“Need to fix”: first results and prospects of medical reform

“Need to fix”: first results and prospects of medical reform

May 7, 10:29

Vitaly Andronicus

1000 hospitals received more money than last year, 500 less

A month ago launched the second stage of medical reform. However, around the future of reform is still more debate. Vladimir Zelensky has signaled that it is unhappy with what is happening in medicine, and the Minister of health has promised soon to make changes.

What are the first results showed the reform and that can change, out the website Today.

The first results of medical reform

April 1 in Ukraine launched the second stage of health reform. It had to be run in the context of the epidemic of the coronavirus COVID-19. However, already there are first results.


Now the financing of hospitals depend on the diseases that ready to treat in the hospital, and the number of patients who come to the hospital. That is, the more patients choose to be treated in a particular hospital, the more she gets paid. If the hospital has the equipment and specialized doctors that can treat complex diseases, such as strokes, heart attacks, cancer, it also affects the income. Since this is a transitional year medical reform, hospitals still receive guaranteed funding for the base budget over the last year.The work of doctors paid by the national health service of Ukraine according to the calculated rates.

In total, the reform has entered 1600 medical institutions, among them 60 private. For the first month of NCSU paid UAH 5.6 billion.

/ Photo: AFP

“1000 medical institutions received more funding than they received in medical subvention. We pay for the result, we do not pay just for the fact of existence, and for specific services rendered to specific doctor in a specific hospital,” – said acting head of the National health service of Ukraine Oksana Movchan.


For example, the budget of the First Lviv city hospital. Prince Lev amounted to 121,8 million UAH are 78 million UAH more than last year. The hospital receives more due to the fact that providing priority services – early diagnosis of cancer, rehabilitation, palliative care. For these services, NCSU pays doctors at higher rate. The hospital has signed the agreement with NCSU 12 packages of medical services.

And the hospital-the champion of Ukraine, which provides most of the services – Kovel city district territorial medical Association. They signed a contract with NCSU for 22 types of medical care, among them five priorities: medical care during childbirth, care for the newborn, treatment of heart attack and stroke, early diagnosis of cancer. Until the end of the year they will receive 184.4 million UAH is 119 million more than the subsidy in 2019.

Only 1000 of the hospitals received more funding than last year, but 500 health facilities were losers and got less than before. The fact that these hospitals were not ready to provide the services stated.

“We sign contracts with hospitals for the volume of services they can provide. Medical facilities at the time of filing of the contract was filed the amount of services they have provided historically. A factor that played a role – equipping. Program megaranto built around five priorities: heart attacks, strokes, neonatology, childbirth and the diagnosis of cancer. For these services , NCSU pays hospitals at higher rates. Medical facilities that meet the requirements for providing services have the necessary equipment and specialists, received the contracts and additional funding. 1000 medical institutions received more than before in grants. Approximately 500 received less. The main reason why it happened – equipping hospitals. If the hospital claims that it provides certain services, then she should be able to do it. Not all hospitals responded to the basic requirements for the provision of services, which they claimed,” – says Oksana Movchan.

It is important to note that hospitals pay NCSU. However, equipment of municipal hospitals engaged owners of the health facilities and local authorities. Therefore, where local authorities have bought equipment, hired additional doctors, no problems with financing. Preparation for the full launch of medical reform was carried out from 2017.

It is necessary to correct


Recently Vladimir Zelensky said that madrepora need to be corrected. In February, the President assembled a working group of academicians, professors, distinguished physicians who assessed madrepore.

“They, together with the new leadership of the Ministry of health analyzed the situation. The truth is that reform has both big advantages and obvious disadvantages. Our goal is to maintain all positive aspects and it is urgent to correct the mistakes,” said Zelensky.

According to him, the reform can be fired about 50 thousand physicians and closed 332 hospitals in Ukraine. Hundreds of hospitals will receive much less money than last year. Zelensky criticized the tariffs for medical services. According to him, the calculations were supposed to are not economists, and doctors.

“Why tariffs were no specialized doctors, and officials without an in-depth understanding of the process? How could one call an ambulance actually appreciated as much as 75 UAH? Why stroke and heart attack the amount on the paper at least twice less than the actual cost? Under the new arrangement, some hospitals will have enough money except for the door lock and the poster: “We’re closed. Hold on. Good luck.” Regional children’s hospitals will not receive almost UAH 200 million. On the verge of closing – most of the TB hospitals and dispensaries,” said Zelensky.

The President did not mention that the Cabinet and Parliament approves the budget for healthcare. And instead of the 5% of GDP on medical safeguards were then allocated to two times less 72 billion UAH. That is, the tariffs had to fit the allocated amount. “Today” wrote about it in the material: “Money may not be enough: how much to spend on medical reform in 2020“.

/ Photo: Ministry Of Health

The next day the Minister of health , Maxim Stepanov said urgently prepare amendments to the reform.

“The process which started from April 1 (second stage of medical reform – Ed.) it is difficult to call it reform. It does not imply in any way, neither for physicians nor for patients. Moreover, none of the adherents of these processes are not fully aware of the catastrophic consequences that will be felt by Ukrainians”, – he said.

Promised that specialized hospitals would return funding for 2019, and doctors will raise the salary by 50%. Salaries to doctors looking for 11 billion UAH. From June 1 to separate areas add funding. This is primary care, emergency care, acute myocardial infarction, acute cerebral stroke and four packages for treatment of coronavirus disease. And the 2021 Stepanov promised to establish fair tariffs.

Which means doctors will raise wages and will allocate funding to the hospitals which can receive less, the health Ministry did not say. Sources “” in the health care system reported that Stepanov intends to abolish the priority services and contracts with hospitals NCSU to distribute the money evenly among all hospitals.

During the Cabinet meeting on may 6, Prime Minister Denis Shmyhal instructed the Minister of health to understand the issues of health reform, “without stopping madrepora”. Also Shmigal said he plans to direct taxes from the “Naftogaz” for the construction of the reception wards of hospitals throughout the country. It is about 6 billion that will go to the reconstruction 210 of the support of hospitals and purchase of equipment.

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