Open Letter in Support of Ulana Suprun as a Minister of Health of Ukraine | VoxUkraine

Open Letter in Support of Ulana Suprun as a Minister of Health of Ukraine

7 February 2019

We, as economists, are concerned with efficient use of resources – i.e. such use which ensure the greatest return per each hryvnia spent. We have written this letter to draw your attention how the healthcare reform led by Ulana Suprun has either already moved us to a more efficient use of limited healthcare funding or has a great potential to do so in the near future. If you agree with our arguments, please add your signatures to this letter.

This letter is a personal opinion of the authors, it did not pass the VoxUkraine peer-review process.

Since early 1990s Ukraine has been falling deeper and deeper in the state of severe population health crisis. Our country is a one of the world “leaders” in total mortality, and what is more important dire dynamics in terms of avoidable mortality among comparable post-Soviet countries. These are the deaths for which healthcare system can be held accountable – deaths from diseases which can be prevented or effectively treated with the existing state of medical technology (through vaccination, early detection and proper treatment).

Lagging far behind many European countries on this indicator and being squeezed in terms of available funding, Ukraine clearly needed a completely revamped health care system.

Under such circumstance the best model to follow would be that of the United Kingdom National Healthcare System (NHS), which for many years in a row has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health think-tank. UK has the highest health care system performance compared to spending – which is the best measure from an economics perspective and the one which is most important for countries with limited resources, like ours. This means that despite some existing shortcomings, the NHS gives the best return per pound spent on healthcare. By the way, avoidable mortality in the UK is four times smaller than that in Ukraine. Thus we support the restructuring of Ukraine’s healthcare system along the NHS model which inspired many changes implemented by the Ministry of Health team for over two years.

Here are the key features of the healthcare reform led by Ulana Suprun, which have the potential to get us closer to the desirable population health outcomes:

  1. Honest acknowledgement of the limitations of the existing funding, which makes it impossible to demand free delivery of all needed healthcare (as people are not prepared to contribute more into the system, they have to admit that there is a limit to what they can receive out of the system). Lack of such acknowledgement and acceptance of this reality by the population provides fertile ground for populist speculations and effectively stops any reform effort.
  2. Shift from financing a medical institution to financing services provided to a patient. This provides enormous opportunities for increasing returns in terms of improvements in health per each hryvnia spent – by creating incentives for healthcare establishments to keep and maintain assets which are needed for delivery of services.
  3. Adoption of internationally recognized scientific-based protocols for diagnosis and treatment, which will eventually become mandatory. This again will provide great improvement in efficiency by allowing to eliminate unnecessary tests and procedures as well as treatments which have not been shown to lead to improvements in patients’ outcomes.
  4. Introduction of the National Registry of Essential Medicines. Although subject to the available budget, this is an honest way to improve access to treatment for most vulnerable population groups, as well as reduce the cost of treatment via reference pricing.
  5. The start of the reform from the Primary care has a potential to lead to a more efficient use of resources via timely prevention, early detection and proper channeling of patients towards specialists and services which are justified by the condition.
  6. Shift to a greater managerial and financial autonomy of healthcare facilities and flexibility in setting remuneration of medical personnel. These changes will bring in much needed competition among doctors and hospitals and create incentives for professional development and attraction of talents, which will lead to improvement in both quality of services and use of resources.
  7. Reorganization of the emergency medical services, highly specialized care and development of transplantology. These changes will lead to a more efficient use of resources in especially complicated cases by (i) better identification of such cases, (ii) more intensive use of expensive equipment and highly qualified personnel, and (iii) savings on medical treatment in other countries.
  8. Development of the Public Health System. This is the system which recognizes that population health does not only derive from the formal healthcare system, but also from other systems beyond the medical realm. By recognizing this intersectoral contribution, Public Health System works towards modification of health affecting behaviours, development and introduction of mechanisms for disease prevention, ensuring equal access to services for vulnerable population groups and, thus, working towards improvement of early diagnosis, as well as engagement of various organizations which can be instrumental in improvement of population health, etc.
  9. Reform of medical education aimed at increase of quality of future healthcare workers.
  10. Reform of government procurement of medicines. Temporary shift of procurement to international organizations already allowed to save up to 39% of funds. In 2019 procurement will be permanently assigned to a specialized government agency and performed via electronic auctions.

