Journalist Contest

The EU Project "Health Financing and Management in Ukraine" has announced a journalist contest on the topic “Healthcare Reform in Ukraine”. Journalists of central, oblast and rayon level television, radio, printed and electronic mass media are invited to participate in the contest.

The contest executive committee is organized. It includes the representatives of the EU Projects “Health Financing and Management in Ukraine”, “Development of Healthcare Standards”, Ukrainian Educational Center of Reforms, “Ekonomichniy Visnyk” TV program, “Vashe Zdorovja” (Your Health) and “Simeyniy Likar +” (Family Doctor Plus).

What topics are accepted for covering by the contest materials:

The journalist contest is conducted in the following nominations:

The contest requirements to the eligible materials:

For this contest, only the materials that were prepared within the period 1 October, 2005 – 31 March, 2006 can be submitted. The deadline for submission of the materials is 10 April, 2006.

The contest materials should be mailed to the address: Київ, 04205, а/с 12
Please, note: the envelope with the submitted materials must be marked as "for the contest".

The materials should be submitted with a brief cover letter. None of the submitted documents are criticized and/or returned. The obligatory information to be submitted: author(s) full name(s), name of the mass medium, date of the publication of broadcast, the issue of the printed medium, a web link for the electronic medium, a VHS or audio cassette for TV and radio, as well as the corresponding sealed broadcast memorandum, contact phones, e-mail, home and work addresses.

The contest final results will be reviewed by the jury. The jury will consist of the prominent journalists from central mass media and specialists from governmental and non-governmental organizations.

The contest results will be announced in May, 2006 on the web-site of the EU Project and through the media of information partners, mass media, etc.

The contest winners will be invited to the official award ceremony to the City of Kyiv in May, 2006.

Training Module for Health Administrators and Managers #4 “Social Health Insurance Implementation in Ukraine”

19 – 20 January 2006 Training Module for Health Administrators and Managers #4 was held under the name Social Health Insurance Implementation in Ukraine

Within the framework of the module the following issues were considered:

The presentation Planning and System Components of Social Health Insurance: Public Coverage and the Package of Services made by Team Leader Dr. A. Malagardis was devoted to the interpretation of main categories of financing, to consideration of advantages and disadvantages of health insurance, planning services packages and separate services. In particular, among basic disadvantages of social health insurance the following ones were mentioned: high administrative expenditures, the problem of control over prices for services and provision of services to farm labourers and the unemployed. The advantages of social health insurance are the stability of profits from services provided, financial allocations to the healthcare system, guarantee of patient’s rights, provision of a higher level of autonomy from government bodies. Financial resources, relevant infrastructure and the quality level of services are required to plan the provision of services packages.

Another important issues tackled by Dr. A. Malagardis were cost assessment, financing and management in the sphere of health insurance. In his opinion social health insurance must be implemented only after assessing expenditures and recognizing their availability – expenditures are the only assessment criteria. The cost of social health insurance depends on those who are covered by insurance, on kinds of health services included and on the cost of different constituent services provided.

In his presentation The Development of Regulatory Basis in the Sphere of Mandatory Health Insurance Implementation in Ukraine: Comparison of Two Conflicting Paradigms Volodymyr Rudyi dwelt upon the following issues:

• what health insurance is
• taxonomy (classification) of health insurance
• comparison of different models of mandatory health insurance and the experience of legislative competitions regarding attempts of its implementation in Ukraine

The speaker compared basic conceptual differences between existing draft laws on mandatory health insurance. He divided existing draft laws into two groups. V. Rudyi referred draft laws oriented towards the model of social insurance to the first group and draft laws oriented towards the model of mandatory civil insurance to the second.

V. Rudyi believes that the model of social health insurance based on the use of a single potent insurance fund must be chosen, when making a political decision regarding the implementation of mandatory health insurance system in Ukraine.

The following issues were discussed in working groups: social insurance or national system? What suits Ukraine the best? What mechanisms suit both systems?

The seminar “Change Management”

On December 13th, 2005 the seminar “Change Management” was held in cooperation with National Academy of Public Administration (NAPA).

