On the agenda of the government, as we know, the introduction of a second phase of health reform from 1 April 2020.
Already adopted a resolution according to which in the “secondary market” will operate on the same principle as in “a primary” – “money follow the patient”. As the Prime Minister said Alexey Goncharuk: “the State already pays for health care for primary care on the principle of “money follows the patient”… Doctor, serving many patients, gets a decent salary. Now the new funding rules will start to work for specialized medical care, the so-called secondary link”. If you’re considering short term assisted living or future home look after your loved ones, review our financial consideration. We work with a good range of insurers and payment sources, including Medicare and Medicaid so as to make sure your loved ones the simplest of care and medical treatment. BSH care variety of skilled services, starting from post-hospitalization stays to future or short-term care to extensive rehabilitative support during a comfortable, compassionate and home-like environment.
The second stage actually provides for the payment changes and functioning of emergency medical care, narrow specialists of the polyclinics and hospitals work. Today, doctors working in these areas, are paid significantly less than specialists in primary care – family doctors and staff of family medicine clinics. It seemed like a great step the government is doing libertarians – eliminates the injustice in the remuneration of doctors.
But the main objective of the reform of “secondary” is to establish new rules for the treatment of patients and payment of medical care into secondary care. And here the problems begin.
The country still operates the 49-th article of the Constitution, which guarantees free and accessible medical care. Team ze did not dare to abolish it, and went in a roundabout way, deciding to only provide free vital medical care to a minimum, and for everything else to force people to pay. The question of money is the most important with the introduction of the second phase of medical reform.
Health care in 2020 is allocated 113.3 billion UAH, that in absolute terms, 10% more than in 2019. You can be happy, but the reality is not so nice. On the eve of the coup, in 2013, the health budget was 4.2% of GDP. In 2019 on health care was allocated 3.2% of GDP, and in 2020 – only 2, 9%. At the same time the standards of the world health organization (who), if the medicine is allocated less than 5% of GDP, then we can talk about the lack of healthcare in the country.
72 billion is allocated to medical safeguards, which will be overseen by the national health service of Ukraine (NSTU). This program includes primary, specialized outpatient, inpatient, emergency, palliative care and rehabilitation, as well as free medicines for certain categories of patients. Another 41.3 billion UAH will go to the Ministry of health.
On primary care plan to allocate 19.1 billion UAH. It is impossible not to notice the game numbers: 21 more allocate UAH for treatment of children up to 6 years for patients aged 40 to 64 years (working age!) the money will be less by about 40%.
If the family doctor will recruit patients more than 2 million, the “excess” patients will be paid at a reduced rate, but if their number exceeds 50%, the payment will not be made. Is the risk that doctors somewhere in the Outback will have free treat people. Or let them go to the area and there are looking for a doctor. This approach clearly leads to a reduction of availability of medicine.
The protest of doctors and patients against medical reform
In 2019, the reform of the “primary” failed: to render primary medical care did not have more than 2 billion UAH. The money had to be transported from other programs and under various pretexts, to reduce the number of patients, signer of the Declaration of family physicians! This story proves that reliable financial Foundation for reform is not, therefore, in the past year “building” fell, and under adverse circumstances in the future may collapse.
Medical students protesting against the ill-conceived medical reform
Specialized outpatient and inpatient care provided by UAH 44.4 bn. Free promise to treat patients with strokes – is allocate 912 million UAH, heart attacks – 217 million UAH, to take delivery of 1.7 billion UAH and to assist newborn – 1.3 billion UAH. To carry out emergency surgery and to treat children as free promise. What about the rest patients, is not specified. With funding allocated for the treatment of specific diseases, is also not going smoothly. For example, the cost of treating stroke in specialized clinics is 19 thousand UAH. Given that the country annually about 200 thousand diagnoses of stroke, from the allocated funds, one is only 4.6 thousand UAH – it is not enough such money in the district hospitals the relatives of the patients spend a few days.
