Ukrainian health reforms must continue

Alexandra Chyczij, National President of the Ukrainian Canadian Congress.

For many years, Ukraine’s health care system was held hostage by over-bureaucratization, corruption and intense political lobbying by pharmaceutical interests. The state routinely overpaid for medicine and drugs; doctors, nurses and health care workers were underpaid; patients were were forced to pay bribes for care and services that were ostensibly free. The result, of course was predictable – a country of 50 million people with one of the lowest life expectancies in Europe.

Recent decisions by the Zelenskyy government – which has seen three different health ministers since the start of the covid-19 crisis in March – threaten to undermine efforts to reform Ukraine’s health care system that were undertaken by the previous government.

In 2016, the first honest efforts to reform Ukraine’s sclerotic health care system began. What was, for a quarter century, an almost completely unreformed Soviet model of health care began to see rapid and essential changes. The health care reform plan developed by then-acting Minister of Health Dr. Ulana Suprun and her team, began to yield results. Now, those changes and the good work accomplished in the past few years are under threat.

The basic principle of the reform plan was to increase incentives for the provision of quality care – “money follows the patient.” Suprun and her team moved quickly to implement changes that addressed the most egregious abuses in the old system. National drug procurement was conducted through international organizations, which brought more transparency and cut out corrupt middle-men – resulting in a marked decrease in prices and quicker access to essential medicines.

A reimbursement system – Dostupni Liky (Affordable Medicine) was introduced, which reimbursed patients taking cardiovascular, diabetes and asthma medication. Ukrainians were given the right to choose their own family doctor – over 25 million have signed a declaration with a family doctor – improving care, rewarding good service and substantially increasing pay for doctors. Western standards for the education of health care practitioners were adopted.

In the second phase of the medical reform plan, healthcare facilities were to receive funding from a newly independent National Health Service of Ukraine, based on the number of patients treated, rather than on the number of beds in the facility. It makes little sense for a healthcare facility with 100 beds that treats 1000 patients a year to receive the same amount of state funding as one with 100 beds that treats 200 patients a year. That was the way the old model worked, the one that Suprun and her team were changing.

With the change in leadership at the Ministry of Health following President Zelenskyy’s election in 2019, these changes, and those that were to follow under the reform plan are under threat. Since the beginning of the Covid-19 pandemic in March, Ukraine has had three Ministers of Health. Both the current (as of this writing) Minister, Maksym Stepanov, and President Zelenskyy, have begun to harshly criticize the reforms brought in between 2016-19. The National Anti-Corruption Bureau is investigating possible corruption in the procurement of PPE.

Concerns have been raised over the lack of transparency and obstruction by Minister Stepanov in the hiring of a new head of the National Health Service. The embassies of Canada, the USA, the UK and the EU have stated publicly that they are closely watching the process for the appointment of a new head of the NHS, and stressed the importance of continuing the health reforms begun by Dr. Suprun.

The Covid-19 pandemic cannot be used as an excuse by the Ukrainian government to stall or roll back health care reforms. If anything, the disarray caused by the pandemic has shown why the reforms need to continue apace.

Ukrainians have the right to a health care system that provides them with competent, compassionate and considerate care. Reform is difficult and requires the expenditure of political capital by political leaders to see them through. For over three years, Dr. Suprun and her team took on vested interests in the pharmaceutical industry, the Ministry’s bureaucracy, and politicians. It is now up to President Zelenskyy, his team, and his government to continue their good work.