June 8, the Verkhovna Rada voted with great creak for the beginning of the medical reform in Ukraine. About Ukrainian medicine for certain know three things. The first - medicine, according to the Constitution - is completely free of charge. The second, and all Ukrainians know that - for all services, medicines, doctors work in Ukraine is always paid by the patient. And the third - there is no medicine in the country. Ukrainians have the expression "heal to death". It describes the state of medicine in the country as best as possible.
Once in hospital, patients pay physicians, nurses, nurses. No checks, or contracts. Cash only. "Charitable contribution", that is, payment for the operation transferred to the health insurance fund, does not relieve the patient from the need to pay separately for the medicines and services of doctors. However, the fully paid price list does not give the patient any guarantees. "Charitable contribution" is not a payment for a medical service. This donation "on the development of domestic medicine," - writes Larisa Voloshina for 7days. Us. - It is not a reason to expect a qualitative treatment or a correct diagnosis. Full-fledged health insurance in the country is also impossible. In Ukraine there are no clear criteria, medical standards, price list of hospital services. Insurance companies can cover the cost of drugs, but not expensive "free surgery" and post-operative care. The state budget pays for the maintenance of polyclinics and hospitals, a meager salary for medical workers and 3.5 hryvnias for the treatment of each patient a day. Everything else - income, prestigious cars, real estate - the doctor "earns" himself.
Ukrainians know for sure that if they really care about their own health, they must postpone a few thousand dollars in advance for treatment, undergo a survey in a paid medical center where there is hope of obtaining reliable test results, and in case of getting to the hospital - contact a doctor for confirmation Diagnosis. It is recommended to clarify "by familiarity", is this specific, prescribed by the hospital medication helps with this particular disease. Even the need for a designated operation. After all, it may be that the doctor simply earns money on the patient, prescribing to him unreasonable expensive procedures.
A patient in Ukraine is a serf. He is obliged to be served in the district hospital at his place of residence or in a paid clinic, in which often all the same doctors work. This leads to the fact that district hospitals are transformed into private fiefdoms of head physicians, to get out of which is healthy or not brought to ruin, the patient has virtually no chance. Diagnoses, lists of drugs, procedures - all this may be a fiction. Ukrainians tell heartbreaking stories about how patients die without quality medical care only because the attending physician refuses to write out to them in time a "referral" to a regional or republican hospital. The reason is banal - money. Since "free Ukrainian medicine" in fact represents an underground multibillion-dollar industry, one can not voluntarily give up a patient willing to pay, not every doctor. And the quality of medical education in the country over the years of the decomposition of medicine has reached such a level that a doctor with a diploma is not always able to diagnose a disease that goes beyond his "innocent" commercial activities.
And this terrible system is proposed to change. In the reform approved by the Ministry of Health, the principle "money goes after the patient". Now every citizen without a link to age, chronic diseases and place of residence will be able to sign a contract with a family doctor, which he chooses himself. The number of patients will depend on the income of the doctor. This put an end to the original serf slavery of Ukrainians and removes from the market "dealers from medicine". "If the family doctor recruits two thousand patients, he will be able to earn about 120-150 thousand UAH per year," said acting health minister Ulyana Suprun.
According to the bill, Ukrainian citizens will receive a guaranteed package of medical services and medicines from the state budget. Here I would like to note that the medicines were paid even in the times of the Soviet Union with its vaunted state medicine. The proposal of the Ministry of Health laid down a norm that is new for Ukrainian citizens. It may very well be that only because of the increase in the number of patients' appeals for a free service at the primary level will it be possible to reduce the number of chronic diseases in the country.
Free medical care and provision of medicines will be extended to three areas: emergency, palliative and primary medicine. The idea of ??the Suprun reform is to redirect those funds that are already allocated by the state to the needs of the health care system in a new way. Now about UAH 100 billion ($ 400 million) is spent each year not on treating patients, but on maintaining a network of hospitals and clinics that are turned into free doctors' offices. The population pays twice: first in the form of taxes, and then - for medicines, procedures and bribes. The reform proposes to transfer buildings to the maintenance of local communities and to direct budget funds directly to pay for services and medicines.
Another innovation of the reform is the development and implementation of standards of medical care, the assessment of medical technologies and the accreditation of health facilities. All this will be carried out by a specialized state non-profit agency. Reformers offer to introduce pan-European clinical protocols, which will enable insurance companies to implement high-quality individual patient insurance programs. In fact, the health reform, which the ministry is trying to implement, translates inarticulate state medicine into medical insurance. Partially public, and partly voluntary private. Such a system is already operating in the UK. It is based on the principle that medicine is the direct right of a citizen. That is, a citizen does not just receive medical care at the expense of the state, he gets the opportunity to be treated and cured at his own expense in a clinic of his choice.
This is what the opponents of the reform do not say, but what every Ukrainian knows. The problem of domestic health care is not that the state has no money for health care, but that patients and doctors can not fully interact. The state not only does not guarantee its right to health by its presence. It limits it, creating the ground for the most vile kind of corruption - corruption on health. Responsibility and openness between the patient and the doctor with the participation of the state - that's what the medical reform proposed by the ministry is.
The reform has opponents. They appeal to the Constitution guaranteeing fully free medicine for Ukrainians, and they criticize the Ministry of Health for closing down rural hospitals, which have long had neither staff nor patients. The fact that the state simply does not have the money to maintain the non-functioning health care system that exists in the country does not bother the fighters for social justice. "The state must!" - they exclaim. "So this is a bad state," sounds in response to a remark that medicine in the country has long been paid. Well, and the cherry on the cake, which is especially popular with the voters of populist politicians: "We must steal less!" So, as if they themselves are not related to the system that for twenty years has robbed Ukrainians of opportunities and lives.
The main gap of the reform is that the list of services and medicines will be determined annually by the Cabinet. Roughly speaking, the therapist's reception will be guaranteed free of charge. And here is a list of free medicines. Difficulties may also arise if the patient needs to get to a specialist. Since the specialized and highly specialized level of services was decided to cover only partially, at the rate of "social payments", it is not yet clear in what proportions the state's participation in treatment is planned. 50 to 50%? 20% by 80%? All these are questions that still need to be answered. But in order to improve medicine, it must be reformed.
During the years of independence in Ukraine, 21 draft laws on insurance have been developed, more than twenty health ministers have been replaced. Meanwhile, Ukrainians continue to die because of a lack of medical care in the country, which annually spends huge sums on health care.
"Social payments" for which officials and deputies criticize reform are the joint responsibility of the patient and the state for the health of Ukrainians. Today she is 67 at 1600. 67 people per hour, 1600 per day die in Ukraine, while the society is nostalgic for unrealistic norms in the Constitution. These proportions should have sobered the Ukrainians, awaken them from the Soviet paternalistic anabiosis.
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