These are the major initiatives which have either already led to a better use of available resources or have a great potential to do so in a foreseeable future. We wholeheartedly support such developments and the team which has been pushing for their implementation, along with its leader – Ulana Suprun, who has long deserved to be confirmed as a Minister of Health – the most productive Minister of Health in the history of independent Ukraine.

We invite all those who support the ongoing reform and Ulana Suprun its engine to add their signatures to this letter.

This letter has been signed by:

  1. Olena Nizalova, VoxUkraine, University of Kent
  2. Ilona Sologoub, VoxUkraine, KSE
  3. Larysa Voloshyna, journalist
  4. Roman Basalyha, VoxUkraine
  5. Olga Marchenko, self employed
  6. Borys Davydenko,
  7. Olga Nikolaieva, KSE
  8. Maksym Skubenko, VoxUkraine
  9. Kateryna Bornukova, BEROС
  10. Elena Besedina, KSE
  11. Max Moskalenko
  12. Oleksandr Zholud, VoxUkraine
  13. Sergii Kiiashko, KSE
  14. George Vyshnya, CTO, SBC
  15. Valentyn Hatsko, UA:PBC
  16. Andriy Radomskyy, Bayer
  17. Katerina Lisenkova, RBS
  18. Oleksandr Talavera, University of Birmingham
  19. Maksym Ivanyna, IMF
  20. Maksym Sukhar, business consultant
  21. Oksana Basalyga, Abbott
  22. Andy Zapechelnyuk, University of St Andrews
  23. Serhiy Kandul, University of Neuchatel
  24. Oleksandra Antonova, Clarendon Sixth Form College
  25. Olga Kupets, KSE
  26. Olha Yolkina, Ciklum
  27. Olga Pindyuk, Vienna Institute for International Economic Studies
  28. Dariya Mykhayliv, University of Bradford
  29. Iryna Piontkivska, Centre for Economic Strategy
  30. Yuliia Mincheva, VoxUkraine
  31. Dr Erica Gadsby, University of Kent
  32. Prof. Nataliia Kussul, Space Research Institute NASU-SSAU
  33. Alina Kudina-Lundstrom, City University
  34. Oleksiy Bardyeyev D.V.M., C.V.A., veterinarian
  35. Dariia Mykhailyshyna, Centre for Economic Strategy
  36. Vladlena Russova, ЧНУ імені Петра Могили
  37. Tymofiy Badikov, ГО «Платформа Здоров’я»
  38. Fedir Lapiy, ГО «Батьки за вакцинацію»
  39. Dariia Mykhailyshyna, Centre for Economic Strategy
  40. Eugénie Kulozhenko, BNP Paribas
  41. Olena Bilan, VoxUkraine, Dragon Capital
  42. Volodymyr Shportyuk, National University of “Kyiv-Mohyla Academy”
  43. Oleksandra Betliy, Economist at Міністерство фінансів України
  44. Lenka Talavera, NHS Improvement
  45. Tetyana Tyshchuk, VoxUkraine, Institute of Economics and Forecasting, NASU
  46. Oleksandr Shepotylo, Aston University
  47. Otto Stoyka, Київський міський Центр здоров’я
  48. Denys Nizalov, VoxUkraine
  49. David Menabdishvili, Simcorp Ukraine LLC
  50. Galyna Gych, МОІППО
  51. Larysa Krasnikova
  52. Kateryna Zharikova, ПАТ КРЕДІ АГРІКОЛЬ БАНК
  53. Borys Gubanov, Луганський обласний центр дитячо-юнацького туризму і краєзнавства
  54. Tatyana Gvozdiova, KSE
  55. Anna Ahundova, Миколаївський коледж бізнесу і права
  56. Volodymyr Vakhitov, KSE
  57. Maksym Sukhar, бізнес-консультант
  58. Oleksandr Shliuganov, Хмельницька АЕС
  59. Igor Semenenko, ПрАТ Київобленерго
