Ukrainian officials discuss ailing health-care system (08/20/00)

Ukrainian officials discuss ailing health-care system

by Yaro Bihun
Special to The Ukrainian Weekly

WASHINGTON - A group of Ukrainian health-care officials visiting here on a U.S. government-sponsored program, discussed the shortcomings and accomplishments of the health-care system in Ukraine with a group Ukrainian American physicians and specialists in that field.

It was not a surprise to any of the participants that the sad state of Ukraine's economy was seen as the overriding reason for the system's problems.

As Dr. Nina Goida, who heads the mother and child care department at Ukraine's Ministry of Health, pointed out that the Verkhovna Rada passes health-care legislation and the president issues decrees, but the programs remain underfunded.

The roundtable, held July 26 at the Embassy of Ukraine, came at the end of the group's 10-day visit here, which included meetings with congressmen on health-care-related committees, U.S. government agency physicians and health specialists, and health-care system lobbying groups.

The roundtable was organized by the Greater Washington chapter of the Ukrainian Medical Association of North America.

"Our problem is not that someone does not want to fund these programs," Dr. Goida said, "it's basically the state of the economy."

Dr. Vitalii Chernenko, who chairs the Committee on Health in the Verkhovna Rada, provided the numbers: out of a total national budget this year of 31 billion hrv, health care was allocated 4.6 billion hrv - less than half the 9.5 billion hrv it would need for full funding, he said. The projections for the 2001 budget are not any better, he added.

In providing an overview of Ukraine's health-care system, Dr. Goida noted that Ukraine "did not inherit the best of health-care systems" when it became independent, but it decided to retain the system, for the sake of some of its positive aspects, rather than start from scratch. But there are problem areas, she said, among them a hospital system with 400,000 beds - three times the per-capita level in the United States - which devours 85 percent of the country's health-care budget.

Ukraine, however, cannot apply the American ratio, she explained, because the circumstances are different: the frequency of illness requiring hospitalization in Ukraine is much higher than in the United States, and the patients cannot be released as fast for recuperation at home as they are here.

This is especially true in the rural areas, where there is a lack of physicians, medications, telephones, transportation and other necessities, said Dr. Dmytro Zabolotnyi, a national deputy and head of the Ukrainian Medical Association.

As a result, Dr. Goida pointed out, the average hospital stay in Ukraine is 12 days - needlessly long by American standards.

Dr. Goida said the government is working on establishing some sort of health insurance system in Ukraine, but all realize that it will not be easy.

Dr. Chernenko said that Ukrainian experts have studied health-care systems in the West, the East and in Central Europe. "And I'll tell you very frankly that we would never recommend the adoption of the American system in Ukraine today," he said. Ukraine would do better with a system that is partially financed by government funds and partially by insurance programs, he noted.

At this time, however, because of the economic situation in Ukraine, insurance payments would be an unwelcome additional financial burden on the individual, he said.

"I am an optimist among our Verkhovna Rada deputies with respect to our economic and health-care problems," Dr. Chernenko said. "We will overcome them, but it will take some time."

There will be some privatization, he said, "but we do not need a revolution." Asked which of the world's health-care systems he would like to see adopted in Ukraine, he said, "Given a good economy, the Canadian system."

U.S. Rep. Marcy Kaptur (D-Ohio), who had met with the Ukrainian health-care group earlier in the week, also participated in the UMANA roundtable and spoke about health insurance for Ukraine.

It will not be an easy choice, she said. "We have debates in our own country as to what the most appropriate system is. And we struggle with this all the time," Rep. Kaptur pointed out.

The American doctors at the roundtable asked questions about the Ukrainian system and commented on the good and bad points of the health-care system in this country, including the wastefulness of the multiplicity of insurance programs and health maintenance organizations, as was pointed out by Dr. Daniel P. Shmorhun, a pediatric cardiologist at the National Naval Medical Center in Bethesda, Md., and the lack of attention to preventive medicine, a point addressed by Dr. Daniel Hoffman of George Washington University.

Both Drs. Chernenko and Goida stressed, however, that the foundation for a viable health-care system is in place in Ukraine.

"We are moving forward," Dr. Goida said. Programs exist and they reflect the government's health-care priorities: dealing with tuberculosis, heart disease, childhood diseases and reproductive health.

"Our demographic situation is catastrophic," she pointed out. "Statistically, deaths outnumber births two to one."

While some health indicators continue to worsen, she said, others are showing signs of bottoming out and improving.

One of the alarming health problems facing Ukraine today is tuberculosis, which is aggravated by declining living conditions, its prevalence in the prison system and the unavailability of medications, Dr. Goida said.

Another problem, she said, is AIDS. "While today's numbers may not appear so catastrophic," she said, "its rate of growth in Ukraine is the worst in all of Europe."

Dr. Roman Goy, president of the Ukrainian Medical Association of North America, pointed out that, despite its many problems, the Ukrainian health-care system appears to be holding its own, according to a 1997 World Health Organization study. It was ranked 79th out of more than 180 countries in "overall health-system performance." The United States ranked 37th, while Russia came in at 130th.

The statistics look even better, Dr. Goy added, when one compares the per capita expenditures that brought about these performances: $4,000 in the United States $150 in Russia, and only $50 in Ukraine.

The coordinator of the U.S. Agency for International Development program that brought the Ukrainian officials to Washington, Dr. Olena Radziyevska, said a major goal of the program was to show the health-care experts from the executive and legislative branches in Ukraine how these two branches cooperate in the United States and to engender this same spirit of cooperation among the Ukrainian officials.

"And I think it worked," she said.

The UMANA roundtable discussion was organized by Daria Massimilla of the National Institutes of Health, who is president of the Greater Washington Area Chapter of the UMANA, and Dr. Roksolana Horbovyj of the Food and Drug Administration.

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