Changes in the Ukrainian healthcare system are underway

We want human capital to be the main thing for our country in ten years, not minerals. For this to happen, the next ten years must be a time of radical reforms in health and education, as well as unprecedented investment in them.

Revamped healthcare in 2030 means first and foremost:

– an effective health system for children,

– a reliable National Health Service that protects families from excessive treatment costs, and

– modern health infrastructure for the elderly.

With such priorities, Ukraine will become a dynamic modern country in ten years. After 2030, it will be able to join the Baltic States, Scandinavia, or Southeast Asia and be among the 30 countries with the best human capital index.

The state formulates general rules and concentrates resources to create an appropriate level of security for its citizens. This can happen after the partial or temporary restriction of the individual freedom of each of us.

So that the need for security does not threaten our basic freedoms, the use of coercion by the state has clear and strict boundaries. Within these boundaries, each of us must strictly follow the instructions. Beyond these boundaries is our private life, in which the state has no right to interfere. The boundaries themselves are set only through democratic mechanisms.

To respond successfully to dangers, the state must move from a “mobilization only in times of danger” approach to a “ready for danger every day” approach. To do this, these three functions need to be strengthened:

– Intelligence (intelligence and analysis). Powerful intellectual and technological resource for risk management and anticipation. This resource must function continuously and be the “eyes and ears” of the system for timely detection of health threats.

– Militarization. It is needed to implement quick solutions based on predefined algorithms. The main factor of successful response is discipline and developed skills of behavior in critical situations.

– Subsidiarity. It is the ability to make instant local decisions for rapid resource mobilization. It requires organic links with communities and local authorities.

The state must regulate the system so that the rich pay for themselves and the poor, those who work, pay for those who worked before or are not yet working, as well as for those who do not work temporarily. This is how the founding principle of solidarity in the Manifesto is realized.

To stimulate the development of human capital, the state can provide services, finance services, and regulate the provision of services. These methods are different in cost for taxpayers: regulation is the cheapest but requires appropriate competencies from the state apparatus; provision is the most expensive, and besides, the state is not the best provider.

Traditionally, the Ukrainian state maintains a huge apparatus to provide services, hardly finances them and regulates them very poorly. This pyramid should be turned upside down. Services, with some exceptions, must be provided by competing independent providers. The state must finance the services guaranteed by it (through the mechanisms of strategic procurement on contractual terms). The main thing that the state will do is regulation, namely, the creation of fair rules of the game.

To do this, the state should not rely on an army of officials, but on small professional teams of modern, educated, and well-paid politically neutral civil servants.

The role of the elected legislature (the Verkhovna Rada of Ukraine) and the top executive branch, appointed by the Verkhovna Rada (the Cabinet of Ministers, MoH), in the field of health care is to articulate and operationalize the public procurement. They answer the question of what the public consensus on the needs of citizens is, how it should be reflected in public policies, what should be the design of the system and the architecture of institutions within it. Their decisions will have an effect in the case of sustainable implementation for 3-5 years.

The role of institutions is to ensure the ability of the state to put this or that vision into practice. Independent institutions accumulate industry expertise and experience, as well as ensure longevity in the process of implementing public policies. The absence of such institutions dooms any government policy to failure due to lack of operational capacity.

Professional institutions must be protected from political cyclicality. Transparent and honest procedures for their formation and election of leadership, stable management processes will help here, and direct communication between institutions and people will ensure their legitimacy.

The main factors in maintaining good health are the way and conditions of human life, and medicine only partially influences this. The community must take care of the health of its residents: support and encouragement of healthy habits, infrastructure for a healthy lifestyle, ecology, employment structure, leisure structure, etc. Managing these factors should be a priority for local governments. Creating effective targeted local programs to maintain health, improve the quality and quantity of social services, care for vulnerable people (the elderly, people with disabilities, children), families with palliative patients, involving such families in active self-realization in the community, creating infrastructures for a healthy lifestyle create a healthy community. Communities should also receive the necessary tools and standards to design such programs.

What are healthy relationships between the community, the hospital, and the doctors?

Hospitals are autonomous enterprises. Doctors are independent specialists. The community should set doctors the task of preserving and restoring the health of their population as part of a community strategy and in collaboration with other businesses and services.

When investing in hospitals, the community should not violate managerial autonomy; for instance, by telling the director who can be fired and who can’t, or how to distribute hospital budget money. The director of the hospital is responsible to the owner for its financial capacity, quality of services, and satisfaction of the population. How it achieves this is an internal matter of the autonomous institution.

At the same time, the community should make sure that a professional manager is involved in the management of the institution based on a transparent competition. It should promote the effective work of corporate governance through the creation of a supervisory board, active participation in creating a clear strategy for the development of the institution, considering the unique needs of the community.

Management at the regional level should create conditions for cooperation and joint efforts of all medical institutions of the region and their work as one network to preserve the health of residents throughout the region.

The doctor’s independence is based on two pillars: self-government, which supports and protects them, and the status of an independent profession, which allows the doctor to legally receive remuneration and be less dependent on the employer.

The medical chamber will grant doctors the right to practice medicine and will thoroughly examine them. The doctor will become equal among equals in the independent community of professionals. Each doctor will be able to enter the chamber’s office or delegate there someone they trust. The doctor’s professional actions, including mistakes, will be evaluated by their colleagues, not by officials behind closed doors.

Following the doctors, the nursing profession will also begin to organize its own self-government. From a doctor’s secretary, a nurse should become an independent professional who can work in a team with a doctor or independently.

Unspoken taboos on painful and sensitive topics hinder the development of health care and leave the worst problems unresolved for years. In recent decades, the culture of victimhood has taken root in this area. Doctors or patients are considered to be humiliated groups. Politicians are willing to strengthen this image, hoping for cheap popularity.

In the new system there can be no taboos on the discussion of corruption and informal payments, low professionalism due to poor education, medical error, conflicts of interest in the communities of doctors, patients, and others.

Self-respect, which comes from inner freedom, respect for the opponent, which comes from the belief that everyone acts in the interests of the patient, and dialogue will be a tool for revealing and solving these problems.

Civil society should include professional associations, patient associations, religious and human rights organizations, business associations, and so on. We believe that investing in civil society will contribute to the ability of every citizen to become a full-fledged subject of the new system.