In the course of the seminar the following issues were proposed to the consideration of participants:

1. Introducing change in Ukrainian health care system: organizational and normative-legal aspects (A. Malagardis and V. Rudyj)
2. Leadership and management: basic concepts, theories and research. (Maryna Bilynska)
3. Management of change and conflicts: basic concepts, theories and research. (Maryna Bilynska)
4. Multi-professional and inter-organizational teams: development and management of teams. Inter-organizational collaboration: building a coalition for health care. (Solonenko IM)

The 3-rd videoconference session “Economic activity of newly created health enterprises. Relation between the Purchaser and Provider of health services”
Kyiv-Kharkiv-Zhytomyr

On the 7-th of December 2005 the third module “Economic activity of newly created health enterprises. Relation between the Purchaser and Provider of health services” of the distance learning course was held . The videodiscussion was organized between Kyiv Medical Academy of Postgraduate Education named after P. Shupik (KMAPE), Kharkiv Medical Academy of Postgraduate Education (KhMAPE), National Academy of Personnel Administration supported by the President of Ukraine (NAPA), and Zhytomyr Oblast Diagnostic Center.

EU Project “Health Financing and Management in Ukraine” team leader Dr. Antonis Malagardis, deputy team leader Eero Linnakko, Ukrainian Project Director V. Rudiy, prof. O. Mintcer (KMAPE), prof. I. Solonenko (NAPA), prof. O. Serdiuk (HMAPE), representatives of Project Pilots K. Dyakova, O.Gavva, V.Kostuk representatives of healthcare facilities of Zhytomyr and Kharkiv oblasts as well as journalists of “Medichna gazeta” (Kharkiv), “Puls” (Zhytomyr), “Vashe zdorovia” (Kyiv) took part in the videoconference.

The second Task Force Group Meeting

On 2nd of December 2005 the second Task Force Group Meeting was held.

During the meeting the following issues were discussed:

1. Information about 3-d Project Information Campaign results
2. Discussion of cooperation on health reforming, dissemination of Project achievements on final stage of Project implementation (January – May 2006)
3. Contest for journalists - increasing of awareness, professional skills and incentive to active highlighting of health reform issues in Ukraine mass media (organization committee, jury, regulation of contest, awards).

І.Movchan, CURE , V. Polunya, CURE, О.Muhina, TV program „Економічний вісник”, L. Zabrodskiy „СвітЮА” internet magazine, L. Porokhnyak-Ganovska, newspaper/radio program „Сімейний лікар+” V. Movchanjuk, newspaper „Ваше здоров’я” А.Leutina, EU Project “ , L. Batih, EU Project “Health Financing and Management in Ukraine”, N. Louchsheva, EU Project “Health Financing and Management in Ukraine” participated in the second Task Force Group meeting

Training of Healthcare Administrators
Module 2 “Contracting between purchasers and providers”

On 17 – 18 November 2005 Training of Healthcare Administrators Module 2 “Contracting between purchasers and providers” was held in Kyiv.

In the course of the seminar the following presentations were presented:

1. Normative-legal background to contract introduction in Ukraine (V Rudij)
2. Contracting of health services as a mechanism of effective resource allocation and increase quality of services (Yevgeniy Orel)
3. New mechanisms of payment of health care service and indicators of performance to be used for contracting in Ukraine (Antonis Malagardis)
4. EU practice in contracting of health services: The polish experience in primary health care (Zbigniew Krol)
5. Kharkiv Pilot (Oblast level) Role of Oblast Health Department (IT Center) in Contracting Process (Mr. Oleksandr Serdyuk; Mr. Boris Barysenko)
6. Kharkiv Pilot (Zolochiv Rayon level) Introduction of the contract on Zolochiv exqmple (from providers point of view) Mr. Oleksiy Gavva; Mrs. Katerina Diakova
7. Zhytomyr Pilot (Oblast level) Plan of contract introduction from purchasers point of view Mr. Oleksandr Tolstanov; Mrs. Tatiana Uzegova
8. Zhytomyr Pilot (Popilnya Rayon level) Introduction of the contract on Popilnia example (providers point if view) Mr. Valeriy Stanislavchuk; Mr. Vladimir Kostiuk

Practical group work was devoted to issues related to how implement contracts from purchaser’s and Provider’s point of view as well as Pilot experience in contract implementation in Popylnia and Zolochiv was evaluated.

