6 months after the start of medical reform of the primary and secondary levels: is everything ok?..

Abstract

Background. The main goal of reforming the primary health care system (PHC) is to improve its quality and accessibility. At present, 30.45 million declarations have been signed in Ukraine with 23,453 primary care physicians. More than 70 % of those who signed the declaration are satisfied with their family doctor (FD). All PHC utilities have signed the agreements with the National Health Service of Ukraine. However, only 9 % of respondents considered health care reform successful.
 Objective. To describe the current condition of PHC reform.
 Materials and methods. Review of the available statistics and publications on this issue.
 Results and discussion. High-quality transformation of PHC requires consideration of historical experience, regulatory framework, financial efficiency, organization of quality medical care, effective human resources policy, and social efficiency. The groundwork for the current reform began in 2006, when the concept of the State Program for PHC development was adopted. Since 2010, there is a separate medical specialty “General practice – family medicine”. By 2020, there should be a complete retraining of physicians and pediatricians for FD, who had to take care of 80 % of the patient’s needs. New principles of financing for real patients and the functioning of the system allowing to choose a doctor were implemented only in 2017-2020, and all the imperfections of PHC could not be eliminated. FD should be aware that their competence and the depth of services provided are now particularly important. Another task of the reform is to improve the financial efficiency of PHC: streamlining the budget, providing the feasibility and justification of costs, establishing the free package of guaranteed medical services. The disadvantages of the current financial system are that the re-indexation of doctors’ salaries has not taken place, inflation and rising drug prices have not been taken into account. Apart from that, there are no adjustment factors for rural doctors and payment for home visits. The reasons for inefficient funding are the lack of budgetary resources, the inertia of management in the context of frequent changes in the leadership of the Ministry of Health, non-transparent management of some institutions, negative lobbying by representatives of other sectors of health care. The organization of medical care also does not address a number of issues: there are no national screening programs, no criteria for the quality of work of doctors and nurses, and no mechanism of life and health insurance of medical staff. The eHealth system and the personnel aspects of PHC also need improvement. Thus, in 5 out of 6 outpatient clinics there is a shortage of medical staff. The forced retraining of long-serving physicians has provoked considerable resistance, and some of these physicians have never become FD. Among other issues that need to be addressed are the establishment of interactions between the departments of medical universities and clinical bases, legalization of scientific and pedagogical workers in the system of the National Health Service of Ukraine, payment for the work of interns. In terms of social efficiency, the benefits for the patient are the ability to choose a doctor and a PHC facility, the availability of an electronic queue, free basic services, the ability to communicate with a doctor and order medication online. Disadvantages include problems with medical care in case of temporary absence of a doctor, especially unpredicted, lack of possibility of emergency admission in some institutions, long travel distance to the PHC institution.
 Conclusions. 1. The main goal of reforming the PHC system is to improve its quality and accessibility. 2. Qualitative transformation of PHC requires taking into account historical experience, regulatory framework, financial efficiency, organization of quality medical care, effective personnel policy, social efficiency. 3. The current PHC system has a number of gaps that should be gradually addressed. 4. Among other issues that need to be addressed – the establishment of interactions between the departments of medical universities with clinical bases, legalization in the system of the National Health Service of Ukraine of scientific and pedagogical workers, payment for the work of interns. 5. The advantages of the modern PHC system for the patient are the ability to choose a doctor and a PHC facility, the availability of an electronic queue, free basic services, the ability to communicate with a doctor and order medication online.