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

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.

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.

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, LIGA.net
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