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54 I Eastern Europe bne May 2018
But even she hasn’t been immune from political boondoggling: she is still offi- cially considered “acting minister”
as disputes in the parliament prevented her from being duly appointed.
More money and less corruption
The first component of the reform kicked off at the start of this month with the creation of the “family doctor” concept. Instead of the current system where Ukrainians can go visit any doc- tor, they will now have to choose one general practitioner who will follow them over the long-term.
This new relationship between doctor and patient also entails a new type of healthcare financing aimed at reducing corruption while raising doctors’
of the total. [...] It’s the most common way for doctors to make money.”
It’s also a major source of revenue for healthcare facilities. In Dynjak’s hos- pital, a naked concrete building in the outskirts of Kyiv, the pharmacy is the first thing patients see when entering. Despite free healthcare being guaran- teed by the Constitution, patients are systematically forced to pay for their medication, often at the hospital’s pharmacy.
Suprun argued this effort to reduce cor- ruption in the healthcare sector was one of the main reason behind the opposi- tion to the reform: “In the last years,
we were able to decrease the price of medication by 40% using international
Critics and fear
Critics argue that the reform could leave millions of Ukrainians without proper healthcare as some services become more expensive. Olga Bohomolets, a doctor and Rada deputy from the Petro Poroshenko Bloc party as well as the head of the parliament’s healthcare commission, wrote on Facebook the vote for the reforms would lead to “the closure of hospitals, the reduction in
the numbers of doctors, and the disap- pearance of rural medicine.” Ukraine’s Health minister promised subsidies for those unable to pay while the govern- ment announced a 12% increase in health spending this year, but details on the subsidies remain unclear.
Suprun, who only received Ukrainian citizenship in 2015 but is fluent in Ukrainian, has been heavily involved in communicating about the reform: the day she met with bne IntelliNews at the Health Ministry, she was chaining interviews with Ukrainian journalists in an attempt to counter the often negative narrative about the reform in local media. Her Facebook page is also filled with educational content, from explanations about the reform and myth-busting claims about the dangers of vaccines to calls for doctors to stop using photofluorography to diagnose tuberculosis.
Opposition to the reform has been fierce every step of the way, despite a recent poll claiming 65% of Ukrainians supported it. The bill on healthcare was voted in October 2017 after months of negotiations and heated debates, with Bohomolets writing the reform could lead to “genocide.”
In early January, as the launch date of the reform loomed closer, criticism of Suprun was ramped up. The issue was ostensibly about Suprun’s request to
fire the rector of Kyiv’s medical univer- sity after she had reportedly failed to organize an exam. In response, a group of students organized a strike calling for Suprun’s resignation, which, accord-
ing to some local media, received the support of the university. Suprun herself complained on her Facebook page of having received death threats.
“For me, it’s like a canary in a coal mine. When attacks against me get stronger, I take it that we’re doing something right.”
revenues. Doctors will now be paid UAH370 ($14) a year for each patient they treat, with a maximum number of patients capped at 2,000 for general practitioners. The scheme is currently limited to primary care doctors, but authorities plan to extend this to specialists and hospitals in the next three years.
This step is described by Ukrainian authorities as a way not only to enhance the quality of the healthcare but also
to reduce corruption. In the current system, an average monthly salary
of $200 for the doctors means the overwhelming majority of medical workers rely on bribes or shady deals with pharmaceutical businesses to complement their income.
The latter is very common according
to Andrii Dynjak, an internal medicine doctor working in one of Kyiv’s state hos- pitals: “You prescribe some drugs to a patient for a couple of weeks, the patient spends maybe UAH3,000 or UAH4,000 on this, and at the end of the month the pharmaceutical company gives you 10%
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procurement. That’s money that some- one in Ukraine is not making anymore,” she said.
And she is serious about tackling the issue. Suprun was recently approached by Andriy Bohachyov, an aide to the con- troversial Radical Party leader Oleh Lyas- hko, who offered Suprun a new apart- ment in Odesa in exchange for assigning some expensive medical equipment to
a particular hospital. She immediately reported Bohachyov to the National Anti- Corruption Bureau of Ukraine (NABU) officers, the Kyiv Post reports. NABU launched a sting operations and Suprun played along, even going to inspect the apartment, all of which was secretly filmed. The video was released and aired on the TSN television channel on April
6 leaving Bohachyov to rapidly back- track: he claims there was no connection between the apartment and the medi- cal equipment and he was only trying
to help Suprun out. Imported medical equipment is valuable and comes with money for maintenance that is often stolen, before the equipment is also stolen and sold.