How to reform Ukraine’s medical system
A roundtable recently took place at Kyiv City Hall, attended by the chief doctors of the capital’s main medical institutions. The head of the standing commission of the Kyiv City Council on health and social protection, Dr. Olha BOHOMOLETS-SHEREMETIEVA, presented a plan for reforming our capital’s health system in 2008.
How do explain the fact that, while the state continues to allot increasingly more funds for medicine, no improvement of medical services is taking place?
“At the moment, one hears many justified complaints about the quality of medical services. However, we have bad medicine not because, as some people believe, irresponsible professionals are working in this sphere, but because the term of usefulness of the Soviet health system was already over in 1981. The years have passed, but no concrete reforms have taken place in the medical sphere. If you compare the general funding of medicine, it is increasing every year, but real expenditures on drugs and feeding patients are decreasing because of the constant increase in prices and doctors’ salaries. Whereas recent direct expenditures on medicine totaled 25 percent, now they have decreased to 17 percent, and the rest goes for salaries, utility fees, heating, and administrative needs. This type of budget is destructive to medicine because it does not provide for its development.”
How can the medical system be rescued?
“Ukraine finally has to develop its own economic model of the health system by taking into account its national peculiarities: no European model for the development of medicine is suitable for us under existing socioeconomic conditions. Therefore, our legislators have to prepare an appropriate legislative base. Reforms should also be supported by doctors and members of the public, not only by the heads of the state.”
We hear a lot of talk about reforming medicine, but the situation does not change for some reason.
“The state is afraid of losing grounds for political speculations or sparking public dissatisfaction with the reforms. Medical professionals are afraid of losing their jobs and resources by which they can profit without the need to work better. Because they distrust the government, members of the public are afraid of losing the rest of their social guarantees. So health reform should be implemented gradually. We have developed a plan of measures that we will be submitting to the Kyiv City Council in order to improve the medical system in the capital in 2008.”
What types of things are being planned?
“The health system should be managed like a branch of the economy. An independent inventory of medical institutions and economic analysis of their activity should be held every year. A single medical space and a centralized dispatch center should be established: if a hospital is responsible for a certain direction (e.g., neurology), patients should be brought only there. This will improve the quality of services and reduce expenses for maintaining unnecessary beds. A single computerized information management system should be created, as well as a unified administrative system. Finally, we have to start educating employees to work in the new health system, which, I hope, will be implemented in the nearest future.”
Don’t these health reforms in Kyiv call for a reduction in the number of medical institutions or their reorganization, as was the case with the Central Clinical Hospital, when its doctors had to picket the Cabinet of Ministers in order to save their hospital?
“There is no question of reducing the number of medical institutions or closing them down. As for the Central Clinical Hospital, I can say that the picketing of the Cabinet of Ministers was connected to political games being played by certain individuals. The staff of this hospital is regularly given false information that their hospital has been turned into a raion hospital, a reduction of its status. In fact, it has always been a city clinical hospital and it still is, and there has been no scaling back of beds or financing. The only change that was introduced was that it ceased to be a central city clinical hospital. The reason for this is that it is not fulfilling its main functions. In my opinion, there should be no central hospitals in Kyiv. They should be re-profiled into institutions with narrow specializations. Of course, any kinds of reforms are never painless. But the end result is that both hospitals and the residents of Kyiv will benefit from what is being done.”
