Stroke “at a discount” after the reform of “secondary.” How change Ukrainian medicine next year

Инсульт "по скидке" после реформы "вторички". Как поменяют украинскую медицину в следующем году

What will change in medicine after the next stage of reform, which was announced in the Cabinet. Photo: hs.oblast.onlinefrom next spring medical reform, which is still limited to only the primary link (advice of family doctors and certain types of diagnosis), promise to extend to the secondary, and this consultation specialists (ENT, neurologist, etc.), outpatient care (including simple operations), hospital, and emergency medicine.

They will pay on the same principle that works in a primary — the money goes to the patient. That is, the idea is that people pay do not have to.

The new system should work with 1 April 2020. This is later than previously planned — she wanted to run from the beginning of next year. But the other day the Cabinet adopted a resolution which extended the period of the pilot project for secondary housing in Poltava region for another three months. And then “experiment” will spread all over the country.

Experts with whom I talked “Country”, saying that the reasons for the postponement of several. The main doctors do not have time to prepare for the launch of the reform of the secondary, plus not the fact that she has enough money.

And in such a situation to quality medical care, for which patients do not need to pay and I under great difficulty.

The reform of the secondary, which they themselves invented, already criticized in the team of the former head of the Ministry of health Ulyana Suprun. “There are two options. First — the reform will include, without leadership and a plan. This can be compared with the “Hard Broksita” — will work the new system, there will be new rules in the market of medical services, and hospitals and patients will be left alone. Survive those who are lucky. The second option — the reform will be delayed, fearing the first option. The problem is that the results will be even worse,” wrote in one of his blogs the ex-Suprun Deputy Pavlo Kovtonyuk.

On his page on Facebook he predicts “the failure of the government” to reform the secondary.

“Country” understood that changes in hospitals in the next year, and how it will affect the health of Ukrainians.

What is resale and how it will change

A secondary system of health care is divided into outpatient and inpatient. The first is consultations of specialists, examinations, and number of procedures (including surgery). Second — hospitalization and in-patient treatment, planned and emergency surgery.

Also applies to the secondary emergency medical care. All of these links promise to reform from 1 April 2020.

How will this work in practice?

At the initial stage for patients, nothing will change. They, as now, have to conclude a Declaration with the family doctor and, if health is something wrong, consult first with him. If the therapist deems it necessary, he will refer you to a specialist. As there is now. But still will be a few differences.

First, now the state does not pay for specific services of specialized doctors. Here, supposedly, and their attitude to patients — from the banal vulgarity to requests to “thank”.

The reform primarily involves a change in principle of funding. As for the primary, the secondary housing first “money follow the patient”. That is, the idea is that the clinic will be interested to serve as many people as possible.

Second, you can go to specialists or, for example, to be operated on, not only in the clinic or hospital, and in any medical institution of the country. The family doctor will issue an electronic direction, which was to operate throughout the country. And in the hospital you select, the National service of health will transfer the money for your treatment.

In theory, the “bad” hospital people will turn less often, and eventually they will be forced either to raise their level, or close.

Dentistry for the money, the rest — on the situation

But there are some nuances.

First, the state does not pay for everything, but only a package of guaranteed medical services. In this package are the most important services a primary and secondary in medicine (including elective surgery), emergency, palliative care, childbirth and medical care to children. Also in inpatient care includes all medications now patients often buy.

At the same time the “extra” in it, and it is, for example, massages and even dental care, including baby. It turns out that they will need to pay solely for its own account. Although, as noted in a recent interview, the now ex-head of Dazzleby of health (United NSSO) Oleg Petrenko, “it is possible for kids dentistry will be partially free”.

Second, to get the money from NCSU, the clinic needs to fulfill several conditions: to undergo a process of autonomisation, to have computer equipment and connect to the common medical database and have the necessary equipment.

“Before we spend budget funds for the purchase of health services in a particular institution, NCSU must ensure that it will provide high quality and safe medical services and will effectively spend the budget money”, — explained in the National service of health.

But all the requirements of NSSU there are problems.

So, the autonomy, according to Dazzleby health, as of November, was only 70% of the health facilities. The highest rates in Poltava (97,2%), Vinnytsia (96,9%) and Kharkiv (91,8%).

