Olek­sandr Linchevskiy: “The best-off Ukraini­ans are demon­strat­ing against the Health Min­istry”

Deputy Min­is­ter of Health on the re­form of the med­i­cal sys­tem

The Ukrainian Week - - CONTENTS - In­ter­viewed by An­driy Holub

Deputy Min­is­ter of Health Olek­sandr Linchevskiy talked to The Ukrainian Week about the re­form of Ukraine’s med­i­cal sys­tem.

One of the main ac­cu­sa­tions be­ing made by your op­po­nents is that the state is not al­lo­cat­ing enough money for health­care while peo­ple are get­ting poorer, mean­ing that health­care spend­ing needs to grow and re­forms should come later.

The Verkhovna Rada es­tab­lishes the per­cent of GDP that is al­lo­cated for health­care. How cyn­i­cal can peo­ple be, to com­plain that lit­tle is be­ing spent on medicine, and then to vote for 2-3%? There is never enough money for health­care. Not in any coun­try. How­ever good med­i­cal treat­ment is, it can al­ways be bet­ter, even when health­care is fully taken care of: the doc­tors are smart, the equip­ment is avail­able, the treat­ment fa­cil­ity gleams... you still want to sow some pretty flow­ers so that pa­tients will have a nice view from their win­dows. There is no limit to im­prove­ment. As soon as ev­ery­thing is fine at the hos­pi­tal, some new tech­nol­ogy ap­pears that also needs to be bought. This is a con­stant process. No sys­tem of med­i­cal ed­u­ca­tion has ever said, “That’s it! Enough’s enough. Let’s stop here be­cause ev­ery­thing’s per­fect.” In fact, all this non­sense about al­lo­cat­ing and not al­lo­cat­ing comes down to one thing: the state isn’t al­lo­cat­ing any­thing right now.

Your op­po­nents also claim that, af­ter re­forms, 80% of health­care will re­main with­out funds.

Right now, it’s 100%. Try to take even one step in a hos­pi­tal to­day for free. The only thing the hos­pi­tal won’t take money from you for is heat­ing and elec­tric­ity. That’s it. The money that is avail­able now is be­ing used by our op­po­nents. Af­ter re­form, that money will go to serve or­di­nary Ukraini­ans. There’s only one rea­son for all these con­trary state­ments. How to fool peo­ple, to ma­nip­u­late them, to cry on cam­era is all just a mat­ter of tech­nique. Only func­tionar­ies and crooks don’t want to see the sys­tem changed. Pe­riod.

How do these crooks get their hands on the money?

There are a lot of ways. Right now, UAH 50 bil­lion is avail­able for medicine and this money has to be split among 25 oblasts. These sub­ven­tions that go to the oblast are then al­lo­cated to the coun­ties, which fur­ther dis­trib­ute them among med­i­cal fa­cil­i­ties. The ques­tion is, which fa­cil­ity and how much? For ex­am­ple, de­pend­ing on per­sonal re­la­tions. What do we pro­pose? Say that one hos­pi­tal has 10 pa­tients and the one next door has 20. We will set up a Na­tional Health­care Ser­vice that will di­rectly trans­fer funds to the hos­pi­tal. Oblast and county of­fi­cials, and bad hos­pi­tals, don’t like this idea.

What will stop the Na­tional Health­care Ser­vice from also en­gag­ing in cor­rup­tion?

The cen­ter will have a com­puter that reg­is­ters ev­ery­thing. A pa­tient comes in a hos­pi­tal and money is trans­ferred. That’s all. The avail­able funds can be dis­trib­uted fairly but on the ba­sis that those who work get paid. Those who don’t re­ally work have al­ready started to protest. When did you ever see the di­rec­tors of clin­ics, head physi­cians and aca­demics stand­ing out­side the Min­istry’s of­fices? When did VR deputies ever lead ral­lies? To­day, the wealth­i­est peo­ple are demon­strat­ing against the Min­istry of Health. Where were they be­fore? Where were they when Raisa Bo­hatyri­ova was min­is­ter or when Vik­tor Yanukovych was pres­i­dent? That sys­tem suited them just fine.

