Low quality of medical services, especially in primary healthcare, obsolete equipment, unmotivated personnel, rampant corruption, inefficient use of budget funds – the list of challenges the reform is facing goes on. Semashko system is obviously unable to revive healthcare in market economy.
Nevertheless, the reform is already underway. Private healthcare market is expanding, new funding mechanisms and expert teams are being formed. Moreover, local reform-related projects are blooming, such as the one in Chuguyev District of Kharkiv Region. After presenting the Concept of Ukrainian healthcare funding reform in February 2016, a new team of reformers at the Ministry of Healthcare started implementing the plan with the aim of changing the model and principles of healthcare funding and laying the groundwork for improving the quality of medical services.
A number of influential politicians connected with the medical community are against such a revolutionary transformation of healthcare. They fear the loss of existing infrastructure and qualified personnel, citing Article 49 of the Constitution of Ukraine that makes it the state’s duty to create favorable conditions for medical services that are readily accessible to all citizens. In addition, the number of public and municipal clinics shall not be reduced, and their services must be provided free of charge.
However, preserving status quo is a road to nowhere, which is why the government, Parliament and active members of the public are discussing options for a new healthcare model that will efficiently gather funds, cover the health-related risks of the populace and allocate them for acquiring medical services. This system can be either insurance-based (i.e. mandatory health insurance) or based on the tax revenue. The idea is to create a brand new approach where the state buys medical services for the patients, thus stimulating infrastructure and competition and providing the true control of the quality of medical services.
Ukraine’s healthcare market is highly promising. Private healthcare has been a success in dentistry, reproductive technologies, psychology, and clinical trials. Insurance medicine is also on the rise. No matter what shape the Ministry of Healthcare picks for the reform, we should expect the emergence of primary healthcare market no later than 2017, and 2018 will see changes in secondary and tertiary specialized healthcare. Therefore investors eyeing this industry should actively prepare for the new game rules.
Special attention must be paid to the primary healthcare reform and preparing the infrastructure for the future competition in the family healthcare. Some highly qualified doctors are already doing well in private practice or starting their own small clinics. That is why, with newfound access to budget funding programs and mandatory health insurance, those who contribute to the creation of medical infrastructure, such as a network of out-patient clinics, will get a strategic advantage over public and municipal clinics that have already discredited themselves.
The government allows investing in public and municipal healthcare within the framework of public-private partnerships. During socialism a large number of specialized hospitals and research institutes were built to provide in-patient treatment and medical research. These institutions take up space and personnel that could be put to good use by private business. So, with the support of local authorities and territorial communities, it is possible to implement some of the PPP models, particularly lease and concession.
Making public and municipal clinics self-sufficient and transforming those into non-commercial enterprises will give rise to more competition in healthcare market. Patients will get more options, which in turn will bring more money, both from the state and the insurance. The smart move is to start preparing for tenders and training actuaries in advance.
Ukraine’s healthcare is in a unique place right now – we are witnessing the birth of a real market. And while the course of the reform is still unknown, it is clear that without a significant rise in private healthcare it will never happen. Patients today are forced to vote with their money to get decent medical treatment. However, after the government changes the approach to the healthcare funding, investors will get a chance to start a business and provide quality medical services using public funds. The changes are just around the corner.
