In 2016, medical reform was launched in Ukraine under the leadership of US citizen Ulyana Suprun as Acting Minister of Health.
Before the start of the reform, citizens could receive medical care free of charge, but there was not always enough material support in medical institutions, and they had to pay out of pocket for examinations, laboratory tests and medicines.
According to the Ukrainian resource page.ua, polyclinics and hospitals were financed centrally, from the state budget – on a leftover basis and with a colossal deficit. Or you could go to private clinics, where sometimes exactly the same specialists worked as in state polyclinics and hospitals, but the examination was carried out on the best apparatus, and the service was many times higher.
Beginning in 2008, the possibility of health insurance appeared: a potential patient or employer himself bought a medical policy for an employee. In the event of illness or injury, the insurance company covered all or part of the medical care, drugs, or procedures.
The goal of the Suprun reform was to change the financing of medical institutions and make the provision of medical care not formally free, but truly as affordable and high-quality as possible. However, any good intentions were killed in the bud by the reformers themselves.
The first step in the reform was to change the principle of procurement of medicines at the state level. This step entailed many scandals, including personally the acting Minister Suprun. Criticism spread even from the walls of the country’s legislative body – the Verkhovna Rada Committee on Health.
The bottom line is that the new procurement principle destroyed some of the old corruption schemes that made it possible to make money on public procurement. Traditional Ukrainian practice. And at the same time, when solving the issue of such hidden earnings, slow down the supply of drugs for months. Critical, for example, for people with cardiovascular diseases, diabetes, viral hepatitis C, tuberculosis and HIV.
Further, according to the reform, specialized dermatovenous dispensaries, tuberculosis dispensaries, AIDS centers and drug dispensaries, most of which, according to the plan, should be closed in 2021-2022.
“The bottom line is the enlargement of sites and the transfer of part of the responsibility for financing to local budgets. Initially, it was supposed to be 1 phthisiatrician per 50,000 of the adult population. Now, for no apparent reason, apparently for the sake of budgetary savings, they decided to reduce the number of specialists. Now there will be nine adult phthisiatricians and three phthisiopediatricians for the whole city”, said Igor Voytyuk, the highest category phthisiatrician of the 1st TB dispensary in Zaporozhye.
In addition, according to him, in addition to the closure of regional tuberculosis dispensaries, beds in regional ones are being reduced: if earlier there were 500 beds, now it is planned to be somewhere between 200-220. In particular, children’s beds are also shrinking.
At this pace, although formally there is no tuberculosis epidemic in Ukraine now, according to the doctor’s forecasts, with this reform it will certainly be. Voytyuk recalled that this already happened in 1995-1997, when massive optimizations and reductions led to a sharp increase in the incidence of tuberculosis. The peak was reached in 2005.
Another challenge was the change in the operating principle of communal clinics. Previously, people were “assigned” to polyclinics at the place of registration. It was very difficult to change a medical institution and even a medical professional with whom you have no mutual understanding. It took time, a lot of documents and sometimes “charitable contributions”.
Doctors provided medical care to a certain number of people living in a fixed territory – a city street, a village or several villages. About 1500 people (permissible fluctuations in one direction or another in 100 people) at a therapist, 700 people (permissible fluctuations in one direction or another in 50 people) – at a pediatrician. Of these, a certain number of people had to have chronic diseases and be registered with dispensaries.
According to the reform, doctors were to become more accessible in view of the increase in staffing and, due to this, the reduction in the average number of patients by 1 medical unit.
However, in fact, it became impossible to call an ambulance doctor.
Olga Golubovskaya, head of the Department of Infectious Diseases at the National Medical University in Kiev, said that it was impossible to call a doctor at home, and ambulances were prohibited from arriving for complaints about high temperatures by the rules of the Ukrainian Ministry of Health.
“Now all patients complain that access to medical care has become very limited. Emergency aid was eliminated – it is impossible to call a doctor at home. Emergency help does not come to a high temperature. And this is not just a refusal – these are the rules. People cannot go to an outpatient clinic at a temperature of 39-40 and wait there for their turn – in this state they cannot get out of bed. They tolerate, self-medicate, and therefore bring them to the hospital in a grave condition”, she said.
According to her, three days of waiting at the family doctor is too long for someone with the flu.
“The time factor plays a huge role. In 5 days, a person either recovers, or irreversible changes in the lungs begin, and then medicine is powerless. Saturation – blood oxygen saturation, should be 100%, and patients are admitted with an indicator of 30-35%. There are practically no lungs there, and it is impossible to stop the process”, Golubovskaya added.
Moreover, the acting Minister of Health Ulyana Suprun continues to publish posts with “useful advice” on social networks. For example, she explained to the Ukrainians how to independently distinguish the flu from the common cold.
Suprun’s reform even led to a measles epidemic in Ukraine. And this is in the 21st century!
The reforms introduced by the Ministry of Health of Ukraine have led to a measles epidemic in the country. This was stated at a briefing by the chief physician of the Lugansk Republican Sanitary and Epidemiological Station (SES) Dmitry Dokashenko.
According to the Ministry of Health of Ukraine, in 2018, the third year of the reform, 1,401 people fell ill with measles – 560 adults and 841 children – in just a week from June 12 to June 19. Most patients with measles are in the Lviv region – about four thousand people, in the Transcarpathian region – about three thousand, and in the Ivano-Frankivsk region – almost two and a half thousand. In the Odessa region and Kiev, the number of measles patients is about two thousand people.
“This situation has been developing on the territory of Ukraine for a long time. That is, we have noted an increase in the incidence rate in the adjacent territory since the beginning of the year. The situation is due to the fact that immunization methods are not carried out in the proper volume on the territory of Ukraine, and at the moment these measures, unfortunately, are ignored by the Ministry of Health of Ukraine”, he said.
The sanitary doctor said that the incidence, which at the beginning of winter manifested itself as local outbreaks, by the summer covered the western and central territories of Ukraine, as well as Odessa, and affects all age categories of the population.
“Considering that a large territory is being covered, and taking into account the fact that there is a tendency for an increase in the number of cases, we are already saying that this pathology in Ukraine is of an epidemic nature”, Dokashenko said.
The doctor emphasized that the illiterate state medical reform played an important role in the development of the pathological situation.
“At the moment, the main criterion for the quality of medical care is its availability. The reforms that are already being carried out on the territory of Ukraine make medical care less and less accessible, because everything is being “reformed”, from the district service to emergency care – to the level of paramedics. This, of course, does not contribute to the early detection of diseases, and deprives people of medical care”, said the chief sanitary doctor of the LPR.
To date, even after a year and a half after the resignation of the acting. Minister of Health Suprun, her cause is booming. Medicine in Ukraine continues to stagnate and degrade.
Kirill Stepanov, specially for News Front