Ingenuine Medical Reform. Part One. The Minister’s Manipulations

Analysis of Maksym Stepanov’s on-air statements during “Freedom of Speech” on ICTV

Valeria Zolotaryova, VoxUkraine

Authors:

Healthcare and land reforms top the list with regard to the number of lies and manipulations surrounding them. But land reform, although stripped down, was approved and “forgotten” in the good sense of the word, with currently no attempts being made to “improve it”. The same cannot be said for healthcare reform.

Its second stage began on April 1, 2020. And everything would be fine, if not for a barrage of criticism from the regular opponents who lost their positions – Bohomolets, Tymoshenko, Todurov and others. This fueled the situation more, and with the President and the Ministers of Health (both previous and current) joining in the criticism, it completely got out of hand. There are way too many lies and manipulations surrounding the reform.

We have repeatedly fact-checked the main allegations against the medical reform, for example, made by:

Borys Todurov  Factcheck of Borys Todurov on ZIK TV Channel and Not Taking a Step Without Suprun. Quick Check of Another Interview of Borys Todurov, and Maksym Stepanov (Un)beneficial Medical Reform. Checking at the Expense of Life or Vadym Aristov in Elon Musk, Ulana Suprun, Ventilators and an Unknown Guy and Indefatigable Aristov: More About Healthcare, More Manipulations

This time, several people made themselves conspicuous on Freedom of Speech on ICTV. Maksym Stepanov, Minister of Health, Yuliia Tymoshenko, leader of the Batkivshchyna party, and Olha Holubovska, infectious disease specialist and one of the reform’s main critics.

In the first part of this article, we will fact-check the Minister’s words. Tymoshenko and Holubovska will be featured on Thursday in the article “Ingenuine Medical Reform. Part Two. In Unison”. Not to be missed! Subscribe to our Facebook VoxCheck page and Telegram channel Anthology of Lies.

FALSE

Maksym Stepanov: “What’s more, the order on distribution and how it will be done and to which hospitals it is going.” Olha Stefanyshyna: “Can I see the order? It is not on the Ministry’s website.” Host: “Please specify, is there an order?” Olha Stefanyshyna: “It is not on the website. We looked just today.” Maksym Stepanov: “Of course, it is on the website of the Ministry of Health. It can’t help but be there, because all such orders are on the website of the Ministry of Health.”

Maksym Stepanov, 25/05/2020 (16:15-16:40) 

The order in question is Order No 1168. It is true that it was not on the Ministry’s website at the time of the dispute between Stepanov and Stefanyshyna. Here we explain why: 

  1. When the document was finally located, it had a publication date of May 20, 2020 and only 24 views (this is several times less than even on more recent documents)
  2. But the main thing is that PDF documents are attached to any order published on the website. And if you look up the date when these documents got updated, it is May 26 at 00:46.  That is, after the on-air dispute. Just a coincidence?

MANIPULATION

“So that’s the reason (the protective suits supplied to the hospital by volunteers – ed.), including the incidence among medical workers, I have repeatedly said this. When we have suits that protect, yes, but on the other hand, there are suits that are not medical clothing, they are used as work clothes”.

Maksym Stepanov, 25/05/2020 (16:54-17:11)

Stepanov is manipulating. The suits coming from volunteers, even assuming that they do not provide sufficient protection, cannot be a cause of disease. The suits from volunteers were needed because the Ministry of Health did not provide hospitals with sufficient protective equipment. Therefore, doctors had a choice between the suits obtained from volunteers and the lack of protection.

MANIPULATION

“That is, the certificate (for protective suits – ed.) is a piece of paper saying that it is in line with the DSTU. This is not a laboratory confirmation.”

Maksym Stepanov, 25/05/2020 (28:14-28:21)

MANIPULATION

“The MoH does not issue certificates (for protective suits – ed.), certificates are issued by respective laboratories.”

Maksym Stepanov, 25/05/2020 (29:05-29:14)

Firstly, the Minister contradicts himself. He first says that the certificate is an ordinary piece of paper that is not a laboratory confirmation, but a minute later, he states that these certificates are issued by laboratories, i.e. certificates are issued following laboratory confirmation. Secondly, a certificate is not an ordinary piece of paper but a legal document certifying that goods or a production technology conform to national or international standards. Laboratory tests provide the basis for the issuance of the certificates.

Manipulation

“In early April, when they had already concluded all their contracts, we saw, with them, in the calculations they gave me, that 984 hospitals received less funding than last year. What’s more, out of these 984 hospitals, 332 hospitals received 50% less funding than in 2019.”

Maksym Stepanov, 25/05/2020 (32:15-33:01)

The Minister of Health has been talking about the closure of hospitals since the beginning of May, e.g. on the air during the show Right to Power, during a meeting of the Committee on Health of the Verkhovna Rada, as well as in an interview for TSN and Ukraine 24.

This data is incorrect, but the Minister continues repeating it.

According to more recent calculations by Liga.net, funding from the state budget has decreased for 573 health facilities, not 984. But part of the funding for health facilities comes annually from local budgets, and 2020 is no exception. That is, the actual number of hospitals with less funding will be even smaller.

Besides, according to the same calculations by Liga.net, 224 hospitals received less than fifty percent of funding, not 332. Of these, a third are dental clinics. How long has it been since you have received free dental care? It is a rhetorical question. These establishments are able to sustain themselves financially.

As in his previous statements, Stepanov is trying to say that the underfunding of hospitals will lead to their closure. However, this is not so. More than 900 million hryvnias were re-allocated as a subvention to finance low-capacity hospitals in the regions.

Furthermore, under the law on state medical guarantees, local governments still can finance public health facilities, namely in terms of upgrading the material and technical facilities, conducting repairs and reconstruction, increasing salaries for medical workers (“local incentives” programs), as well as local public health programs and other programs in health care (Article 4).

The speaker also keeps mum on some data. Because 961 medical institutions (nearly 60% of all) will receive more money than in 2019, as a result of medical reform. 

MANIPULATION

“We started analyzing the fees. Well, for example, we take the fee of a heart attack treatment case of UAH 16,001.43. Well, it is clear that, well, that is, this case, it is calculated to the penny, 43 kopecks. Unfortunately, we haven’t found a single hospital in Ukraine that can treat this case for UAH 1,6001.43.”

Maksym Stepanov, 25/05/2020 (33:51-34:20)

Firstly, the Cabinet’s resolution  (page 6) explicitly states that the fee does NOT include the cost of medicines, medical devices, and consumables. Secondly, the reform provides for adjustment factors. For example, there is a coefficient (1.3) for surgical departments working around the clock. Thirdly, private clinics also sign contracts with the NHSU. For example, as of April 24, 2020, 5 clinics will also provide surgical care. If the fees were too low, it would not be profitable for private health facilities to do so.

And calculating to the penny can be accounted for by the fact that it is not about one service, but thousands of services, where the pennies turn into hundreds and thousands of hryvnias, which should be taken into account in the budget.

MANIPULATION

“For example, it took 4 years for Germany and 8 years for Croatia to make the transition, it was done gradually, by evolution. And we have decided, we can do it all from April 1 and it will make us happy.”

Maksym Stepanov, 25/05/2020 (51:00-51:12)

The minister compares the countries that it took many years to develop with Ukraine, where reform was to begin only on April 1 but making a logical mistake, he is manipulating. Each country that has gone through many years of development also once started with its own “April 1”. Reform is not done in one day, but it is possible to define the day to begin reform. Ukraine is also to make a gradual transition to a new financing model. Furthermore, some hospitals have been preparing for this transition since 2017.

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