Health Reform 2019: Our Aims and Aspirations

By Pavlo Kovtoniuk, deputy Minister of Health of Ukraine, for UP.Zhyttia (the Ukrainska Pravda online resource)

Oct. 2, 2018

18 million Ukrainians have already chosen their doctors.

Our key objective for 2019 is to ensure a positive patient-provider relationship, so that patients want to visit their doctors.

What does this mean?

Patients can schedule a doctor’s appointment and no longer have to worry about things like waiting and queues.

Doctors have all the tools necessary to provide quality care, to perform diagnostic tests and medical examinations.

Doctors focus on you as patients instead of paperwork and statistical reports.

You know exactly which medical services are covered by the state, so you certainly do not have to pay anything for those. When it comes to the services that are not covered by the state, you have a defined list of paid services and the tariffs set by a health facility of your choice, so you can pay for these services at the cash desk, according to the official pricelist.

The new patient-doctor relationship is a safe relationship where there is an exact list of services and no room for bribes, informal and unplanned healthcare expenditures.

You should not feel worried when you need to go to the doctor. On the contrary, your doctor must become a person who actually helps and understands the situation.

However, primary care physicians need tools to be able to address 80% of their patients' health needs, and to provide quality care free of charge. Therefore, one of the priorities of our plan for 2019 is to provide doctors with these tools.

FREE MEDICAL DIAGNOSTICS

Today, primary care physicians perform clinical examinations and carry out the most common diagnostic tests. However, additional laboratory tests are often required for an accurate diagnosis.

In such cases, patients have to pay, and these are usually informal payments.

In the second half of 2019, we will launch the Free Medical Diagnostics program.

With a referral from your family doctor, you can undergo x-rays, ultrasounds, mammography, echocardiography, and other medical analysis and diagnostic procedures at any health facility of your choice.

These services will be covered by the National Health Service of Ukraine.

As is the case with family doctors, this reform will be implemented gradually, region by region.

When your town or city joins the reform, you will see the Free Medical Diagnostics program stickers on the front doors of local clinics and health facilities.

REFERRALS

The outpatient clinics will join the reform process during its second stage. The National Health Service of Ukraine will pay for the specialist’s consultations and related services provided to patients only if there’s a referral from a primary care physician.

But when you go to see a specialist without a referral, you will have to pay for a consultation and other services at the cash desk, according to the official pricelist.

So, if you do not want to pay, just visit your doctor first and ask for a referral.

Still don’t have a doctor? Choose one. Not satisfied with your current doctor? Choose another one. It is that simple.

In fact, it is easy to teach oneself to visit a primary care physician whenever the need arises. After all, you may now freely choose a physician you trust.

PAID SERVICES

The outpatient services of unproven effectiveness and those provided using the outdated models, as well as the cosmetology and aesthetics services, like balneotherapy or massage, will not be covered by the state.

Health facilities may charge formally approved fees for these services.

This will free up resources to ensure the provision of healthcare services, which are of critical importance for the health of Ukrainians.

A uniform list of paid outpatient services to be used by health facilities nationwide is currently being developed and will be soon submitted for public consultations.

ELECTRONIC TOOLS

Doctors should concentrate on caring for their patients rather than filling out paperwork.

Next year, we will introduce some new eHealth tools.

All patients will have their individual electronic medical records.

E-medical records will be used to store the patient’s medical and medication history, including electronic prescriptions. The system will also manage electronic referrals, prescriptions for reimbursable medicines provided under the Affordable Medicines program, sick leaves and other medical certificates.

These electronic tools will make the work of doctors much easier. Many of health professionals are tired of the "futile work" of filling out dozens of reporting forms. In addition, the introduction of e-medical records enables the automatic statistics collection.

For patients, this is also important – the information will be securely stored in one place, and protected from data loss.

TASKS FOR LOCAL COMMUNITIES

Local authorities remain the driving force for the health reform implementation. They are fully empowered to play a leading role in this process, and to make sure that all citizens benefit from the reform.

There are three key objectives for them to achieve in the coming year:

1. To reorganize all health facilities into public non-profit enterprises. All health facilities – outpatient and ambulatory clinics, hospitals – should switch to independent management and fulfill the other requirements to sign an agreement with the National Health Service of Ukraine to receive payments for the actual services rendered to patients under the new healthcare financing model. Otherwise, the reform will not be implemented in their communities.
2. Purchase ICT equipment (computers, etc.). All Ukrainian doctors will switch from paper-and-pen based systems to using laptops or tablets, and there are no alternatives to this process. In 2019, we must ensure that 100% of all Ukrainian primary care physicians and specialists are provided with the necessary ICT equipment.
3. Attracting and retaining healthcare professionals. The Ministry will not force doctors to move to your city, town or village. You should aim to provide attractive conditions for work and life, to equip the workplace, to purchase the necessary equipment. Meanwhile, the NHSU payments will be sufficient to ensure that physicians earn decent salaries.

The last two years have shown us that even the most ambitious changes can be implemented only when everyone understands what needs to be done and is working toward a common goal.

The target for 2019 is to ensure that 80% of the most common health needs of the population, i.e. health needs of each of us, like consultations of a primary care physician, visits to specialists, medical tests and diagnostic procedures, are provided to patients free of charge.

This will form a solid foundation for moving to the last major step – the hospital care reform, which will start in 2020.

Please follow the link to read the original publication in Ukrainian: https://life.pravda.com.ua/columns/2018/10/2/233396/