Medical reform in Ukraine is not only a change in the principles of facility financing, but also a competition for the patient, linked to the need for constant improvement in the quality of services. This is how Dmytro Govseiev, Director of the Kyiv Perinatal Center, obstetrician-gynecologist of the highest category, and Doctor of Medical Sciences, analyzes the reform. He spoke about how the Perinatal Center, formed in the capital on the basis of two powerful medical institutions, functions and develops under such conditions in an interview with UNN.
Medical reform has been ongoing in Ukraine for several years. One of its stages was the formation of a capable network, which led to a change in the landscape of the medical network. The first stage concerned changing the logic of financing medical services—"money followed the patient."
"When the reform started, we began receiving funds from the NHSU not for the number of beds, but for the treated case—in our case, these are births and surgeries. That is, even before the start of the full-scale war, we understood that institutions that were less powerful simply would not 'pull through' in such conditions. Competition was becoming tougher even among municipal institutions. Private ones are a separate story; they are also starting to work with the National Health Service and are becoming our competitors."
"Understanding where the development of the medical industry was headed, we saw that it was necessary to create a powerful center that would handle not only extragenital pathology (the main profile of Maternity Hospital No. 5, which became part of the unified Perinatal Center - ed.), but everything related to perinatal medicine," said Dmytro Govseiev.
At that time, as the head of the capital's 5th maternity hospital, he and the then-head of the Perinatal Center reached an agreement to form a unified institution. Dmytro Govseiev headed it, while Viktoriia Bila, who previously managed the Perinatal Center, took the position of deputy director in the newly created institution.
"This merger was not a result of coercion or pressure," Govseiev emphasizes.
The merger was officially approved, and a powerful mono-profile obstetric institution was formed in the capital—the only one of its kind and the largest in Ukraine.
"A very powerful institution, a very large number of births—what we earned through the National Health Service of Ukraine was absolutely sufficient for us," says Govseiev.
The NHSU fully covers childbirth (naturally or via cesarean section) under the medical guarantees program. The amount does not reach 20,000 hryvnias, but patients covered by medical guarantees do not need to pay anything extra.
However, the birth rate is currently declining, and consequently, the number of births is decreasing, along with funding. Despite this, as Govseiev explains, the salaries of doctors at the Perinatal Center increase every year.
"Every year, our doctors' salaries only increase. There is salary growth, but not as much as we would like, of course, considering inflation and the constant rise in the price of basic goods. As a director, I would like salaries to increase and medical workers to be more interested in their work. Here, everything depends on the number of births at the Perinatal Center. Because the only source of funding is the NHSU. And, unfortunately, a decrease in the number of births cannot ensure salary growth," says the head of the Perinatal Center.
Under such conditions, retaining high-class specialists becomes not just a confirmation of the institution's status, but a condition for its survival.
"And the reality is that patients follow the doctor. This should encourage doctors to have sufficient professional authority so that women want to give birth specifically with that obstetrician-gynecologist. And it is quite logical that the advantage will go to the doctor who has delivered 18 babies, rather than the one who has delivered one. In our profession, this is absolutely normal," explains Dmytro Govseiev.
The Director of the Perinatal Center said that paid services were officially introduced at the facility. This makes it possible not only to provide them to those who do not fall under medical guarantees, or to those mothers who want to receive, for example, personal support from a specific doctor, but also to stimulate and encourage the medical workers themselves.
"Today, we have paid services in two areas: individual support and special accommodation conditions—meaning a separate improved room where the mother can stay with her husband. But let me emphasize once again: ordinary childbirth—even with anesthesia or if you want the husband to be present—does not require additional payment," Govseiev explained.
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