In June, Ukraine will start an insurance system in primary medicine. And by 2020, the country will fully switch to the new system of financing health care. Compulsory health insurance, has been working since 90-ies in all neighboring countries, except Belarus. However, this model worked not everywhere. In Russia the health insurance exists only in words, but in Poland decided to abandon it. What will the Ministry of health of Ukrainians and how health care is financed in neighboring countries, recognize the site Today.
What is the model of health needs Ukraine
“According to the Constitution Ukrainian the medicine is free. But the state shifts the responsibility on hospitals and local authorities. 95% of Ukrainians buy drugs at their own expense. The availability of medical care is extremely limited, despite the fact that in the country the number of hospitals almost the largest in Europe,” said Alexander Yabchenko, Manager, healthcare group of the Reanimation package of reforms.
In Ukraine until now, the health care works according to the Semashko system. The full dependence of hospitals from state budget introduced in the Soviet Union in the postwar years. The first time the model was effective: the person was assigned to a specific hospital, and was funded by the industry strictly according to plan. However, in the 90s it became clear that the system does not develop the medicine: it is not stimulated to implement new technology and are not motivated by physicians. After the collapse of the USSR in Ukraine, the system is not changed, and all the reforms were limited to the closure of hospitals.
For specialized medical assistance to Ukrainians will have to pay. Photo: A. Boyko, “Segodnya”
According to acting health Minister Uliana Suprun, Ukraine this year will enter a state insurance. The state will put up a list of free medical services. The other will have to pay through the cashier. Since July the country will work to reform primary care – every Ukrainian will have to sign a contract with the family doctor, internist or pediatrician about the provision of medical services. The Ministry of this reform is called the primary insurance. The salary of a doctor will depend on the number of accepted patients. For every Ukrainian the national health service will pay the hospital for 210 hryvnia per year, and the clinic itself will allocate money for salaries or the purchase of new equipment. From 2018 the new system will be medical specialists: cardiologists, ophthalmologists, trauma specialists and others. In 2019, the new system will cover specialized medicine: Institutes of endocrinology, cancer and obstetrics.
The bill on guarantees of provision of medical services in the country, free will be only emergency care, palliative care and primary care. They will get money through public insurance. The rest of the medicine will be partially paid from 2019. The patient will have to pay for part of medical care through cash, part will cover the state. Every year the Ministry of health will establish unified tariffs for medical services. Socially vulnerable layers of the population from the budget will provide targeted assistance.
“Copayments will apply to diagnostic and inpatient care. Emergency assistance will fully cover the budget”, – said Deputy Minister of health Pavlo Kovtonyuk.
In Ukraine will be introduced the British model of public insurance, noted in the Ministry. In the UK the government fully pays for medical services to socially unprotected citizens. The doctors act as hired employees. The state pays doctors for the number of services provided and the qualifications of the doctor. However, this system requires large investments.
The world health organization identifies three basic models of health care: the state, insurance and private. Pure no system anywhere works, but one of them in the state prevails. For example, in U.S. medicine paid, however, for the poor and seniors is a government program.
How does health care in neighbouring countries
In Poland there is mandatory health insurance. Each working pole gives almost a tenth of the salaries in the national health Fund. The Fund enters into with citizens of the Treaty on medical care. The contract gives the right to receive medical care in any public hospital. Each medolago in the country has set the tariff. In Poland is long gone usual the Ukrainians the records of different sorts of papers and illegible notes of the doctors. Medical history and information about the tax on medical care is stored on a plastic chip card. To access information, the patient can online. Poland receives health care assistance from the EU. The money goes for a modern system of heating and energy saving, IT technologies and educational programs for young people.
In Belarus there is no compulsory health insurance and voluntary underdeveloped. The main source of financing for health – contributions of enterprises and not tax from the wages. As in Ukraine, the Belarusian local authorities collect taxes and transfer a portion to the national budget. After consultation with the President and the Parliament, the Ministry of health distributes money to hospitals. Belarusians are guaranteed free medical care, however, a formal co-payment for medicines, dentistry and ophthalmology. The amount of payment the Ministry of health sets.
The EU allocates money to Poland on a new techologie and development of IT in health care. Photo: polpharma.pl
Russia is financing health care from the state budget and by compulsory insurance contributions. All types of medical care free of charge, except the cost of medical materials, medicines, and dentistry. Much of the money the Russians have to pay informally, says the report of the Tacis BISTRO. Due to the low rate of health insurance is 3.6% health care not enough funding. The money is distributed to hospitals opaque and ineffective, and the insurance system does not actually work.
Moldova introduced compulsory health insurance in 2004. Healthcare is financed by employers and the state budget. Hospitals paid for by the national company of health insurance. She concludes with the health facilities of the contract and pays for every assisted patient. Moldovans deduct 3.5% of the salary the medical insurance Fund, an additional 3.5% paid by employers. Contributions in lieu of children, seniors and the disabled makes the state. However, in case of hospitalization insurance only covers 10 days of treatment at the hospital.
Hungary provides health care through contributions to the social insurance Fund. Every employer pays 11% of the salary of the employee, and the employee – 3%. Part of these taxes goes to the national health insurance Fund. The basic principle of insurance is that medical services are provided to the extent required by the patient’s health. In General, medical care is free. However, the cost of drugs the Fund covers partially. Insurance Funds pay hospitals according to the results of activities, not costs.
Whether Ukraine will be able to reform health care
“No countries in the world, which provide everything and all for free. But there are States that fit this balanced, guarantee the population of a specific package of medical care. For these services the country provides specific guarantees and each year analyses the ability of the budget to change something. However, the example of a country cannot be applied to Ukraine. In each state its approach,” notes Zoryana Chernenko, chief experte medical group of the Reanimation package of reforms.
The Ministry of health no reasonable calculations for the introduction of health insurance, she said. The rate for a primary 210 hryvnia does not take into account many aspects of the work of the physician and the hospital: “If to carry out calculations correctly they will be quite different and that everyone understands the doctor. In government there are no calculations of the risks incurred by local budgets and the population,” – added Chernenko.
Neighbouring countries need a long time to work to restore order in health care, she said. However, in Poland and Belarus is the government medicine with calculations and predictions, not dramatically unfolds.
“Russia has already introduced medical insurance, about which we all say. The citizens of this country are not provided with opportunity to receive medical care. In Poland more than 10 years to build a system of insurance and understand that it doesn’t work. The poles have said that next year will abandon the insurance system. Belarus has a completely balanced approach, understanding that health need the money. In 25 years Ukraine allocated for medicine, 30-40% of needs. All neighboring countries have a lot of work. But none of them turned around, except Russia, I guess. Initiatives that we hear from the Ministry, do not belong to the care of the population, they are about how to redistribute the flow of Finance. There are no calculations, as it will improve the lives and health of Ukrainians”, – said the expert.