In a chronic underfinanced system of public health care sickness funds are one of the alternative sources of health financing that are able to promote the development of health care, to protect patients’ rights, and to maintain population?s access to health care.
In Ukraine operate currently about 230 sickness fund schemes, which sometimes have their own peculiarities due to different organisational approaches in delivering health care to its members. In order to identify, generate and standardise general management principles, to promote its integration, and to improve the professional management skills of its managers, there was carried out a target group training programme in Zhytomyr.
In the capacity building training module ?Organisation and management of sickness funds in Ukraine? took part 20 participants from sickness funds of different regions of Ukraine. The training was carried out in a five days programme cycle that lasted from March 15 to 19, 2010. It was designed by the all-Ukrainian citizens? organisation ?Association of workers? sickness funds Ukraine? in cooperation with National Medical University named after O.O. Bohomolets, Kyiv. Managers and experts listened to professional lectures and participated in seminars and workshops. The chairman of the ?Association of workers? sickness funds Ukraine? Professor Valentin D. Pariy introduced in his lectures trends in health care development of European Union and the CIS countries, modern approaches of developing health care in Ukraine, evidence-based medicine as an objective source for quality assurance in health care, analysis methods for assessing the economic performance of sickness funds, organisational and historic aspects of the existence of sickness funds in Ukraine and the role of the association of workers? sickness funds Ukraine.
Professor Alla V. Stepanenko, PhD and deputy head of the Central Committee for pharmaceuticals of the Ministry of Health Ukraine (MoH) described the state standard form of pharmaceuticals, its present situation and its implementation perspectives. Tatyana M. Dumenko, deputy director of the department of health care standardisation at the MoH presented the rational therapeutic use of pharmaceuticals according to safety rules and its results of 2009 including the cooperation with the State Pharma Centre of the Ministry of Health Ukraine and the sickness fund of Zhytomyr region to track adverse effects of drugs. B. H. Kaunzinger, expert within the framework of the technical cooperation programme between Germany and Ukraine ?GTZ/CIM?- held a lecture on marketing principles and measures for health insurance schemes. Alexander Y. Gusak, deputy head of the Oblast state health care administration presented the experience of the work of expert-monitoring committees at the regional state health administration and the imporatnce of the sickness fund of Zhytomyr region from the perspective of state authorities.
The practical parts of the training programme were carried out at the premises of the charitable organisation “sickness fund of Zhytomyr region?. The participants became acquaintanced with the on-site work in the departments and gathered experience about interactions between a sickness fund scheme and health care providers at primary and secondary health care levels. In particular, the participants received knowledge about the collaborations with the Zhytomyr regional hospital named after Herbachevsky, and with the central district hospital of Zhytomyr. They also learned issues about the decentralised network of branches of the sickness fund in the Zhytomyr region, as well as how to deal with corporate clients, state authorities, and family physicians based on a sickness fund?s perspective.
The participants of the programme were particularly interested in the quality assurance scheme of the health service delivery process, and the automated resource management system.
Galina Pustovaya, head of Voznesensk city sickness fund shared her impression confirming that she appreciates having had the opportunity to attend such courses. She told that a lot of useful information has been given to the participants and stated that she sees further development potentials for sickness funds based on the particular experience from Zhytomyr region. Vitaly V. Shevchenko, executive director of the charitable organization ?sickness fund of Poltava region? added that taking part in such activities allows sharing best-practice knowledge and encourages the professional improvement and implementation of new techniques. Thus, these assemblies are useful to find new colleagues for cooperation from other sickness funds. Thanks to the achievements and experience of the sickness fund of Zhytomyr region, other organisations are able to learn from existing best practice and may unite resources to jointly move forward to improve the provision of health care in Ukraine.
All participants expressed their satisfaction and proposed to continue carrying out such kind of measures on a regular basis. Special thanks to V. D. Pariy and his crew for the excellent organisation of the educational process.
Svitlana Myhalyuk
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Zhytomyr – Yaroslav is now only 2 months. But unfortunately, this little child has a congenital heart defect. This means that he needs surgical treatment. When the little boy grows a bit older, the operation can be carried out at the Ukrainian Specialised Children’s Hospital ?OKHMATDYT?. Of course, this kind of treatment will cost a lot of money.
Yaroslav has 4 brothers – Andriy, Bogdan, David, Benjamin and 5 sisters – Anna, Elena, Natalia, Victoria, and Irina. All of them live with their parents in the village Grishkovtsy located in the district of ?Berdichev. Their dad works as boiler operator, and their mum takes care for the children. Realising that it?s hard to raise ten children and cover their expenses, the charitable organisation “sickness fund of ?Zhytomyr region? has decided to help out the Nagorny family.
Just recently ago, the children?s mother Evangelina Mykoleyevna Nagorna and father Danyl Mykolayevych Nagorny visited the main office of the sickness fund at which the executive director Volodymyr Stanislavovych Myshkivskyy welcomed them as new members of the sickness fund and handed out to the family a membership confirmation booklet.
