Medical facilities at all levels will switch to a new funding model for the NHA (National Health Service of Ukraine). And patients will have a clear understanding of what medical services they can get for free under the medical guarantee program. Changes await both the secondary housing and emergency assistance.
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Professional licensing for doctors
A license is a recognition of the state that a physician can engage in his profession. This provides, first of all, protection for licensed doctors: they cannot simply be dismissed, not provided with work, etc. Uliana Suprun said that representatives of the Ministry of Health completed a tour of the country and talked with more than a thousand doctors to create the best option for how exactly this would look.
Advantages for patients: the ability to file complaints against doctors whose work they are unhappy with the licensing board. They will be examined and / or fined by doctors or require additional training, or even be deprived of their license.
An advantage for the state: this is the only way to find out what doctors are, where they work and what they do in order to understand, for example, what specialties are missing. The current register of medical workers is very outdated and many people entered into it no longer work as doctors or occupy three or four positions at the same time.
Medical facilities will switch to a new financing model
They will also have an agreement with the NSZU. As part of the medical guarantee program, services will be paid by the NHA under direct agreements with these medical institutions. Hospitals will become unprofitable enterprises (according to the Commercial Code of Ukraine). That is, they will be able to independently manage their money, draw up a financial plan, form a salary for medical workers and the like.
Hospitals that are not reorganized and do not enter into an agreement with the NHSS will not be able to receive funding from the state budget and will be forced to look for other sources.
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Health Guarantee Program Earned
It will include medical services in 6 areas: primary care, specialized outpatient care, specialized inpatient care, emergency care, palliative care, and rehabilitation.
Hospitals will provide services based on the "money goes after the patient" payment model. At the primary link, it was possible to completely switch to such a model in one year. For specialized assistance, this will not be so fast – the Ministry of Health predicts a transition in two to three years.
For patients, the system is simple: specialized services are divided into two parts – emergency and planned. The cost of the former is fully covered by the NHA (they are part of the medical guarantee program). Emergency care is provided regardless of whether you have a declaration with a family doctor.
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As for planned medical services, there are several important rules for the NHA to pay for them:
Directions are required. They can be obtained from the family doctor, and if necessary, from a specialist doctor. Accordingly, a declaration with a family doctor is necessary. The patient himself chooses a hospital and a specialist from whom he wants to receive a service. It is important to pay attention to whether there is a mark of the NHRI in this institution (and what list of services it covers) – this means that the medical guarantee program works there. Make an appointment online. Getting services at a specified time and from a specific doctor.
The transition to the model will take 2-3 years
If the service was provided poorly or require payment, there is feedback from the NSZU (hotline number: 16-77).
It is worth noting that the program of medical guarantees will not include all services. Medical facilities will have a completely legal right to charge for some of them. First of all, this is what does not apply to the provision of medical care: improved service, improved ward, food and everything that is not related to the treatment itself.
Also, the program does not include services whose receipt is not critical. For example, dentistry (except for children and except for urgent). A full and updated list of such services has not yet been made publicly available by the NHA.
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As for drugs, there are two main things here:
All medicines that are necessary for the service, which is paid by the NHRI and provided according to the national list of medicines, are included in the payment for the service and the patient receives them necessarily. Running to the pharmacy and buying everything yourself is no longer necessary. There are situations when the cost of the service is much lower than the price of the drug. For example, in the treatment of cancer. There are centralized procurement programs for such medicines through international organizations. Medicines are delivered to health facilities and they are also part of the service that is provided.
At the primary link, electronic referrals to doctors and e-sick leave will be fully introduced. They also promise the introduction of e-recipes, e-certificates and the like.
It is also expected that from 2020, institutions that are considered to be "for the elite" clinics will enter the unified medical space. We are talking about "Feofania" (Kiev) and the institutions of the Academy of Medical Sciences – now everyone can be treated here. In addition, private clinics will sign contracts with the NHA.
The Free Diagnostics program is part of the medical guarantees program and was supposed to start in 2019. However, the pilot project was not launched. The Ministry of Health explained this by the fact that both institutions and the NSSU need to take additional actions to do this. Therefore, these services will be provided under general medical guarantees from January 1, 2020.
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"Task" for the new government
The next parliament will have to adopt a law on the state budget, which will provide for state funding so that the obligations that the NHRI will make to patients can be fulfilled. The corresponding project does not need to be done from scratch – it has already been processed by the Ministry of Health and the Ministry of Finance.
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At the same time, local authorities, hospital owners and hospitals themselves must also do "homework" – first of all, it is necessary to complete the reorganization of medical institutions into communal non-profit enterprises so that the institution can conclude an agreement with the NSZU. You also need to computerize your medical institutions enough to conclude an agreement and report on the medical services provided. It is the local authorities that are responsible for the repair of hospitals, the availability of the necessary equipment there and the payment of utilities.
In addition, according to the Deputy Minister of Health Pavel Kovtonyuk, the next government and parliament have the task of protecting things that have already worked and are inherent in the design of the system:
Separating health care financing from politicians and from politics. NHA, an expert and independent body, directly pays for services to medical institutions. In fact, this happens automatically online. There is not a single official between the money and the medical institution that provides it. Transparency provided by the electronic health care system. In the primary link, we can now see the fate of every hryvnia paid by taxpayers. All this should be publicly and in no case transferred to paper and to offices.
Kovtonyuk added: if these principles are preserved, there is no reason why next year we would not see new successes in medicine at the level of hospitals and specialized services.