Healthcare reform: how will the “secondary link” change?

Yevhen Meshko, Regional Coordinator for Healthcare Reform Support in Zakarpattia Oblast


All attention to the secondary healthcare level is focused on a change in the funding system. Everyone is actively preparing to reach an agreement with the National Health Service of Ukraine. Only fierce conservatives are still pondering whether to carry out autonomisation or not? Will it be cancelled, or will it go on? And this is a completely logical and natural process.

As a reform implementation coordinator of the U-LEAD with Europe Programme, I have had many meetings with healthcare providers, and I see that heads of healthcare facilities expect funding to increase. However, we often forget that profitability and financial efficiency depend on another component – payment (or expenses).

First, will there be much more funds and who will have them?

We're talking about inpatient treatment. The global budget is 60% of the previous subvention (at least in Poltava at the moment). Will it be the same 60%? This will depend on the number of service package agreements that the hospital can enter into (https://nszu.gov.ua/likar-2020).

How to become more effective? Increase funding or optimise spending. The issue is that everyone understands efficiency in their own way.

What is the product of healthcare facilities? The treated case, i.e. a hospitalised patient who has completed treatment (the result is not specified). Therefore, the higher the quality of the treatment, its effectiveness and the shorter its duration, the more successful the institution will be. A striking indicator will be the level of wages at the enterprise – whether they are decent or close to the present ones. Neither the MoH nor the NHS will affect the level of wages within the enterprise, and the remuneration system will be regulated by the collective agreement and financial capacity of the hospital. And of course the development fund as the ability to invest in the right strategic goals.

We have considered the financing, let's focus a bit on the costs.

I will not describe the overmanned staffing structure, a large army of non-medical technical staff, surplus rates of surgeons, obstetricians, neurologists, etc. I will not consider why there are so many of them ... Everyone has their answer.

Of course, in order to know where we are, it is necessary to carry out accounting and cost analysis. One of the top-down methodologies is described in the CMU Resolution No. 1075 dated 27 December 2017 “On Approval of the Methodology for Calculating the Cost of a HealthCare Service”.

In 2017-2018, WHO experts conducted analysis of healthcare facilities of secondary and tertiary level in Poltava, Odesa and Lviv Oblasts.

What can be taken from this data? One should not buy medicines with an unproven base, should identify patients who are not hospitalised and take measures to prevent such cases, control the length of stay in hospital. And the first assistant in this is MIS, which in a few minutes gives verified information on the indicators that interest you. However, this is preceded by a lot of work on its implementation.

So, the MoH and the NHSU will fulfill their promises and commitments, and what will we do at the periphery at this time? Won’t we be puzzled by contracts with the NHS in the middle of the road? Now a window of opportunity pops up that will close quickly. Skillful management, financial analysis, optimisation of structure, personnel and development of logistic processes will yield results. It is only necessary to realise that it is time to improve the quality of medical services and launch the Deming Cycle – plan-do-check-adjust).

The full version is available in Ukrainian – please click HERE

Колонка відображає винятково позицію її автора. За достовірність інформації відповідає автор колонки. Точка зору редакції порталу «Децентралізація» може не збігатися з точкою зору автора колонки.
21.11.2019 - 15:06 | Views: 14535
Author list afe6d31d5a9fd70e79c8a0db94b98a95

Author: Євген Мешко

Tags:

healthcare

Share the news:

Коментарі:

To add comment you should be authorized or sign_in
Read more:

01 March 2021

150 leaders of municipalities take part in the “Steps for Leaders” course organized by the U-LEAD with Europe

150 leaders of municipalities take part in...

Today, on the 1st of March, the U-LEAD with Europe Program is launching a unique project created specifically for...

01 March 2021

Hromada digital transformation: how it is going on in Ukraine

Hromada digital transformation: how it is going...

A panel discussion at the press-centre of the Ukraine Crisis Media Centre was dedicated to peculiarities and...

01 March 2021

The starosta and the hromada head: accountability, subordination and organizational independence

The starosta and the hromada head:...

One of the starosta’s obligations being considered, a few more issues have been raised concerning work relationships...

26 February 2021

98, 5% of facilities have been transferred to the hromada communal ownership – data by the MinRegion

98, 5% of facilities have been transferred to...

The process of transferring property from the rayon level to the hromada communal ownership is underway. According to...

26 February 2021