?We are very grateful that we have received a reliable friend who is willing to support us in these difficult times ? our friend is the sickness fund of Zhytomyr region. When having applyed for membership at the sickness fund, we did not even expect of being accepted, because we live in these kind of times where our social environment is likely to forget about benevolence and mutual aid? – told Mr.? Danyl Nagorny. ?Now, we feel that our children are better off, in case of need for necessary medical care? – added Evangelina.
It?s a good thing, when children grow up and do not get sick. All parents wish to have this condition. But in real life, things occur to be different. Almost all the girls and boys of the Nagorny family caught the cold without complications, except for five-year old Iryna. She had been hospitalised with pneumonia at the central district hospital of ?Berdichev. The father phoned to the office of the sickness fund and thanked for the high quality treatment, which the girl has received, including all necessary pharmaceuticals and diagnostic measures. He also pointed out that his daughter has been taken care of by high dedicated hospital employees such as Natalya Rovkova, the physician in charge and her team of nurses.
?It is pleasant to find out that the sickness fund of Zhytomyr region does not only care for the Nagorny family, but for orphans, pupils from boarding schools and children?s homes, including Hryshkovetska, a specialised boarding school. It is of utmost importance as public funding is limited and therefore I would like to address a separate thanks to the sickness fund? – told N. Rovkova.
Under the patronage programme of the sickness fund are nearly 900 orphans. Now it?s up to take forward this good practice of the sickness fund of Zhytomyr region, in order to contribute to a healthy growing up generation for our country.
Svetlana Romaniuk
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Basically, patients approach a physician in order to receive medical aid for health recovery. But is it possible, when at this point adequate state financing for pharmaceuticals is absent and costs are constantly increasing? It is not likely to be. But these kinds of problems do not occur to those in our region, who have taken in advance measures to receive necessary health care treatment in case of need by joining the scheme of the charitable organisation ?sickness fund of Zhytomyr region?.
How to protect patients? rights in the present condition of insufficient health care funding, how to ensure population?s access to medical care and how to improve its capacity, efficiency and quality? These issues were the main topics at the annual meeting of the board of the charitable organisation “sickness fund of Zhytomyr region”, which was chaired by the head of the Zhytomyr regional state health care administration Alexander K. Tolstanov and the president of the sickness funds of Zhytomyr region Prof. Valentin D. Pariy, merited physician of Ukraine.
A constructive conversation was carried out in regards to the present work and future plans of the sickness fund, including ways to improve health care delivery to its members. The executive director of the charitable organisation “sickness fund of Zhytomyr region? Volodymyr Myshkivskyy presented the annual report on the activity of 2009 and informed on the implementation of the financial plan for the period of the second half year. Chief accountant Lyudmila Pastushenko introduced the financial plan for the first half year of 2010 and deputy executive director Sergey Grischuk gave an overview on the membership development of the sickness fund.
The sickness fund of Zhytomyr region has 193 271 members, which is 14.9% of the total Oblast population. The highest membership/population ratio has been achieved in the districts of Lugyny (27.4%) and Malyn (22.5%). 20.8% of the city population of Zhytomyr are members of the sickness fund. The districts with the lowest ratio are Novograd Volyn (6.3%), Ruzhyn (8.3%), Emilnyche (8.4%) and Korostyshiv (8.7%).
The sickness fund received 11 204 new members last year. Most of them appeared in the area of the city of Zhytomyr (3631), followed by the cities of Berdichev (1533), Novograd Volyn (601) and Korosten (575). Among them were 77% (8661) which entered the sickness fund scheme as individual members and 23% (2543) who became new members due to collective corporate agreements, which means that the membership fees are being paid by the employer. 47% of the sickness funds new members received medical services during the course of the year of entry. 75% of contributions that those members have paid were spent during this period. 59% of the new members received medical care from the sickness fund after having been 4-6 months in the organisation.
Not all members do appreciate the advantage that derives from the sickness fund?s membership including its entitlement to timely access to necessary pharmaceuticals and medical screening. Some of them seem to believe that its favourable just leave the sickness fund right after having received health recovery: One year after entry, 24% stop paying contributions. 58% of them are members under 30 years, stated the executive director. The membership structure of the sickness fund is dominated by individual members (52% – 81 655), the proportion of those whose contributions are being paid by employers is 29% (46 415 people). Thus 22 105 members (14% of total) have contribution debts that exceed 250 UAH. They are seen as candidates for membership exclusion. Approximately 18% of individual members do not regularly pay their contributions. Since its existence, the charitable organization ?sickness fund of Zhytomyr region? has excluded 51618 members due to lack of contribution payments and 7928 of them in the year 2009.
Under the patronage programme of the sickness fund are nearly 900 orphans, who received free of charge? pharmaceuticals with a value of 20.5 thousand UAH last year. 67 World War II veterans obtained medical treatment with an amount of 15 thousand UAH at the expenses of the sickness fund. The targeted revenues of membership contributions for 2009 of 22.47 Million UAH have been achieved by 22.84 Million UAH of performed revenues including the unearned income of 232,7 thousand UAH (Current degree of target achievement: 101.6%).
