introduction of compulsory health insurance will become a regular fees for employers. For insurance to work, doctor and hospital should be interested in providing quality services.
If professional

holidays did not exist, they truly would be worth to think. Each year to the day medical in Ukraine is the national program, developing laws to improve health. Take the number, not quality: In Ukraine there are 25 national programs in health, although financed by (and at the level of 30-40% of required), only seven. But bills to impose mandatory health insurance (MHI) was developed by the whole ten.

for the June holiday health workers have developed a new, eleventh, - on the financing of health care and mandatory health insurance. And, unlike earlier, his chances of becoming law is very high. Despite the fact that its adoption by the authors presented a document - People's Deputy Valery and Tatiana Bahteevoy Konovalyukom - as a panacea for all ills, the introduction of insurance medicine in the proposed form would only be another extortion for employers and useless obyazalovkoy for ordinary citizens.

Effect empty coffers

authors of the bill and do not hide the fact that, to seek additional sources of financing of Medicine (see the blitz-interview with Tatiana Bahteevoy). Assump ¬ asked that employers and ordinary citizens will be equally unstrap from their wages for the compulsory health insurance. Onye not exceed 6% of the minimum wage (currently at 630 UAH).. For the disabled, the unemployed and pensioners to 3% of the average subsistence minimum will pay pensions and other social funds.

In the end, this will result in double taxation - convinced Nikolai Polishchuk, Adviser to the President of Ukraine, ex-Minister of Health. - People will continue to pay current tax for the maintenance of the health care system, and parallel yurlitsa will transfer the money to go to payment insurance premium.

plan to enter service in two phases. At first the money will accumulate in the State health insurance organization, its charter capital budget would require 10 billion hryvnia. Yes, moreover, an additional 10% of collected premiums in the country will be able to keep the organization itself. However, it will be allowed only at the stage of JMS, but for how long it will last - the bill does not say.

After three years, the system will be able to join private insurance companies, but only those that are medical (for which health insurance is the sole activity). But today in Ukraine there are none - according to the Law On insurance, the insurers are at risk and life insurance companies.

In most developed countries impose mandatory health insurance from independent insurance companies - said Galina Tretyakova, a member of the Ukrainian Federation of security. - Because the insurer is interested that the patient cured, and the insurer does not bear vposledst ¬ deemed cost. A modern domestic medicine seeks to ensure that the citizens again and again treated in the hospital and bought a lot of drugs.

According to Mykola Polishchuk, of 16 billion UAH. spent Ukrainians to Medications in the past year, more than 9 billion gone in vain - to inefficient, useless or harmful means. The authors of the bill acknowledge the problem, but believe that their bill will help increase the effectiveness of treatment in Ukrainian hospitals. For monitor expenditure of budgetary funds allocated for the purchase of medications, will be the same state health insurance organization.

Now we are purchasing drugs through several government agencies, resulting in every third hryvnya settles into the pocket of government officials - said Valery Konovalyuk, head of the subcommittee on the formation of government programs and control the use of budgetary funds for the VR Committee on Health. - As soon as State Fund will be introduced (and it happens roughly 1 January 2010), this practice will come to an end.

insurance for insurance

introduction of insurance medicine - a move inevitable, the road went all the developed countries. However, each of which preceded the introduction of insurance medicine health reform. In Ukraine, according to the intent of the sponsors of the bill, this reform will go hand in hand with the implementation of JMS. According to Tatyana Bahteevoy for the effective operation of insurance medicine should take about 60 laws (see the blitz-interview). However, medical insurance will be effective only when changed the basic principles of Ukraine's health system.

To get started, you need to equalize the rights of private and public clinics, to head past to dispose of their own clinics. This will create a tool for promoting the best doctors, why the past would be interested in providing quality services. Because public hospitals account for 95% of all medical institutions of Ukraine, to improve the quality of medical services without changes in the state of medicine is a priori impossible.

But such reform - a long process, and fund CBOs, to the intent of the deputies should start already in 2010. That is, health care will receive additional funds, but the main principle - the lack of incentive for the effective operation of public clinics - will remain ¬ it. Therefore, how much money for medicine or allocate its quality will not change. And proof of this is fact: from 2000 to 2008, funding for health has increased 7.5 times, but its quality remains the same.

Good doctor heals poorly there - he still gets the same salary. Is that followed by a gift in the form of an envelope with money from a grateful client, or from the pharmaceutical companies for the appointment made by the drugs. But the introduction of insurance medicine problem of corruption is not eradicated.

Is that the collusion of doctors with pharmacists become problematic, as would be formed by a list of diseases and their impact in defining the main parameters of their treatment, - said Alexander Sosis, co-owner of an insurance company ASKA. - At last the public will be ordered at prices medical services.