Let’s look at the de­tails. Right now, wher­ever a pa­tient goes, they have to pay for ev­ery­thing. They have no con­trol over things and they don’t know any­thing. So you come to the hos­pi­tal and the staff say, “Oh, we don’t have any­thing.” But they charge ev­ery­one, in one way or an­other. We see sit­u­a­tions

WE WILL SET UP A NA­TIONAL HEALTH­CARE SER­VICE THAT WILL DI­RECTLY TRANS­FER FUNDS TO THE HOS­PI­TAL. OBLAST AND COUNTY OF­FI­CIALS, AND BAD HOS­PI­TALS, DON'T LIKE THIS IDEA

to­day where even peo­ple com­ing in in a state of emer­gency are told to pick up this and that be­cause the hos­pi­tal doesn’t have it and the gov­ern­ment isn’t hand­ing any­thing out. That’s sim­ply not true. The state is giv­ing money out, but the pa­tient has been brought to one place while the state gave it some­where else al­to­gether. But no­body knows that. For­mally, the UAH 50bn has been al­lo­cated, but in fact noth­ing gets to the hos­pi­tals them­selves. We have no med­i­ca­tions, no blan­kets, all the ele­men­tary things that should be in a hos­pi­tal, while in the mean­time some­thing ex­tra­or­di­nary shows up else­where. The most pow­er­ful to­mo­graphic ap­pa­ra­tus in the coun­try, for in­stance, stood in Kalush (a town in Western Ukraine – Ed.) for a long time. Why was it there? What was such a pow­er­ful ma­chine, in­tended for heart surgery, do­ing in Kalush? Be­cause some­one in Kalush got their hands on the money and spent it that way.

Or­di­nary Ukraini­ans don't al­ways un­der­stand this. For in­stance, I heard a lot of grum­bling that a re­cently ren­o­vated vil­lage ma­ter­nity ward was be­ing

shut down. To these peo­ple, the re­form­ers make no sense.

If the ma­ter­nity ward sees less than 400 births a year, it is bad for both the mother and the child. If there isn’t at least one birth a day, the med­i­cal staff be­gins to lose its skills. This is the kind of ma­ter­nity ward where more prob­lems arise, more chil­dren end up dam­aged, and more new­borns and moth­ers die. The WHO rec­om­mends shut­ting down such ma­ter­nity wards be­cause they are harm­ful.

Get­ting back to re­form, what's its main com­po­nent?

We pro­pose cov­er­ing for the most vi­tal ser­vices with 100% fund­ing, be­cause ev­ery­thing de­pends on them: emer­gency treat­ment, pri­mary care, and pal­lia­tive care. This is the guar­an­teed ba­sic pack­age. There was noth­ing like this be­fore and to­day, the state guar­an­tees pa­tients noth­ing. The am­bu­lance drives up to the pa­tient’s home and says, we don’t have this med­i­ca­tion. The pa­tient has no con­trol over any­thing and can­not de­mand any­thing from the state sys­tem. Any com­plaint gets the same an­swer: the share of GDP is too small.

What's this guar­an­teed ba­sic pack­age? Let's say I came to an out­pa­tient clinic with a com­plaint about some­thing. How can I find out what rights I have?

The guar­an­teed ba­sic pack­age is a list of spe­cific ser­vices that must be pro­vided. The clinic is ba­si­cally guar­an­teed. Ev­ery­thing that’s in the clinic can be pro­vided to the pa­tient ab­so­lutely free. We trans­fer the funds to that clinic be­cause this is the ba­sic pack­age of ser­vice guar­an­teed by the gov­ern­ment. Pri­mary care is guar­an­teed. You can’t show up at a clinic only to be told that there’s no doc­tor that day. The doc­tor is paid to be there, the bud­get is there, the cash is avail­able, and so on. Nor can you show up at a clinic only to be told that they can’t do the nec­es­sary tests. The tests are all avail­able. We have guar­an­teed and funded that. And we’re say­ing that the ba­sic ser­vices—out­pa­tient clin­ics, emer­gency treat­ment, pal­lia­tive care—are cov­ered 100%. Spe­cial ther­apy and ur­gent surgery are guar­an­teed 100%. We are telling peo­ple truth­fully that the coun­try has enough money for this much.

