Potential changes in TB service in light of healthcare reforms
On April 16 the Minister of Healthcare of Ukraine Oleksandr Kvitashvili presented healthcare reform plan to the National Reform Council (you can see the presentation here). The presentation shows disadvantages of the current system and outlines the key areas of changes. These reforms are designed to reorient healthcare from being focused on system to being focused on patient. Below we shall consider two areas of changes that are particularly important for improving TB care in Ukraine.
1. Substitution of financing model "by number of hospital beds" by funding "for services rendered".
International missions for assessment of previous TB programs repeatedly recommended to review the principles of financing and reduce the bloated network of TB institutions. Thus, in 2013 we had developed instructions within "Stop TB in Ukraine" program that were approved by MoH Order: Instructions on calculating the optimal bed capacity in specialized TB institutions that provide inpatient medical care for TB patients. According to the instructions, regional health departments should carry out reductions of hospital bed capacity. During 2014 their number was reduced only by 4.4% *, the reduction is slow due to the fact that under the existing conditions of financing it is almost impossible for a medical institution to redirect savings on other expenditure items. This means that earlier the funds that were allocated for TB institution were reduced according to reducing number of beds. Obviously, under such circumstances managers did not hurry to reduce the number of beds in their institutions. Now, after adoption of draft laws on changing the legal status of medical institutions and changing the funding principle from "by number of hospital beds" into "for services rendered" (in DRG system - calculation of the cost of each service provided), managers must be interested in this. We hope that funding will be preserved and redirected for a patient, for example it will be possible to buy the full pathogenetic therapy, which used to fall on a patient's shoulders before.
A possibility to reduce inpatient units and redirect funding would also improve delivery of TB care in outpatient settings, which is an important step in transition to the International Standards of TB treatment. For example, payment for services, rendered to patients, may also include social support. And it is increasing the percentage of patients with positive treatment results, due to growing adherence to treatment.
To prove the financial and programmatic effectiveness of TB treatment at home, according to DRG system, vs. inpatient care, we created an "Outpatient Care" project, which is currently being implemented in Kramatorsk and funded by Rinat Akhmetov Foundation. You can find more details on this project here.
2. Simplified registration of medications that have been permitted to the market of the EU, Canada, USA, Australia, Japan, Switzerland and other countries.
It enabled purchasing and delivery of new TB drugs (e.g. bedaquiline and delamanid) to treat multi-resistant TB. Before it was impossible and, as a result, restricted the ability to form individual treatment regimens for patients with multi-resistant TB, so they had to be transferred to palliative care.
Therefore, in view of MoH plans to introduce significant reforms to this sector, we hope that the aforementioned changes will only have a positive influence on the management of TB treatment institutions.
* When calculating the indicator, the medical institutions of Crimea, Sevastopol, and parts of Donetsk and Luhansk regions, not controlled by Ukrainian Government, were excluded.