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An interview with Olha Drachevska on topical issues of the medical sphere in Ukraine.

Dmedical sphere in Ukraine медичної галузі

An interview with Olha Drachevska on topical issues of the medical sphere in Ukraine

– The reform of the healthcare system started by the Ministry of Health of Ukraine strives to change completely not only the medical sphere but public thoughts, redefining the perception of medical services as a phenomenon. How far have we moved with its implementation?

– Almost five years ago, Ukraine started a medical reform by passing the Law of Ukraine “On State Financial Guarantees for Public Medical Services” dated 19.10.2017. Unfortunately, within these years, we failed to implement the medical reform fully. There are several reasons: political controversies around the healthcare system’s reform, inadequate state funding, the weak infrastructure of the medical sphere, training human resources, etc. Moreover, the outburst of COVID-19 made its contribution and slowed down the reform. 

In my opinion, the first step of the medical reform started on April 2018, was relatively successful. At that first stage, Ukrainians had to choose a family physician to conclude a respective declaration. The second stage was fairly ambiguous.  Its start was scheduled for the beginning of 2019, with “Free Diagnostics” services for Ukrainians. Unfortunately, it was suspended in favour of equipping hospitals with PCs.

Additionally, a Program of Medical Guarantees (PMG) started on 01.04.2020. Today, it is a key component of medical reform because PMG is associated with a list and scope of medical services and remedies to be paid for a patient from the state budget.

It is worth reminding that an Order by the President of Ukraine No. 369/2021 came into force on 20.08.2021 to enact the Resolution by the National Security and Defense Council (NSDC) of 30.07.2021 “On the National Healthcare System and Urgent Matters to Provide Medical Aid to Ukrainians”. This is the next message to confirm that the state is moving towards reforms. I consider it necessary to proceed with medical reform because it is the only way to ensure a real quality of medical services.

– On January 07, 2022, Law No 1967-ІХ “On Alterations to Some Laws of Ukraine Governing Transplantations of Human Anatomical Materials” came into force. What options does it open and what will change?

– It’s no coincidence that developed countries see organ donation and transplantation as efficient means to preserve national health. Our state is not an exception. Within several recent years, Ukraine has transplanted tens of hearts, hundreds of kidneys, and the first lung and eye cornea.

In 2019, the Verkhovna Rada of Ukraine passed a Law on transplantation to unblock the transplantation of organs. The Parliament legitimized a donor’s lifetime consent. Otherwise, relatives may give such consent after the donor’s death. Moreover, the state has launched a Unified state informational system on transplantations (USIST), containing information on donor-to-recipient compatibility. Law No.1967-ІХ prescribes that USIST shall combine donor-recipient pairs automatically according to specified criteria to eliminate a human factor.

Law No. 1967-IX governs another essential issue, paying transplantation fees. The document stipulates that the state shall pay for all transplantations, making them free for a patient. Within the context of the medical reform in Ukraine, such a decision can be welcome!

– What about another sensitive law project, No. 6475 on assisted reproductive technologies? Could the state regulate the issues of the ART adequately?

– Today, the sphere of ART technologies in Ukraine lacks legal regulation. The governmental law project No.6475 strives to solve this problem. The authors of the project propose to allow the procedure of surrogate motherhood, but only for accredited medical institutions. The document contains an explicit list of requirements for surrogate mothers, including non-disclosure of information on genetic parents and the transfer of the child. Undoubtedly, draft law No. 6475 is extremely sensitive and has already raised questions from experts and the general public. Representatives of the Pan-Ukrainian Council of Churches and Religion Societies have already had a meeting with a speaker of the Verkhovna Rada of Ukraine on this law project. In my opinion, the complete implementation of ART in Ukraine requires reprocessing of the document to consider thoroughly the interests of the state, surrogate mothers, and the responsibilities of biological parents.

– One of the most scandal draft laws talks about the legalization of medical cannabis. Is this the right time for such a document and are there any restrictions?

– This matter has been in the air for a long time. According to international experience, cannabis is applied not only for industrial but also for medical purposes. The so-called Cánnabis satíva or derived chemicals are used in medicine for pain management or treatment of diseases related to the nervous system’s distortions.

