At the beginning of last year the healthcare reform was launched in Ukraine, aimed at improvement of quality of medical service and creation of family medicine. At first the reform was launched in pilot regions - Vynnytsya, Dnipropetrovks and Donetsk regions.
However, the Kyiv city decided to join the pilot regions, and the experiment has already been launched in Darnytskiy and Dniprovkiy districts. The reform has appeared controversial and come under both criticism and praise. The  government, though, estimates the results positively, and on April 17 the Kyiv council decreed to extend the reform to all districts of the capital. ForUm has decided to look into the innovations and find out what has changed for patients.
1. Outpatient department instead of policlinic
Earlier, if you felt sick you went to a district policlinic. Now, if the policlinic is far from your house or you don't want to stay in line, you can visit an outpatient department of family medicine. There are already 125 such departments working in Kyiv, and one of them is definitely closer to your house than the district policlinic. The outpatient department has a physician's office, examination room for women, treatment room, and in some departments - dental office. In the outpatient department a doctor will make initial diagnosis, a nurse will make an injection or carry out necessary treatment procedures. Patients can submit to tests, take out a sick leave and get full service except for a specialized consultation like ultrasonography, for example, as not all departments have proper equipment.  All these services are free of charge. According to head of the healthcare department of the Kyiv city state administration Vitaly Mokhorev, patients no longer need to run around the city to get all tests and papers done. "In the morning, for example, a patient can submit to blood or other tests in the outpatient department of family medicine. A car will bring the tests to the center of primary health care, and in the evening the patient can learn the results from his family doctor. In the future, the information will be sent directly to the patient's e-mail."
2. Not policlinics, but PHC centers
Now policlinics will be called primary health care centers (PHC centers). Patients should know that PHC centers are communal enterprises, which have the right to manage their finances. If a PHC center does not have enough means, it can introduce some services on a fee-paying basis. If things go too bad, a center may turn bankrupt and shut down.  
Vitaly Mokhorev specifies that in this case patients should know to differentiate such notions as medical help and medical service. Medical help - doctor's consultation or establishment of initial diagnosis - will be given free of charge. All medical institutions must render certain amount of services set by the main healthcare department, and only then they can earn money on additinal services.  
At the same time, head of the healthcare committee of the Kyiv Council Olha Gorbunova told ForUm that there is no common list of free-of-charge medical services to be rendered by all medical institutions at all levels. "We need a list of services approved by the Healthcare Ministry for a patient to receive free-of-charge medical assistance in any institution of Ukraine, even a private one." Thus, for example, there is a standard treatment of pneumonia, which includes cardiogram, fluorography, antibiotics, etc. If this standard is approved at the state level, patients diagnosed with pneumonia will receive full complex of services free-of-charge.
The staff of PHC centers will consist of family doctors only. At the first stage of the reform, family doctors will work together will primary care physician and pediatricians. Later on, these specialists will be qualified for family doctors. Apart from emergency and routine medical assistance, PHC centers will provide  welfare beneficiaries with medications, control the quality of services, plan and coordinate activities of structural subdivisions as well as manage finances.  As legal entities, PHC centers will be responsible for licensing medical practice, purchase of medications, equipment and consumable products.
3. Not to a surgeon, but to a family doctor

If you have stomachache, you go to a gastroenterologist, if you have pain in the leg, you go to a surgeon. From now on, patients with any kind of problem have to go first to a family doctor, who will examine  you, take samples and prescribe treatment. If a family doctor considers it necessary, he will send you to a specialist for more detailed examination in a clinicodiagnostic center. Such centers will be hospital-based (one center per district), and patients will be able to apply to any center regardless of the place of residence. Family doctors will also decide whether their patients need hospitalization or operation. However, according to the chair of the Kyiv Council commission on humanitarian policy Alla Shlapak, some questions remain unresolved. Thus, the Healthcare Ministry has not decreed to assign highly specialized doctors to the staff of PHC centers, thus the latter practice illegally for now.
4. Not any doctor, but a favorite one
Earlier patients had to go to a doctor assigned to their place of residence. Now, with a simple application form patients can actually chose a family doctor. If you no longer like your doctor you can always change him. The files of family doctors and patients' feedbacks are available on the website
5. Not when it is too late, but beforehand

