Archive for June 3rd, 2017


Cura ti ipsum – (Physician) Heal thyself. Ukrainian health overhaul

June 3, 2017

There is much to do in Ukraine with regard to reform.  Much, if somewhat plodding along, has been done.  Not much of it is consolidated and much can be undone.  Progress there has nevertheless been.

Much can be accomplished simply by repealing legislation that is long since unfit for purpose and that is no more than a Soviet legacy for a society that is anything but Soviet.

There are numerous urgent and significant statutory upgrades – or better still – legislation that simply should start afresh.  How can 2017 Ukraine still be using a Labour Code almost unchanged from the 1973 Soviet Ukraine statute?  (An issue that one way or another can hopefully be expected to be dealt with by 2020 at the latest.)

It is but one example of a prolonged Soviet legislative hangover  that requires serious legislative attention and that continues to have daily debilitating effects upon contemporary Ukraine.

Other, similarly unfit for purpose legislation surrounds other core social policies (education, health etc) and associated legislative frameworks.  For the past two decades and more since independence the feckless political class have fought over issues such as language that rightly ranked incredibly lowly as an issue among the Ukrainian constituency whilst ignoring clearly unfit for purpose statute such as employment law, education and health legislation stagnated in an era (and system) long since past.

Given the events of the past 3 years and the circumstances Ukraine now finds itself within, it can be fairly certain that whilst issues of language and national identity more broadly consume a lot of political time and energy, the vast majority of the Ukrainian constituency would still place labour law, health and education, (infrastructure, defence, rule of law and so much more) far ahead when it comes to the amount of political energy that should be spent in areas of societal and economic development.

That is not to say issues of language and identity are not political issues deserving of attention – but it is suffice to say quite confidently that societal and political class priorities are not necessarily aligned.

Of course it is possible to argue that giving the public what they want is not the same thing as giving the public what they need when it comes to perceived priorities and vice versa.  However regardless any societal differences issues of education, labour law, health (and so much more) are social policies that cross all societal cleavages.  Everybody is subject to the policy benefits – or as is much more often the case policy deficits equally.

June, prior to the Verkhovna Rada summer holidays, will see a package of Draft Bills relating to health be subjected to parliamentary vote.

After several years of public animosity between the Ministry of Health (under any reformist Minister) and the relevant Verkhovna Rada Committee, notwithstanding a Health Ministry that suffers from an inherited and almost unsackable civil service that simply sabotages many attempts at reform at every opportunity, it is fair to say progress has been glacial.

(The blog has a friend currently contracted to advice the current Health Minister/Ministry, and the confidential tales told of obstruction and outright sabotage would dictate the firing of most of the ministry mandarins – at least it would under any sensible Labour Code.  But Ukraine doesn’t have a sensible Labour Code.)

Despite some less than encouraging incidents, the outsourcing of drug purchases from the Ministry through an external international buyer was a significant move.  It is not a move that can be anything other than temporary, but for now despite a few errors and some questionable product acquisitions and associated weak validation claims,  the policy of outsourcing rather than continued rampant nefariousness surrounding drug purchases by the Ministry on a national scale, was on balance a wise move.

Of the Draft Bills  to reach the Verkhovna Rada relating to health reform before the month end the most important is Draft Bill 6327 – “On public financial guarantees of medical services and medicines”.  It is the framework legislation for the future of the Ukrainian public health system.  The others relate to amending the national budget, specific ATO issues, amendments to the public procurement statute and health insurance.

If this appears somewhat piecemeal, then it is perhaps the only way to gain parliamentary support for the legislative framework required.   It would be nothing short of stupidity to see the most necessary Draft Bill 6327 refused due to disagreement over State or Private or State-Private health insurance for example.  (Whatever the outcome of that health insurance legislation, pray God it avoids the medical insurance monster that evolved in the USA.)

It is in fact probably wrong to classify Draft Bill 6327 as a medical/health Bill.  To be blunt it is a complete and necessary shift in social policy, albeit obviously health-centric as a new national health service will be built around the framework legislation.  It will take years to implement.  It is also, like almost all Ukrainian legislation, not perfect.  However it would be extremely foolish to throw out the good (or at least vastly improved) in pursuit of perfection and delay this matter any longer.

Will it manage to gather the votes necessary to pass its first reading in the Verhovna Rada?  Probably, but only just.  Both President and Prime Minister have made clear their expectation of it passing.

Naturally that does not mean it would get through a second reading unscathed, and if it did, would not be subjected to “amendment sabotage:” thereafter, but one battle at a time.  Rome wasn’t built in a day and neither will Ukraine be.

However, cura ti ipsum Ukraine.

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