The guar­an­teed pack­age can, of course, change, de­pend­ing on the bud­get al­lo­cated. If we get more fund­ing, the pack­age will ex­pand. Later on we may be able to cover rou­tine treat­ment (treat­ment of chronic ill­nesses, non-ur­gent treat­ment – Ed.). Right now we can only cover that partly be­cause we don’t have enough money. Our op­tions are co­fi­nanc­ing based on pri­vate in­sur­ance plans, em­ployer in­sur­ance ben­e­fits, lo­cal bud­gets, char­i­ta­ble funds, pa­tients them­selves. But the hos­pi­tal will know that it will al­ways get money for these listed ser­vices that is guar­an­teed and es­tab­lished by the Min­istry of Health.

Can you give us some ex­am­ples of rou­tine or non-ur­gent treat­ment? For in­stance, if some­one has been di­ag­nosed with can­cer, is that pri­mary care?

This is in­cluded in pri­mary care. In this, some med­i­ca­tions are cov­ered, some are not by the state fund­ing. Right now we’re cov­er­ing even fewer of those be­cause money is be­ing spent on ev­ery­thing but the pa­tient: we’re buy­ing things no­body needs, while the things that are re­ally needed aren’t be­ing bought. What’s im­por­tant for us is that both the hos­pi­tal and the pa­tient know about the guar­an­teed ba­sic pack­age and that the state is pro­vid­ing it. There shouldn’t be a sit­u­a­tion where the pa­tient is re­ferred to a spe­cial­ist but the means of treat­ment are not pro­vided. At the sec­ondary level, you know ex­actly what’s state-funded, and what you have to pay for. Pa­tients sup­port the idea of co-pay. Right now, re­la­tions be­tween the hos­pi­tal and the pa­tient are un­clear. The state might be al­lo­cat­ing some­thing to the hos­pi­tal but no one knows ex­actly how it’s be­ing used. Elec­tive items, such as cos­metic den­tal work, will not be cov­ered at all. And this is what our op­po­nents are fight­ing against. MPs are against co-pay­ing. They don’t like it. They want pri­mary care to be 100% cov­ered and sec­ondary care 0%. Be­cause the con­cept of co­pay­ing is po­lit­i­cal poi­son. Ev­ery­body’s hav­ing fits be­cause ev­ery­thing was sup­pos­edly free and now pa­tients have to pay for some­thing.

Does that mean that re­forms have al­ready been taken down?

Well, MPs have agreed to a guar­an­teed pack­age and a dif­fer­ent dis­tri­bu­tion of funds. OK, so at least we’ll have that. At least we’re guar­an­tee­ing some­thing. The rest re­mains as it was at this stage. This is the max­i­mum com­pro­mise for us.

As to state in­sur­ance, that’s just a lot of talk. We are talk­ing about the Bri­tish NHS model, where your and my tax money are dis­trib­uted in this way. We al­ready pay these taxes. But our op­po­nents have their views, their own in­ter­ests in the in­sur­ance business.

How in­ter­ested is the in­sur­ance mar­ket in your co­pay­ment pro­posal? How pos­si­ble is it to have nor­mal in­sur­ance cov­er­age now?

Frankly, it’s im­pos­si­ble. It’s like we’re in the Mid­dle Ages. The pa­tient will be conned by ei­ther one side or the other. For us at the Min­istry what’s im­por­tant is the guar­an­teed pack­age, so that ev­ery­one can feel re­as­sured. We’re telling peo­ple openly: this is avail­able and that’s not, be­cause there’s no money for it.

