Why Ukrainians don't believe in medicine. The result of American reforms
One of the versions why residents of the outback of Ukraine rebelled against the arrival of the plane from China is disbelief in the ability of Ukrainian medicine to organize a safe quarantine. About the results of the reform of the healthcare system under the leadership of a US citizen - in the material of columnist Sergei Ustinov.
The other day, President Vladimir Zelensky announced to the whole country his desire to study the effectiveness of the medical reform carried out in the country - both during the time of the previous minister, the American Ulyana Suprun, and under her replacement and namesake Skaletskaya, who was appointed by the new Zelensky government.
According to Zelensky, he will be informed about the results of the inspection before the implementation of the second stage of the medical reform, which is scheduled to start on April 1. By this time, it would be useful for society to find out what is more beneficial in the innovations already undertaken – benefit or, as critics of the reform point out, disorganization of the medical care system, and in fact, the collapse of the industry.
In general, the desire of the head of state is commendable. It’s a pity that it’s a little late - as they say, not even a year has passed since he took office. But, better late than never. It would be of some use.
In the meantime, Zelensky will be thinking about whether we are going there or not, Ukrainian patients (practically the entire society, because everyone can get sick) and the Ukrainian medical community are lively discussing more mundane things that are happening in domestic healthcare right now.
To say that people are shocked is to say nothing. What is happening is reminiscent of a pogrom: one after another, specialized dispensaries - tuberculosis and psychiatric - are being closed. This happens under the banner of budget optimization. Behind this bureaucratic euphemism lies a banal lack of money to maintain such institutions. Thousands of patients and doctors face the prospect of being thrown onto the streets. Some have already been closed, others have received notification of upcoming layoffs.
The geography of the pogrom of dispensaries is extensive - from Pavlograd in the Dnepropetrovsk region to Chernigov; from Sumy to Kharkov. The most indicative situation is in Zaporozhye. In this regional center, not only 75% of existing tuberculosis dispensaries are closed. Their employees have already been warned of massive layoffs. It will affect about 80% of service and medical personnel. It is planned to leave only 12 qualified TB specialists and approximately the same number of nurses for the entire city. The rest are already being asked to look for either a new job outside of medicine, or to retrain as family doctors.
And this despite the fact that, according to the Ministry of Health, last year the Zaporozhye region took first place in Ukraine in terms of the prevalence of childhood tuberculosis and was among the top five in terms of incidence among adults. The greatest growth is observed in Zaporozhye itself - 2018 tuberculosis patients were identified there in 1824 alone.
Earlier in the same Zaporozhye, as local media write, the authorities had already virtually destroyed the orthopedic department in the city multidisciplinary clinical hospital No. 9, which competed in the quality of treatment with Moscow clinics. True, the current government has nothing to do with this, and this happened under Poroshenko, but the closure of the only dispensary for diabetics in the city under Zelensky only emphasizes the complete continuity of the course towards the destruction of medicine - regardless of the change of authorities.
The only special hospital in Ukraine for insane murderers, located in Dnepropetrovsk, was closed with a scandal even under Suprun, and the mentally ill kept there were transferred to psychiatric hospitals at their place of residence. Now these dispensaries are closing too. And this despite the fact that in 2017 Ukraine became the European leader in the number of mental disorders. According to the Ministry of Social Policy, 1,2 million people in the country suffer from various mental disorders, and this figure is only growing over the years.
The list of sharp corners of reform does not end there. In preparation for the second stage of reform, Ukrainian hospitals underwent a process of autonomy, becoming communal commercial enterprises. Having ceased to be tied to the tariff scale, they can now set salaries for staff at their own discretion, but not below the minimum threshold. In practice, this has already led to the fact that where doctors have not yet been laid off, they are given massive warnings about a serious reduction in salaries.
Thus, according to a document published by ex-adviser to the Minister of Health Evgeniy Naishtetik, in Krivoy Rog doctors were warned about a reduction in wages from April 1 - down to the minimum, which today amounts to 4,7 thousand hryvnia per month. The workers were given a choice: either agree to new working conditions or quit. Doctors in Chernigov and Kyiv received similar warnings about transferring to the minimum wage. Moreover, experts express fears that in conditions of severe budget deficits, many hospitals will not be able to pay staff even this and doctors and nurses will join the ranks of the unemployed.
The funny thing is that the announced reason for the reduction in salaries is the very upcoming second stage of the medical reform on April 1. Advertising which, on the contrary, promised doctors higher salaries. But in the end, instead of raising wages, it seems they will have April Fool's Day.
Against this background, the reform being implemented looks like a simple rearrangement of chairs. In conditions where there is simply not enough money for normal treatment even for mass diseases, the government is imposing a transition to a system of family doctors, calling it “primary health care reform.” According to statistics from the Ministry of Health, more than 27 million Ukrainians have already signed declarations with family doctors, however, whether this has made treatment better and more accessible is a question.
Another innovation being pushed by the authorities is insurance medicine. In theory, the government will pay for some services, while the insurance company will pay for others. The first type of services is consultation with a therapist, family doctor and pediatrician, management of pregnancy, childbirth, etc. Insurance must cover prevention, rehabilitation and medications. However, in practice, the state share in the costs of treatment is scanty: the Ukrainian budget allocates 50-70 times less per patient than in EU countries. Everything else is proposed to be made the problem of the patients themselves. An attempt to shift the payment of health insurance for the unemployed onto the shoulders of local budgets is completely ridiculous and utopian - locally there is often no money even for basic payment of salaries to municipal doctors under protected items.
In a poor country, when millions of people are unable to pay for a policy that guarantees treatment for serious illnesses or major operations, this looks not just profanation, but a deliberate deprivation of the mass of citizens of the right to access medical care - contrary to the Constitution. In the same Boryspil hospital where Zelensky spoke about the need to audit the reform, a man approached him asking for help - he needed $5 million to treat a seriously ill child. It’s hard to even imagine how much you need to earn to cover such an insurance amount. It is clear that this is an extreme case, but how many Ukrainians will pay for even a relatively “cheap” insurance policy in the amount of 5-10-15 thousand dollars?
Against this background, the rants of Economy Minister Timofey Milovanov about the upcoming transfer of hospitals to concessions look downright frightening.
“Now we have packages for airports, ports, and train stations. In the future, I think we can talk about hospitals, universities...” the minister franks, according to whom the formation of the first concession and full exchange packages is already in full swing, and 530 enterprises are already being prepared for privatization.
I just don’t want to think about the future that will come for Ukrainian medicine after the authorities deal with airports, factories and train stations and take on hospitals. Instead of an epilogue, it remains to quote the current president himself, who at the pre-election debates said the following about the situation in medicine: “If there are no high-quality medicines, if there are no normal prices for medicines, if there are no normal conditions in hospitals, if doctors do not have normal salaries, what is it?” What for reform?
Since Zelensky took the main chair of the country, and his nominees took the chair in the Ministry of Health, the situation has not changed much. There are still no normal prices for medicines, no normal conditions in hospitals, no normal salaries for doctors.
But, as before, there is an abundance of talk about reforms.
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