While informing the board about the actual spending, Volodymyr Mishkivsky stated that during the financial year of 2009 occurred only 23.546 million UAH of total expenditures, out of which the percentage of expenditures for the main cost centres such as pharmaceuticals and medical services were 82.4%. The surplus between revenues and expenditures is 708.1 thousand UAH, which corresponds to 3.1% of the revenues.
During the financial analysis of internal budgets that are given to each sub unit, V.S. Myshkivskyy drew attention to the fact, that in 2009 the balance between revenue and expenditure was negative in following areas: city of Zhytomyr – 500,226 UAH, Novograd Volyn district – 51,849 UAH., Zhytomyr district – 152,791 UAH, City of Berdychiv – 100,246 UAH, Chernyakhovsky district – 60,247 UAH, Romanivs’kyi district – 44,186 UAH, and Lyubarsky district – 18,109 UAH. In the districts of Chudniv and Korostyshevsky occurred a positive financial result such as in the district of Popelnya that managed to improve its financial position.
The sickness fund is aimed to continuously improve health care delivery not only to those who are members of the organisation, but also for the entire residents of the Oblast. The sickness funds donated medical equipment with a total value of 161 thousand UAH to health care facilities.
The effectiveness the sickness fund scheme and its contribution to health promotion to population and its rising utilisation may be demonstrated by the following figures: In the year of 2009 medical care was provided in 310 551 cases by the sickness fund (17% increase compared to previous year). In total 105 454 persons received health treatment (2008: 101 702). The average cost for treatment was 155.28 UAH (2008 – 113.93 UAH).
It’s pleasant to mention that the sickness fund even supports improving the demographic situation, as it provided pharmaceutical care to 1870 pregnant women (including 673 deliveries by cesarean section) on which an amount of almost 296 thousand UAH was spent. Analysing the structure of medical care provided, the executive director noted that 9% of patients were treated at primary health care level, 71% at secondary and 20% at tertiary health care level.
There has been a gradual increase of members of the sickness fund, who received medical screening (in 2007 131,801 with a value of 811.1 thousand UAH; in 2008 148,270 with a value of 975 thousand UAH; and in 2009 190,910 with a value of 1.480 Million UAH). In 2009 there were spent 335.5 thousand UAH for computer tomography imaging, reported Volodymyr Mishkivsky.
In the frame of the current underfinanced public health care system, the charitable organisation ?sickness fund of Zhytomyr region? is a real mechanism to collect additional financial resources in order to improve the accessibility to health care in the region. The amount of the funding on top of the governmental resources was 36.49 UAH per citizen (2008 – 35.58 UAH).
Those who are members of the sickness fund, can rely on receiving medical coverage at all health care levels, because their treatment is carried out according to local clinical guidelines. The guidelines are approved by the regional State Health Care Administration in its order ? 754 from 30.12.08 “on approval of local clinical guidelines of health care for residents of Zhytomyr region” and by the list of the pharmaceuticals used by the sickness fund.
It has to be mentioned, that members of the sickness fund are likely to have more advantages than other patients, because they do not face financial burden receiving pharmaceutical care, they obtain their medicines on time and only those that meet international quality standards. The selection of effective and safe pharmaceuticals that are chosen to treat the sickness fund?s members is being achieved through cooperation with the State Pharmacological Center at the Ministry of Health Ukraine.
84 percent of the sickness fund?s members received prescribed pharmaceuticals during the very first hours of their medical treatment at a hospital. The members of the sickness fund are entitled to take part in health promotion measures, to get access to modern medical care, including systemic thrombolysis for the treatment of acute coronary syndrome, pulse therapy, the use of prostaglandins for rheumatology treatment and for vascular surgery, the extensive use of low molecular weight heparin, the method of lithotripsy in case of chronic obstructive pulmonary disease.
As a result of the on time delivery of quality pharmaceuticals to patients, the mortality rate of those who are members of the sickness fund became significantly lower than those of the average population of the region during treatment (4.16% in comparison to 6.59%).
A system of human values in health care is of particular importance whenever patients have lost or worsen their health – the sickness fund provides health recovery to its members up to the required amount, based on the principle of solidarity.
Author: Svitlana Mykhalyuk
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15.2.2010 – Capacity building and development of the system of sickness funds in Ukraine is one of the key areas of our activity. Therefore we are ready to provide management and financial support to our member sickness funds. We are ready to look at proposals from regional and local sickness funds that request organizational or financial support. Please submit your proposal to our executive director Kyryl Pischikov.
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12/03/2010. During a working visit to the 4th City Hospital of Poltava, the chief physician of the hospital of the National Academy of Sciences of Ukraine I. A. Yaremchuk and assistant medical director of the surgical ward ? 3 of the National Medical University, S.M. Kozlov got acquainted with the latest information technology at the 4th City Hospital of Poltava, the lay-out of the city’s corporate IT network and the work of the sickness fund of Poltava region. The meetings were accompanied by the international expert within the framework of the technical cooperation programme between Germany and Ukraine B. H. Kaunzinger.
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