People often come to visit a doctor when a problem is already aggravated. With assigned family doctor, patients will have no choice but to visit him regularly. The doctor may even call and invite you for examination, or pay a home visit. Your doctor will follow you and your family members for years, thus he will be able to prevent seasonal and/or genetic diseases and to advise on your lifestyle.  
6. No more pediatricians
According to the current system, children visit children's doctors, and at the age of 18 get transferred to adult policlinics.  According to the new system, medical institutions will not be divided into adult's and children's. Departments of family medicine will follow patients from childhood, and later on grown-up children will bring their children to the same institution. Such specialist as pediatrician will disappear within the time, as all pediatricians will be qualified for family doctors.    
As Valentyna Zalesska, deputy head of the Main Healthcare Department, told ForUm parents should not worry that children's policlinics will be shut down. Clinics will just change the name, and parents and children will feel no difference - same place, same doctors. Thus, policlinics will become PHC centers, and departments of functional diagnostics will become clinicodiagnostic centers.
7. Not to maternity hospital, but to perinatal center

Pregnant women suffering complications or some pathologies will be able to apply directly to perinatal centers and receive necessary medical assistance, as regular maternity hospitals do no have proper equipment to treat complicated cases. The first perinatal center for "complicated" mommies was opened in Kyiv in February of last year. The center helps women in case of premature delivery, nurse underweight newborns using high technologies of European quality. The authorities promise to open the second center by the end of 2013, which will render medical assistance to pregnant women with infectious pathologies, and later the third one to help pregnant women with extragenital diseases.

8. Emergency care instead of first aid

Since January 2013, when the law on emergency medical assistance came into force, the usual first aid was renamed into emergency care. Not only the name has changed, but the very system as well. There are new criteria, determining emergency or non-emergency calls. Thus, ambulance will come within 10 minutes to patients in unconscious state, suffering convulsions, sudden respiratory distress, sudden heart pain, vomiting blood, acute stomachache; to patients having signs of acute infection disease, psychotic break, injuries caused by car accident, occupational accident, etc. In case of non-emergency like temperature rise, headache, cough, dizziness, increase of blood pressure or acute-on-chronic flare, patients will be visited by paramedics within an hour. Anyway, patients can be sure that after dialling 103 the emergency care will arrive. Moreover, according to the new law, if a patient needs urgent hospitalization any driver must provide his car free-of-charge.

9. No more transfers from one hospital to another

A transfer of a patient from one hospital to another due to lack of adequate equipment or specialists is a very common practice nowadays.  No need to say that it can be very inconvenient for patients in grave condition. However, the reform of the secondary system of medical assistance is called to solve this problem.

According to the draft bill, submitted by the healthcare department of the Kyiv city administration to the Kyiv Council, all hospitals of the capital will be united into three hospital districts. The first one will include in-patient hospitals of Darnytskiy, Dneprovskiy and Desnyanskiy districts, the second one will be formed of hospitals of Podolskiy, Shevchenkovskiy, Obolonskiy and Pecherskiy districts, and the third one will unite in-patient departments of Holoseyevskiy, Svyatoshynskiy and Solomenskiy districts. Every hospital district will have multi-field hospitals of intensive care for adults (five institutions) and for children (2 institutions). Moreover, there will be 17 hospitals of planned treatment with three hospice departments, four specialized medical centers (maternity hospitals) and two recovery centers.

According to Vitaly Mokhorev, the current system being followed by hospitals is a waste of resources and finances. Large hospitals now provide mixed services, but planned treatment, for example, does not need sophisticated equipment of intense caser facilities. For the equipment not to stand idle and for patients to receive proper treatment, all hospitals of Kyiv will be transformed into relevant departments. Thus, if a patient needs to be operated for appendicitis, he will be delivered not in the closest city hospital, which might not have proper specialists or equipment to do the operation, but to a hospital of intensive care.

Hospitals of planned treatment will have specialized centers. Thus, hospital #2, for example, will have a center for thermal injuries, and hospital # 4 - a center for multiple sclerosis and recovery orthopedics. Every hospital district will have hospices for terminally ill patients. As for rehabilitation treatment, patients will be sent to special recovery centers in order not to occupy beds in hospitals.
In the near future the authorities promise more innovations. Thus, after the creation of working stations for doctors, patients will be able to make an appointment via internet, to keep electronic medical history sheet, to receive on-line prescription or test results on e-mail. According to the draft bill, developed by the Healthcare Ministry, in 2015 we will switch to the system of obligatory medical insurance. Well, let's hope that the new Ukrainian medicine at least won't be worse than the current one.

Anastasia Pika


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