In two months, the National Health Service of Ukraine (NHSU) has already transferred more than UAH 500 million to the accounts of primary care facilities under its contracts. Most facilities received considerably more than they did under the medical subvention program. And, as it turned out, not all chief physicians understand what to do as heads of municipal non-profit enterprises with the income their enterprises have started receiving from the NHSU.
And so we at the NHSU began receiving all kinds of questions from chief physicians. Can we hire more nurses? What about a boiler operator? Can we repair the stairs? Which is better: spending the money on computers or equipping the registration desk? How, and to whom, should we report on the use of this money?
Heads of healthcare facilities generally wait for instructions and directions from the NHSU. This is understandable: for years, the system not only dictated terms and rules but also punished initiative and enterprise. Budget money had to be “wrung out” or “begged for” and then “used up”. Decisions on staff positions, door repairs and equipment purchases were made not within the facilities but somewhere in the offices of officials and in regulations.
Now the system works under new rules. To join the Program of State Guarantees of Medical Care for the Population and sign a contract with the NHSU, a healthcare facility must become autonomous. Budget institutions are being transformed into enterprises. And enterprises are not maintained — they receive income for the amount of work done; in other words, they earn. The chief physician has gained autonomy, and with it much more authority and responsibility. The new system requires new competencies. There will be no more directions or clear instructions.
The state no longer “funds facilities”. A healthcare facility provides services, and the NHSU pays for them. The money earned is managed competently and independently for the benefit of the enterprise, its employees and owners, and ultimately for the benefit of the patient, who freely chose a doctor and a facility and signed a declaration with a family doctor. This is unlike budget funds, which are simply “used up”.
And this is the main thing that has to change in a chief physician's work. Instead of depending on the budget, he becomes a manager: he organizes the facility's work, runs all the processes, thinks about how to cut costs, where to direct funds, what to buy, and whose salary to raise or whom to award a bonus. Of course, the local community remains the owner of the healthcare facility, and the head of the facility is accountable to it.
But he allocates and spends the funds received for providing medical services to the population on his own. This is now his responsibility. There are effective managers among the chief physicians of primary health care centers. Some optimize the staffing table, abolish the positions of heads of outpatient practices and direct the freed-up funds to the salaries of primary care doctors, because they are the facility's main source of income. Other heads have already started saving money and placing it on deposit in order to buy modern equipment in the future. A financial plan of the enterprise has appeared instead of a fixed budget estimate. All these people have become managers and have understood the main thing: the contract
Oleh Petrenko, Head of the National Health Service of Ukraine