Healthcare reforms are in danger, civil society groups warn.Â
Legislation submitted to the Rada in the last week of August may get in the way of international organizationsâ ability to procure medications and threatens to undo former Acting Health Minister Ulana Suprunâs reorientation of the healthcare system.Â
Suprun is credited with introducing some of the most far-reaching changes in Ukrainian healthcare. While Suprunâs reforms proved very popular with anti-corruption crusaders, they met resistance from some segments of the public — as well as Suprunâs rivals in government. She has has now been replaced by Zoryana Skaletska, a doctor of medical law and former head of the committee on health care reform at the Ministry of Health.Â
Civil society groups are also concerned about a planned audit of the health ministry and its procurements from July 2016 through August 2019 — when Suprun was minister.Â
Petro Bagriy, head of the Association of Medical Manufacturers of Ukraine, sent a letter to the parliamentary health committee, requesting the audit, according to a copy of his letter posted on Facebook by Voice lawmaker Olga Stefanishyna. Committee members approved the audit.
Bagriy had been accused of using his companies and exploiting his connections with previous health ministry officials to win medical procurement tenders and sell drugs to the state at highly inflated prices, according to investigations by the Anti-Corruption Action Center, known as ANTAC, and investigative reporting project Nashi Groshi. ANTAC and several pro-patient watchdogs stated that Ukraineâs medical procurement reforms cut into Bagriyâs bottom line.Â Â
Bagriy did not immediately respond to a request for comment.Â
Inna Ivanenko, director of the watchdog Patients of Ukraine called the audit âthe epitome of cynicism.â Sherembey said that an audit would work, but only if it encompassed administrations and health ministers, so that their performance in the medical sphere could be compared.Â Â
The audit was backed by the committee head, Mykhailo Radutsky, former owner of the private clinic Borys. David Arakhamia, the head of the Servant of the People fraction, previously said that Radutskiy would become the next health minister but Radutskiy disavowed the role. Nonetheless, Radutskiy is seen as the informal supervisor of the current healthcare system.Â
Radutskiy did not immediately respond to requests for comment.Â
Multiple watchdogs see Radutsky as having a broad influence on which personnel make it into the health ministry. This is partly due to the fact that a journalist took a photo of Radutskiyâs phone while he was texting a friend that Skaletska was â[his] person.â Radutskiy later told media that he only meant that he would have liked Skaletska to become minister, more than Suprun. Skaletska publicly denied having a relationship with Radutskiy.Â
âAs patients, we want to record Radutskyâs responsibility for appointments made with the complete monopoly of power,â Sherembey stated. âIt is he who will be responsible for appointing the representatives of Petro Bagriy.â
Several of Skaletskaâs chosen advisors and a lawmaker in the parliamentary healthcare committee had worked together or are associated with controversial former health minister Raisa Bogatyrova, who was charged with the embezzlement of over Hr 1 billion from the state budget. She returned to Ukraine at the end of August and was arrested upon arrival.
Since 2015, Ukraine relied on international organizations for medical procurement. Under this system, UN bodies and the UKâs Crown Agents help the Ministry of Health acquire drugs, medical supplies and vaccines.Â
Officials said that this helped cut corruption out of medical procurement — previously, suppliers manipulated the procurement system, relying on chains of affiliate companies or corrupt officials in the ministry and hospitals to inflate prices.Â
The Accounting Chamber of Ukraine and the Ministry of Health found that using international organizations lowered drug prices by about 40 percent.Â Â
On Sept. 10, parliament accepted legislation 1076 at first reading. The bill creates leeway for bidders to correct errors in their submissions; mandates the use of ProZorro for all procurements above Hr 50,000; and sets up a way for customers to analyze the market, among multiple other provisions.Â
By failing to provide an exemption for the Ministry of Health, the law would effectively shut down the Ministryâs ability to rely on international organizations starting in mid-2020, experts told the Kyiv Post.Â
âFirst of all, I want to say that this legislation is very progressive and… had been expected for a long time by experts and legislators,â said Stefanishyna. However, if it causes Ukraine to lose procurement through international bodies, âthis becomes very dangerous.âÂ
According to Patients of Ukraine, international procurement is important for the availability of supplies for oncology and cardiovascular care, as well as vaccines.
Stefanishyna said that lawmakers will introduce an amendment to the bill before the second reading, which would extend the ability of international organizations to continue procurements.Â
One of Suprunâs major reforms was to change the relationship between Ukrainians and their doctors. She introduced a system oriented around primary care physicians, whom patients can freely choose. These physicians could then refer patients to specialists. Doctors would receive payments for each patient.Â
Under the new system, the National Health Service of Ukraine began funding a package of primary health services, instead of the old system, where healthcare was technically âfreeâ but de facto, Ukrainians had to make unofficial payments for everything.Â
Starting in 2020, all levels of healthcare institutions would move to funding by the National Health Service of Ukraine. Other major steps in healthcare reform are pending. The change was supposed to take place on Jan. 1, but Skaletska stated that it will most likely be delayed until Apr. 1.
Suprunâs opponents and some medical experts repeatedly aired a laundry list of criticisms against the new system. For example, some of their allegations included that the new system leaves some towns without a primary hospital, imperils rural patients, and puts some doctors at risk. Suprun had argued that this is not true.
On Aug. 29, the Opposition Platform â For Life party submitted legislation 1114, which would undo Suprunâs reforms. Natalia Korolevska, one of the authors of the bill, wrote that Suprun’s reforms are “unconstitutional,âÂ tantamount to the “destruction of Ukrainians,â caused a spike in medication costs and a precipitous drop in Ukrainians’ access to effective healthcare and supposedly caused the outflux of tens of thousands of medical professionals.Â
Civil society groups and proponents of Suprunâs work had said that these statements are false. Suprun herself was quoted as saying that adopting this law would abolish changes for 28 million Ukrainians and tens of thousands of doctors and nurses who work in new conditions with decent pay. It would also destroy the National Health Service of Ukraine, she added.
Another bill, 1178, was submitted by former Prime Minister Yulia Tymoshenko and Valeriy Dubil, both of the Batkivschyna party. It called for the introduction of mandatory health insurance for all Ukrainians. Tymoshenko has long been a staunch critic of Suprun.Â
Civil society groups dismissed the bill as populist showmanship, saying that the state lacks the resources to provide mandatory health insurance without an increase in taxes for Ukrainian citizens. Suprun said that it would reduce both patientsâ choice and quality of care.Â
“Compulsory health insurance, as opposed to voluntary, means violation of the principle of universal access to healthcare,” wrote Victoria Tymoshevska, a public health director at the NGO International Renaissance Foundation. “So, those who cannot buy health insurance will be left behind.”