  60. Hanna Vakhitova, KSE
  61. Dmytro Yablonovsky, Centre for Economic Strategy
  62. Sophia Senchuk, Укртелеком
  63. Olga Romaniuk, пенсіонер
  64. Lesia Tymkiv
  65. Olga Shamrai
  66. Tetiana Kulagina
  67. Iryna Naidenova
  68. Galyna Oliynyk
  69. Nadia Kalennyk
  70. Vasyl Vakarenko
  71. Sergiy Kypich
  72. Anna Alexeenko
  73. Liudmyla Bublyk
  74. Arkadiy Druker
  75. Nataliya Levenets
  76. Olena Gres
  77. Tetyana Globa
  78. Larisa Biblaja
  79. Eva Zaklunna
  80. Olga Meshkova
  81. Valentyna Kasianenko
  82. Oleg Fokin
  83. Mihail Stoyko
  84. Oresta Tarnavska-Senko
  85. Natasha Maznichenko
  86. Vladimir Rapov
  87. Svetlana Boberskaya
  88. Borys Kolomyichuk
  89. Svetlana Olhovska
  90. Yaryna Ivanova
  91. Nikolay Shchur
  92. Viktoriya Pogorilyak
  93. Alla Kisilevska
  94. Valentyna Gladchenko
  95. Nadia Chygyna
  96. Evgen Chygyn
  97. Roman Koziy
  98. Galia Chubok
  99. Olga Kashalaba
  100. Maria Gryn’
  101. Nataliya Gvozdanna
  102. Oleksandr Sakhatskiy
  103. Oleksandr Menchinskiy
  104. Olena Yatsina
  105. Vasyl Shapar
  106. Natalia Sergienko
  107. Vira Tyvodar
  108. Vasyl Tyvodar
  109. Alla Markovych
  110. Klavdia Molchanova
  111. Larysa Diordieva
  112. Volodymyr Diordiev
  113. Liudmyla Shchetinina
  114. Sveta Tamarova
  115. Svitlana Mykhailova
  116. Iryna Torgovenko
  117. Inna Serbin
  118. Yaroslava Terekh
  119. Viktor Dmitrovych
  120. Yuriy Lymar
  121. Nataliya Yukhimenko
  122. Svitlana Savchenko
  123. Olga Novitskaya
  124. Larysa Kovaleva
  125. Anna Semerenko
  126. Darusia Kozak
  127. Liudmyla Belezhinskaya
  128. Maria Babak
  129. Mykola Shepelya
  130. Alexandr Mitin
  131. Zhanna Zozulya
  132. Maria Bilous
  133. Tetyana Yurieva
  134. Igor Lektiy
  135. Andriy Ponochevny, IT
  136. Oleksandr Voloshyn
  137. Maria Yar
  138. Nataliy Mochulska
  139. Galyna Skuibida
  140. Tetyana Lyashenko
  141. Anna Kravchuk
  142. Alla Markovych
  143. Klavdia Molchanova
  144. Zebo Babaeva
  145. Olena Tarasenko
  146. Natalia Demchenko
  147. Mariya Rura
  148. Lesya Kovalchuk
  149. Bogdan Bily
  150. Katerina Olkhovska
  151. Tetyana Rybalchenko
  152. Vasyl Nykolaychuk
  153. Iryna Usyk
  154. Liudmyla Kryvenko
  155. Yuriy Nikolayevych
  156. Svetlana Ivashchenko
  157. Vitaliy Volotovskiy
  158. Mycola Tymchyk
  159. Olena Dzhura
  160. Dmytro Bilokonniy
  161. Alexander Kurbanov
  162. Mariya Furtak
  163. Volodymyr Rurka
  164. Yuriy Fotikov
  165. Nina Dovbenko
  166. Natalya Shchukina
  167. Nadia Rasiak
  168. Svitlana Freylykhman
  169. Irena Dushna
  170. Hanna Dziuba
  171. Tetyana Pavlenko
  172. Petro Babiy
  173. Evgeniya Pozhidaeva
  174. Aleksandr Halfin
  175. Viktorya Naumova
  176. Natalia Brizh
  177. Anna Kogut-Skrypynets
  178. Ryta Dobrovolskaya
  179. Natalya Sevruk
  180. Halyna Vysochanska
  181. Mikail Gazuda
  182. Lidiya Marynevich
  183. Hanna Ruchay


The authors do not work for, consult to, own shares in or receive funding from any company or organization that would benefit from this article, and have no relevant affiliations