What will you be do­ing right now for sec­ondary care? The­o­ret­i­cally, if you man­age to break the Rada and MPs agree to med­i­cal re­form with these changes, does that mean that sec­ondary care will re­main com­pletely un­changed?

Let’s wait and see. The sys­tem for al­lo­cat­ing funds is be­ing changed to one where hos­pi­tals that treat 100 pa­tients get fund­ing for 100 pa­tients and cer­tain ser­vices are cov­ered while oth­ers are not.

So, af­ter re­forms, will Ukraini­ans have a Bri­tish model of health­care or will it merely be a soviet one with frills?

That’s a point­less ques­tion be­cause no one here knows ex­actly how the NHS works. No one is aware that it’s the best work­ing sys­tem to­day. Based on all the prob­lems and ad­van­tages of dif­fer­ent sys­tems, the Bri­tish one is the best and it suits Ukraine. With our way of do­ing things and the way peo­ple co­ex­ist here, this is the best op­tion. The Amer­i­can model wouldn’t work here, so no point in even go­ing there. What’s im­por­tant for us is a guar­an­teed ba­sic pack­age. As to co-pay­ing, we wanted what was best, but we lost that one. The pop­ulists keep say­ing let’s go for what’s worst.

What we want is for the med­i­cal fa­cil­ity to be au­ton­o­mous, to get its money and use it the way it needs for its pa­tient. Not for de­part­ments and min­istries to de­cide things: this much for util­i­ties, this much for medicine, and this much for pay­roll. Be­cause that means that pay­roll is cov­ered 100%, util­i­ties 90% and noth­ing goes for med­i­ca­tion. The hos­pi­tal should man­age its money on its own. Right now there are such dis­tor­tions that hos­pi­tals are funded “based on their needs.” But if the hos­pi­tal “needs” UAH 18 mil­lion for util­i­ties, do we re­ally need that hos­pi­tal? Is it ac­tu­ally serv­ing pa­tients? Should half of it be shut down? Or should it be ex­panded? Are there any other op­tions? The main prin­ci­ple should be au­ton­omy: the op­por­tu­nity to man­age fund­ing in­de­pen­dently.

How are we do­ing with ex­pe­ri­enced spe­cial­ists and doc­tors who want to work un­der a dif­fer­ent sys­tem?

Build a church and the peo­ple will come. Even at the cur­rent level of GDP, Ukraine could eas­ily raise wages. If we op­ti­mize doc­tors’ salaries, they will feel mo­ti­vated. If we op­ti­mize over­heads, money will ap­pear to buy med­i­ca­tions. It’s a win­win for pa­tients. The only losers are those who op­pose med­i­cal re­form.

But those peo­ple are in power. You'll never achieve any­thing with­out them. What kind of com­pro­mise is pos­si­ble is this a clash of world views that can't be rec­on­ciled?

Would you like this kind of com­pro­mise, as a pa­tient? For us, what’s im­por­tant is not how MPs vote for a bill but how pa­tients will vote for those MPs.

Pa­tients al­ways vote the same way.

That de­pends on the press, on how well you will be able to ex­plain what’s hap­pen­ing.

What about the Min­istry's ed­u­ca­tional ini­tia­tives?

Money has no mean­ing if the doc­tor is un­trained, un­mo­ti­vated and in the wrong place. He won’t be able to treat you prop­erly be­cause he won’t know what to do. This is a se­ri­ous prob­lem and it’s part of what needs to change. What can be done so that medicine is high qual­ity? The would-be physi­cian has to ap­ply to uni­ver­sity, spend six years study­ing, go through an in­tern­ship, and find a job. What hap­pens at the en­trance stage? Who are our stu­dents? Will these peo­ple make good doc­tors and be able to op­er­ate on our chil­dren? Our po­si­tion is that those with C’s and D’s should not be study­ing at uni­ver­sity. It’s al­ready clear that they are not study­ing prop­erly.

