The Ministry of Health of Ukraine presented the plan for the implementation of primary health care reform for 2017. It includes nine major aspects of work providing for the development and approval of regulatory documents and practical steps. The transition to the "money follows a patient" principle will start in spring. It was informed so by Pavlo Kovtonyuk, Deputy Minister of Health of Ukraine, during the press briefing at the Ukraine Crisis Media Centre.
The aspects of work include the development of regulatory framework for launching the new model, the independence of publicly funded health care institutions, which independence provides for entering into service agreements with them; the establishment of a sole national consumer of health care services - the National Health Service who will order services, enter into agreements, and pay for each particular patient; the establishment of a uniform electronic health information exchange system. Also, it includes the preparation for the transition to a new funding model of the secondary and tertiary health care: the establishment of hospital districts, calculation of service cost. Other aspects include the review of clinical protocols for the most common medical circumstances and the simplification of requirements as to the paper-and-pencil reporting; the introduction of a national system of medicines reimbursement for a determined list of medical circumstances, and the reference pricing.
What changes will take place in the legislation
The first innovation is the possibility of entering into direct agreements with all types of health care institutions providing primary care. "As of today, it is possible to do so with primary care centres only. We want that it could be done with ambulance stations, private practices - all health care institutions in a community. The community should have the opportunity to independently form its network," Pavlo Kovtonyuk noted. The second innovation is the opportunity for paediatricians to provide primary care. "We declared that we saw three specialities at the primary level - the family physician, paediatrician, and general practitioner. We do not want to raise any artificial barriers: if people select them, they should have such an opportunity", the Deputy Minister explained.
We have developed a package of subordinate acts - the agreement on the selection of a physician, the agreement between a primary care institution and the state on the delivery of health care, as well as the detailed guaranteed health care package, the procedure for medical assistance, and proposed tariffs. "The document deals both with the general functions of the primary level physician - prevention, treatment of main medical conditions in accordance with protocols, and the specifics - for instance, a list of estimations pertaining to the primary care, screening procedures - specifically described preventive examinations. It also contains requirements as to the equipment of an institution," Pavlo Kovtonyuk noted.
On 8-9 February, all draft documents will be discussed with the expert community and regions. After that, they will be submitted to the Cabinet of Ministers and the Verkhovna Rada (Parliament) of Ukraine for approval.
How much the physician will earn
The wage of a physician will not be fixed, it will depend on the number of his or her patients and the tariff determined for certain categories of patients. "There is a recommended number - two thousand patients. It may differ, depending on the circumstances, since it is not physically possible everywhere. And the physician may not say 'no' to the patient when he or she comes to the physician", the Deputy Minister noted.
The tariffs will depend on the age of the patient. "210 Hryvnias is the average tariff. It will be twice as much for a small child aged up to five years and a person of 65+. There will be also intermediate tariffs - for children at the age of five to 18, and so on", Pavlo Kovtonyuk said. In a month, that tariff scale will be published. Starting from the next year, the possibility of the introduction of other rates will be considered - for patients with chronic diseases, etc.
The model of allocation of funds among the physicians within institutions will be determined by the management of the specific health care institution, however, the physician will have the opportunity to choose where to work. Thus, the managers of institutions and the local community will be interested in offering better terms to physicians.
For which purpose the uniform electronic register is needed
It will be a uniform electronic health information exchange system to which the data on all patients will be entered, and the funds will be distributed accordingly. "The uniform register of patients is the mechanism which will allow us not having a patient registered at three locations. When the patient goes to a new physician and is registered there, the previous entry shall be cancelled, therefore, this should be done in a responsible manner", the Deputy Minister explained. He added that the register would not extend to cases when a person needs emergency care. Pavlo Kovtonyuk noted that the overwhelming majority of software programmes currently available in the market will be suitable to work with the register.
For which purpose the hospital districts are needed
"In Ukraine, it is not infrequent that there is a hospital, but the service is unavailable: you are taken there, but they are unable to do anything for you there. Hospital districts are introduced in order that the service is closer to the individual", Pavlo Kovtonyuk explained. The councils of hospital districts will have to design a network of institutions which will ensure an optimal route for the patients of such hospital district and their access to all services. One of the requirements as to the establishment of districts is that a person should be able to reach a primary care physician within one hour.
When the new system will start to operate
"Before spring, we will have approved all documents required for the new system to operate. This system will start to operate in spring in those regions which become ready sooner, and in summer, in those moving slower. From 2018, in all regions without fail", Pavlo Kovtonyuk informed. The main readiness evaluation criteria are the awareness of patients and physicians, smooth dealing with the electronic register, and readiness of the institutions to enter into legal agreements.
Please find the plans of the Ministry of Health of Ukraine regarding changes in the health care system for 2017 HERE
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