Doctors will be Sacked and Patients Kicked Out into the Street. The NHSU Refutes the Myths

Starting from April 1, 2020, the medical guarantees program (MGP) is fully operational. Patients are now eligible for free outpatient, inpatient, emergency room, palliative care and rehabilitation services. However, the media are teeming with false information about the start of the second phase of the medical reform. We are going to refute the most common myths.

Myth 1. Specialized communal medical facilities have not signed the contract with the NHSU. The patients are left without medical care

1,645 specialized medical care facilities have signed the contract with the NHSU for the provision of health care services under the Medical Guarantees Program (MGP). This means that virtually all municipal health care institutions, district, city, and regional hospitals of the country are part of the reform process and will receive funding under their contracts with the NHSU. The number of hospitals, regions and areas of medical care provided can be looked up on the NHSU dashboard “Contracts for medical services with the specialized health care institutions”. Among the high priority services are delivery in childbirth (400 medical institutions), including help with difficult neonatal cases (120 hospitals), medical rehabilitation, colonoscopy, cystoscopy, and surgery.

Myth 2. Scheduled examinations and surgeries have been suspended during the pandemic resulting in less patients and ultimately less money. Patients, including those with severe COVID-19 symptoms, have been left without medical aid

Firstly, the NHSU initiated a number of changes to the current regulations relating to implementing the MGP in 2020, and the contracts for medical services under this program. 

For instance, during Q2, the cost for the medical services under the inpatient adult and pediatric surgery treatment package and the inpatient adult and pediatric non-surgery treatment package are to be fully covered by the budget instead of by a combined payment, as previously planned. The Cabinet of Ministers has already approved these changes. Therefore, medical care facilities are guaranteed to receive funding under these packages, regardless of the number of patients seeking medical help during this period.

Secondly, the NHSU initiates changes to the MGP. We propose to add package 28 to the existing 27 health care packages, relating to the treatment of patients with COVID-19. This package will primarily be contracted with 242 first wave hospitals designated for hospitalization of COVID-19 patients.

Thirdly, due to the spread of coronavirus infection, the NHSU reallocated UAH 905.8 million from the MGP to regions to support the activities of hospitals during the pandemic. The hospitals receiving these funds are determined by local authorities.

Myth 3. Starting from April 1, TB dispensaries will be closed down, and tuberculosis patients will be left without medical aid

The myth that the NHSU closes down TB dispensaries leaving patients to their fate is not true.

The NHSU has already concluded contracts with 45 TB dispensaries. Except Luhansk, each region has a health facility providing treatment to TB patients. All of these facilities meet the requirements and will treat patients in line with current methods and protocols.

It is important to note that the new system of funding will not encourage unnecessarily long hospitalizations, with patients kept in hospital for months regardless of whether they need it or not. Long-term hospital stays not only increase budget spending on the treatment for such patients, they also result in in-hospital transmission and resistance to anti-TB drugs. In developed countries, tuberculosis inpatients have a two-week treatment program – depending on the complexity of the case – followed by outpatient treatment. WHO recommends that Ukraine introduce new forms of treatment, e.g. outpatient medication.

We have examples of a successful change in approach to tuberculosis treatment. Specifically, the Odessa Regional Center for Socially Significant Diseases has combined the treatment of tuberculosis and HIV infection by merging 3 TB dispensaries with the AIDS Center. The average hospital stay is now 34 days compared to 232 days for the multiresistant form and 90 days for the regular form, previously. Only severe patients still secreting the bacterium are left in hospital. With the cost of treating one patient in hospital being UAH 9,373.12, the NHSU will pay UAH 20,663 UAH for the treatment of one patient this year.

After inpatient treatment, 11 follow-up outpatient models are offered to patients, with doctors monitoring medication uptake using VOT and SmartBOX applications (when patients take pills, their doctors receive a respective notification).

Myth 4. Starting from April 1, ambulance is a paid service

Emergency medical care is provided free of charge to any patient, regardless of whether they have a declaration signed with a doctor or not. If you are in serious condition and have called  ambulance, you will definitely not be asked if you have a declaration. It does not matter for this type of care. They will help you in any case. 

All 25 emergency care facilities have contracts with the NHSU. The NHSU will allocate UAH 4.7 billion to emergency medical services operating under the MGP.

Myth 5. the NHSU has been dismissing doctors since April 1

Firstly, the NHSU has nothing to do with dismissing doctors. The new model of funding health facilities creates the same rules for everyone – institutions and doctors. The best health care institutions and doctors will get more funding from the state, as well as opportunities for development. In 2019, all institutions under the Medical Guarantees Program having contracts with the NHSU, received UAH 16.8 billion. It is now the patients who will choose their hospital and their doctor, with funds from the NHSU “following” the patients to the hospital. Therefore, medical institutions will be interested in attracting qualified professionals.

Secondly, providing health care services and ensuring that the necessary amount of doctors are available in the regions is the responsibility of local authorities. Local governments need to analyze where doctors or nurses are unavailable and direct them there. Someone may need to upgrade their skills or undergo retraining, depending on the requirements. For instance, in Chernihiv Oblast, they have adopted a retraining program for nurses in areas of specialist shortage.

 Myth 6.  Starting from April 1, mental health facilities are to be closed down and people with mental disorders are left without care

The NHSU has concluded contracts with 196 specialized health care facilities within the package Psychiatric Assistance to Adults and Children and 210 within the package Substitution Therapy Treatment for Patients with Mental and Behavioral Disorders caused by Opioid Substance Use. The NHSU will exclusively pay for inpatient psychiatric care in the cases of mental and behavioral disorders, if psychiatric care is available only in an inpatient setting, and also for outpatient psychiatric care in the case of psychiatric and behavioral disorders, in line with the patients’ needs.

We understand that psychiatric care is at the intersection of two types of care – medical and social. But the NHSU finances health care services only. Social adaptation of people with mental disorders is a common problem requiring a comprehensive solution and the involvement of relevant ministries, local authorities, and support from international programs.