The interior of one of the Ukrainian hospitals
Tariffs for the provision of qualified and specialized medical care are still classified.
Reformers promise that the patient will be able to seek medical help not only your local, but to any clinic or hospital in the country. This is due primarily to the fact that in 2020 entered the hospital district and a Central district and district hospitals are simply closed, so ill have to go for medical help, and thousands of doctors and staff of hospitals will be thrown on the street.
Under this special mechanism.
To provide specific skilled care hospital must be certified and have a whole range of complex medical equipment. For example, in order to obtain permission to conduct surgical and gynecological surgeries in the hospital should be mammography, endoscopic apparatus, apparatus for ULTRASONIC diagnosis. To be eligible for the treatment of strokes and appropriate funding from NCSU in the hospital must be a computer tomography device and magnetic resonance imaging. They are expensive, then the sentence many medical institutions have already signed on. Like many patients who simply do not have time to get to public clinics and private not find the money.
Rivne doctors blocked the highway Kyiv-Chop, demanding to be paid
The Ministry of health introduces “a package of priority health services”, which must be paid at higher rates, if the facility meets all the criteria. These clinics a little. Recently resigned due to disagreements with the Minister of health, the head of NCSU Oleg Petrenko explains that, “if a person gets diagnosed with a stroke in any hospital where there is no computed tomography, neuroimaging, self-monitoring, highly qualified medical staff, the institution may not conclude a contract with us for priority service.” A situation where many hospitals will not be able to sign a contract with the National health service. Thus, public funding will be deprived of hundreds of hospitals who now have successfully carried out treatment of various diseases. They have no output – either shut down or demanding money for treatment in patients. The medical insurance system in Ukraine is missing. Wages and pensions are barely enough for utilities and food. Than to pay for treatment, the government explains.
Now the pilot projects for the introduction of secondary medical care are held in Vinnytsia, Poltava, Donetsk, Odessa, Ternopil regions and the city of Kiev. One treated case 1534 allocate UAH (about $64 at current exchange rate). But money is not enough.
The November 2019. Employees require cardiologic center salaries
From the decision about the medical safeguards has removed the provision on the co-payment made there by American Ulyana Suprun, but the head of the Verkhovna Rada Committee on health Michael radutsky insists. In any case, patients will have to pay for treatment out of pocket.
To implement the second phase of the medical reform in the “secondary market” there are several obstacles.
First, not all hospitals have undergone the process of autonomisation and moved to the communal property. As of November of this year, such institutions are only 70%. The local government and doctors are afraid of autonomy, as in the case if the hospital will not meet all the criteria of NSSO, the state funding it will not get all the funds for the salaries of doctors and utilities, she will have to earn money or to close.
Second, to connect to electronic health care system and to enter into a contract with NCSU, clinics and hospitals should be computerized. At the moment of only 31.5 per cent. Where to take money for computerization and connection to the electronic system? From the state budget this money is not allocated. Local authorities do not have the funds – free money.
Emergency medical treatment libertarians Goncharuk promised to allocate UAH 4.6 bn. The money going to buy 470 ambulances and to open 25 offices emergency care. Plans are wonderful, but the prospect of emergency sad. Meager salaries, difficult working conditions and the impending replacement of the EMT personnel, paramedics doctors and paramedics led to a massive dismissal of staff. The head of the Free trade Union of medical workers of Ukraine Oleg Panasenko says that in Kiev due to the lack of specialists daily stand 50 ambulances. On the periphery fared similarly or worse. In the future it may happen that the new machines will ride the paramedics, who can only apply a bandage or a splint and bring the patient to the nearest hospital.
Protests medical emergency
In the second stage of health reform could lead to wholesale closure of public hospitals. Afloat will only medical institutions in regional centers and large cities and private owners. And the introduction of co-payment (which in the future will happen) will make free medical care available. And not to change the Ukrainian Constitution, the government has introduced a rule that every ill has the right to seek free medical care in any hospital of the formal medicine is still free. But in reality, people are forced to pay.