For Ukraine to Survive, We Need to Change Healthcare

Editor’s note: on July 12 President Poroshenko offered Ulyana Suprun to become Deputy Minister of Health and recommended the Cabinet of the Ministers to appoint Ms. Suprun to this position. This decision of President Poroshenko came after the controversial arrest of the previous Deputy Minister, who was allegedly caught accepting bribes via complicated a scheme involving a number of doctors at the high-profile Oleksandrivska Hospital, located in downtown Kyiv. We published this column in which Ms. Suprun states her views on the future of the Ukrainian medicine and the changes that should be made to brighten its future. On July 27, 2016 Ms. Suprun was appointed acting Minister of Health of Ukraine.

Since the 1930s life expectancy in Ukraine has remained at the same level and the number of deaths increased significantly in the last 25 years. Currently we are world number two (after Lesotho) by the number of deaths among countries which are not experiencing an ongoing large scale military conflict (WHO, World Bank, UNESCO, CIA).

Mortality rate per one thousand of the population. As of 2015 it was 14.46 in Ukraine. Source: The World Factbook

Comparing us to the rest of the World: during the last 25 years life expectancy increased by 10 years in Western countries and the number of deaths decreased to the level which is almost half of this indicator in  Ukraine now.

Comparing life expecrancy in Ukraine and the UK. Source: World Health Rankings

Speaking in plain language: the Ukrainian nation is dying out and the question of our health is now a matter of our national security.

The current healthcare system of Ukraine is incapable of caring for the health of our citizens. The system should be changed. It must be based on the recognition of personal dignity. The needs of the patient should be put at the center of the new system.

To change the healthcare ecosystem of Ukraine we should increase the role of first response medicine, create a new paramedical service, develop preventive medical procedures and national medical insurance, improve existing medical standards, introduce international ones, and ensure the accurate and complete collection of information.

Primary Medicine and First Medical Response Teams

Ukraine needs to create a new paramedical service which would include first medical response brigades consisting of first aid technicians and paramedics — nurses who received special medical training according to updated and internationally recognized medical protocols.

Like the reformed National Police, the new First Medical Response Service can be partially supported by international donors.

Doctors who are now involved in the first response brigades will have an opportunity to become primary medicine doctors in the newly created primary medicine clinics after completing additional training. This would lead to an immediate increase of medical generalists.

Most of the patients in the West have access to a generalist doctor, who monitors their life and medical history. This is a doctor who conducts periodical health checks on a yearly basis.

Such a system creates a doctor—patient relationship in which the patient is receiving real medical care and not control from the Health Ministry. Ukraine needs this right now.

In the long run the policy of the Health Ministry should provide stimuli for medical students to select primary medical care as their profession. Decent compensation plays a role here.

Preventive Medicine

Preventive medicine is one of the cornerstones of modern healthcare. We need social programs aimed at increasing the awareness of the population and preventing diseases.

The Ukrainian healthcare system has to continuously monitor preventive medical and first aid programs to analyse trends in population structure and types of diseases. It is not shocking that a healthy population consumes less healthcare resources.

That is why an effective use of the resources and introduction of a ‘tax on pernicious habits’ like alcohol and tobacco is required. It would allow to increase the salary of healthcare professionals and introduce public health programs.

This step will be very unpopular, taking into account the current level of consumption of alcohol and smoking in Ukraine, but it should be done. Consider one fact: an average pack of cigarettes costs £12 in London, while in Kyiv it costs 20 times less.

Medical Education

Medical education in Ukraine requires radical reform to start producing high quality doctors. The statistics compiled by the Testing center at the Health Ministry demonstrates the critical condition of the educational process at certain medical universities.

In one of the medical universities almost 50% of graduates failed the ‘General Medicine’ exam, in two other universities this number reached 20%.

Medical graduates passing or failing the ‘General Medicine’ exam. Source: Report by the Testing center at the Ministry of Health for 2016

Today a medical graduate can be employed as doctor in Ukraine after getting a diploma and completing an internship lasting for one or two years. In total this is 8 years after graduating from the medical school.

To compare: it takes 16 — 17 years to become a surgeon in the United States, including 4 years of baccalaureate, 4 years at medical school, 1 year of internship and 6 years of residency, after which you might need additional 2 years of studying for a niche specialization.

Ukraine needs to introduce standardized national exams using the US system developed by the Council on Medical Education for nurses, first aid and pharmacy technicians, paramedics and other healthcare professionals.

Besides, we need new academic programs for healthcare professions like paramedics, physical therapy, ergotherapy and other professions, which are non-existent in nowadays Ukraine but are already the norm in the international practice.

