The twelfth “Oxford Club” public debate, organized by the Foundation for Effective Governance and the British company Intelligence Squared, has recently been held in Kyiv. This time one of the most burning and unsettled issues — the medical reform in Ukraine — was discussed. The debates were called “Public healthcare is better than private healthcare.” At the very beginning this thesis provoked questions, irony and denial from the debate’s participants and the audience. The goal of the debates, attended by leading Ukrainian specialists in medicine and public health and the British neurosurgeon, Professor Henri Marsh, was to organize a meaningful conversation concerning the development of medicine and to make “the future generations disagree.” The discussion participants were guided by the idea that Ukraine needs healthcare reform since the current system hasn’t been fulfilling its main task, to preserve the nation’s health, for a long time now.
“The current public health system is unable to maintain the nation’s health, which is why Ukraine has to choose if the system should remain state-operated, or if privatized healthcare offers better possibilities for the country,” says the director of Foundation for Effective Governance Natalia Izosimova. “The experience of various countries, for example, of the US and Canada, shows that both private and state systems can work well. However, the situation in Ukraine is paradoxical: de-facto medicine is private and de-jure it is state-run. That is why the government now faces a choice: either to modify the public health system, left after the USSR’s breakdown, or to build the new one.”
THE STATE OF PUBLIC HEALTHCARE
Unfortunately, the government is unable to prevent the deterioration of Ukrainian healthcare and the deplorable tendencies, what with the permanent growth of the worst diseases (cancer, cardiovascular diseases, tuberculosis, AIDS, alcoholism, etc.)
“The tuberculosis epidemic in Ukraine has been progressing since 1995, during the last decade the number of children with cancer has been increasing. We are among the European leaders in cancer detection in its third and fourth stages among adults. I will also tell you that we are among the European leaders in the spread of AIDS in our country,” emphasizes Tetiana Bakhtieieva, MP and Head of the Parliamentary Committee for Public Health.
According to the World Health Organization and the UN, only 55 percent of people in Ukraine are satisfied with the state of their health, whereas in Great Britain the number is 85 percent, 84 percent in France, 72 percent in Poland, 76 percent in Cuba. Also, since 1990 the number of doctors has increased from 44 to 48 per 10,000 inhabitants, yet the quality of medical services and people’s health have not improved: during this period mortality increased from 12 to 16 people per 1,000 inhabitants, and the average life expectancy has decreased from 71 to 68 years.
ADVANTAGES OF STATE MEDICINE
Almost all the debate participants agreed that private and public medicine shouldn’t be opposed. Instead, we have to make them coexist and complete each other without competing. Bakhtieieva opines that now we cannot be proud of either. State medicine is extremely underfinanced whereas the main goal of private medicine is not people’s health but their own enrichment. However, personal gains motivate doctors working in state hospitals, too.
“The permanent lack of money in the Ukrainian healthcare system over many years has resulted in a ‘gray’ economy with unofficial or official payments for medical services,” says the director of the Foundation for Development of Ukraine Anatolii Zabolotny. He thinks that the situation can be improved if the ‘gray’ budget is legalized, and if they stop buying poor-quality and needless medications, and start to reasonably use their equipment. Zabolotny also remarks that when their foundation initiates a medical project (concerning the tuberculosis, cancer, etc.) they choose state hospitals to be their partners. This means something.
State run medicine has its advantages. “None of the private doctors deals with tuberculosis, family medicine or infectious diseases,” says Bakhtieieva.
“One day in a private hospital in Ukraine costs one to four thousand hryvnias,” she adds.
That is why, according to the head of the Parliamentary Committee for Public Health, “only the state is able to provide medical help for all the people, regardless of their social status and income.” Many experts say that low incomes don’t allow people to seek recourse in private medicine.
However, this is only half true. Even children know that free medicine doesn’t exist in Ukraine.
“I’ve been coming to Ukraine for about 20 years now, and conducting neurosurgery here, and I can tell you that there’s no difference between the state-run and private hospitals, since people have to pay everywhere,” says the founder of the International Neurosurgery Center, member of the Royal College of Neurosurgeons in London Henry Marsh. “I have many times encountered that in Ukraine they prescribe expensive but needless medications that don’t give any results. Unfortunately, when we’re ill, we cannot choose what we want and it’s easy to manipulate and exploit us… I think, you should give up the thesis that public healthcare is better than the private one, and think how to combine the two models.”
PROS AND CONS OF PRIVATE MEDICINE
According to the founder and director of the specialized clinic Eurolab Andrii Palchevsky, private medicine is better because it uses innovative technologies, the doctors “open up” more while working and they’re personally responsible for their patients’ health, which is different from the state’s responsibility for people’s health.
The experts agreed that the disadvantage of the private medicine is the possibility to make money from people’s diseases, as the doctors benefit from making people use more expensive medications. The director of Medved Ecohygiene and Toxicology Institute Mykola Prodanchuk thinks that we have to go through this stage.
“In most countries private doesn’t mean profitable. Most of the private clinics ‘live’ on the sponsors’ donations. For example, it’s common in the US. That is why we should introduce this in Ukraine and the government’s task is to provide the conditions,” believes Prodanchuk. Palchevsky who shares this opinion, believes that people should think “what they will do in the third part of their life.” By this he refers to the wealthy people who can invest in hospitals, sponsor various medical programs, etc. At the same time he recalls that several years ago he wanted to create a hospice. But the government didn’t support it.
WAYS TO REFORM
Olha Bohomolets, director of the private clinic Doctor Bohomolets Institute of Dermatology and Cosmetology, professor in dermatology and venereology at the National Medical Institute knows everything about the state of medicine. She suggests separating the concepts of “medicine” and “public health,” and thinks that medicine has to be private and public health has to be state-run.
“The goal of private medicine is profit, the goal of a public health system is a healthy taxpayer. The government has to be interested in this,” says Bohomolets. “However, at present the government doesn’t fulfill its role in preserving the health of people who pay taxes. I think the way to reforms is in the economic sphere. We should start with separating public healthcare from politics: reforms have to continue and the programs have to be financed regardless of the people in power. We should also develop the agro-industrial complex in order to have our own vegetables, fruits, meat and dairy products. High-quality food is a guarantee of health. I travel a lot throughout Ukraine, I talk to people and I see that people are hopeless, they don’t want to live as they don’t see any future in this country.”
Bakhtieieva thinks that the government’s goal is to have fewer diseases, which is why it has to be interested in prevention and efficient treatment, and it also has to provide medical help for each person. She opines that only the introduction of medical insurance can improve investments in the public healthcare system. By the way, according to Prodanchuk, at present the government can subsidize only 20 percent of healthcare’s needs. That is why experts agreed that healthcare reform is a global issue comprising economic, social, political, ecological questions, future doctors training, charity, government responsibility, etc.
However, they’ve already started this reform in Ukraine by launching pilot projects in order to restructure patient care institutions in Donetsk, Vinnytsia and Dnipropetrovsk oblasts. It is still too early to discuss their effectiveness as they are planned for three years. The Deputy Head of the Presidential Administration Iryna Akimova opines that among the positive results expected from this pilot project is the fact that “the reforms have to check the new financial mechanisms for a purposeful and efficient use of budget money, and will encourage medical workers to work better and will restore the status of Ukrainian doctors.” It is planned that if the result of the pilot projects is positive such solutions will be implemented all over Ukraine.