Oth­ers are not mo­ti­vated for the right rea­sons. If they don’t dream of be­ing the best, they shouldn’t be in med­i­cal school. They stud­ied any old way and went to uni­ver­sity ei­ther to marry or be­cause their par­ents are doc­tors. These aren’t the peo­ple who should be work­ing in health­care, yet from the very start, we let any­one who wants to go to uni­ver­sity. Then they study on a paid ba­sis, man­age to some­how pass their ex­ams, fin­ish their in­tern­ships, and pay ev­ery step of the way. Then they get a job and the hos­pi­tal is stuck with a bad doc­tor.

One of our propo­si­tions was for ap­pli­cants to have a min­i­mum of 150 points on their ex­ter­nal in­de­pen­dent test­ing (ZNO, a school grad­u­a­tion test). Af­ter­wards, six cor­rupted rec­tors ap­proach two MPs: the chair of the VR Health­care Com­mit­tee and the chair of the VR Ed­u­ca­tion and Science Com­mit­tee. The Rada be­gins to ex­ert un­prece­dented pres­sure on the Gov­ern­ment, and the Gov­ern­ment drops the pro­posal. The 150-point ini­tia­tive has been around since March. Where are the vot­ers? Where are the fu­ture pa­tients? Where’s the press?

In 2015, we saw 40,000 heart at­tacks in Ukraine. Of that num­ber, 20,000 needed stents im­me­di­ately. At that time, 7,000 stents were pro­cured for X mil­lion UAH. In 2017, we are buy­ing 10,500 bet­ter-qual­ity stents for half the money. Now, if we can buy an­other 10,500 with the money saved, we'll com­pletely cover this need

Then we move to the open com­pe­ti­tion. This is a sit­u­a­tion where places are left for ap­pli­cants with high ZNO grades. They can gain ad­mis­sion to any post-sec­ondary in­sti­tu­tion they choose. Ob­vi­ously, the stronger, bet­ter in­sti­tu­tions get the stronger ap­pli­cants, ad­di­tional spots and more fund­ing. Weaker in­sti­tu­tions lose out. Where will those rec­tors go? To their pro­tec­tors in the legislature. We’ll see what hap­pens this year with the open com­pe­ti­tion, be­cause last year there wasn’t any in medicine. Right now, if you’re a poor uni­ver­sity, you will get zero ap­pli­cants.

We lost the first round in the bat­tle for the 150-point re­quire­ment. The open com­pe­ti­tion is cur­rently un­der at­tack. The third is the Krok [Step] exam. Dur­ing the sixth year and the in­tern­ship we have Krok-2 and Krok-3, which is the ex­am­i­na­tion for li­cens­ing. Who­ever fails it doesn’t get to be a doc­tor. These ex­am­i­na­tions are or­ga­nized by the In­de­pen­dent Test­ing Cen­ter at the Min­istry of Health, which was es­tab­lished along the lines of the Na­tional Board of Med­i­cal Ex­am­in­ers in the US and has been ac­knowl­edged by NBME. The test­ing pro­ce­dure is the same as in the US.

This is the only bar­rier that saves pa­tients from un­qual­i­fied physi­cians. The uni­ver­si­ties don’t do this be­cause they’re happy to teach the D stu­dents. Just watch how they start at­tack­ing that exam. This year, we added 30 ques­tions from the Amer­i­can exam to Krok-3 and only 3% passed (see A ma­jor deficit on p. 24). Which means that only 3% are doc­tors in the Amer­i­can sense of the word. That’s the price for a med­i­cal ed­u­ca­tion. The av­er­age mark across the coun­try was 37% and only 3% reached the pass­ing grade of over 70%. The Ukrainian ques­tions for Krok ex­ams are writ­ten by Ukrainian in­struc­tors. Then they are shuf­fled in a bar­rel and is­sued. As a re­sult, the Ukrainian test is passed, but not the Amer­i­can one. Why is this im­por­tant? In fact, our stu­dents get nor­mal re­sults in those things that they have stud­ied: 95% passed Krok-2. Only this test, like all our med­i­cal ed­u­ca­tion, does not re­flect mod­ern con­di­tions. Our stu­dents aren’t be­ing taught what they need to know and not that which is be­ing taught all over the world.