But there are regions in which the process is still far from complete. As explained by “the Country,” Deputy head of the Ukrainian medical society Constantine Inflated, for example, Kiev and Zaporozhye region began to mass autonomy only recently. Local authorities without enthusiasm perceive the autonomy, because then “to patch financial holes” medical facilities they have at their own expense from local budgets, where the already “holes” missing”— said Pouting.

According to the head of the National chamber of Ukraine Serhiy Kravchenko, formerly on the financing of local government clinics received medical subventions from the state budget. The money covered the cost of salaries, and the communal purchase of drugs. But avtoemissionnye hospitals will have to earn a living for yourself. Next, the medical subsidy will significantly cut.

That is, in order to survive, hospitals will not only have every possible way to lure patients but also to reduce staff, and that’s a guaranteed social explosion that is feared by the local authorities. Therefore, in the field to the maximum delay situation, because the budget for next year provides a subsidy for those who are “not yet” autocomservice in the amount of UAH 1.5 billion.

With computerization worse. According to NSSO, computerized a mere 31.5% of institutions (mostly in Poltava, Lviv and Vinnytsia regions). The doctors complain that to buy computers they simply don’t.

“What money should undergo computerization and software institutions of the secondary is still unknown,” — said the head of the Bow of Milashevskogo Center primary health care (Vinnitsa region) Yury Sheremet.

According to conservative estimates, to connect to a shared electronic system, the medical institution should spend at least 3-4 thousand dollars, can not afford to not only rural, but also many regional clinics.

It turns out that if clinics do not have time to autocomservice and to acquire computer equipment before 1 April 2020, and to “CH” there are not many, they simply did not get the money from Dazzleby health. And will either have to live at the expense of local budgets (and it is not affordable for all communities), or to make “other means not prohibited by law.” In the recent list, according to Sergey Kravchenko, includes paid services to the population, charity (including from patients), etc. — in Other words, people will have to pay for treatment in such hospitals from their own pockets, or to go to others with the agreement of NSSO and state funding. But the choice is not always. For example, it is unclear how to be rural residents, especially if their district hospital suddenly becomes “paid”. It is theoretically possible to go to the regional center or in Kiev, but it is clear that this option is not suitable for everyone.

Therefore, many Ukrainians risk all to stay without treatment.

Childbirth infarction — not for everyone

A separate issue — the implementation of the requirements of NCSU for medical services.

On the official website of Dazzleby posted several lists of requirements for applicants to budget money.

For example, in the outpatient services clinic shall provide laboratory diagnostics (tests), functional and instrumental diagnostics, minor surgical intervention.

Additionally there will be another package of the so-called priority medical services. It will include research for early detection of the most common cancers: hysteroscopy (to identify problems in gynaecology), gastroscopy (examination of the stomach), colonoscopy (intestines), cystoscopy (bladder), bronchoscopy and mammography.

To make these “priority services”, which, incidentally, promise to pay at higher rates, the clinic must have the appropriate database equipment, for example, the mammography, endoscopic equipment, what you have not all medical institutions, especially in the provinces.

Hospitals will be able to conclude with NCSU several contracts:

on surgery different profiles (gynecology, Oncology, cardiac surgery, children’s, etc.) surgical specialized services (dermatology, gastroenterology, endocrinology, cardiology, etc.) – TPO women and children (childbirth and neonatology)- specialized care for acute stroke and myocardial miokarda this, as stated by Oleg Petrenko, childbirth and neonatology of the first month of life, and treatment of cardiovascular pathologies is also included in the priorities of the state. That is, they will have to pay more. But only if the clinic meets the criteria.

“To be eligible for the priority service, which will be paid the applicable fare, the institution must meet certain requirements. If, for example, it does not meet the requirements for treatment of stroke do not get the priority rate and will be charged at base. That is, 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 for priority services,” explained Petrenko.

This approach, according to him, Ukrainians will go only on advantage. “That man survived and became a profound disability, it is more important to create conditions so that it fell not to the nearest hospital, and one where he will provide quality and safe care in accordance with standards”, — said Petrenko.

