EU HELPS TO REFORM UKRAINIAN HEALTH SYSTEM

There are many suggestions today as to how the Ukrainian health care system needs to be reformed. Such initiatives are put forth by representatives from state authorities, NGOs, professional organizations, and scientific institutions. In their suggestions, they emphasize the necessity to take into account relevant positive international experience, specifically that of EU countries. An optimal way to transfer the experience is immediate participation of European experts in making recommendations on optimization of the Ukrainian health care system operation.
Since late 2003, the European Union has been implementing a project on Health Financing and Management in Ukraine. The key element of the Project is to promote implementation of a compulsory state social health insurance system. The Project deputy manager, Eero Linnakko from Finland, kindly agreed to tell about Project activities and implementation progress.

Eero Linnakko, deputy manager of the EU Project "Health Financing and Management in Ukraine"

Q: Mr. Linnakko, what made the European Union start implementation of the Project in Ukraine?

A: In Europe, there is the following point of view on the organization and operation of health system: medical aid and prevention are the public goods that every member of society is eligible for irrespective of his or her ability to pay. The efficiency of the health system operation, however, is directly dependent on relationships among existing traditions, social values, medical technologists, and the level of economic development of the society. In this respect, we think, Ukraine is the state with quite good prospects, able to make successful use of the European experience in this domain. Many countries, after they implemented a similar Program, have already seen substantial positive developments in there health systems.

Q: Tell us please about the Project objectives and main activities in its implementation.

A: The project is part of the technical assistance from the European Union. Its implementation will involve international and Ukrainian experts in legislation, health care economy, information technologists, and public relations. During its implementation, the project will make use of the positive experience in reforming medical care and health insurance systems that exists in European countries, particularly Germany, the Netherlands, Czech Republic, Poland, and Estonia, where similar technical assistance projects helped to achieve positive results in reforming their national health care systems.

The Project implementation involves experts from Finland, Spain, Sweden, Poland, and Estonia, representatives from international organizations, Ukrainian ministries and other state agencies, and health care and prevention institutions.

The Project objective is to promote efficient and effective financing and management in the health sector, also through establishment of proper conditions for implementation of a state system of social health insurance in the future.

The Project started on December 12, 2003. It is scheduled for two and a half years, and expected to be complete in April 2006. It is envisaged to introduce one of the most important and efficient - as shown by our own experience - tool of health system reform: the institute of social health insurance. Such a system needs to be based on personified contributions from people, which will be accumulated in a special fund. The fund will be intended exclusively to finance medical care of population.

The most important advantage of the health insurance system must be in its transparency. At the same time, it must ensure more adequate identification of the resources required for the health care system operation, and their collection and use in a more efficient way. The implementation of the social health insurance system is expected to improve the quality of medical care, and accordingly, the level of supervision on the part of the state, NGOs, and professional associations over the health sector as a whole and the spending of financial resources in particular. The process of implementing the system requires creation of appropriate legal, economic, and social conditions, and conduct of education activities among relevant public servants, medical workers, and general public to explain the advantages of the new system. The Project activities include analyzing the operation of the current medical care system in order to identify and eliminate its drawbacks, while enhancing and building up on its accomplishments. Under the Project, there will be two pilot projects to implement a local social health insurance system in Popelnya Raion of Zhytomyr Oblast and Zolochiv Raion of Kharkiv Oblast. The Project staff will take part in the development and justification of the contents of a guaranteed medical services package to be provided at the expense of the state or to be paid for from public financial resources.

We can thus single out the following basic components of the Project: assistance in modification of the staff and organization structure of the Ukrainian Health Ministry to ensure favorable conditions for implementation of social medical insurance; development and implementation of two pilot projects to exemplify the effectiveness and efficiency of the world's best practices in social health insurance (this, in the first place, must help reforming the operation of raion hospitals and policlinics); organization of complex trainings for the industry's specialties and managers of health care institutions; and formation of positive public perception of the reform through wide-raging information campaign in the media.

Q: Could you please elaborate on the pilot projects?

A: As I have already mentioned, one of the most important activities under the Project is to practice the implementation of the social health insurance system based on pilot projects in the two regions. The regions were selected by a commission composed of specialists from the Ukrainian Health Ministry and the European Union, who are in charge of the Project implementation. In these political units, the efficiency of new models of medical service provision and health care management principles will be checked in practice. To this end, we will use up-to-date techniques that have already proven their effectiveness in other countries, including those that experienced similar problems in their health care systems until recently. In such a way, we hope to illustrate the expediency of taking into account the accomplishments of this activity under the Project when the corresponding Ukrainian regulatory framework will be developed. So there need to be developed, for the pilot regions, a package of medical services containing a list of what is guaranteed and accessible to all - and this is its advantage. That is, the services on the list will be accessible to every insured individual irrespective of his or her ability to pay. This will become possible because of contributions paid by employees. Medical services to students and children will be also compensated. As for the unemployed, it is planned that money for their treatment will partially come from raion unemployment insurance funds. Pensioners will be able to use treatment and diagnostic services also in part at the expense of pension funds in the pilot regions. It is expected, however, that a local Health Insurance Fund will become the main source for compensation of treatment and diagnostic expenses. The revenues of the fund will include earmarked contributions charged on wages of employees and contributions from state, public, and private organizations. It is planned that the Health Insurance Fund will cover a major portion of the costs of treatment and diagnostic services, additional pays two medical workers, etc.

Q: What other steps are planned within the pilot regions on the way of identifying optimal directions and methods of reforming the Ukrainian health care system?

A: We will carry out an experiment on introducing the practice of signing appropriate contracts between a medical service provider (health care institution) and the Health Insurance Fund. In the future, it is not excluded that this procedure will be based on bidding, which is expected to create an atmosphere of constructive competition among treatment and diagnostic facilities. I would like to note separately the expediency of changing the official status of some city hospitals and policlinics. For example, giving them the status of municipal enterprises must ensure additional incentives for them to carry out their activities, plan, and use financial, human and material resources in a more efficient way. Another important activity will be to promote the practice of signing labor contracts between medical worker and employer.

Q: Mr. Linnakko, is it possible to extend the Project to political units neighboring the pilot ones?

A: Taking into account the short period of time allowed for implementation of the Project, it is yet early to say about its rapid territorial dissemination. In the mean time, however, we are carrying out appropriate training and advisory activities with specialists from neighboring raions and oblasts.

Q: In which way is the Project going to influence adoption of progressive regulations in Ukraine?

A: We are not trying to enforce our point of new on state institutions, all the less so to press them and give them an ultimatum demanding to adopt some or other laws, decrees, or orders. Our mission is to help them introduce a positive health reform experience already developed in other countries, and by implementing pilot projects in the territories of separate political units, create and practice a model that will be expedient for introducing throughout Ukraine.

Q: Mr. Linnakko, do you think the Ukrainian society is ready for introduction of an absolutely new system of medical services in which health insurance must become a basic component?

A: In my view, it will be early to say about any global changes in the conscience of the entire Ukrainian population regarding this issue. However, the fact that the Project has received a comprehensive support from all branches of power in your state is encouraging. And as we know by our experience, every day in Ukraine the number of supporters of this health reform direction steadily grows.

Oleksandr Siroshtan; photo by Yevhen Chorny