The videoconference session “The Main Directions of Health Reform in Ukraine and Other Countries”
Kyiv- Kharkiv-Zhytomyr

Distance learning entered Ukrainian market of educational services a few years ago, but it already proved to be an effective way of information transfer and sharing ideas.

On the 9th of November, 2005 the EU Project "Health Financing and Management in Ukraine" held a first videoconferencing session “The Main Directions of Health Reform in Ukraine and Other Countries” with participation of Kyiv Medical Academy of Postgraduate Education named after P. Shupik (KMAPE), Kharkiv Medical Academy of Postgraduate Education (KhMAPE), National Academy of Personnel Administration supported by the President of Ukraine (NAPA), and Zhytomyr Oblast Diagnostic Center.

This videoconference launched 12-module distance learning course that is set up within the Project activities. During the 2-hour conference, around 150 persons in total from Kyiv, Kharkiv, and Zhytomyr took part in the video session.

Among them were EU Project "Health Financing and Management in Ukraine" team leader Dr. Antonis Malagardis, deputy team leader Eero Linnakko, Ukrainian Project Director V. Rudiy, prof. O. Mintcer (KMAPE), prof. I. Solonenko (NAPA), prof. O. Serdiuk (HMAPE), expert from Poland Zbigniev Crol, expert from France Philippe Espagnol, chief-doctors of rayon hospitals from Kharkiv and Zhytomyr oblasts.

The speeches of experts were dedicated to issues of autonomy of Healthcare facilities, purchaser provider split, information technologies in healthcare.

Further participants asked their question on topic of videoconference.

Training of Healthcare Administrators
Module 1 “Setting up Autonomous Healthcare Facilities”

On 13-14 October 2005, Module 1 “Setting up Autonomous Healthcare Facilities” of the Training of Healthcare Administrators course was held in Kiev.

In his opening speech, Dr. A. Malagardis presented to the participants of the course the main objectives of the curriculum and topics to be discussed during the course. He stressed the necessity of building up the administrative structure of healthcare system and pointed out to the importance of educational policy in healthcare. The aim of the training is to create such policy.

Mr. S. Khanenko, the Deputy Minister of Health of Ukraine, welcomed the participants of this new training course and said that healthcare reforms in Ukraine are being implemented slowly. In this view, it is very important to use the best international practice and to avoid mistakes made by our neighbours.

Then Dr. Malagardis made his presentation “Strategic Planning Based On Efficient Resource Allocation & Improved Management Requirements In Ukraine”.

Project experts from Poland (Ms. K. Czarniecka), and from Germany (Mr. B. Kaunzinger) made presentations “The EU Practice In Autonomization Of Health Providers”

The issues of setting-up autonomous health care facilities: Legal & Administrative aspects, and IT support were considered in the presentations by Mr. V. Rudiy and Mr. S. Dyachenko.

V. Gryschuk, V. Stanislavchuk, O. Serdjuk, and O. Gavva informed the participants of the 1st module how the Project is being implemented in Zytomyr and Kharkiv Pilot regions.

Conference Training for journalists “How to use funds for health effectively?”.
Kyiv

For the purpose of presentation of methods and tools of contract relations implementation, foundation of autonomous health enterprises, representation of the real experience obtained in Zolochiv rayon of Harkiv oblast and Popilnja rayon of Zhytomyr oblast and for involvement of mass media into more active coverage of healthcare issues, the EU project "Heath Financing and Management in Ukraine" in partnership with Ukrainian Educational Center of Reforms (UECR) hold on October, 6th, 2005 in Kyiv the conference training for journalists “How to use funds for health effectively?"

The conference consisted of three conditional blocks within the framework of which the following issues were considered:

• What percentage of Ukrainian medicine’s needs is financed
• What share of healthcare financing is made up by funds of central and local budgets, patients’ payments for medical services rendered
• Whether medical personnel is interested in reforming the sphere
• Whether the model of the healthcare system reforming is created and what the role of pilot regions in development of this model is
• What the legal bases for reforming the health financing and management sphere are
• How it is possible to control the quali class="plain"ty of health services
• What the advantages of health facili class="plain"ties’ autonomisation are
• Who can act the purchaser and provider of health services
• Which additional financing reserves were discovered by pilot regions in the course of implementation of the healthcare system reform
• The role of mass media in shaping the publi class="plain"c opinion concerning innovations in the healthcare sphere

The first Deputy Minister of Health of Ukraine S.M.Hanenko, the project’s team leader Antonis Malagardis, the Ukrainian director of the project Volodymyr Rudy, experts of the project Lubov Batih and Natalia Luchsheva, as well as over seventy journalists from 26 areas of Ukraine took part in the work of the conference.

