Family medicine in Ukraine: to be or not to be?
The main driver of private primary healthcare, as international experience shows, is transitioning patients from state-owned medical facilities to private because the latter have better service and equipment.
Ukraine has prerequisites for such a transition too. First of all, the patients themselves are largely discontent both with the service quality and the actual expenditures incurred as patients of state-owned clinics. In this situation, the government’s objective is reforming the healthcare system to improve the service quality and economic efficiency of state-owned medical facilities. In practice, however, it is the opposite. Reforming the healthcare sector in neighboring countries shows that the actual result of reforms is a reduced accessibility and downgraded quality of medical services against the reduced number of state-owned clinics.
The specific nature of healthcare is that the government acts here as the key player. For Ukraine, it is a significant factor due to the still-standing habits of the people, poor quality of the services and small experience with health insurance. That said, many healthcare areas are represented by state-owned clinics alone.
As the budget deficit kicked in, the government was compelled to change the funding system and invite commercial companies to the sector. The plans and business profile of private medical establishments depend on the healthcare policy of the state and how efficient reforms are. Moreover, it is critical to have a legal framework and engagement from private medicine representatives to determines the tariffs.
In this article, we look into the situation in the primary healthcare as part of the state reform that seeks to extend the pool of primary medical services rendered by family physicians. We also analyzed the factors, which can allow a family physician to start a private practice and become a profitable business in Kyiv, the types of resources and events required and optimum business structure.
By private healthcare (medicine), for the purposes of this article, we understand primary healthcare services rendered by therapists, pediatricians, and family physicians operating in the private sector.
1. Quantitative and qualitative analysis of the market
Most countries have the healthcare control embedded in state priorities, which is why the leading developed countries increase their spendings on healthcare. According to Webeconomy, over the last twenty years, Poland and Norway increased their healthcare spendings 4 times, Great Britain and Spain – 3 times, Germany and USA – 2.5 times. To that note, the USA remains to be the global leader in GDP spent on healthcare.
According to ConferenceSeries, the global healthcare market in 2017 accounted for USD 69.4 billion. Of that amount, three-fourths (US$ 54.8 billion) fall on ambulatory care.
Family medicine is the most common service. A family physician supervises and gives treatment to patients for many years, knows all individual health issues, offers healthcare recommendations and sends to medical specialists when needed. A family physician has many advantages, including a full array of procedures (diagnostics, prevention, and treatment) available in one place, which provides for more savings.
Being certified as a family physician, which is a sub-specialty of a general practitioner, a doctor can advise families and their members in any medical area and engage medical specialists for consultations and coordination of treatment procedures only on special occasions.
Many countries use the benefits of family medicine, above all, to enhance the medical services. Today, family medicine is at the core of healthcare in such states as Germany, French, Canada, USA. There are many studies reading that the implementation of family medicine became one of the reasons to increase the average life expectancy. In Europe, for instance, the implementation of family medicine ramped this figure up by 8-10 years.
To hire a family physician, a patient has to conclude an annual service contract.
2. Structure of the Ukrainian healthcare market, the role, and function of private clinics
The average life expectancy in Ukraine is 9-10 years less than in EU countries, and the morbidity statistics are one of the most alarming even if compared to the Eastern European countries (by cardiovascular mortality Ukraine ranks Europe’s first for many years already). To that note, the national healthcare system is rather underfunded. This industry is not on the priority list for the state: the ratio of government healthcare spendings to GDP did not exceed 3% in 2014, while the World Health Organization recommends this figure to be at least 5%. To compare, the US ratio of healthcare costs to GDP is at 6% according to WHO.
According to ILF, Ukraine’s commercial segment includes 50 thousand private companies. Of that number, 10 are major multi-discipline clinic networks. Most private medical clinics are concentrated in urbanized areas with about 40% of them based in Kyiv. Private clinics own 50% of the Kyiv market, whereas towns with a population of up to 100,000 have this figure at no more than 10%. Given that up to 15% of the solvent urban population does not use private medical services, regional private clinics have no plans to enter the market in the upcoming years…
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