Today's health care in Ukraine comprises three distinct systems (10/17/99)

Today's health care in Ukraine comprises three distinct systems

by Yana Sedova
Special to The Ukrainian Weekly

KYIV - Health care has become one of the most expensive commodities in Ukraine, as well as one of the most essential.

With lingering environmental problems caused by a Soviet system that took little care of the ecology, not the least of which are the aftereffects of Chornobyl, the state of people's health in Ukraine has been declining for a decade.

The question of payment for state medical services at one time wasn't relevant; medical services were free and everybody was eligible. However, in a country that continues to experience economic difficulties, costly medical care is a critical problem for many people. Today most everyone pays in one way or another. There are formal fees and payments, and those made under the table.

Currently Ukrainians can utilize three general forms of medical care. First are the familiar state clinics, financed by the central state budget. They are officially free and accept people who are registered ("propysani") in the city district or regional county in which they operate.

There are also clinics that belong to large enterprises that have entered into joint ventures with Western firms. These clinics were created for the benefit of the workers and are somewhat less expensive than private medicine. The companies subsidize a part of the cost.

Third are the private clinics, which are the most expensive in comparison. Ironically, although the costs vary, often the same doctors work both in state clinics and as staff in private clinics.

What is interesting is how people comprehend the novelty of paid medicine. Many say that paying for medical services is justified - that someone who takes money can be counted on to give good service. Others believe that private clinics have better medical technology, but, nonetheless, they cannot afford the costs.

"Last month I visited a private dentist. I was told the cost of the services I needed was 75 hrv, but my pension is only 60 hrv a month," said pensioner Oleksander Dmitrievych.

Private medicine is simply a luxury for most Ukrainian citizens. Ambulance services from the private clinic Medicom, considered one of the best in Kyiv, runs from 193 to 230 hrv. The monthly pay for a teacher with eight years' experience is about 160 hrv.

In a country that still has not developed an identifiable middle class, the clients of private medicine are for the most part either employees of joint ventures with Western firms, foreign embassy workers or a minority of well-to-do Ukrainians, seldom ordinary people.

Ironically, even with the higher prices charged by private clinics, the level of services often can be lacking.

"I once visited a private dentist at the Vyshnevskyi Clinic," said Irina, the director of a small Kyiv shop called Kolos. "The dentist left a piece of tooth while operating. After I noticed it a few days later, I went to another clinic."

Although many people believe that in private clinics the doctors are more interested in the payment than the patient, in state medicine the deterioration of medical ethics has become especially painful. As a result, administrative and criminal offenses have become common.

Bribes have always been a problem in the state system, but have now risen to disastrous proportions, especially when life or death can depend on whether a patient is able or willing to pay.

"My mother has asthma," explained Oleksander Vasylenko, a student at the International Institute of Linguistics and Law. "Once she had an attack, and I called a state ambulance. The doctor who arrived refused to give her treatment until I paid him."

In the hope of obtaining better care, patients are often willing to give bribes to state doctors. The thinking goes that it is more efficient and productive to give the money to a state doctor who will give individualized attention than to pay a cashier at a private clinic.

Doctors who have experience and a reputation as experts in their specializations find work in private clinics on a contractual basis. In this way they avoid the headaches associated with running a business in Ukraine.

The industry is far from free of abuse and malpractice. For example, a Kyiv clinic, LDC Nika, lost its license when a doctor improperly diagnosed a patient with syphillis and then, to add insult to injury, failed to keep the information confidential. As a result, Nika was forced to pay the patient damages after a court judgment against the clinic.

All medical institutions and specialists are regulated by the Ministry of Health of Ukraine, and medical workers must be licensed every three years by the ministry's Department of Accreditation and Licensing.

Since 1996 the department has issued 8,246 licenses for private medical practices in Ukraine. In 1998-1999 123 licenses were revoked.

Andrii Huk, acting director of the department, admitted that the current medical oversight system is not perfect and that a new system is currently being implemented.

"We have already started the [new] accreditation program, which gives us the ability to check a company's entire structure before it begins operating," explained Mr. Huk.

The requirements are more stringent now and presuppose reviews of a staff's qualifications and the procedures for patient registration. The new system, developed as a result of a Cabinet of Ministers resolution, has a broad range of tools to influence pricing policies and subsidies to children, pensioners and invalids.

Currently more than 100 firms in Ukraine have already received accreditation, among them the well-known Kyiv medical clinics Medicom and Borys. The accreditation program is scheduled to conclude by 2000.

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