Addressing the journalists, Svyatoslav Hanenko emphasized that mass media should act as partners in the common work on the way of carrying out the healthcare reform. He characterized the modern status of Ukrainian domestic and introduced to the audience the further steps of the Ministry of Health concerning the sphere’s reforming.

Conference "Autonomous health facilities and implementing contractual relationship - main components of health reform in Ukraine".

The conference "Autonomous health facilities and implementing contractual relationship - main components of health reform in Ukraine" was held at the hotel "Yalta-Intourist" in Yalta, on September 23rd-25th, 2005.

The aim of the conference was to present concepts, tools and techniques of implementing contractual relationship and establishing autonomous healthcare units, as well as to present specific examples and share the Project pilots experience.

Participants of the conference: Khanenko S.M., Deputy Minister of Health of Ukraine, Pidgorna L.M., Deputy Head of the Division of Healthcare Development, Health Insurance, Licensing, Accreditation and Metrology within the Department of Economy, Finance and Privity, Grygorovitch V.R., Head of the Division of Healthcare Development, Health Insurance, Licensing, Accreditation and Metrology within the Department of Economy, Finance and Privity, Nadutiy K.O., Deputy Head of the Department of Public Healthcare Organization and Development, Pariy V.D., Chief Doctor of the Communal Enterprise "Zhytomir oblast medical clinical and diagnostic centre", Musiy O.S., Head of the Minister of Health of Ukraine's Public Collegium, Tolstanov O.K., Head of Healthcare Administration within Zhytomir oblast state administration, Serdyuk O.I., First Deputy Head of Healthcare Administration within Kharkiv oblast state administration, representatives of all oblast healthcare administrations and representatives from the Pilots of the EU Project "Health Financing and Management in Ukraine", international and local Project experts.

Project Team Leader Dr. Antonis Malagardis made a presentation "Strategic Planning for efficient resource allocation and management of healthcare services in Ukraine". The presentation included the following components:

• Lessons from funding, pooling and insurance abroad;
• Lessons from pilots in Ukraine;
• Elements for a strategic plan: principles and tools;
• A roll-out of pilots as high priority

Ukrainian Project Director Volodymyr Rudiy spoke on the regulatory and administrative aspects of health providers' autonomous status and implementation of contractual relationship in Ukrainian health sector.

He pointed out that the driving force to provide the increase in efficiency of resource allocation and cost control with simultaneous improvement of healthcare services quality is the autonomous status of MCF and implementation of strategic procurement of such services. Absence of the two mentioned components characterizes the command administrative health financing and management model still applied in Ukraine, thus contrasting it to a more transparent, fair and effective contractual health financing and management model applied in healthcare systems in European countries irrespectively of the form of health financing (through general taxation or social health insurance)

The issue of contracting was further considered by assistant professor Eugene Orel (NaUKMA).

In his report he specified the definition of the "contract in healthcare system", parties of the contract, structure of the contract and the system of reimbursement under the terms of contract. Besides, the presenter spoke on implementing contractual relationship in Poland, Estonia, Germany, the Czech Republic, Romania and Russia.

Professor Valeria Lekhan from Dnipropetrovsk State Medical Academy spoke on the new reimbursement mechanisms for healthcare services and environment for their implementation.

Mr. Alexander Serdiuk, Mr. Valentyn Pariy and Mr. Alexander Tolstanov made presentations "Legal framework and decision-making process on the way to reforms" on the Project realization in pilot regions.

Head doctors of CE Popilnya CRH and CE Zolochiv CRH V. Stanislavchuk and О. Gavva shared the experience of establishing autonomous healthcare units and implementing contractual relationship in Popilnya and Zolochiv rayons.

Mr. Eero Linnakko spoke on the issue of cost calculation for health services. The expert defined the notions of cost accounting and financial accounting (book-keeping) and the difference between them. The presenter also explained the process of cost calculation in healthcare.

