliminating non-medical intermediaries and harnessing technology will release 30 percent of funding to go directly to patient care.
“This is a continuation of the Revolution of Dignity,” she said. “We’re going to provide dignity to patients, to doctors who lose dignity when they have to beg for money,” she said. “We want to guarantee doctors a living wage and guarantee Ukrainians healthcare, as do European countries, so that nobody should have to worry.”
This reform must, and likely will, pass. Universal access to care is a human right in all civilized nations. Ukrainians deserve no less.
Diane Francis is a Senior Fellow at the Atlantic Council's Dinu Patriciu Eurasia Center, Editor at Large with the National Post in Canada, a Distinguished Professor at Ryerson University's Ted Rogers School of Management, and author of ten books.