How ca­pa­ble are these in­struc­tors of teach­ing some­thing dif­fer­ent?

Where might they get that from? It’s these same stu­dents who even­tu­ally be­gin to teach. It’s a closed cir­cle. So now, imag­ine what will be hap­pen­ing with re­forms if we say that this year the Amer­i­can sub-test is op­tional, whereas start­ing next year it will be manda­tory? Imag­ine what will hap­pen when a por­tion of in­ter­na­tional tests is added to Krok-2? I mean, there’s still the In­ter­na­tional Foun­da­tions of Medicine (IFOM), a test that was de­vel­oped (by the NBME. Ed.) not for the US but for other coun­tries. We have taken this IFOM as part of our own test and have made it manda­tory. Who at the uni­ver­si­ties will be happy to see this hap­pen? Who will teach pay­ing stu­dents for six years, at the risk that they will com­plain later that they failed the exam? There will be enor­mous re­sis­tance.

Still, we have to start some­where. We say that there are qual­i­fi­ca­tion re­quire­ments of a doc­tor, which is to pass the IFOM test. If you pass IFOM, you can call your­self a doc­tor.

But now, the uni­ver­sity has to re­view its cur­ricu­lum and its staff qual­i­fi­ca­tions. Do the in­struc­tors know even a mod­icum of English? Are they pub­lish­ing? Are they read­ing? If you want your uni­ver­sity to sur­vive, hire those who can teach prop­erly. Find them and hire them. Teach less, but teach bet­ter. Give us doc­tors with a Euro­pean ed­u­ca­tion. Right now, our coun­try is miss­ing the boat. Peo­ple are in­dif­fer­ent, the Rada is in­dif­fer­ent, the uni­ver­si­ties couldn’t care less, and the me­dia is not keep­ing an eye on any of it. As a so­ci­ety, we al­lowed them to ac­cept D stu­dents, so shame on us. Af­ter that, the en­tire sys­tem of fund­ing uni­ver­si­ties suits ev­ery­one so it’s not con­ve­nient to ex­pel them.

If Ukraini­ans as a so­ci­ety want to have high­lyqual­i­fied doc­tors, then we should sup­port Krok. We should de­fend the Cen­ter for Test­ing and this exam, and make it as de­mand­ing as it is in the West. Once we de­cide we want high-qual­ity doc­tors, a lot of peo­ple are go­ing to feel the pain, most of them C- and D-grade. So why do we feel sorry for them?

We have in­terns and they con­tinue to learn. We give them an in­stru­ment such as De­cree #1422, which al­lows them to treat fol­low­ing western pro­ce­dures. We say, you weren’t taught this, but we’re giv­ing you a chance. Look: this is how this par­tic­u­lar dis­ease is treated around the world. From now on, you can choose what you want: a Ger­man course of treat­ment, a French one, a Bri­tish one, or an Amer­i­can one. Go and treat your pa­tients. Be­fore, this was not al­lowed, but now we’re giv­ing peo­ple the op­por­tu­nity. Sur­pris­ingly, it turns out that ev­ery­one’s against this, too.

One of the ar­gu­ments op­po­nents bring up is that the pro­ce­dures need to be trans­lated into Ukrainian. Has this been done?

The de­cree states that they are sup­posed to be trans­lated into Ukrainian. But first of all, there are thou­sands of these pro­ce­dures and ob­vi­ously you can’t just sit down and trans­late all of them at the same time. Se­condly, they are con­stantly be­ing up­dated. They’re not set in stone so you can trans­late them once and that’s that. Medicine is al­ways on the move. The de­cree also pro­vides an ad­den­dum with sources that are con­stantly be­ing up­dated and the in­ter­na­tional aca­demic so­ci­eties are con­stantly up­dat­ing the pro­ce­dures. This year, it’s like this. Later a new ta­ble or treat­ment method ap­pears and ev­ery­thing changes. We ac­tu­ally al­low doc­tors to take those pro­ce­dures and trans­late them, so yes, they are all be­ing trans­lated, but not by the Min­istry but by the hos­pi­tals that need them.

