Olena Goncharova, Special To NP-UN.
On April 1, Ulana Suprun, Ukraine’s former acting Minister of Health of Ukraine, joined the video lecture organized by the Contemporary Ukraine Studies Program at the Canadian Institute of Ukrainian Studies. She presented her views on how the COVID-19 pandemic will impact Ukraine’s fledgling healthcare reforms.
Dr. Suprun, American-born physician, moved to Ukraine in the early days of EuroMaidan Revolution in 2013 and was appointed acting Health Minister three years later. A doctor and chief organizer of the Patriot Defense NGO, which trained 35,000 medics and soldiers in battlefield first aid, she has been one of the few transformative ministers in the Ukrainian government since independence.
When Dr. Suprun joined the government, the situation in healthcare was far from perfect, she admits. But there’s still hope that Ukraine’s healthcare system has a chance to be healed of a chronic disease: endemic corruption.
NP-UN shares the highlights of the lecture.
Problems and solutions
Every year, a non-profit organization Patients of Ukraine together with Renaissance Foundation makes a so-called Health Index of Ukraine and asks patients about how much of the services they had received were paid out of their pocket. The 2016 research shows that at least 56 per cent of the respondents had to pay for doctor’s services and surgery, and a whopping 97 per cent had to dive in their pockets to cover the medicine. “There was no money or medicine being provided at the hospital,” Dr. Suprun said during the video conference, adding that many Ukrainians had to take out their cash savings in order to pay for medical services. “This is not a very healthy way of financing a healthcare system,” she said.
“There was a decree No 33 that regulated the flow of cost to the hospitals and designated a number of staff appointed to these facilities. One of the first things we did when we came to the government, we cancelled this decree,” Supruin said. It raised a wave of criticism and anger; the medical elite was prognosticating that the medical system will collapse. The system didn’t collapse, moreover, it benefited from the fact that the heads of the hospitals and local governments could make choices based on the patients’ needs rather than on paper written in the Ministry 10 years ago.
Surpun also showed a few pictures of Ukrainian hospital facilities as well as its outdated equipment that includes old ventilators from the Soviet times on which the country relies now in its fight with COVID-19.
Dr. Suprun and her team tried to change Ukraine’s healthcare system one step at a time.
In February 2015, the Ministry of Public Health presented a bill on delegating state procurement of drugs to the World Health Organization and UNICEF. Before, the ministry used to procure all drugs for Ukraine’s state hospitals. The job of procurement often went to a handful of companies that could buy drugs abroad and inflate their price through a chain of subsidiaries. The new system caps the final price and delegates much of the procurement to international organizations. Reform backers claim that this made drugs and medical supplies 40 per cent cheaper.
In October 2017, a new law on financial guarantees of healthcare services was signed. “And that’s when the reform began,” Dr. Suprun added. Under the law, the guaranteed package clearly defines which services the patient will be able to get free of charge, which are to be paid partially or in full, and what the tariffs will be. Dr. Suprun said that her team aimed at switching to the model of healthcare financing in which the state clearly guarantees its citizens provision of healthcare services and medicines, as well as implements the guarantees. “It differs from the actual state of play when the patients allegedly have some guarantees but do not actually feel them.“
Under the new healthcare reform, Dr. Suprun created a base for a national insurance system that pays doctors by the number of patients they have. Hospitals are supposed to be paid for services through the new system, rather than receiving lump sums from regional administrations, as was the practice before. It also allows patients to choose their doctor for the first time, rather than being tied to the doctor assigned to the area in which they registered as living.
The new system also introduced a “money-following-the-patient” principle, intended to increase the overall efficiency of the healthcare system, provide patients with better access to treatment, and to introduce standardized pricing for services throughout the country – for both public and private hospitals.
Is Ukraine ready for COVID-19?
Dr. Surpun admitted that “there wasn’t much planning and strategy,” when Ukraine first learned about the virus from the other countries in the beginning of 2020. “At first, they (the ministry) counted how many beds are available. Also, nobody was sure how many ventilators the hospitals have.” According to Ukraine’s chief anesthesiologist, some 6,000 ventilators are in proper order in all the hospitals around the country, home to almost 42 million people. This number includes 3,500 ventilators that are in ICUs.
The other problem that needs to be addressed is lack of trust in government and media. Dr. Suprun noted there was little educational work done on informing society and teaching them where to get reliable information in order to prevent fake news from spreading. Unfortunately, lack of coordination in different ministries also didn’t add to the right response. The first tests to detect the novel virus only came to Ukraine in late February, but first people to get tested were those returning from abroad and lawmakers. The fact that Ukraine has changed three health ministers in the last month, Dr. Suprun said, also doesn’t show a lot of stability in the government.
“The situation with the pandemic now is similar to the beginning of the war (in Ukraine that started in 2014 after Russia annexed Crimean peninsula). The government then wasn’t able to react properly, the military was decimated and there wasn't enough capacity. The people of Ukraine rose up and began to supply their military. Similar things are happening now and when the medical system was decimated for the last 25 years, people stood up to help doctors,” Dr. Suprun said. There are currently 240 hospitals designated in Ukraine for treating COVID-19 patients – they have to be strong, they need all the equipment and tests, she added.
“Those countries, who have tested more and placed timely measures to keep people apart are doing better in terms of the numbers,” she said. “Those are countries like Germany, South Korea, Vietnam.”
Dr. Suprun also added that Ukraine needs to think on how to successfully come out of the quarantine: “When we come back out, we’ll start infecting one another. And we know that the economy can’t handle three, six months or a year under a quarantine. We need to follow the right examples and one of those could be Germany where they plan to test 100,000 young adults who supposedly had the virus and see if they have antibodies (or a self vaccine), then they will have a certificate and could get back to work.”
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