As long as hospitals are not businesses, who will serve as a business, but fear of losing customers because the introduction of compulsory insurance is useless - I am sure Yuri Grishaev, Head of the Insurance Company Iljichiovsk. - As in the model with the participation of insurers and in a model with a government entity as a distributor of funds, the money will be plundered, and go into the pockets. Do the distribution of insurance funds will be officials - warns Nikolai Polishchuk. - In knocking out the money hospitals will write non-existent diagnoses.

to whom treatment?

To date, 90% of the budget goes to hospitals and clinics, staff salaries and utilities, the patient remained 7-10% of the allocated budget. While in developed countries this figure reaches 40%.

We need a restructuring of the health sector, - said Mykola Polishchuk. - Today we have doctors in the two times higher than in Europe, but there is no standard treatment, or control over the drugs! health should be given the status of nonprofit enterprises , independent economic entities. They should get an order from the Ministry of Health to treat a certain number of patients.

Sources in parliament called the bill a consequence of attempts to create a coalition BYuT and the PR. By agreement of parties, regional, lobbying document in Parliament, were to gain control over public health insurance organization. It can be comical nuance, which oppose the introduction of local self-government bodies will be Ministry of Health itself, for which medical insurance is an additional source of financial income. According to Health Ministry official who asked to remain unnamed, the introduction of MHI vamp there was only one positive thing: it will allow hospitals to upgrade their equipment quickly.

While this issue is relevant to public hospitals, it can be resolved fairly quickly, as soon as the medical insurance in Ukraine should work. But if her work would be inefficient, it would create a much more long-term problem that is harder to solve than to update the fixed assets of hospitals. It is about undermining the very idea at the root of compulsory health insurance.

In case of a registered bill, such an outcome virtually inevitable. And employers who have been forced down in a crisis time, it is very difficult to be persuaded that mandatory health insurance may actually improve the quality of meduslug. If the original order in times of socialism stuck in Ukrainian hospitals.

Background medstrahovki

Ten bills on CBO reduced to three basic concepts. The first - the introduction obyazalovki involving commercial insurance companies, which is the self-regulating organization that distributes insurance flows. This idea was strongly supported by physicians. It is quite understandable - commercial entity with an interest in cost savings will be meticulous monitor possible attempts to fan the cost of treatment, prescribe expensive and ineffective drugs. The second concept proposed to merge the four social insurance fund (on a temporary disability, accident, etc.) into one - and reformat it to fund CBOs. Supervision over the structure of farm out as representatives of the Cabinet, as well as trade unions and employers. It is this ideology inclined powerful in pre-crisis period. But because of falling production and degradation of the Social Insurance Fund of the attention focused on the third plan, which was nominated by Valery and Tatiana Bahteevoy Konovalyukom.

Tatiana Bahteeva: Without the additional money we will lose the health care system

Tatiana Bahteeva People's Deputy, Chairman of the Committee on Health BP, one of the sponsors of the bill on the financing of health care and mandatory health insurance, reported that for the full work of CBOs need to be adjusted to 60 laws.

Is there a need to introduce compulsory health insurance now?

- The reason for the lack of budgeted funds for the financing of the health care system. There are clear standards for the World Health Organization: in this industry should be not less than 5% of GDP. In Ukraine, this figure has never exceeded 3%. Offers a profile of BP on the budget for next year accounted for only 30%. This depreciation of medical equipment is 70%. Therefore, if this is not to find additional funds for medicine, the health care system as such we will not.

What kind of health insurance you have the basis for writing the bill?

- We have studied the experience of the introduction of insurance medicine in Russia, Germany, Austria, Italy and France. In all these countries, in addition to the budget, there is another source of funding: National Health Insurance. The same will be in Ukraine, a state fund, whose budget will be accountable to Cabinet and the Verkhovna Rada podkontrolen. The budget will fund a 30 billion UAH. and will be formed in equal proportions of employers and local authorities. The development of the fund in its budgeted 3%. For example, the four existing in Ukraine, the social fund had a total budget 156 billion UAH. and development spending 12% of this amount.

introduction of compulsory health insurance will increase funding for copper ¬ tsiny. But how it will improve the quality of medical services ¬? Because of the need for reform of the health care system, creating the conditions under which doctors and clinics will be interested in providing quality services.

- indeed, to reform the industry, there is a need for a number of bills, according to various estimates from 10 to 60, for example, the bill on patients' rights, on protecting the rights of health workers and so on. But our bill is designed to introduce other laws that globally change the entire health care system. Standards of treatment and care, to be located in secure care, yet planned to adopt in the Verkhovna Rada. They will depend on the size of the accumulation of an insurance policy.

Julia Pihnovskaya, Margarita Ormotsadze

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