Europe Day in Kiev

On 14 May 2005, the Project took part in Europe Day celebration. The European village was organized on Khreschatik street. Each tent represented a separate state-member of EU or EU project being implemented in Ukraine. The EU Project "Health Financing and Management" shared a tent with other EU Projects working in healthcare sector in Ukraine.

The information about the Projects was represented with printed materials: newspaper "Family doctor +" (issues N 1 and N 2), project information brochure, pocket calendars.

Pilot region representatives (Katerina Dyakova, the Deputy Head of Healthcare Department of Zolochiv RSA, Inna Pogorila , "Slobidsky kray" newspaper, Volodimyr Kostiuk, Head of Popilnya Rayon Healthcare Department, Viktor Svinarenko, Deputy Chief Doctor of Popylnya Rayon Hospital, Emma Budnyk, "Puls" newspaper) took part in the event. During the day, the Pilot representatives talked with guests of the village, gave interviews to journalists.

The Joint EU Projects' Seminar

Round Table Discussion Healthcare Reform: Where and How to Begin

On 28th of October 2004 a round table discussion "Healthcare Reform: Where and How to Begin" took place within XIII International Specialized Exhibition "Health Care 2004". Its organizers were the Ministry of Health of Ukraine, the EU Project "Health Financing and Management in Ukraine", the EU Project "Preventive and Primary Healthcare in Ukraine, Kyiv, and Selected Regions".

The purpose of the discussion was to find out how far the healthcare reform had moved ahead, to join the efforts of all those dealing with healthcare reform, and to begin constructive cooperation between different ministries and institutions to implement the healthcare reform more rapidly.

The following issues were discussed:

1. Accessible and quality medical aid - today's urgent demand
2. The Ministry of Health - Reform Strategy
3. The Law on Mandatory State Social Health Insurance - What Will It Bring and What Can be Done Without It
4. The Components of the Reform: Efficiency Boost of the Available Financial and Managerial Resources
5. Obstacles on the Way to Healthcare Reform
6. What Will the Healthcare Reform Give to Patients, Doctors, and the State?

Volodymyr Zagorodniy, the Deputy Minister of Healthcare, Lyudmila Pidgorna, the Head of the department of healthcare insurance regulatory provision, Vasyl Mihkalchuk, the Head of Primary Healthcare Administration, Vitaliy Chernenko, the Head of the Secretariat of the Verkhovna Rada Committee on Healthcare, Maternity and Childhood, Olexandr Serdyuk, the First Deputy Head of Kharkiv Oblast Healthcare Administration, Volodymyr Golovakov, the First Deputy Head pf Zhytomyr Healthcare Administration, the representatives of the World Bank, the Central Committee of the Healthcare Union, local authorities, research institutes (Valeria Lekhan, Dnipropetrovsk State Medical Academy, Nina Goida, Kyiv Medical Academy of Post-Graduate Education, Borys Rogozhyn, Khrakiv Medical Academy of Post-Graduate Education) took part in the round table discussion.

Starting the discussion Volodymyr Rudiy, the Ukrainian Director of the EU Project "Health Financing and Management in Ukraine", admitted that receiving quality health care is the right of every citizen in every civilized country. However, the lack of funds, their irrational utilization and absence of political liberty at the level of local authorities hinder this process.

Volodymyr Zagorodniy, the Deputy Minister of Health, confirmed that regulatory base allows carrying out healthcare reform and guaranteeing quality health care. The final stage of the healthcare regulatory base reform has already begun which will result in the adoption of the Law on Mandatory State Social Health Insurance. The Law on Healthcare Facility, Draft Law on Protection of Patient's Rights and the Law on Self-management of Medical Associations have been registered in the Verkhovna Rada which speaks for active preparation of legislative ground for effective reform implementation.

Lyudmila Kazarina, the Head of the Healthcare Union Central Committee, commented that healthcare quality would be adequate only if doctors were morally and materially interested in results of their work.

Touching the issue what the Law on Mandatory State Social Health Insurance would give and what could be done without it, V. Rudiy admitted that today's contracting, change of healthcare facilities' status would become that practical basis providing effective reform implementation.

The participants of the round table discussion noted that medical community was not informed well enough as to the advantages of mandatory state social health insurance and that is why there was no unanimity concerning the issue. Thus, there is a question regarding training of specialists in the field of health economy.

In conclusion, the participants of the round table approved the resolution of their discussion.

Resolution

We, the participants of the Round Table discussion entitled "Healthcare Reform: Where and How to Begin" that was held within the framework of ХШ International Specialized Exhibition "Health Care 2004" - the representatives of the Ministry of Health, international, Ukrainian and regional public organizations, scientific societies and business organizations working in healthcare reform in Ukraine, make the following statement:

1. The existence of a disbalance in accessibility and quality of health services provided to different social categories of population causes a certain social tension in Ukraine.
2. The healthcare reform has already begun with the restructuring of primary care on the family health care basis. The reform is currently characterized by slow pace and inconsistency, and it mostly depends on positions taken by local authorities, as well as initiatives and technical assistance from the part of the EU projects and other donors of the Ministry of Health of Ukraine.
3. There are no systemic economic and legal mechanisms for a broad reformation of the field. There is discrepancy in the activities of different Ministries and departments. It results in discrimination of private doctors and private healthcare units, which have no right to issue patient documents like patient's record book, prescriptions for some pharmaceuticals, sick-leave certificates, etc., which is the violation of patients' right for a free choice of doctors.
4. The current legislation in Ukraine allows for the launching of the reform but does not provide consistency of conducted changes. The Ministry of Health of Ukraine does not possess the sufficient legal and economic mechanisms for a wide-scale reform in the field.
5. Healthcare community is not an active participant of the reform due to the absence of ethical and financial incentives, as well as their poor awareness of the trends in the healthcare reform.

We make the following propositions:

1. Create the Healthcare Regulatory Council under the supervision of the Cabinet of Ministers of Ukraine.
2. Improve the health personnel training system, introduce a training system for training managers for healthcare, economists and analysts of the field.
3. Develop and introduce new financing methodology and mechanisms of contracting for health services in order to increase the efficiency of resource utilization in healthcare.
4. Practice systematic public discussion of health reform issues to develop a unified and transparent social strategy of the reform, which should be clear for the Ukrainian public.
5. Introduce changes to the corresponding legislative documents in order to overcome the discrimination of health personnel and private health facilities.

On June, 15 2004 Verhovna Rada rejected draft law #4505 "On Mandatory State Social Health Insurance".

The MP Lilya Grygorovich, a co-author of the draft law, mentioned in her speech that the suggested draft law would provide the opportunity of making medical assistance accessible, would define the list of medical services.

Vasil Hara, the Head of the Committee in social policy and labor, expressed his support for approval of the draft law, having emphasized that problems in the system of public health of Ukraine are among the most poignant social problems. The law "On Mandatory State Social Health Insurance" will help to solve these problems. The speaker noted that experience of European countries testifies for the benefit of the model of mandatory social insurance, since it provides a high quality of medical services and the appropriate level of observance of social guarantees in the sphere of public health.

The Head of the Committee in issues of healthcare, motherhood and the childhood Mykola Polіshchuk also urged to support the draft law. In the course of the discussion, MPs agreed with the idea of the draft law, recognizing the necessity of changes in the medical sphere. However, it was stated that the above mentioned draft law requires revision, in particular they expressed their caution concerning creation and functioning of the health insurance fund.