The medical reform can not be cancelled and the Security Service of Ukraine is seeking to expand its powers

Medical reform: is a patient the source of income?

Even the most skeptic individuals have admitted that the reform could not be cancelled. On that spoke Lilia Olefir, the Executive Director of NGO “Life”.

While presenting a draft of the analytical healthcare brief she listed the main achievements of the medical reform from 2015-2019:

• “Money comes with the patient” system has been introduced;
• Automation of 97% of state-run primary care facilities;
• Public procurement at the national level with the involvement of specialized international organizations: nearly 39% of state-funded funds are saved;
• Formation of the list of purchases for 2020 using the methodology of health technology assessment;
• Implementation of the “Available Medicines” program;
• Implementation of the eHealth system;
• Legislative regulation of transplantation.

Key challenges of reform:

• The financial failure of certain sectors of specialized health care (such as phthisiology), which may lead to a worsening of the population’s access to quality health care;
• Health care budget expenditures increased by UAH 70.4 billion – this growth is more nominal, due to inflation rather than real spending growth.

The key tasks of reform for the period of 2020-2024:

• Completion of the implementation of new financial mechanisms based on the principle of “money comes with the patient”;
• Establishment of an effective emergency medical care system according to international standards;
• Introduction of the country’s own transplant system;
• Complete the development of a public health system, especially in areas such as the prevention of non-infectious diseases

The failure of the reform will replace the principle “money comes with the patient” to the principle of nepotism. This will cause a wave of doctors’ dismissal, as it is impossible to live on minimum wage only, says Igor Pasternak, Chief Medical Officer of the Odessa Regional Medical and Physical Training Center.

The principle “money comes with the patient” must be fully provided for, as in Odesa and in the region some hospitals are half empty while maintaining their full state funding, added Alla Khodak, the head of the Odessa branch of the 100% Life NGO.

Progress in overcoming corruption in the medical field is the introduction of an electronic register of hospital letters. After all, it is difficult to check the authenticity of hospitals if they exist only in paper version. Oksana Velichko, the head of the public-government initiative “Together Against Corruption”, drew attention.

According to the Deputy Head of the Odessa Regional State Administration Vitaly Svichinsky, psychiatry is one of the most non-optimized branches of medicine.

“There is an oversized network of mental health facilities. We plan to combine 4 existing institutions in this area into a single big one,” he says.

And for the financing of specialized medical institutions in Odessa, they demonstrated the Estonian method: while maintaining state funding, they were allowed to make part of the services paid for a certain period for financial stability.

What is harming the anti-corruption reform?

Presenting the draft anti-corruption policy brief, Head of TI Ukraine Legal Department, Kateryna Ryzhenko, described the main achievements of the 2015-2019 corruption prevention reform:

• Launch of the National Anti-Corruption Bureau, the Specialized Anti-Corruption Prosecutor’s Office and the Supreme Anti-Corruption Court;
• Implementation of public procurement through the open electronic system “ProZorro”, which has saved $ 3.4 billion since 2016;
• The abolition of the monopoly of state expert centers for the examination of criminal proceedings;
• Recovering criminal liability of officials for illegal enrichment, which was abolished by the Constitutional Court of Ukraine in February 2019.

The key challenges of reform:

• Registration in the Parliament of Resolution No. 3039 on dismissal of NABU Director Artem Sytnyk, despite the illegality of such actions and the absence of legal grounds for dismissal;
• NABU Audit Delay;
• Lack of reform of the Security Service of Ukraine: it continues to perform its functions that are not inherent to it in the areas of combating corruption and combating economic crimes.

Recommendations for reform for 2020 – 2021:

• Adopt a new law on the audit of NABU and the SAP, as well as improve the procedure for appointing the heads of these bodies;
• Adopt a law for more effective implementation of the ARMA asset management function;
• Deprive the SBU and the National Police of the right to investigate economic crimes.

Not only does the Security Service of Ukraine not reduce its powers, it also tries to extend them: recently, SSU Chairman Ivan Bakanov spoke in support of the return of criminal responsibility for smuggling. Tetyana Shevchuk, an expert from the Center of Corruption Combatting, drew attention to this.

“Instead of fighting corruption, law enforcement continues to control the business,” she says.

Volodymyr Deulin, Director of the Odessa Territorial Directorate of the Bureau drew attention to the extreme burden on NABU’s workforce: there are 22,000 criminal proceedings for 240 detectives. However, there is a good tendency: civil servants become perpetrators of corruption.

But a large number of acts of bribery committed by officials do not fall under the authority of NABU, as their activities are classified by other law enforcement bodies. Public activist Yuri Nikitin says.

According to Oksana Velychko, the most common corruption spheres in the regions are passenger transportation and kindergarten queues.

“Regional Discussion of Reforms: On the Road to Vilnius” was organized by the RPR Coalition in partnership with the Embassy of the Republic of Lithuania in Ukraine with the support of the Ministry of Foreign Affairs of the Republic of Lithuania.