The MSEC reform: a loud name or real changes?
Kyiv • UNN
The Ministry of Health has drafted a bill to reform medical and social expertise. It is planned to liquidate the MSEC and create new expert commissions, change the procedure for referral and assessment of a person's functioning.
The Ministry of Health has put up for public discussion a draft law on reforming the medical and social expert commission. The draft law provides for the elimination of MSECs, the introduction of examinations in cluster and supercluster hospitals, changes in the procedure for referrals to the commission, and much more. UNN decided to analyze what exactly the Ministry of Health proposes, whether it will be possible to overcome the old corrupt system and remove the pile of papers required to pass the commission.
What is MSEC
The institution called the Medical and Social Expert Commission, which has long been called a "private company" by the people, has existed in Ukraine since 1992, when it replaced the Soviet medical and labor expert commissions. Over the years, the MSEC has unfortunately become synonymous with the word "corruption," especially since the beginning of the full-scale invasion.
In recent years, members of the MSECs have become newsmakers of large-scale abuse and corruption. For example, an MSEC official from Khmelnytsky Oblast who, together with her son, the head of the Pension Fund's regional office, enriched herself with millions. During searches, they were found to have almost $6 million in cash in various currencies.
Also last week, law enforcement officers established that the chairman of the interregional medical and social expert commission in the Kiev region assisted citizens in evading conscription during mobilization.
What makes MSEC members so influential, and thanks to corruption abuses, so rich? First, let's understand what an MSEC is and what it is used for.
Medical and Social Expert Commission is a special institution in the healthcare system that conducts medical and social expertise for persons applying for disability determination upon referral of a healthcare institution after diagnostic, treatment and rehabilitation measures.
That is, it is the MSEC that decides whether a person has grounds for establishing a disability group or not.
In Ukraine, MSECs are under the jurisdiction of the Ministry of Health and are formed according to the following territorial principle:
- regional;
- central cities in Kyiv;
- city, inter-district, and district districts.
Probably, no one noticed it before, but after the full-scale invasion, the MSEC process became even more bureaucratic and corrupt. It comes to absurd situations when a person without a disability can get a group, and a person with a disability has to prove that he or she has grounds for it.
Reform of the MSEC
For some reason, the reform of the MSEC began to be actively discussed only after the detentions. Against this background, Health Minister Viktor Lyashko stated that 3,000 complaints have been received against the actions of the MSEC.
The head of the Verkhovna Rada Committee on National Health, Medical Assistance and Medical Insurance, Mykhailo Radutskyi, is convinced that corruption in medical and social expert commissions is a legacy of the Soviet Union.
So, what does the draft law developed by the Ministry of Health provide for? Probably, the most important thing in this document is the elimination of medical and social expert commissions as a fairly well-established body, and instead it provides for the creation of "expert commissions for assessing the daily functioning of the individual" (ECADFI). A distinctive feature will be that the composition of such commissions will be formed individually for each case from among doctors and specialists in rehabilitation in the field of healthcare.
The functions of the commission will be:
- referral, if necessary, for additional examination of the functionality of the body's structures and functions;
- formation of the result of the assessment of the person's daily functioning based on information about the state of health;
- determination of compensators for the daily functioning of the face;
- planning and conducting a reassessment of the person's daily functioning;
- identification of the disability group, recording the causes and time of its occurrence in accordance with the documents confirming this;
- determination of the degree of loss of professional ability to work;
- entering information about the result of an assessment of a person's daily functioning into the electronic health care system.
It is also envisaged to eliminate the "medical and social examination" conducted by the MSEC and replace it with an "assessment of a person's daily functioning" - a type of medical examination conducted by an expert commission for a person with disabilities in order to determine the levels of disruption of the structures and functions of the human body, including physical, mental, intellectual, sensory, which may lead to a limitation of life.
The draft law stipulates that the state ensures the conduct and financing of assessments of a person's daily functioning.
It is planned to eliminate the medical and social expertise of disability and persistent life restrictions, and instead introduce a "medical examination for temporary disability".
It also provides for the addition of the law "on health protection" by Article 69-1 "Comprehensive assessment of life restrictions and assessment of the daily functioning of a person", which is carried out in order to determine restrictions that prevent or make it impossible for a person to perform daily activities in the way and in the amount usual for a person and leads to restriction of life activity.
