On January 1, not only the new year 2025 began, but also a new life in the issue of examination of functional disorders of Ukrainians. Until 2025, issues of “loss of ability to work” were dealt with by medical and social expert commissions (MSEC). These commissions, good or bad, but professionally assessed people with diseases. Someone's stay on sick leave was extended. Someone was diagnosed with a disability. And for some people this disability was not confirmed.

At the end of 2024, it was decided to liquidate MSECs and replace them with expert commissions for the assessment of daily functioning of a person (ECOPFL).. What will this bring to patients And what about the doctors Let's try to figure it out.

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Few people have not heard about various scandals related to MSEC, especially in the second half of 2024. Fictitious disability groups for entire groups of officials, corruption scandals, etc.. The media were lively discussing more and more new news stories, and people were surprised at the wealth of the MSEC leaders mentioned in the news.

The only way out that the country’s authorities found in this situation was to liquidate MSEC, and entrust their functions to medical institutions and doctors. Unfortunately, if the only tool is populism, then there is no other solution to be expected.

A few months later, a resolution of the Cabinet of Ministers was adopted, the adoption of the corresponding law and orders of the Ministry of Health was launched. It is for this function that the electronic system was created. And the process of implementing changes began.

At the end of December 2024, when ordinary Ukrainians celebrated Christmas, doctors from those hospitals where ECOPFL were created day and night entered digitized cases received from MSEC into the new electronic system.

The electronic system, outraged by such a cheerful and massive “rape” of her, responded in kind: it either did not allow you to choose the date of the examination, then made it impossible to save the entered data, then hid the names of medical institutions, or even completely “lay down”, and even go to the site itself.

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At the same time, competitions continued in Ukraine: who managed to enter more cases into the system. Treatment of patients became an almost secondary task, because the governing bodies also gradually moved the deadline, leaving fewer and fewer days for entering the entire array of cases into the electronic system. If at first they demanded to do this before January 1, then a few days later - already before December 29.

With grief and curses in half, with heroic efforts, we managed to enter into the electronic system the cases that were submitted to the MSEC in December, November, October and even September 2024... Some of the patients at that time expired their period of disability. Someone had to register because of a long stay on the list of incapacity for work. Without the decision of the MSEC, doctors already refused to extend this disability, because they were afraid of receiving a monetary punishment from the state, which is not too concerned about the quality of treatment or the fate of palliative patients with chronic pain and without quality pain relief, but is very effective in taking money from doctors if they.... These, unfortunately, are the peculiarities of the organization of Ukrainian medicine..

Also, in an extremely urgent manner, the process of training doctors in new functions was launched.. The hastily organized webinars contained little specific information, but were endlessly repeated, forcing doctors to quit their work in order to once again hear what was already discussed at the previous webinar several days ago.. In addition to the urgent task of entering hundreds of MSEC cases into the electronic system, doctors also urgently had to learn the contents of Cabinet Resolution No. 1338. In several groups created in different messengers, hundreds of messages appeared daily, which would be very interesting to read if doctors, already working in a rather intensive mode, did not also need to provide medical care to patients during the day.

Medical institutions (as best they could) tried to create all the conditions for the full work of the newly formed commissions. As an employee of an oncology center, I can note the high-quality work of the management of our institution.

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Since January 2025, the newly formed expert commissions began to make decisions on patients for whom, in some cases, MSEC had not made decisions since September 2024. Very long queues formed for months of work.

Unfortunately, I have to admit: not all patients lived to see their cases reviewed. And sometimes the secretary of the commission, who called to call the patient to a meeting (or in the case of an absentee assessment, to ask about his well-being), was informed that the patient had already died... These are the realities.

What will patients and doctors get from innovations

Let me note right away: it’s too early to evaluate. Much must be judged by its fruits. And the quality of these fruits can be determined in a few months or even a year or two.

But now you can see both obvious disadvantages and advantages of the decision made. Let's start with the negatives, probably to end with something sweet.

In my opinion, a much more correct decision would be to introduce changes (the introduction of an electronic system and clear criteria, finally spelled out in the resolution of the Cabinet of Ministers) without liquidating MSEC. It was necessary to restore order there, but not to liquidate the structure. Bring to justice those who committed crimes and make the necessary personnel decisions.

I repeat, good or bad, but MSEC performed a certain function professionally (they spent years learning to perform it) and did only that. Now this has suddenly and urgently been blamed on doctors who, firstly, have no experience in such work, and, secondly, they are already often overloaded with their main work. Now, for doctors who have become members of expert commissions, the process of their main activities has been made as difficult as possible. How the daily “theft” of several hours of working time will affect the quality of work of these doctors is a rhetorical question.