But, most likely, many medical facilities will not be able to issue a full pack of contracts — some just do not will be selected, others simply do not want to get involved in complicated preparation and to fulfill the “wishlist” of NCSU, especially if patients on this profile, they have relatively little.

It is therefore quite possible scenario is that “your” hospital will not deliver babies or treat heart attacks by the state program, that is, free of charge. But it can provide these services for money. And if the account goes for minutes, while at the other hospitals not, people simply will have to agree.

Constantine Inflated said that Ukrainians should prepare for “change medical route,” that is, clinics that you used to visit, can suddenly be “paid”, if not to deny one or another of assistance. And if in big cities the costs of reforms are not very critical, the inhabitants of the provinces will notice it in the first place — because before they “updated” secondary housing may simply not be reached.

“Sometimes it’s better an hour and a half to go to a specialized center where will provide appropriate assistance, to not go where the patient is put to bed, and he will eventually die from complications,” he comforted Ukrainians Petrenko.

Will there be enough money to “free medicine”

The main intrigue of the reform of the secondary — will there be enough money on it. On the reform of the secondary in next year’s budget planned: for outpatient care and hospital — UAH 44 billion on emergency assistance to 4.6 billion for the medical rehabilitation of 500 million and palliative care — 300 million

For treatment of strokes has allocated 912 million, heart attacks, 217 million, for a delivery of 1.7 billion, to help the newborn — 1.3 billion.

The authorities claim that they have enough money.

However, depending on what fees to pay. The average cost of treating stroke in a specialized center is about 19 thousand. But on the basis of budgetary financing and statistics of the cases of stroke (up to 200 thousand a year), it is easy to calculate that each patient was allocated a total of 4.6 thousand. That is, or will pay less to hospitals, or the money simply is not enough at all.

The base rate for one treated case will be about 1500 USD, but this amount will still have different coefficients depending on the diagnosis and complexity of treatment (for infections — 0,98, for Oncology — 1,135, pregnancy is 1.7 etc).

This tariff is already operating in the Poltava region, which is a pilot project and this year, for example, the first city hospital received about 10 million for outpatient care and about 11 million for the hospital.

The official price at which the state will pay for medical services on the secondary market, broken down into specific diseases, is not disclosed.

At the end of last year, the Ministry of health has put up for public discussion the project with the prices at which the state agrees to pay the illness of Ukrainians in pilot projects. In it, in particular, a blood test for creatinine (indicates kidney function), bilirubin (liver test) is estimated at 29 hryvnia, Cala 63 hryvnia, chest x-ray — 134 hryvnia, ECG — 117 hryvnia, mammography — 109 hryvnia, colonoscopy — 613 UAH, removal of tumors on the ear, nose or throat — 358 hryvnias. It was assumed that the same or similar prices will be throughout the secondary.

But even then the doctors raised the price on laughter, claiming that it does not even cover the cost of services, not to mention the depreciation of the equipment that hospitals now have to buy for your money.

Therefore, it is possible that hospitals will simply ask patients to pay.

“While it is illegal, as the law on health guarantees at the last moment removed the provision on the co-payment. But now the relevant Committee on health strongly lobbying for the return of this concept in the law”, — said Sergey Kravchenko. That he soplata, “Country” told the head of the profile Committee Mikhail radutsky. She alleged need for the introduction of the model of health insurance.

However, while the co-payment is not legalized, nothing will stop the doctors to charge patients co-pay “by cash”.

Moreover, the regularity of the calculations of NCSU not guaranteed. This year a primary is not enough money and (about 2 billion) have been forced to take for the free diagnosis.

According to rumors, the resignation of the head of NCSU Oleg Petrenko can also be tied to a monetary issue. Petrenko allegedly hurried to leave, until he was accused that he had stopped payment.

Sergei Kravchenko said that the National service often distributes the money in manual mode, and it is fraught with abuses. “To change the system, you need a network of regional offices NCSU, the experts are able to make an examination before you can pay the bills,” he says.

It is therefore possible that the money for the secondary housing can end long before the end of the year. And what do Ukrainians is an open question. After all, to treat them for free then no one will.Liudmila Ksenz

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