Public offers a remedy for corruption in healthcare

It is an open secret that the sweeping investigation has been brought on primarily by cadre shakeups in the upper echelons of power. The key argument of medics administering treatment to the healthcare system is that, before anything else, one must know what needs reforming. Although Andriy Pidayev, the newly appointed Healthcare Minister, pledged a radical approach, the actual state of health of both Ukrainians and the healthcare system is still anyone’s guess.

To illustrate, according to Olha Lukashenko, manager of a group of consultants on the international project titled “Support of State Management Reform in Ukraine,” an analysis of the effectiveness of the Healthcare Ministry has shown that officials spend most of their time writing noncommittal replies to petitions. Moreover, experts were surprised to learn that officials assume virtually no personal responsibility for performing their functions. Tellingly, any commission is given to six persons, while none of them assumes full responsibility for executing it. Moreover, the investigation revealed no documents that would attest to either the quality of work performed or the practicality of measures taken. To top it all off, not cooperating with professional medical organizations, the ministry licenses medical establishments and issues doctor’s certificates and permits for handling infectious pathogens and using equipment containing radioactive elements.

Yaroslav Flissak, member of the Counting Chamber board and director of the department for controlling allocations for social sphere and science, reminded once again that the misuse of budget funds and Western loans by this ministry remains all to common. For instance, in a tender to buy kits for prosthetic cardiac valves and cardiologic oxygenators, the Healthcare Ministry paid the go-betweens 6 million hryvnias more than the actual cost of the equipment. For over a year, 34 ambulance vehicles worth UAH 749,900 awaited to be distributed among hospitals. While the cars rotted in garages, the shortage of ambulances reached 5,318. As there is no state register of diabetics, the Ministry does not know the real figure and the required daily dosages of insulin. As a result, the ministry buys far more insulin annually than is really needed and ends up paying 15 to 20 million hryvnias more. Incidentally, according to Mr. Flissak, the ministry officials were not the only ones who mismanaged funds. The Medical Sciences Academy paid UAH 7 million for a cardiologic unit for the center of infant heart surgery. According to experts, it was fit only for cardiovascular examinations of adult patients. As a result, Ukraine could lose up to 2,000 newborns.

Today this is past history. Most importantly, experts believe that the time has come to dispel myths about the transparency of the healthcare system and the accessibility of free medical service. The more so that, according to Anticorruption Fund manager Hennady Samofalov, healthcare tops the list of the most corrupt sectors of the economy. A survey conducted by the Socis-Hellup sociologic center suggests that over the past three years, 71% of Ukrainians did not receive free medical service. Tellingly, 40.6% of pollees bribed medical personnel and 39.1% paid for surgeries. Among the specialists, services of surgeons, gynecologists, and anesthetists were found to be the most expensive. Incidentally, anesthetists admit that for one surgery they receive the equivalent of their monthly pay. And finally, 85% of respondents have never heard of doctors being brought to account for taking bribes. According to the Healthcare Ministry, last year only 20 corrupt medical workers were taken to court.

Tellingly, the organizers of the conference on the results of the all-Ukrainian drive, titled “Public Offers a Remedy for Corruption in Healthcare,” mailed invitations to 130 medical establishments and to all chiefs of oblast and district healthcare departments. However, fewer than half of them showed up. Thus, letters of complaint mailed to the Anticorruption Forum were read out in a quite narrow circle. V. Shcherban, a war veteran and pensioner from Sumy oblast, heard a chief physician of one of Kyiv’s clinics say on television that pensioners could receive free medical service at his clinic. On coming to Kyiv, he learned he could undergo treatment after he paid UAH 1,000. When Mr. Shcherban appealed to the television program, he was told “he has not ripened enough to undergo treatment.” A native of Ivano-Frankivsk, Mariya Levytska, writes that after a car accident her son was rushed to the hospital. But even after she “contributed” a few thousand hryvnias to the hospital, the medics were still unable to find blood, plasma, and medication for her son.

All of the above suggests a question: what should be done? The respondents believe that stricter bribery laws and higher wages could help fight corruption. Notably, medical workers occupy 24th place in the size of wages, followed only by forestry workers. Nonetheless, the majority of those polled (75%) are opposed to so-called voluntary contributions. Incidentally, such contributions have made it possible to fight corruption among medics on the local level. This is where the example of the Odesa municipal hospital fund comes in handy. Fund Director Serhiy Batechko managed to create a public nonprofit healthcare sector whose major element is the hospital fund. Each resident — the potential patient — makes a monthly contribution of about UAH 10. So long as he stays fit, his money and contributions from other persons are used to administer treatment to those who need it. Should the person fall ill, the same mechanism is used to help him or her recover, which is quite comfortable, considering the fact that state allocates a mere UAH 0.65 for one day of free medical service for one patient at outpatient clinics and UAH 4 at inpatient clinics. The so-called medical lawyers keep a close watch on how the medical service standards are maintained. In fact, they form a middle link between the doctor and patient.

The Odesa hospital fund served as a prototype of a similar fund in Kyiv. Notably, businesses have taken a keen interest in the fund. The monthly per-person fee varies depending on whether the company has paid in advance for outpatient or inpatient care, or preventive treatment for its employees. Even in case of the minimum monthly per-person installment of UAH 15, the contract covers all details concerning the quality of medical service. Both the patient (with his membership card) and doctors (who cooperate with the hospital fund) know what services the patient can afford. Unfortunately, this does not work out in practice. To quote Volodymyr Pohorily, director of the hospital fund, occasionally unscrupulous doctors demand additional contributions from insured patients. But one phone call to the hospital fund — and from there to the chief physician — will do the trick. The unprincipled doctor will be punished, while the patient will receive free medical service, provided this type of service is on the list of services prepaid by the company.

Similar incidents were also discussed during the Anticorruption Forum session. President of the All-Ukrainian Doctors’ Association, Liubomyr Pyrih, attributed them to the lack of scruples in healthcare resulting from the demoralization of the whole system from top to bottom. The study has shown that corruption and abuse of power are directly proportional to the status of an establishment. However, Volodymyr Zahorodniy, deputy state secretary of the Healthcare Ministry, did not mention this. Not attempting to refute the accusations against the Ministry (he had valid reasons not to, as he has been appointed only recently), he only said that it is immoral to hit a man when he is down.