It’s been a good week for Ukrainian healthcare system. On October 19 the parliament finally passed bill no. 6327, on financing the healthcare system from the country’s budget, which will kickstart the long-awaited medical reform and change the outdated Ukrainian healthcare system that is often described as one of the worst in Europe.
According to the bill, at least 5% of the state budget GDP will now need to be spent on the health insurance programs, which will be developed by the Ministry of Healthcare in guidance with the Ministry of Finance. In practice, this means that patients who have a doctor's’ prescription will soon be able to receive medicine for free from pharmacies that will be reimbursed by the government.
“Both doctors and patients do not like the healthcare system that we currently have,” the Acting Health Minister of Ukraine Ulana Suprun wrote on her Facebook page on October 19, after the bill was passed. “[But] from next year onwards, the Ukrainian healthcare system will start to change. This is our victory and the victory of the Ukrainian parliament.”
Among other things, the implementation of the reform means that patients will be able to choose the doctor they would like to go to instead of the old system when patients were attached to a certain hospital that is closest to the address they’re registered at, limiting their freedom of choice.
“We have the right to choose now, we have the right to get good service, and the right to get answers to our questions,” explains Iryna Lytovchenko, the co-founder of international charity foundation Tabletochki.
She adds that thanks to the reform doctors will be earning much higher salaries: around $2,000-$3,000 in cities and towns and around $500-$1,000 in villages. That, in Lytovchenko’s opinion, will likely eliminate the need for bribes, as well.
“[Doctors] will be motivated to go to a village, to work there and our country will provide them with maybe a house or a room near the hospital. So they are going to have pretty good [living] conditions.”
Hromadske spoke with Iryna Lytovchenko, the co-founder of international charity foundation Tabletochki, to discuss how medical reform law will impact the daily lives of Ukrainian doctors and patients.
Iryna, what does the adoption of this medical reform law mean for Ukraine?
It means a lot as for patients and the same for doctors. Because it actually changes the rules on how we’re going to get medical help. As of now, we were going to the hospitals and the country was paying for the amount of beds they have in a hospital and for the sustainability of the work within the hospital. What we’re going to have now is that the country will start paying for a particular patient and it will pay money to that hospital where the patient went. So we have the right to choose now, we have the right to get good service, and we have the right get answers to our questions.
Photo credit: HROMADSKE
We have the right but do we actually have the opportunity?
We didn’t have the opportunity before because we actually had to bend to one doctor who’s near your house or maybe you have certain registration in your passport and you have to go to that particular hospital. Now we can change it: we can pick any other doctor, make an agreement with the doctor and then visit him. And if we’re not satisfied with the service level, we can change the doctor. That’s the right we have now.
Ukraine’s Acting Health Minister Ulana Suprun is a big supporter of this medical reform, which in her opinion will end the old Soviet-style healthcare system. But the reform has also received some harsh criticism. Among those who criticized it is doctor Olga Bogomolets, the chairperson of the Verkhovna Rada’s Health Committee. In her opinion, the implementation of the reform will ruin lives of those who are socially vulnerable.
Do you think that what she says is right when she criticized the reform so much? And do you see any drawbacks or disadvantages in what has been voted for?
Basically, why are doctors like Olga Bogomolets against the reform? Because they’re used to getting some additional income from patients and they understand that after this reform they will get a legal salary — let’s say $2,000 to $3,000 — and that’s a pretty ok salary. But they are not satisfied with it. Actually this morning I was visiting a doctor, and he told me “I was taking bribes, I take bribes and I will continue to take them until I have a salary of about $5,000,” and I told him “ok, maybe then you should choose another profession?” Because he’s in the medical market, he’s a doctor and this is the rule of this market. If you want to have a bigger salary, get more money, go to some private clinic or go to another country to get salary. Here in Ukraine, the country can offer you $2,000 — I think that’s good enough. And young doctors and doctors in some small villages, they will also have good salaries. It’s going to be less, of course — maybe some $500 to $1,000 — it will depend on a doctor. But for a small village, it’s actually a very good salary. So they will be motivated to go to the village, to work there and our country will provide them with maybe a house or a room near the hospital. So they are going to have pretty good [living] conditions.
Iryna, what can you tell us about bribes and all this kind of stuff [that] might be true and I know that basically it is true. But I don’t think it applies directly to doctors like Olga Bogomolets. Because apart from being a doctor, she is, as far as I know, an owner of a private clinic. So she doesn’t actually need to rely on bribes. How does the medical reform impact private medicine in Ukraine?
They can be a part of the medical system now, meaning they can receive money from the country if a patient picks that private hospital. But patients should [also] pay a part of that service they want to get. You've also asked me about some negative things about the medical reform. I can tell you some negative things that were voted for [on October 19]. The worst thing was that they got rid of the international treatment protocols part in the law, so we will still have our local protocols and we will be cured according to these protocols. As for me, as for a young person, I don’t understand this because people in France and Germany have the same diseases. So why should we, here in Ukraine, be cured some other way? I don’t understand why they removed that part.
Photo credit: HROMADSKE
As a head of an international charity foundation, what does this reform mean for your work? I suppose that the situation will be gradually improving and finally we may come to a situation when you are no longer needed?
That will be the best situation actually. But it would be a miracle because charity foundations [operate] in all countries: in the US, in the UK, everywhere. What does it change for us now? As of now, nothing. We’re going to feel the change later. Because now parents will be more comfortable taking their children for a doctor visit because it’s going to be free and they can get blood testing for free and get some other help — this is the first thing. The second thing is the medical education and these international protocols. We really hope that maybe later, maybe in half a year or a year our MPs will come back and discuss these international protocols again because they’re very fast-developing. The way the oncology looks in Ukraine now is about 5-6 years behind of the way it looks in Europe. So we should be following those new ways in oncology treatment.
/By Maria Romanenko