It is noted that the comprehensive assessment will have the following stages:
- assessment of a person's daily functioning;
- assessment of a person's needs for social services, in accordance with the law “on social services", which is carried out by analyzing documents, facts and information collected during communication with a person/family and their immediate environment, as well as received from legal entities and individuals;
- assessment of the needs of an education applicant in the educational sphere, which includes the formation of an individual educational trajectory;
- assessment of employment needs, which includes determining the level of working capacity.
Assessment of the daily functioning of a person is carried out in order to determine the presence or absence of violations of the structures and functions of the body.
The assessment of a person's daily functioning will consist of the following steps:
- identification of the need to assess the daily functioning of a person;
- referral for additional examination if necessary;
- formation of results of assessment of the daily functioning of the individual;
- determining the need for other stages of a comprehensive assessment of disability;
- determination of compensators for the daily functioning of the face.
According to the draft law, "compensators for the daily functioning of a person" are a set of medicines and medical devices and auxiliary means of rehabilitation of temporary or permanent use/use, prescribed by medical professionals or rehabilitation specialists.
If the draft law is adopted, the decisions of the MSECs during their work will remain in force, but they will be reviewed in cases determined by the Cabinet of Ministers.
The MSECs themselves will continue to exercise their powers until the establishment and start of the activities of expert commissions to assess the daily functioning of a person in the relevant field, and then will be liquidated by the founder.
The draft law stipulates that the examination will be carried out in cluster hospitals (multidisciplinary hospitals that will meet the needs of the population in the treatment of the most common diseases) and supercluster hospitals (specializing in rare diseases), where all the necessary specialists and the possibility of additional examinations are available.
Also, referral for examination will take place on the basis of clear criteria, with their confirmation through the electronic health care system; it is planned to introduce an electronic referral for passing the examination.
The family or attending physician will be able to refer for examination independently, without involving the Medical Advisory Commission (MAC).
In general, the bill introduces amendments to 27 laws and codes of Ukraine.
The explanatory note to the draft law states that the main task is to simplify the processes in establishing disability by formalizing the relevant criteria and regulating procedures; digitalization of passing the examination; introduction of transparent appeal mechanisms; changing the mechanism for financing medical and social examinations.
The Ministry of Health hopes that the implementation will begin in 2025, and a special budget program "Ensuring the provision of medical services to assess the daily functioning of a person" is planned for this purpose, which will require UAH 458 million 646.5 thousand over the next three years.
How things are going now
Now, in order to get to the MSEC, you need to go through 9 circles of hell, because the referral to it is already given to the MAC. First, a person who wants to either establish a disability or continue the group should consult a family doctor to undergo a diagnosis, full medical examination and treatment. A full medical examination means that a person must pass the necessary tests within five days and pass all the specialized doctors who will draw conclusions about his illness.
After visiting specialized doctors, which can last for weeks, because the appointment to them can be scheduled for months in advance, the person again turns to the family doctor. After filling out a pile of papers by a family doctor, a person needs to contact the MAC, and here is a surprise: you need to go to the offices again, which can take a long time to get a coveted signature from the doctor about passing specialized specialists.
Note that health certificates from narrow specialists, the results of tests and other examinations are valid for a month, and if you come to the MSEC, for example, in a month and a half, the person can be sent for a second examination.
It seems that everything is already there, the signature is there, the doctors ' conclusions are there, but then you need to go to the MAC, which is the first to decide whether or not a person has a disability.
When all members of the commission agree on the results of the examination and sign Form 088/o, the person is sent for medical and social examination. The examination must take place within five working days - since the MAC sent the patient's referral.
This examination should not only confirm a person's disability, but also provide them with the necessary treatment and rehabilitation plan based on examinations.
Already at the MSEC itself, a person is established, or not established disability. A disability group can be assigned from 1 to 3 years, or for life. There are absurd cases when a person without a hand is given a disability group for a year, and every year he has to beat the doorsteps of hospitals to re-confirm the absence of a limb. Perhaps the logic of MSEC is that the brush will grow back in a year?
The Ministry of Health pointed out that the general goal of reforming medical and social expertise is to determine the needs of a person and maximize return to society with the possibility of an active life and employment.
Health Minister Viktor Lyashko stated that the MSEC reform provides for targeted changes that simplify the process of passing the MSEC and should prevent any manipulation, as well as a general reform of expertise, which provides for changes in the medical and social part.
It should be noted that the Verkhovna Rada has taken a step towards a targeted reform of the MSEC by adopting in the first reading a draft law that concerns certain procedures for passing medical and social expertise, in particular, it is proposed to exclude the obligation of a person to undergo a medical examination in the MSEC and provide for the right of a person to determine the form of their participation in the MSEC meeting (in person or online).
