Time or money: why the British medical system is suitable for Ukraine

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Profile photo of Роман Крегг
Спеціаліст з алгіатрії (науки про біль) та анестезіології у Державній лондонській клініці неврології та нейрохірургії, президент Української медичної асоціації Великої Британії, доктор медичних наук
Роман Крегг

In spite of the fact that this may seem strange, but the British and the Ukrainian health care systems have similar roots. And therefore, it is much more easier to implement the British model in Ukraine, than the other models.

Unlike the British model, the American or the German insurance medicine models work in such a way: there are hospitals that shall make money and pay for their bills. The more procedures they perform – surgeries, MRI scans, ultrasound investigations, other examinations and tests, – the more money the hospital raises and, consequently, the more profitable it is.

The British system is very pragmatic and functions in other way. It is free of charge, but treatment priority here is placed on young people with no chronic diseases that is, on those, who will work and pay taxes, that is, those, who will sustain life of the entire system. When such citizens visit the public doctor, they are more likely to get professional aid in a speedy fashion. And they are treated as quickly as possible – for them to return to their workplaces and keep on paying taxes.

TREATMENT PRIORITY HERE IS PLACED ON YOUNG PEOPLE WITH NO CHRONIC DISEASES

Oncology patients and those, who suffer from cardiovascular diseases are also of top-priority.

But if you are retired and suffer, let’s say, from joint pain or diabetes, you will have to wait quite a long time for your field-specific doctor to make appointment with you. You may also turn to the private clinic. That is, you will have to either pay for medical services, or waste a lot of time. Sure thing, such patients does not seem that this system is pretty justified.

The truth is that in the UK one may not turn directly to the field-specific doctor cardiologist, traumatologist or surgeon. Persons shall first turn to so-called primary medical link – that is, to general family doctor, who will serve as a “barrier” between the patient and the expensive clinical narrow-field experts. This is who will decide whether you get to the specialized doctor in a hospital and how soon you will get to him. In other words, if you are in the UK, you can not just go to the hospital and say: “I have a fever, give me please some antibiotics!” antibiotics will not be prescribed to you just because you need them.

And what is more, the British family doctor receives 100 pounds a year for one person. It seems to be little or nothing, but the system works.

Furthermore, the British health care model predominantly provides for the home treatment – admission to hospital is only performed here if there is no other way, for instance, when person needs surgery. If you have pneumonia, rash or cold, you will be given an antibiotic and sent home. The same goes for palliative care people die at their homes rather than in hospitals.

But in the UK you will have improved chances of getting good-quality emergency aid – it is world’s best.

Ukraine has post-Soviet health care system that is, like the British one – it is free of charge. Switching over from one to another similar model will be much smoother, since few things shall be changed.

Principal difference between the Ukrainian medicine and the British one family doctor, who decides whether to send the patient to an expensive expert or no, is the driving force of the British system. In Ukraine this decision is made by field-specific doctors, to whom the patients may turn  directly. This is the only gross difference. All the rest taxation, payment for services from the budget, periodic health examination are very similar at the baseline.

FAMILY DOCTOR IS THE DRIVING FORCE OF THE BRITISH SYSTEM

Implementation of these two essential things reduction of hospital beds quantity (that is, to cure more at home) and primary, family medicine – will be the most logical change in structure. When this is done, we will be able to cover the needs of medicine from the state budget.

According to unofficial figures, which I heard during several conversations with government officials in Ukraine, only 30% of all the funds spent for the doctors in Ukraine are steered into the bribes. In other words, 70% of all the medical services are now paid from the budget. But the problem is in the point that these funds are being spent completely irrationally – therefore, they are not visible. If these expenses are rationalized, then Ukrainians will really pay out of their pockets for the medical services only 30%. The rest will be covered by the government.

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