The Ministry of Public Health [of Ukraine. – Ed.] has livened up recently, if one tracks at least the number of documents, declarations and messages sent to the media. Minister of Public Health Oleksandr Anishchenko is now very contented with the laws adopted by the Verkhovna Rada and aimed at the implementation of health care reform. It will be recalled that according to the minister, the pilot oblasts chosen for the experiment [Vinnytsia, Dnipropetrovsk and Donetsk. – Author.] have to accomplish the first part of the reform, namely, the creation of the first-aid stations, by the summer 2012.
“Then we will create the emergency services and hospital districts. After that we will restructure the hospitals. Every hospital district will have an intensive care hospital for the patients with acute diseases. Besides, there will be hospitals for the planned treatment, rehabilitation hospitals and hospices. This model will be tested in 2013 so that in 2014 we could evaluate the results. If it works properly, we will be able to start the health care reform throughout the country in the middle of 2014,” Anishchenko declared.
But how do these grandiose plans correlate with the real life? In fact, there are people who need medical aid every day. If the minister says that the health care reform in Ukraine can be launched only in 2014, it means that for the next three years nothing will change and the reform’s efficiency will remain the same: there is no vaccines for children, gauze and hydrogen peroxide are all that the village clinics have, childbirth costs starts from a thousand dollars, insurance medicine is still a long way off and nothing is for free (with rare exceptions).
However, it is not the point. The most important thing for any patient is a doctor whom they can rely on. According to the International Research Agency IFAK, which carried out the public opinion poll on the Ukrainians’ attitude to the health care in Ukraine ordered by the Bureau of the Economic and Social Technologies, 34 percent of the Ukrainians complain about the doctors’ low skill level. According to the information from the ministry, currently the hospitals are only staffed at 80 percent, and the working retirees make 24.5 percent of the personnel. The government clearly understands that the graduates of the medical universities do not want to work in the public hospitals because of the low salaries and “not-prestigious” status of this job.
Probably, this was the reason for the recent Anishchenko’s declaration about the development of the new pay system for the Ukrainian doctors. The point is that the doctors’ rate will exist along with the system of bonuses for the quality of their work and the number of patients they receive. Besides, the additional payment can exceed the rate. The minister’s press service informs “this will give a possibility not only to raise doctors’ salary but also make them interested in the final result – the patients’ health.” The policy experts are skeptical about this initiative.
“The number of patients will not influence the doctors’ qualification at all. According to the standards, doctors have to receive 10-15 people a day at most, they should have an adequate salary from the government (about 10 thousand hryvnias per month) and they should receive bonuses which they could spend on their professional development. It is necessary, since without permanent self-perfection and professional development doctors will lose their qualification with the years,” thinks dentist Yurii Yakhno. “Good courses do not cost less than a thousand dollars, however, there are a lot provincial courses but they are worthless. As for qualification, unfortunately, our hospitals have only 10-15 percent of the adequate specialists since after graduation doctors are reliable for 5-10 years and not longer. Besides, if a doctor does the same job in a clinic for, say, five years, their specialization narrows and it is unreal to make them retrain. The fact that in our country they started “mass-producing” fa-mily doctors with a stroke of the pen means only that quality of medical care is dramatically falling. Most of the people are sent to the mediocre doctors that provide the minimal services of the lowest level since none of the therapists can be a gynecologist or a pediatrician. The system should be built from the very beginning instead of retraining those who cannot be retrained. I think that we should have a limited number of vacancies and tenders, but in our country everything is done through bribing.”
The doctors who respect themselves are unlikely to compete for patients. The information about a good specialist is spread by word of mouth (the same goes for a bad specialist). We are used to calling all our friends when we need to find a good specialist. Probably, this is the reason why nearly 70 percent of the Ukrainians are dissatisfied with the health care system (62 percent of citizens and 71 percent of villagers).
According to the former assistant director of the Dnipropetrovsk oblast sanitary-and-epidemiologic station, now deputy head of the Ukrainian National Party Anatolii Sokorynsky, this part of the reform, namely, the linkage between bonuses and the number of patients is intended to “declare that they carry out some reforms.”
“It reminds me of the former socialist emulation. Back then we used to have the assessment of the doctors’ work. However, it has been known for ages that people come to good doctors themselves. People should have a possibility to choose a doctor who would meet their needs and who is a physician by vocation. How do they want to assess the doctors’ work? If they want to access the patients’ health, it does not depend on doctors’ work but on the whole of the social sphere, living standards, and food in particular, job and everything people need. I do not think that it is something new in the medicine and that it will contribute to the health care improvement and will increase doctors’ incomes. I my opinion, doctors should be paid good salaries. If doctors earn 1,000 or 1,200 hryvnias, they will not work honestly and selflessly for this money. As a doctor, I think that today my colleagues just survive. When the government hastily launches pilot project in the Dnipropetrovsk oblast and other regions, when they retrain elderly physicians trying to make family doctors out of them, it just does not stand up to criticism. It discriminates everyone,” says Sokorynsky.
Tme will show what the patients will get from the implementation of this bonus-patient system. If it does not influence the qualification of medical personnel, maybe it will at least change their attitude to patients from the indifferent to interested one. Today, 34 percent of Ukrainians are dissatisfied not only with doctors’ low qualification but also with the “indifferent attitude of the medical personnel.”