The necessity to replace the manual paper document processing by electronic document turnover based on the use of computer equipment becomes especially important while implementing the new financial and administrative mechanisms in healthcare units operation. Director General of the company "CIET" Serghiy Dyachenko spoke on the role of informational support for contracting, cost calculation and reporting. He also spoke on the EU Project "Health Financing and Management in Ukraine" activities of developing and implementing automated information systems in the Pilots.

Upon closing of the Conference the participants signed the Declaration, stating the reasons behind the unsatisfactory situation in the healthcare of Ukraine, with the appeal to the President of Ukraine, Verkhovna Rada of Ukraine, Cabinet of Ministers of Ukraine, local executive bodies and local governments to take urgent measures allowing to initiate gradual positive changes in healthcare system and providing for the continuity and irreversibility of the process of changes.

DECLARATION
of participants of the conference
Yalta, September, 23-25, 2005.

We, Heads of Healthcare Departments of Oblast State Administrations, leading experts in issues of healthcare economics, management and financing, having discussed the current status of the healthcare system in Ukraine,

having heard report of experts of the European Union Project "Health Financing and Management in Ukraine" concerning the experience of healthcare systems' reforming in other countries of the European region, regulatory and legal, as well as administrative aspects of healthcare providers' autonomization and implementation of contract relations in the healthcare sector in Ukraine, and reports of representatives of the regions of Ukraine that participate in realization of the EU Project specified for the purpose of practical workout of the new healthcare financing and management technologies about their experience of implementing the specified technologies,

ascertain the following:

1. One of principal causes of the unsatisfactory current status of the healthcare system in Ukraine which, in particular, is characterized by poor quality and decrease of health services' availability for population, the low medical workers' salary level, significant popularity of shadow payment for services in the helthcare sector, etc., is the chronic lack of financing.

2. At the same time, inefficient distribution and use of available resources and expenses' control have not less importance in causing these problems of the healthcare system in Ukraine.

3. Such conditions are preserved and become more and more complicated within the command and administrative model of the sphere's financing and management, absence of precise separation of functions between healthcare purchasers and providers, both of them lacking appropriate incentives to maintain effective utilization of resources and improvement of quality of healthcare services for population.

4. Implementation of managerial strategies oriented towards maintenance of efficient distribution of resources and expenses' control in the healthcare system acquires special importance at the conditions of its scarce financing.

In this connection,

taking into account the values on which healthcare systems in the European region are built, principles of managing the process of their reforming proclaimed in the Ljubljana Charter on reforming healthcare systems in Europe, and strategic Euro-integration objectives of Ukraine,

considering what a great value the World Health Organization, other world and European international organizations attribute to autonomization of health services providers and to implementation of contracting between purchasers and providers of medical services in reforming of healthcare systems, improvement of medical services' quality and rationalization of resources use in this sphere,

setting the target of contributing into initiation of gradual transition from the command and administrative model of health financing and management to more efficient and transparent contract model of the sphere's financing and management focused on actual patients' needs, we appeal to:

1. The President of Ukraine, Verkhovna Rada of Ukraine, the Cabinet of Ministers of Ukraine, local executive authorities and self-government bodies to consider the necessity of increasing the level of administrative and financial autonomy of health facilities and other providers of health services, as well as implementation of contracting between purchasers and providers of health services as the basic strategies on which the further reform of the healthcare system in Ukraine should be based.

2. The Cabinet of Ministers of Ukraine, local councils of all levels, local state administrations within the limits of their appropriate competence and within the framework of the current legislation:

• to provide for optimization of the network of state and communal health facilities for the purpose of its compliance with actual health needs of population;
• to maximally contribute into making appropriate decisions concerning reorganization of health facilities that have the status of budgetary organization into state public and communal non-profit enterprises;
• to provide for implementation of the system of state purchases of health services within the framework of state guarantees for granting free medical care to population using legal opportunities stipulated by the Law of Ukraine "On Procurement of Goods, Works and Services at the Expense of Public Funds";
• to support medical workers who are physical entities and who express their wish to be engaged in private medical practice on the basis of a license received officially under the set procedure and to work under conditions of contracts for state purchase of health services for population's needs in their acquiring appropriate premises, including renting premises of communal health facilities which are not being used by facilities specified;
• to carry out activities concerning maintenance of constant, effective and adequate informing of population about objectives and expected results of the healthcare system reform based on the changes mentioned above;