I can tell you that these pro­ce­dures are at a way higher level than Ukrainian ones. We are meet­ing with re­sis­tance, re­gard­less, from those who draw up pro­ce­dures in Ukraine, from those who are do­ing dirty business, and from those who in­cluded their own or oth­ers’ med­i­ca­tions and made their

use manda­tory. Right now, the top 10 med­i­ca­tions in Europe and the top 10 in Ukraine don’t have a sin­gle med­i­ca­tion in com­mon. This is the re­sult of our ed­u­ca­tion, our post-grad­u­ate ed­u­ca­tion, and our pro­ce­dures. Our clin­i­cal pro­ce­dures and our med­i­cal ed­u­ca­tion mean that Ukraini­ans are not treated with the same med­i­ca­tions as other Euro­peans and then we won­der why the re­sults are so bad.

What about the prac­tice to hand over the pur­chase of medicine to in­ter­na­tional or­ga­ni­za­tions? Dr. Suprun promised to sign a re­spec­tive con­tract by March. Has last year's bud­get been spent and are we now spend­ing 2017 al­lo­ca­tions?

Not ex­actly. In 2015, we saw 40,000 heart at­tacks in Ukraine. Of that num­ber, 20,000 needed stents im­me­di­ately. At that time, 7,000 stents were pro­cured for X mil­lion UAH. In 2017, we are buy­ing 10,500 bet­ter-qual­ity stents for half the money. Now, if we can buy an­other 10,500 with the money saved, we’ll com­pletely cover this need. Ev­ery pa­tient with a heart at­tack in Ukraine will re­ceive the most up-to-date, hitech treat­ment ab­so­lutely free.

Are you talk­ing about this year?

Yes. We will be talk­ing about this sep­a­rately and we in­vite peo­ple to join us be­cause it’s im­por­tant that pa­tients, doc­tors, and all health­care pro­fes­sion­als know about this. The Min­istry’s po­si­tion is chang­ing and we will be keep­ing track of this, but the pub­lic also needs to be on top of things. This is the price of in­ter­na­tional pro­cure­ments. It rep­re­sents the ac­tual sav­ing of some­one’s life. Can you imag­ine the scale? We’re talk­ing about some­thing like UAH 150mn. Of course, not ev­ery­one’s happy about in­ter­na­tional pro­cure­ments. Now they can come up with a new ex­cuse: “It took them a month to put it in, so let’s drop it all.”

What's go­ing on with pal­lia­tive care?

We’d like pal­lia­tive care to be part of the guar­an­teed pack­age. Peo­ple have the right to a dig­ni­fied death. Ukraine was still lack­ing hu­mane forms of re­duc­ing pain in the 21st cen­tury. Now, these have been reg­is­tered. We’re or­ga­niz­ing a mo­bile pal­lia­tive care ser­vice in De­cree #41, which lists all the pal­lia­tive states. This means ac­cess to a chap­lain, qual­i­fi­ca­tion re­quire­ments for physi­cians who work there, and changes in the rules for the cir­cu­la­tion of nar­cotics to make it eas­ier for phar­ma­cies to is­sue them. Right now this is very com­pli­cated and not con­ve­nient for the phar­ma­cies, so pa­tients of­ten have to go abroad and buy them. We’re also work­ing with the In­te­rior Min­istry and the process is all in mo­tion. Last year, some of this was pro­vided through hu­man­i­tar­ian aid, more­over for a great low price: about 40¢ a fla­con. This medicine has al­ready been reg­is­tered and we have it in plas­ters and syrup.