I think the implementation of the respective initiative in Ukraine requires strict governmental control of the sales of medical cannabis through strict reporting receipts issued only by special physicians for purchase exclusively from specialized government-controlled drugstores. Moreover, deep research on the effect of medical cannabis on human health and clinical trials is required.

– State government intensively promotes “digitalization”. How correctly does e-Health work?

– Without any exaggerations, the COVID-19 pandemic has fastened the digitalization process. By some estimates, within 2020 and 2021, we managed to fulfil the scope of work that normally requires about five years. And the conservative healthcare sphere accepted digitalization even faster.

Today, Ukraine have several working services to appoint a visit to a physician connected to e-Health. It is a convenient tool to save a patient’s time, collect comments about a physician, to have a personal medical record on a smartphone.

By the way, since 01.10.2021, all medical institutions in Ukraine can issue digital sick lists. An electronic medical conclusion on inability to work is a background for a digital sick list in the Electronic Sick-List Register. Recently, the Ministry of Health announced the launch of e-receipts for antibiotics, one of three stages of the reform relating to medicines. One shouldn’t forget convenient “COVID certificates” and recovery certificates issued in the Diia application.

And the most important thing: working with online services, patients are sure that their personal data relating to health conditions are reliably protected from any unauthorized disclosures.

– Financial support for the Program of Medical Guarantees has risen significantly in 2022. Could they have adequate funding? What patients are entitled to according to the Program of Medical Guarantees?

– No doubts that the budget of the Program of Medical Guarantees has risen significantly in 2022 and makes over 153.3 billion UAH, 33.8 billion more than in 2021. Thanks to it, the Program got extended to 38 packages of medical services, including surgical treatment of adults and children in single-day hospital conditions. Each package means a specific scope of medical aid provided to a patient free of charge. 

Requirements for medical services providers become stricter to increase the quality of medical aid. For instance, the National Health Service of Ukraine shall not enter into agreements with the providers of health services after 30% of transfers. The patients will benefit from the program “Available medicines”, extended with medications against Parkinson’s disease and chronic obstructive pneumonia.

Increased financing of the PMG-2022 will enable physicians to focus on their patients’ requirements and safety. These changes will be beneficial for all: patients will have good medical services, and physicians – adequate remunerations.

– Could we accelerate insurance-associated medicine within the nearest time?

– Today, insurance medicine in Ukraine is developing not as fast, as we would like to. Coming to insurance medicine is an extremely important step in the healthcare of the state. Talking about voluntary medical insurance, we can see it rapidly developing within the corporate sector. In other words, it is the employer, not the government, who bears the financial loading. Speaking about compulsory medical insurance, the Ministry of Health has been trying to change the situation for several years. 

I think that a full-scale implementation of compulsory medical insurance requires the fulfilment of all the stages of medical reform. Having implemented an efficient mechanism of payment for medical services on all levels, having ensured governmental control over their quality, and having created conditions for fair competition in the market of medical services, the government could launch a program of compulsory medical insurance. This process needs more than a couple of years, so today we have to focus on the success of the next stages of medical reform.

– What is the effect of the reform on the well-being of medical staff? Does money follow patients?

– Since April 2020, Ukraine began to implement the principle “money follows a patient”. However, topical remains the matter of providing medical staff with adequate remunerations. Unfortunately, we are witnessing a poor situation with the staff in medicine. The outflow of physicians and nurses from the healthcare system is fastening. Therefore, on 12.01.2022, the Cabinet of Ministers of Ukraine passed Decree No. 2 “Some Matters of Remuneration to Medical Staff of the Healthcare Institutions”, stipulating to increase in the salaries of nurses and physicians. Thereafter, since 01.01.2022, a physician’s salary could not be less than 20 thousand UAH, the same of a nurse – not less than 13.5 thousand UAH. These levels of remuneration are considered in the state budget for 2022.

Our medical experts are the best in the whole world. Especially today, within the pandemic of COVID-19, as they are combatting a vast hazard, saving their patients’ lives and risks with their ones, the state must take care of them. I am sure that our politicians should stop giving empty promises and finally come to work. A state has to ensure adequate financial guarantees and decent funding of medicine!

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