Corruption and inefficiency have plagued Ukraine’s health services for more than two decades, but a fresh push for a series of reforms from a new health minister could see an overhaul of the entire system start in 2017.
Led by U.S.-born doctor Ulana Suprun, who took charge as an acting minister in July, the ministry has been introducing the kind of reforms – like switching focus from treatment to preventative medicine, health insurance and drug purchase cost reimbursement – that would see Ukraine switch to a more Western model of care.
New team
Suprun, who grew up in a Ukrainian community in the United States, moved to Kyiv in 2013 with her husband.
When the EuroMaidan Revolution protests broke out, the pair began helping the protesters out with medicine.
Then in 2014, she founded Patriot Deference, a nongovernmental organization providing medical training and first aid kits to Ukrainian soldiers fighting the Russian-separatist forces in the east. It has provided life-saving training to more than 30,000 soldiers and cadets to date.
Earlier this year, Suprun was appointed acting health minister, succeeding Alexander Kvitashvili, who handed in his resignation – which had been rejected several times in parliament – after his healthcare reform bill got stuck in the Rada following loss of support for it from the Bloc of President Petro Poroshenko faction.
Suprun believes Kvitashvili’s plans were scuppered by a lack of cohesion within his own team.
“He wasn’t able to come in with his own team,” she said. “Some of his deputy ministers worked on their own, and there wasn’t a lot of coordination.”
So when Suprun was offered the position of acting minister, she accepted on the condition that she would come in with her own team. Those who go alone into the system get bogged down by it, she says.
Suprun chose four deputy ministers – a trauma surgeon and Patriot Defence medical director Oleksandr Linchevskyy, Dr. Oksana Syvak, who treated protesters during the EuroMaidan revolution, and two people from the Kvitashvili administration – Pavlo Kovtonyuk and Roman Ilyk.
They have been building on the work of Kvitashvili’s team, who had already laid the foundations for their proposed transformation of the health care system, which is planned to begin in 2017.
Preventative care
Among one of the key changes, Suprun’s team plans to significantly expand Ukraine’s preventative care sector, which currently only receives a small portion of funding.
“That’s completely opposite to other countries,” Suprun said. “Most of the money and most of the attention is on preventing disease. And then once you have it, then there’s about 20 percent that has to be spent on treating the illnesses.”
In 2015, a law was passed to establish a Public Health Center, a new state agency that will take charge of all preventative measures, such as monitoring the spread of infections, and vaccination. The center was never actually created, and that’s what Suprun is working on now.
Another of the center’s functions will be to gather proper statistics about public health – something that isn’t done now, Suprun said.
Suprun said that when she asked three departments of the ministry for the number of immunised children in Ukraine, they gave her three different numbers.
“You can’t make an impact unless we know we can follow statistics and see if something has changed. In Ukraine, up until now, most statistics are false,” she said.
Drug policy
From next year, the Ministry of Health is also planning to start conditionally reimbursing patients for the cost of medicine.
According to the ministry, more than 90 percent of medicine is currently purchased by patients themselves.
Furthermore, 60 percent of the medications bought in pharmacies are vitamins or supplements, rather than properly tested and provably effective medicines.
The ministry wants to narrow the number of registered drugs that can be prescribed from more than 1,000 to just 250, the medical effectiveness of which must be recognized by the World Health Organisation.
“That’s going to take a big bite out of the pharmaceutical industry,” Suprun said. “We’re not taking them off the market, (but) we will not be recognising them for prescription. We will not be reimbursing (the costs of) them.”
The ministry plans to start regulating drugs prices, too. A ceiling and a bottom price will be established, and pharmacies will be able to price the medicine in between.
Drugs used to treat the three diseases that affect Ukrainians the most – cardiovascular disease, type two diabetes and asthma – will be reimbursed fully if prescribed by a primary health care physician.
This will mean that the Ukrainians will be spending much less on their medications.
“There is a lot of opposition to it, because the ‘pharma Mafia’ is not happy with those changes,” Suprun said.
The changes have received support from the prime minister, and the Health Ministry plans to bring them into effect from Jan. 1.
Money follows patients
Over the past two-and-a-half decades, more than 20 healthcare reform bills have been introduced to parliament. None of them have ever passed.
So Suprun’s team has taken a different strategy.
“We’re not making another new strategy, another new plan, another new anything,” she said. “We’re taking what everybody has been saying for 10 years – that Ukraine needs to change from the system we have now, where financing goes to pay for walls and heating and the pay of the medical workers, but no money actually goes to patient care at all.”
Currently the money in the healthcare budget is given to regions, who choose how it is allocated. Under the ministry’s plan, the money will instead be placed into a national health insurance fund.
“That money will then follow the patients, and services will then be paid for as the patients go,” Suprun said.
She said it will also help establish quality health insurance.
“We are taking Western medical protocols and translating them into Ukrainian protocols, and Ukrainian physicians will be required to follow those protocols. We will only be reimbursing those doctors that follow the protocols,” Suprun said.
This plan is expected to run from 2017 to 2020, and has recently been backed by Deputy Finance Minister Serhiy Marchenko.
Furthermore, the ministry is planning to streamline the medical licensing process so that healthcare professionals will be required to hold a license, as opposed to simply working for a licensed institution.
“In the end we want universal access of all citizens to quality healthcare,” Suprun said
