Two Years in Office

By Dr. Ulana Suprun, Acting Minister of Health of Ukraine, for UP.Zhyttia (the Ukrainska Pravda online resource)

Sept. 5, 2018

For two years now, our team has been carrying out duties at the Ministry of Health of Ukraine.

What does "carrying out duties" mean to us? This means developing a strategy for transforming the outdated Soviet system into effective, modern healthcare, in line with internationally recognized standards, and making progress towards a civilized world. This means that our words always match our actions.

The key to transformation lies in the instilling of healthy lifestyle habits and behaviors among the population, and the development of a modern healthcare system, where each hryvnia is used effectively.

Today, Ukrainians on average live 10 years less than Europeans, and this must be changed.

Your Own Doctor

Healthy lifestyle counseling is one of the tasks of family doctors – who are our main "coaches" on all matters related to health.

We have introduced a simple model based on the world’s best health services, where patients can freely choose own family doctors, general practitioners, or pediatricians, and have unrestricted access to all primary care services included in a clearly defined, state guaranteed benefit package.

We have started paying for the actual medical services provided to patients under agreement with the National Health Service of Ukraine (NHSU), instead of simply maintaining health facilities.

The list of primary care services to be provided to patients free of charge includes treating common diseases and conditions, providing preventive medical examinations for at-risk groups, administering standard medical tests and proper analysis, and issuing prescriptions for medicines, including painkillers. The guaranteed benefit package covers up to 80% of all patients’ health care needs.

The new healthcare model promotes patient education and a conscientious approach to protecting one’s own health, preventing diseases, and receiving early diagnoses.

Since July, the new system has been operating in 161 health facilities in 22 oblasts across Ukraine. As many as 462 health facilities joined the reform during the second wave of signing agreements with the NHSU. The other PHC providers will switch to operating under the new system by the end of the year.

The physicians working at the health facilities contracted by the NHSU have already received noticeably higher salaries. The figures are really encouraging – some PHC providers have tripled the salaries of doctors and medical staff.

So far, 85 private PHC providers have joined the system under the same terms and conditions as state, non-profit enterprises.

It does not matter where patients seek medical help, as long as they receive high quality care. Therefore, free competition promotes higher quality service.

To date, more than 17 million Ukrainians have already chosen their own doctors.

Hospitals

The National Health Service of Ukraine (NHSU) pays hospitals for the actual treatment of ill patients. In fact, the payments cover specific services provided to patients.

The guaranteed benefit package is a clearly defined list of services to be provided to all citizens free of charge. This list will be reviewed and approved annually, by the Parliament as part of the program of state guarantees for healthcare.

The transition model and plan are enshrined in the law: pilot projects will be implemented at the specialized care level in 2019, and in 2020, the entire healthcare system will switch to operating under the new principles.

We have also introduced a new procedure for recruiting healthcare managers, which is based on the principles of an open and transparent competition, with the involvement of the public as members of the selection committees.

Competitions break the historic monopoly and feudal-like appointments of doctors to leading positions.

International Guidelines and Standards

Ukrainians should receive high quality care in line with international standards. Therefore, we have initiated the implementation of internationally recognized diagnosis and treatment protocols.

We have introduced these protocols in Ukraine, and in particular, we have purchased licenses for the 972 Evidence Based Medicine Guidelines, developed by the Finnish Medical Society Duodecim.  The first 150 of which are being translated into Ukrainian for use by doctors.

International protocols provide for the use of safe medicines with proven efficiency and results.

This will prevent prescriptions of so-called "sham medicines" – pseudo-medicines with doubtful or unproven efficiency, which are sold in pharmacies under the guise of safe and effective medicines.

In addition, PHC physicians are now switching to ICPC-2 – the international classification system for coding the reasons for encounter and diagnosis, which focuses on individual patient needs. It will replace the inefficient, Soviet-type statistics collection systems.  In addition, we have already canceled many outdated reporting forms.

Doctors should enter the data into the system just once, and all the statistics will be automatically collected.

In addition, national licenses have been purchased to provide all Ukrainian family doctors, general practitioners, and pediatricians, with access to these tools.

Sufficient Medicines Available

We continue developing effective public procurement through international organizations and agencies.

Transparent tender procedures and direct purchases allowed us to purchase twice as many medicines for certain government programs with the same amount of money as paid in previous years.

This means that Ukrainians now have twice as many medicines as before.

