Complain, not remain silent: oncology, like corruption, is not a verdict

What patients complain about in oncology departments

Recently, the National Health Service of Ukraine received a complaint from the wife of a patient with cancer regarding the demand for funds for surgery and medication. Representatives of the patient from the NGO “Athena. Women against Cancer” helped to register the complaint with the National Cancer Institute and submit it to the National Health Service of Ukraine.

In April 2024, a pilot project called “Patient Representative” was launched in five Ukrainian hospitals by the National Health Service of Ukraine, the Ministry of Health of Ukraine, the World Bank, and the “Chesno” Movement. Patient representatives are trained individuals who are present in hospitals during working hours so that patients can approach them. They document complaints, assist in responding to cases of violations, and monitor the processes of providing assistance in medical institutions. The project is designed for 2 months, during which all recorded complaints are forwarded for further processing by the National Health Service of Ukraine.

We reached out to Victoriia Romaniuk, the Vice President of the organization, for comment on the current status of the complaint and the overall results of the project’s first weeks. “Currently, the complaint is being reviewed by the leadership of the National Cancer Institute. Additionally, the complaints have been sent to the Ministry of Health of Ukraine. From the ministry, we received a response stating that the case has been reported to the National Police of Ukraine,” said Victoriia Romaniuk.

As for the inquiries, patients raise various issues, from how to find the necessary department or obtain a referral, to how to file a complaint regarding demands for funds. Representatives also note positive feedback. Patients approach them to express gratitude to doctors for their compassionate care, professionalism, or free treatment.

In general, the most common complaints are about the need to independently purchase medications and pay for immunohistochemical examinations. Moreover, demands may be made not only for the purchase of medicines but also for medical instruments and other products. Additionally, patients also note long queues for examinations and refusals to provide electronic referrals for laboratory tests.

The National Health Service of Ukraine reported that the National Cancer Institute responded to the complaint with managerial decisions. “The National Health Service of Ukraine is not a punitive body. When we receive a complaint, we first inform the healthcare provider and request the restoration of the patient’s rights. Some providers immediately resolve the issues, such as refunding illegally demanded treatment costs. There are also managers who investigate the situation and make managerial decisions regarding the doctors. At the National Cancer Institute, about 10 doctors were dismissed based on patient complaints about demanding payment for treatment,” said the Head of the National Health Service of Ukraine, Nataliia Husak.

The National Health Service of Ukraine also commented that they have prepared a memorandum of cooperation with the National Police of Ukraine. “This document will act in favor of patients to restore their rights, particularly in cases where there are demands for payment or the distribution of medical supplies purchased with state funds,” explains Husak. However, the service notes that not all complaints are objective, so each complaint is processed individually.

Oncology in the Medical Guarantees Program

All types of medical assistance for cancer patients are free of charge as they are covered by the Medical Guarantees Program. Services include diagnosis, treatment, including medications, as well as further rehabilitation and palliative care.

Diagnostic Procedures

For early detection of cancer, the Medical Guarantees Program provides 6 free examinations: mammography, colonoscopy, gastroscopy, bronchoscopy, cystoscopy, and hysteroscopy.

Additionally, when there is suspicion of cancer, patients have the right to undergo free laboratory tests (blood analysis, cerebrospinal fluid analysis, etc.) and instrumental examinations (MRI and CT scans, particularly with intravenous contrast, X-rays, ultrasound, etc.). Electronic referrals for necessary tests and examinations are provided by the family doctor. Tests and examinations can be performed at multidisciplinary clinical hospitals or specialized oncology facilities.

Where to find institution addresses?

• by contacting the National Health Service of Ukraine contact center at 16-77.
• using the dashboard on the National Health Service of Ukraine website: “E-data” section, “Analytical Panels (dashboards)”, “Contracts for medical services provision to the population under the medical guarantees program”

Treatment

A patient with a confirmed oncological diagnosis or hematological disease is entitled to free chemotherapy and radiotherapy, as well as treatment using effluent therapy or apheresis of blood cells.

Treatment can be provided in outpatient or inpatient settings and includes laboratory and instrumental investigations, medications, medical devices, consumables, intensive care, oxygen support, pain relief, and anesthesia.

If the medical institution has a linear accelerator, gamma knife, or cyber knife, radiation therapy with this equipment is also included in the free services. If surgical intervention is necessary for the patient, it is free of charge and covered by the “Surgical operations for adults and children in inpatient settings” package.

Medications

The medications available free of charge for cancer patients are listed in Cabinet of Ministers Resolution No. 216. Additionally, patients in hospitals are provided with medications from the National List of Essential Medicines.

To check whether prescribed medications are included in the National List of Essential Medicines, you can:

• Compare them with the list provided in Government Resolution No. 333;
• Use the mobile application “Liky Control.”

To find information about the availability of medications in a medical institution, you can:

• Visit the hospital’s website or check the information stand in the institution’s premises;
• Use the “E-liky” service.

Support, rehabilitation, and palliative care

When a cancer patient achieves remission, they are guaranteed free support from a doctor under the Medical Guarantees Program. If necessary, the doctor may refer the patient for rehabilitation or palliative care. Both services are provided in both outpatient and inpatient settings.

Why every complaint matters

There is no need to fear making a complaint. Each case of patient rights violation is unique and is considered individually. The main thing is for patients not to remain silent in case of violation of their rights and demands for payment for medical services that have already been paid for by the state. By doing so, they contribute to reducing informal payments. Addressing the National Health Service of Ukraine helps the patient to recover funds or receive the necessary service, and the service collects more information about the hospital’s work, which will be relied upon when making decisions about renewing the contract with the medical institution. This partnership between the patient and the state helps to improve the Ukrainian healthcare system.

So, to improve its effectiveness, the National Health Service of Ukraine has restructured some processes: they have created a department to handle complaints, and improved access to information about the possibility of lodging complaints (clarifications on the National Health Service of Ukraine website, consultations with call center operators and patient representatives), and made information about complaints public (dashboard on the National Health Service of Ukraine website).

“In general, complaints are part of our risk-oriented system. In October 2023, the Government adopted a resolution, according to which the procedure for monitoring medical institutions was changed. Of course, the National Health Service of Ukraine can conduct monitoring at any medical institution, but in those where patients complain the most, planned and unplanned monitoring occurs more quickly,” noted Natalia Husak, the head of the National Health Service of Ukraine.

How and where to file a complaint:

• Fill out the electronic form on the National Health Service of Ukraine website.
• Call the National Health Service of Ukraine contact center at 16-77.
• Send an email to [email protected] or a letter by regular mail to the address: 19 Stepan Bandera Avenue, Kyiv, 04073.
• Submit a complaint in person during reception.
• If you are receiving treatment at the following medical institutions, contact patient representatives: the National Cancer Institute, Kyiv Regional Clinical Hospital, Kyiv City Maternity Hospital No. 6, First Territorial Medical Association of Lviv, and Lviv Regional Clinical Perinatal Center.