Let me note once again: there was such a rush to implement the changes that at the beginning of the work of the expert commissions, the created electronic system refused to work and caught up with the process as it went along.. At first, the commissions generated offline (paper) documents on the consideration of cases. So that later, when the system works, you can add all this there too. An impressive example of a “competent” organization of the process....

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Taking all this into account, I expect a certain percentage of both erroneous decisions and dissatisfied patients. Therefore, once again: doctors were given the urgent task of learning to perform new functions in an extremely limited time frame.. Having an idea of \u200b\u200bcertain principles of such work is one thing, but making decisions in practice is a completely different story.. We must also take into account the fact that due to the prolonged inactivity of MSEC before liquidation (and without even a hint of at least some kind of responsibility for this), huge queues formed for consideration of cases. But everything that could be done has already been done. And this, unfortunately, cannot be changed.

Another significant drawback of this decision is that it introduced additional discord between doctors, even enmity. There was a time when everyone referred patients to MSEC - both doctors of various specialties and local therapists. Then most of this work was assigned to family doctors. Doctors of various specialties are accustomed to giving instructions to family doctors in this matter - about “registration for MSEC at the place of residence”. Now they understand that most cases from family doctors will come back to them. Quarrels started. Doctors of different levels and specialties have already written and expressed many “warm words” to their colleagues.

If the authorities were ready to listen to advice, then I would like to note: it is extremely necessary to create a clear, understandable system that would take into account the workload of each level of medical care and the real required level of specific knowledge for referring patients to ECOPFL. This would provide insight into when and who should refer patients for such assessment and who will make the decision in conflict situations. It’s enough to scold doctors of different levels and specialties among themselves. Organize the referral process like a human being! To do this, it is necessary to qualitatively analyze possible clinical situations and optimize the process from the point of view of the patient’s medical and clinical interests..

Despite all my criticism of this process, there are still, in my opinion, advantages and disadvantages:.

Clear criteria for extramural assessment. There is a whole cohort of seriously ill patients who do not need to physically go to the commission to undergo it. For certain patients this is very important and saves them from unnecessary physical and emotional exhaustion.

Clear criteria for the period for which a disability group is established: in which cases it is necessary to give a group for a year, in which - for two, three or five, and in which - indefinitely.

The electronic form of referral to ECOPFL itself, in my opinion, is simply a huge step forward. It provides for a doctor’s assessment of functional impairments. Especially in cases of absentee assessment, this will significantly help the commission approve a decision on disability..

At least for a certain time, while everyone is hearing about it and many are scared, I think the innovation will reduce corruption risks. ? I don’t really believe in the effectiveness of this particular solution.. Moreover, the motivation of doctors for this work is left to the human factor. It’s good if management acts decently towards its employees, like ours. But I have heard of hospitals where doctors were simply forced (“This is your working time”), without providing any payment for this work. Well, it’s just like in the joke: “They gave you a gun, and then you spin around as best you can.”.

I think that for some time the intensity of rudeness and humiliation of patients who will undergo ECOPFL will decrease significantly. Until the new system and medical workers get used to it.

I think it is positive that the patient will be able to receive treatment, referral for ECOPFL and the assessment itself in one medical institution. It will be much more convenient for him. And if you consider that the system provides for pre-registration for the date and time of consideration of the case, then this seems like just a dream - now you won’t have to sit in line for hours while waiting for an appointment with the commission.

I’ll be honest: if positive changes were introduced while maintaining the MSEC, and they were also implemented professionally (without delaying, but also without haste and extortion of extra efforts for this), then it would be possible to create an almost ideal model for the implementation of this function. Unfortunately, in our country there are people who are professionally and routinely bored; they need some “movement”. And I would like the country to have a professional model of healthcare management and a professional response to problems arising both from patients and medical workers. And also adequate and professional (not totalitarian, but professional! ) reaction to criticism. I hope it's still real.

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I advise patients: get yourself an email and use it. This can be very useful and convenient in the matter of correspondence with expert commissions. Using email is not a very difficult task, so those who can do it (on their own or with the help of relatives and friends) - do it.

I would advise my colleagues to be patient: having survived the first months of such work, in the future there is a chance to get involved. And also try a model of mutual respect during communication, in particular, between doctors of different levels and specialties. Everyone should apply for an ECOPFL referral for at least a few patients to see how the system works. Arrange as planned. So that when this task becomes urgent, you can already navigate the system.

I advise each expert commission to have links to Cabinet of Ministers Resolution No. 1338 on their computer desktop at meetings. It's convenient.

And I really hope that the bullying of patients, which we have heard so often about when it comes to visiting MSEC, will really decrease. And that it will be much easier for them to go through all these stages and circles of solving the issue. I also hope that the doctors will endure. And such a solution to the issue and such methods of introducing changes will not lead to a catastrophe on an all-Ukrainian scale. Then we will live. And, perhaps, we will even live to see high-quality and adequate management of the medical system in Ukraine.

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