Every third pharmacy in Ukraine participates in the Affordable Medicines National Prescription Medicine Cost Reimbursement Program known simply as "Affordable Medicines”. The program provides for reimbursement of essential medicines for treatment of the most common chronic diseases, which significantly impact life expectancy, and reduce the quality of life, such as cardiovascular diseases, asthma, and diabetes mellitus type 2 (also known as type 2 diabetes).

Since the program launch, 23 million prescriptions have been filled for Ukrainian patients to receive fully or partially reimbursable medicines. Currently, 59 medicines are provided 100% free of charge with proper prescription.

In addition, we have introduced an external reference pricing mechanism, to prevent manufacturers from exceeding the maximum wholesale prices approved at a level not exceeding the price in five neighboring reference countries. This has resulted in up to a 60% price reduction for some medicines.

Today, hospitals nationwide purchase medicines from the National Essential Medicine List (NEML) to satisfy 100% of the priority health care needs of the population. The NEML was developed based on the World Health Organization (WHO) Model List of Essential Medicines. All medicines included in the NEML are to be provided to patients completely free of charge.

Long lists from doctors and black bags full of medicines – that people had to buy before surgery – will now become relics of the past.

Cardiac Care

Cardiovascular diseases constitute the leading cause of premature deaths in Ukraine.

To protect the population, we need an integrated system covering all types of care: from family doctors to emergency bypass surgery and stenting.

Today, Ukrainians are provided with free medicines from cardiovascular diseases under the Affordable Medicines Program.

For the first time in the history of Ukraine, we have covered 100% of the hospitals’ demand for stents for urgent stent placement.

We have purchased 26 angiographs and are developing a network of regional reperfusion centers to ensure 24/7/365 care delivery.

Regional reperfusion centers are located throughout the country in such a way, that a patient can be delivered to the nearest RC within two hours.

The number of emergency stroke and heart attack calls has already decreased by 4% as a result.

Vaccines

After a seven-year vaccine supply failure, Ukraine finally has sufficient vaccines to ensure free vaccination of the population according to recommended immunization schedules.

We are implementing a “catch-up” vaccination program for children who have missed scheduled vaccinations, and we have initiated the vaccination of adults in at-risk groups (including physicians and educators).

We have switched to a new international vaccine volume calculation methodology, developed by WHO and UNICEF.

Henceforth, vaccine procurement will be planned for 3 years in advance, to prevent vaccine shortages due to problems in the global vaccine market.

Education

We have introduced the first changes at the level of admission to a medical specialization field. Prospective medical school applicants must achieve a minimum 150-point score on an external independent evaluation (EIE) test, and the allocated state budget funds now covers tuition for the top applicants, who are admitted to medical schools of their choice.

Starting 2019, all medical school graduates in Ukraine will have to pass the Unified State Qualification Exam, consisting of four components: the Ukrainian integrated exam ‘KROK’ (Step), the English language proficiency test, the International Foundations of Medicine exam (IFOM), and the Objective Structured Practical (clinical) Examination (OSPE or OSCE).

The International Foundations of Medicine exam (IFOM) component will be sent to the United States for evaluation.

The monopoly of academies for postgraduate education has been demolished. Plus, education abroad, participation in seminars, conferences, workshops organized by international organizations and professional associations, and online courses are now recognized as additional professional training formats.

Healthcare professionals can freely choose the training topics and formats they are interested in.

This year, we have developed a new professional licensing concept. Upon graduation from a medical school and/or completing internship or residency, those entering the profession will take an exam to obtain a professional license, which will require continuous training and a renewal every three years. All practicing doctors will also have to pass the licensing exam.

Emergency Medical Services

The new emergency care reform concept has been developed and will be implemented gradually starting next year.

It provides for the introduction of new education standards, the development of an advanced dispatching system, IT infrastructure, and the provision of new equipment.

Emergency crews and medical teams will complete retraining programs developed in accordance with relevant international standards and guidelines.

New positions, and new knowledge and skills, will constitute a prerequisite for higher salaries.

* * *

This whole time we have been trying to improve the basic components of the national healthcare system to achieve a step-by-step transformation from the outdated Soviet system, to a modern model based on the world’s best practices.

As it turns out, carrying out one’s own duties is sufficient to achieve this progress.

Please follow the link to read the original publication in Ukrainian: https://life.pravda.com.ua/columns/2018/09/5/233013/