The first results of the new health system legislation

I am happy that the Law of Ukraine “On State Financial Guarantees for Medical Services for the Population” is already in force.

So far, we are only talking about the primary link of the medical system… As I have already stated from the parliamentary rostrum, it will take time for the new financial mechanism to start working. The law will be fully operative – for all types of medical care – starting from 2020. But there are already its first results in the primary link of the medical system.

The “second wave” of conclusion of contracts by the National Health Service of Ukraine (NHSU) with medical institutions of the primary level of various forms of ownership and private family doctors has finished.

As of August 16 of this year, according to the results of the “two waves”, 623 contracts on medical services for the population have been concluded. Of which, 538 with communal non-commercial enterprises (CNCE), 38 with private family doctors and 47 with other private medical institutions.

According to the results of the “second wave”, almost three times more contracts were concluded than during the “first wave”.

Overall, in July, the state paid 255.3 million hryvnias to doctors. In August – 264.6 million hryvnias. That is, in two months the establishment of the primary link of various forms of ownership and individual doctors received more than 500 million hryvnias.

Many institutions received far more public funds under the new financing model than they would have received through medical subsidies.

The good news was that during the “second wave” major cities became more active. The largest number of contracts has been concluded in Lviv, Kharkiv, Sumy, Rivne, Zhytomyr, Ternopil, Chernihiv, Chernivtsi, Ivano-Frankivsk, and so on. Lviv, for example, will receive 17 million hryvnias under the contracts for the provision of medical services to the population.

The NHSU will provide the funding under the contracts concluded during the “second wave” directly to the institutions in October.

Now it is very important to ensure that the management of the CNCE correctly distribute the received funds, because they must understand that these are doctors, not the management, that bring money to the institution. Serfdom is over!

Generally speaking, it is high time to put an end to slavery of doctors organized by chief physicians and health officials.

Now the primary care physicians will have options to choose from:

  • to remain dependent – to go on receiving next to nothing from the chief doctors and feel almost no increase in the financial income;
  • to register as individual entrepreneurs and learn to depend on themselves, to develop a patient-oriented approach, to count their incomes and expenses, to make decisions on hiring medical personnel;
  • to organize group practice when several doctors unite and form an enterprise or other organizational and legal entity;
  • to search for a form of public-private partnership, when the CNCE leases out some premises within a medical institution to private medical business, whereas the latter organizes the work of primary care physicians according to modern management standards, with appropriate furniture, offices, computers, support and services, etc.

This will make it possible for doctors to receive 15-20 thousand hryvnias each, while nurses will be able to receive up to half the salary of a doctor. The manager (executive director) hired by doctors will carry out the management of economic activity while doctors will be engaged exclusively in medical practice. As a result, patients will be able to receive medical services in more comfortable conditions.

That is, this is a win-win for everybody:

doctors will get the opportunity to work in comfortable clinics and receive high wages;

the state will receive the first experience of paying for the medical services provided by hospitals to the citizens;

patients will not have to pay for medical services on their own, but will be able to receive improved services;

medical institutions will have the opportunity to introduce public-private partnerships, in particular, attract investments for the development of the institutions, lease out premises, etc.;

communities will get rid of the obligation to finance the primary link of the medical system;

there will be first examples of public-private partnership in the health care system.

Iryna Sysoienko
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