Educational opportunities have to reflect the real needs of the population and compensation levels have to meet the quality level of healthcare.

Licensing of Healthcare Professionals

The employment guarantees of the healthcare professionals should not be based on bribing the head physician, but instead be rooted in professional and ethical responsibility and the public accountability of the doctor.

To eliminate the corruption currently dominating the healthcare system of Ukraine, a new licensing system for the medical professionals should be introduced, accompanied by the mandatory continuous education to pass license renewal exams.

This approach will allow licensing and compensating healthcare professionals, not the hospital or its head physician. In the current system it is the head physician who determines what the doctor will do based on his cut from this doctor. This is unacceptable.

Creating Professional Associations

Doctors need to create real, not the ‘virtual’ or ‘pro-forma’ professional associations. These associations must develop international medical and ethical standards to guide treatment and rehabilitation.

In the short term perspective the compensation of healthcare professional should be based on the professional standards and evaluation by the colleagues.

This will be yet another mechanism to improve healthcare and implement best international practices based on evidentiary medicine and international research.

Information Gathering

Changes to the healthcare system of Ukraine have to include the national registry of the patients and digital healthcare records which ensure portability and usability of the healthcare records and secure access to the  information.

These digital solutions will become the basis for decision-making, providing decent and timely medical services and for effective use of national healthcare resources.

A reliable information gathering program with subsequent statistical analysis will open new opportunities for research, improve healthcare quality and contribute to the professional development of healthcare professionals.

We need to create standardized and a unified digital medical records system for each and every patient and oblige healthcare institutions to implement it.

Each healthcare institution has to provide its employees with the technical means and conduct trainings aimed at implementing the new system within six months after it is approved.

Switching to digital will also improve patient privacy. This data will be available for anonymized use by the healthcare institutions and professional associations to create strategies, policy planning and reports.

It is evident that this is possible in the modern Ukraine, given the quality of its IT professionals and their motivation to help society.

Financing

Creating a national medical insurance program based on the effective and transparent use of budget money allocated to healthcare should become the government’s top priority. The budget control system should be introduced, based on the participation of the local officials, professional medical associations, patients’ associations and civic society.

Such a model will create a system of clear and exact healthcare payments on a ‘money follows the patient’ principle. The current system of centralized financing limits patients’ choice and doctors’ ability to select the methods of treatment.

Reorganization and optimization of healthcare institutions and personnel on a local level will result in an economy of funds. This will include repurposing medical institutions to provide social services, in particular: a reorganization of the repurposed hospitals and polyclinics into nursing homes for people with special needs, chronic diseases, elderly people and into rehabs for alcohol and drug addicts.

Standardization

We should quickly adopt and effectively implement the new law on rationalization and simplification of registration and certification of the medicines and healthcare products, modelling it on the jurisdictions with well-developed regulatory frameworks.

For example, an emergency military tourniquet is widely used by NATO countries to stop critical bleeding. It was already tested and approved by the US Food and Drug Administration. It does not require to be ‘re-certified’ in Ukraine.

Formation of the updated National Registry of the Medicines and Healthcare Products and implementation of the pilot refund programs for medicines curing widespread chronic ailments (like diabetes or cardiac diseases) will help to overcome the domination of the pharmaceuticals mafia and other special interest groups that are currently crippling the modern healthcare system in Ukraine.

Transparent reporting on the use of the state subsidies in the long term will cleanse the system from corruption and allow to decrease healthcare spending.

Fighting Corruption

Only combining powerful and independent institutions with zero corruption tolerance will change the current status quo. The system must include clear and effective rules aimed at preventing corruption, independent investigation and effective judicial review of corruption cases combined with a smart and transparent state procurements system.

The high profile criminal cases involving shady deals and tender busting committed by state officials should soon result in verdicts and prison sentences.

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We need to act now. In the long term these changes will bring about a healthcare system that cares for patients. But short term, urgent improvements should be implemented in parallel with the long term strategy.

The United Nations World Population Prospects data ranks Ukraine in the top-3 of the countries that are dying out.

According to the United Nations, Ukraine’s population in 2050 will decrease to 35 million people, two million less than in 1950. Time is working against us.

Translated by Gennadiy Kornev

A column serves to express the personal opinion of the author. It does not aim to be objective or comprehensive about the topic in question. The opinion of Ukrayinska Pravda editors may differ from that of the author. The editors are not responsible for the factual accuracy and interpretation of the information, our media outlet hereby only serves as a platform.