Medical reform harmful to both doctors and patients


   Yevhen Zakharov writes that the government began the first stage of medical reforms with a pilot scheme in the Vinnytsa, Dnipropetrovsk, Donetsk regions and in Kyiv, this being set out in a Law from 7 July 2011. Another law making amendments to base legislation was adopted on 7 November last year.

The author echoes other critics of the reforms in saying that the changes have had the opposite effect of that declared.

The changes introduce five levels of medical care: primary – general practice doctors; family doctor in primary healthcare outpatient centres; secondary – treatment by narrow profile specialists in consultative-diagnostic centres; third – treatment of complex diseases in highly-specialized establishments; emergency – where there is a risk to life;  palliative.

The first four should be brought in stage by stage from 2012, while palliative care would be from 1 January 2015.

The author notes that according to the new system it is unclear how patients could exercise their basic right to a free choice of doctor and medical establishment.

The outpatient family doctors will do most of what has up till now been done in clinics.  Such centres will need to be opened in each district of a city or region [oblast]. In Kharkiv there should be one such centre for 2.5 thousand residents.

The author points out that the new network is linked with the number of people, but fails to take into account the condition of roads and public transport.  This means that especially in rural areas the declared timeframe for emergency care or transporting a person to an emergency clinic of 10 to 20 minutes is quite unrealistic.

The primary healthcare centres in the pilot scheme areas, especially in rural areas, are located without consideration for whether people, especially the elderly, can get to them.  This is a major problem with all levels of care.

At present the primary care centres in the pilot regions do not have the number  of general practice doctors nor equipment for diagnosing and treatment the most widespread illnesses, etc.

The author suggests that the reformers seem to have forgotten to find a replacement for an established system of medical services provided at home and providing district clinics according to people’s place of residence with prescription drugs etc. Nor has the issue of licensing such medicines etc been set out.

There is a catastrophic lack of family doctors. The author notes that the idea is fundamentally flawed that people can change their specialization in a mere 6 months, losing pay while doing so, since the changes will cancel out the previous qualification category.

The ambulance system is also to be reformed with emergency and critical services, with the latter being run from a single centre in Kyiv.  It is unclear how this can be called.

The author writes that the public are protesting on a wide scale at the closure of hospitals and clines.

All city medical establishments providing secondary and tertiary care are to be transferred to the budget of the region, with all of them already now supposed to be organizing contracts for medical services with the relevant body distributing funding.  This, the author says, looks like an attempt to shift responsibility for funding onto local bodies and indicates the real aim of the “reform” – to reduce spending on medicine by reducing the number of beds in hospitals and number of specialist doctors. This is when there are already large shortages of doctors with the average ration being 26.9 per 10 thousand head of population, whereas the average European rate is 33 per 10 thousand.

This, the author says, is as well as the fact that the laws passed do not comply with the Constitution or a number of legislative acts.

Yevhen Zakharov says that there is total lack of information regarding the aim and content of the pilot scheme and the reforms as a whole, lack of feedback and dialogue with the medical workers’ trade unions and members of the public. Professionals in the field and trade unions are highly sceptical of the cases if not accompanied by increases in spending. Activists from NGOs point to a tangible deterioration in access to medical services in the pilot regions, especially in rural areas.

There is widespread protest over closure of medical establishments. In the Donetsk region signatures are being collected to a petition.  One city council has refused to introduce the reforms and there have been protests in other places. In Kirovske they were planning to close the only city hospital, despite the fact that the nearest was 25 kilometres away and the hospital serves a city of 30 thousand. Similar protests have been held in a number of other places and so far no medical establishments have been closed. And yet the government is still persisting with its “reform” which the author says simply must be stopped.

From an article by Yevhen Zakharov, Co-Chair of the Kharkiv Human Rights Group posted here

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