The main value of re­form and its philo­soph­i­cal sig­nif­i­cance is in rais­ing the qual­ity of life of the or­di­nary per­son. Our motto is that health is the most im­por­tant thing. We have no re­spect for those who voted in fa­vor of the tax on the ex­port of scrap metal but ig­nored med­i­cal re­form. This is com­pletely un­ac­cept­able. We’re talk­ing about real val­ues and real peo­ple. Health and life are the most im­por­tant. This re­form is not about money and not even about ed­u­ca­tion but about new re­la­tions within our so­ci­ety.

In the end, this is about two great quotes: “There’s no stop­ping an idea whose time has come” and “Free­dom for na­tions, free­dom for in­di­vid­u­als.” In our case, the two echo each other. The hu­man be­ing is im­por­tant to us. Not the na­tion, the state, the so­ci­ety, or the masses, but a spe­cific pa­tient. We must do all in our power to en­sure that the in­di­vid­ual is born healthy, lives healthy, and dies in dig­nity. The per­son is be­com­ing a value in this coun­try. Not achieve­ments, not glory, not the flag, not tele­vi­sion, not even Olympic gold mat­ters as much as the in­di­vid­ual. That’s why this is so im­por­tant.

How much of an im­pact did anti-vac­cine pro­pa­ganda have and how ac­cu­rate are the statis­tics that peo­ple use? What's the cov­er­age of vac­cines in Ukraine to­day?

Our cov­er­age is the low­est in Europe and the press is en­tirely to blame for this. Ig­no­rance, ig­no­rance and more ig­no­rance. Fairy tales about non-ex­is­tent “black trans­plan­tol­o­gists” are killing nor­mal trans­plan­tol­ogy. Spread­ing myths, yel­low press, un­con­firmed “facts.” One head­line chases an­other and all about how bad vac­cines are. I could talk for a long tie about the in­ci­dent in Kram­a­torsk (where a 17-year old died af­ter be­ing vac­ci­nated -- Ed.), but when jour­nal­ists are sloppy with their terms and don’t un­der­stand the dif­fer­ence be­tween a vac­cine and a serum, a crit­i­cal dis­tinc­tion, be­tween an ex­pired li­cense and an ex­pired vac­cine, when they con­fuse “im­port­ing with­out a cer­tifi­cate of com­pli­ance” with “im­port­ing some­thing un­reg­is­tered and of poorqual­ity,” we end up with head­lines that the Min­istry of Health once im­ported un­cer­ti­fied and out­dated vac­cines and a child died. In fact, that child didn’t die af­ter be­ing vac­ci­nated and what was im­ported was a qual­ity vac­cine that was in com­pli­ance with all the rules and laws about hu­man­i­tar­ian aid, and what was ex­pired was not the vac­cine but the cer­tifi­cate for it. Yet the jour­nal­ists took up that head­lines. The peo­ple read them and stop vac­ci­nat­ing their kids. That’s how we’ve man­aged to take a civ­i­liza­tional step back­wards.

Has this process stopped at least?

We re­ally want ev­ery­one to learn. We’re learn­ing ev­ery day our­selves. The press needs to un­der­stand how im­por­tant the choice of words is in this sit­u­a­tion.

RIGHT NOW, WHER­EVER A PA­TIENT GOES, THEY HAVE TO PAY FOR EV­ERY­THING. THEY HAVE NO CON­TROL OVER THINGS AND THEY DON'T KNOW ANY­THING

Olek­sandr Linchevskiy was born in Kyiv in 1975. He grad­u­ated from the Bo­ho­mo­lets Na­tional Med­i­cal Uni­ver­sity in Kyiv. Dr. Linchevskiy took a se­ries of in­tern­ships and pro­fes­sional cour­ses in var­i­ous Euro­pean coun­tries. He holds the Can­di­date of Sci­ences ti­tle. Dr. Linchevskiy worked as a sur­geon at the poly­trauma depart­ment of Kyiv Clin­i­cal Hos­pi­tal No17. Af­ter the war in the East be­gan, he headed the med­i­cal unit of Mykola Py­ro­hov First Vol­un­teer Mo­bile Hos­pi­tal. In 2016,

Dr. Linchevskiy was ap­pointed Deputy Min­is­ter of Health­care.

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