By Marta Znak
KYIV, UKRAINE — Here is the story of Taras, who was refused hospitalization, and two days later died of a heart attack. There is the story of Olya, who died because emergency intensive resuscitation went too long, and the hospital did not have the necessary equipment. Here is the story of Anna, whose parents did not have money for a bribe to go to the department of bone marrow transplantation.
“My daughter was dying in a hospital, I saw it,” said Anna’s mother, Victoria Yurkovich, a 37-year-old economist from Kyiv, pointing at the T-shirt with the name of her daughter at a rally in favor of a healthcare reform in Ukraine.
A rally called “Monuments to the victims of healthcare populism” in Kyiv. Photo credit: Serhii Nuzhnenko
A rally performed crucified T-shirts with the names of deceased people who didn’t receive needed treatment. Photo credit: Serhii Nuzhnenko
“If patients in our country recover, then this is a happy coincidence when several factors come together — a good doctor and a lot of money. But if there is not even one of these factors — be scared, you are doomed.”
The post-Soviet healthcare system in Ukraine is in extremely poor condition now. Most Ukrainians live in fear of being in the hospital because of insufficient funding, lack of specialists, medicines and equipment, rudeness of staff, access to treatment only by bribes while officially the healthcare should be free.
"If patients in our country recover, then this is a happy coincidence when several factors come together — a good doctor and a lot of money."
The Ministry of Health set out to overhaul the ailing system and launched the reform that aims to replace bribes with official payments for some healthcare services. Not all Ukrainians liked this reform, and the country is split. Some people believe the plan would bring money to the underfinanced system while others worry treatment would be even less accessible to people.
The meagre state of Ukraine`s healthcare is clearly reflected by the World Health Organization data. According to it, the life expectancy in Ukraine was 71.3 years in 2015, while 77.5 years in Poland, 78.8 in the Czech Republic, and 81.0 in Germany.
Ukrainians also face high rate of diseases that have been largely eradicated in its neighbouring former Eastern Bloc countries that are now members of the EU. Many years Ukraine remains one of the leaders in the incidence of TB in Europe. According to the WHO, it had 35,304 TB case notifications in 2015, while in Sweden — 821, and in the Czech Republic — 518.
A survey conducted in May 2015 by research agency TNS Online Track showed that 84% of respondents were likely to give bribes to doctors and nurses. It reveals that free services of doctors are de facto paid since the state cannot finance the healthcare industry at the proper level.
Student Volodymyr Prizhko, 23, says that he has only his grandfather left since his parents died in a fatal road accident while driving to work. When his grandfather was hospitalized because of a stroke, Volodymyr had to pay every nurse and doctor for each service. In general, he paid about 3,000 hryvnas (~100 euros), which was very expensive for their small family. The grandfather’s pension is 3,500 hryvnas (115 euros) per month plus Volodymyr has an increased scholarship of 1,200 hryvnas (39 euros).
“If we did not pay, I’m afraid my grandfather would have died because of poor care,” he said.
Volodymyr added that there were six other patients in the ward none of which paid bribes. Only his grandfather recovered. “This ward was called the death room,” Prizhko said. “Fortunately, my grandfather was able to recover. Now I take care of him myself.”
Under the proposed reform, most healthcare would be paid or partially paid. Only primary, emergency and medical care related to childbirth would remain free. Services, including planned operations, inpatient treatment, diagnostics, and tests would be paid. No prices have been announced but officials say that they would be lower than the bribes.
“We insist on increasing the budget, no matter what the co-payment or full payment, it will be lower than the bribes that patients pay now,” said Pavlo Kovtonyuk, a deputy health minister.
The Ministry vows that it would also introduce welfare benefits for low-income patients but at the moment they are only calculated for soldiers in the war zone.
Since the proposal was introduced in May 2017, Ukrainians are deeply divided about its actual outcome. Huge support and protest rallies mushroomed across the country in recent months.
Protest in the center of Kyiv against the healthcare reform. Photo: Marta Znak
Doctors are holding a banner “I see no government money for healthcare”. Photo: Marta Znak
A column of protesters (about 3-4 thousand people) went to the Ukraine’s parliament. Photo: Marta Znak
A 65-year-old nurse from Odessa, Ukraine stands with a poster “Our profession is worthy of respect.” Photo: Marta Znak
Valeria Zhuk, a 48-year-old hospital nurse from Kyiv said that a change is long overdue. She decided to leave her job because she makes only 2,000 hryvnas (65 euros) per month. “It is not enough for a normal life. There are many job places but our work is not appreciated,” Valeria complains.
Speaking about the reform, she fears that pensioners and the poor will not be able to afford treatment after official payments are introduced. “Yes, people now pay extra money for operations, but we ask a little if we understand that someone does not have a lot of money,” Valeria adds.
Some people worry that healthcare will become inaccessible to most of the population and especially people in the countryside will travel far to get medical care after hospital reorganizations.
“They will have to go many kilometers to get to the doctor, and there will be a danger that the patient will not be brought to the doctor, but already to the morgue,” says Mikhaylo Volynets, an organizer of a recent protest against the reform in Kyiv.
Others are confident that the reform has obvious advantages and will bring Ukrainian healthcare closer to European standards.
“I’m a father of three children. I rarely get scared but I remember the horror when they went to our hospitals,” said Andriy Motovilovets, a 35-year-old project manager of public procurement in Kyiv. “This is a reform of the truth.”
But whether any change will come remains uncertain. In June Verkhovna Rada, the Ukraine’s parliament, passed reforms bills in the first reading but it remains in limbo since July as lawmakers postponed a vote on amendments to the budget code, without which the plan can’t go ahead.
That news was not welcomed by Prizhko.
“Becoming ill in Ukraine equals to a verdict at the moment,” he said. “I do not want to be afraid for myself and my grandfather anymore. We do need a change.”
Created as part of Journey 2017 of Bakala Foundation