3. The Cabinet of Ministers of Ukraine, the Ministry of Economy of Ukraine, the Ministry of Finance of Ukraine, the State Treasury of Ukraine and the Ministry of Health of Ukraine, if necessary involving other central and local executive bodies, for the purpose of assistance to maximally quick and effective solution of issues connected with increasing the level of administrative and financial autonomy of public medical facilities and implementation of state contract procurements for medical services, creating conditions for constant improvement of the practice of such state procurements, to as soon as possible provide for activities in:

• development and distribution at the local level of appropriate instructive and methodological materials with explanations concerning conditions and the order of carrying out procedures connected with the change of the economic and legal status of state and communal medical facilities, signing contracts for state procurement of medical services and application of new methods of payment focused on accounting for the volume and quality of medical services suppliers' performance;
• development and approval of sample statutes of state (communal) medical facilities with the status of a public (non-commercial) enterprise;
• development and approval of typical (or sample) contracts for state procurement of medical services within the framework of state guarantees on maintenance of population with free medical care at the levels of primary, in-patient, specialized out-patient and emergency and urgent care;
• acceleration of development and approval of uniform state tariffs for medical services which are subject to procurement for public funds within the framework of state guarantees on maintenance of population with free medical care, as well as the uniform unified methodology of costing medical services;
• more elaborated settlement of the problem of defining the package of state guarantees on maintenance of population with free medical care;
• creation of a uniform medical information space at the national and regional levels and implementation into practical activities of medical facilities and healthcare administrative bodies of appropriate information technologies capable of providing for technical support of their activity within the framework of the new contract financing and management model, as well as to assist to realization of the legitimate right of citizens to access to their personal medical information and data on the public health status.

4. Ministry of Health of Ukraine - to organize training of modern administrative staff capable to provide for realization of the mentioned above transformations within the healthcare system and its management at all levels at new management conditions.

5. Ministry of Health and the State Consumption Standards Committee of Ukraine within the appropriate competence:

• to speed up solution of the issue of development, approval and implementation into practice of the unified state qualifier of medical services (procedures);
• to provide for constant improvement of unified clinical protocols and quality standards for medical services granted for population, taking into account the necessity of using evidence-based medicine principles at that.

6. Verkhovna Rada of Ukraine:

• to bring in respective amendments into the Foundation Law on Healthcare of Ukraine directed at:

а) assistance to rationalization of medical services' use and setting the priority of primary medical and sanitary care and the role of the family doctor / general practitioner in organization of healthcare for population;

b) creation of legal grounds for possible use of the labor agreement contract form at hiring medical staff at state and communal health facilities;

• to bring in respective amendments into the Law of Ukraine "On Enterprises' Profit Taxation" directed at precise and unequivocal settlements of the possibility of recognizing as non-profit organizations of non-commercial enterprises whose primary activity is granting free medical services to population within the framework of contracts for state procurement of the specified services, and attributing incomes of these subjects received owing to granting the specified services to such that are exempted from taxation with the enterprises' profit tax;
• to go back within the shortest terms to the issue of the necessity of consideration and acceptance of the law on social health insurance and its gradual bringing in force;
• for the purpose of providing for the opportunity of more effective pooling of financial resources and risks of population for implementation of social health insurance in Ukraine, to bring changes into the Budgetary Code of Ukraine directed at:

а) pooling of the overwhelming majority of budgetary resources of the healthcare system at the regional level and transferring the function of financing primary and secondary healthcare to jurisdiction of budgets of the Autonomous Republic of the Crimea, oblasts, the cities of Kyiv and Sebastopol;

b) creation of the mechanism of maintaining mutual settlements between local budgets for healthcare provision to citizens who do not permanently reside in the territory at the expense of budgetary funds of which such medical services were provided;

• to speed up processing and approval of the draft law of Ukraine on healthcare organization and medical facilities.

Participants of the conference are convinced that the actions suggested in this Declaration will make it possible to initiate gradual positive changes in the healthcare system, will make the process of these changes actual and irreversible, and will be supported by state government bodies and local self- government bodies, the medical community and the whole Ukrainian society in the name of healthy present and future generations.