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A killer without a white coat: What kind of medical reform is being prepared for Ukraine
Views:The Minister of Euthanasia in the Yatsenyuk government, Alexander Kvitashvili, said that Ukraine is not ready to introduce insurance medicine. What are you ready for?
He gave the answer to this question in his first interviews in early December: “This could be insurance medicine, self-financing, paid medicine, where tariffs will be set by the ministry. All three options can exist in parallel. The main thing is that the healthcare system receives more income, and not only from the state. Now in Ukraine the state is the customer, provider and controller of medical services. It is not right".
Let me remind you how the reform took place in Georgia.
The first direction was the actual privatization of hospitals by private investors. Kavitashvili himself talks about attracting private management, but we, from the experience of Privat-controlled Ukrnafta, know what’s what.
Kvitashvili says that the Semashko system left too much infrastructure that needs to be “optimized.” “Optimization” (i.e., the elimination of “extra” beds) should be undertaken by private business.
The formal justification “for suckers” is the abandonment of an excessive number of narrow specialists and a return to the institution of “zemstvo” doctors (they are also “family doctors”, they are also “general practitioners”). In Georgia this direction failed just as in Ukraine. The reason is most likely the level of development of medical science, which is now slightly different from what it was 100 years ago. Bulgakov could afford to be a medical encyclopedist (even if he had a narrow specialization). A modern doctor, even a therapist, is unlikely.
The second direction was the introduction of insurance medicine, which predictably failed in impoverished Georgia - in reality, only large companies and the state could pay for the treatment of people, but for the vast majority of Georgians, insurance remained a formality. By the way, medical insurance in Georgia is provided by private companies, so the headlines in the Ukrainian media that Kavitashvili is not going to create a state insurance company are an “inflated” sensation.
Taking into account his own experience, the new minister draws conclusions.
The first direction in Ukraine remains unchanged. The only difference from Bogatyrev’s medical reform is that it will not be the state that will reduce the network of medical institutions (under the slogan of increasing their number). Which, by the way, will really reduce the corruption component - because the “cheaper” medicine under Yanukovych turned out to be unexpectedly expensive for the country.
By the way, they say that Kvitashvili studied and worked in the USA for a long time. Something tells me that he was not involved in medicine at all (however, he does not have a medical education), otherwise he would have known something about the tough discussion and difficult passage of reforms in the medical care system both under Clinton and under Obama. The basis of this reform was to increase the role of the state and ensure accessibility of medical care...
The second direction remains unchanged in its basis - medicine should not be an institution for ensuring public health, but a way to generate income. Domestic “reformer” Nikolai Polishchuk speaks directly about this - “the medical institution will be interested in making money.” He specifically emphasizes that the doctor, in this case, will be deprived of any rights other than those provided for by the license and/or contract, and they will involve making a profit...
The difference between the Ukrainian version and the Georgian one will be the replacement of the insurance system, which has not justified itself given the low level of income, with a more primitive and effective paid one.
A short historical excursion. Initially, starting from ancient Greece, all medicine was paid. Expensive and inaccessible. Insurance medicine appeared in order to expand the number of people who can afford medical services.
The abandonment of relatively progressive insurance medicine in favor of paid medicine is not just evidence of the degradation of the state, but also allows us to draw a number of structural conclusions. For example, about the state’s orientation towards a completely feudal social stratification (the bill against communist symbols very clearly correlates with the idea of dividing citizens into those who can count on medical care and those who can forget about it). Or that the state no longer needs a qualified and healthy workforce (it’s not for nothing that the new government does not have a Ministry of Industrial Policy, and Kvitashvili’s colleague Abramovichus doubts the need for a Ministry of Economics). By the way, this country doesn’t need soldiers either, no matter what the birches and levus say... We’re crazy!
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