“Vasha Svoboda” guest: Oleg Musiy, Minister of Healthcare of Ukraine.
Olexandr Lashchenko: Few of you, dear listeners, do not know that Oleg Musiy was one of the most active participants of Maidan, giving medical aid to the wounded. By the way, with risk to his own life.
Now, when more than three months after the victory of Maidan have gone by, after the flight of the former President Viktor Yanukovich – when is it most difficult, Mr. Musiy – when there was a real, direct risk to your life or now, at the post of Minister?
In reality, now it is harder to be head of a Ministry and head of the entire medical industry of the country, than on Maidan. On Maidan we were the ones who organised the medical service ourselves, there was a majority of allies there, who had a common goal, a common task, people came with their conscience clear, with an open soul, with open dreams, practically the same.
Having crossed over to the “lair” of state government, the situation with the change of leadership, for example, has extended over three months. There are many problems. There are many problems in the industry itself, those that cannot be solved the same way as on Maidan, when you give an order and practically within a couple of hours all the medicine is available, within a couple of hours, there are enough doctors. And so forth.
There are subordinates that you have inherited from the times of Mrs. Bogatyryova, the former Minister of Healthcare of Ukraine. Just recently you managed to replace your deputies…
The last deputy was fired on May 16th. And a new deputy has not been appointed in his place as of today. However there is an according petition, checks are being conducted and so forth. It was difficult to replace the deputies. The first two months I de facto worked alone with the first deputy – and that’s it. Another deputy – the main corruption suspect, so to speak, and the cashier of dentist Sasha, the infamous Roman Bogachev, was on sick leave, tried to manipular, appeal to many in order to retain his job. This was a long fight positional fight.
The situation is the same with the National Medicine Service, where Mr. Solovyov, who was the head, though already fired, has retained his human resources in the service. The new head has not been appointed for over a month already. Such a positional [fight] continues…
Are you able do it with a single strike of a pen?
No. This is the decision of the entire government. The entire Cabinet of Ministers only. And there are different people in the government.
Though all of these former deputies that you listed are no longer able to react to your accusations of corruption.
However you managed not only to replace your deputies, but also to shorten the staff of the Ministry of Healthcare by 28 posts. There were 277, now there are 249.
Starting Monday, the re-organisation of the entire Ministry of Healthcare has been underway. All the heads of departments and headquarters will also be replaced. Half of them have already signed the according messages. Because there exists a juridical-bureaucratic procedure of the reorganisation statement, we have to offer them another work placement according to the Labor Code etc. However all the heads will be replaced. And for six of the most important posts in the Ministry of Healthcare, a competition will be announced, an open, public one, for which all those willing will be able to apply with their documentation and participate in this competition. Of course, it will take a long time – 1,5 months, however they will be appointed according to the results of the competition.
And who will be, so to speak, the judges in this competition? Yourself personally?
Myself included, as well as professional human resources experts, the lower-than-mid-level officials, which remain in all Ministries, these are professionals who now their job and do not engage in politics. Because, as a rule, as of today the political figures are only the deputies of the Minister. And the heads of the departments – the former government lobbied to establish “their” people. Therefore even on principle they have to be replaced by other people – young, active, which will move and build a new healthcare system in Ukraine.
A lustration of sorts in the leadership of the medical industry of Ukraine. Can this be called so?
On Ministry level.
Also, it goes without saying, there are other industries, where we also intend to change the leadership and management in the industries that are not able to complete the established tasks. However detailed checks of such institutions have to be conducted.
For example, the Cancer Institute, which is subordinate to the Ministry of Healthcare. At the moment a complex investigation is underway. A second one already. First there was a small one regarding the facts provided by the Office of the Prosecutor of Holosiivsky district, and now there will be a complex full check. If any problems are found, then, of course, such heads will be changed. This regards, for example, “Indar” factory, where insulin is being produced, regarding the change in management. Not functions.
And the return to the “state womb,” so to speak, of all this property: both the land and the buildings that the predecessors tried to steal from us, the Ministry of Healthcare. I have a very harsh policy – everything has to be returned to the Ministry. There will be no distribution or transfer anymore.
What land do you mean?
Where healthcare institutions are located, sanatoria, coastal sanatoria.
So-called “re-profiling,” right?
Yes. There were systems, how to steal from the state for nothing. Everyone knows about this. And not just in the MOH, this occurred everywhere. And with the municipal land in the city of Kyiv. This was a problem. We are trying to build a policy in the MOH that we will not give anything but return everything.
You, as the Minister, have initiated the investigation of the head of the Cancer Institute, as I understand.
But some workers in this Institute were categorically against this. Today there was even a protest in front of the MOH. As I understand, this is not the first protest of this sort, not the first conflict.
This is a long-term conflict. There were many checks back in the times of the old, previous criminal government. Despite the highly negative conclusions, which are pre-emptive, the leadership managed to smooth out these conflicts, and the leadership once again remained at their posts.
And the first check was not initiated by us, it was initiated by the Prosecutor Office of the Holosiivsky district of the city of Kyiv regarding the numerous abuse of power and the facts listed in the Prosecutor’s statement.
This is on Lomonosov street?
Yes. There are numerous addresses of parliament members and civil organisations regarding abuse of power. I am obliged to react. Therefore a final check will be done in order to draw conclusions regarding the leadership of that institution.
So people came to you. You were not afraid to come out to them, you were not afraid that you, forgive me, would have brilliant green or iodine poured all over you, like others? Literally yesterday the former head of Kyiv, head of the Kyiv City Administration Popov suffered such an attack. You were not afraid to face the protesters?
I am never afraid of people and I always communicate with them. I am trying to give them arguments, not emotional ones, but based on what is happening. As I consider it right, in reality, that the people have, first, the right to protest, and second, they have the right to listen to the leadership from the source, not through the journalists which sometimes describe the situation wrongly or tear out some facts, or overall are led by some rumours, what would happen to our Institute? Whether it would be privatised? There was a question today. Of course, nobody will do this.
Will it remain with the state?
Yes. Definitely. This issue is not even being discussed here.
And the issue of checks should not regard the workforce of the doctors which are doing their professional duty. This is also prohibited intervention. And I emphasise this categorically at every committee meeting, that they should not interfere with the professional activity and the provision of medical aid. The checks regard the management, the leaders exclusively, which are conducting leadership rightly or wrongly in various institutions. This is the philosophy of approaching these checks – facts.
What could lie in the wrongness of conducting the leadership of a certain medical institution?
For example, participation in tender purchases. Healthcare institutions have the right to purchase various equipment, medicine. There can be abuse of power, heightened prices and so forth. There can be illegitimate firing of dissenting workers. For example, such a complaint exists in the Cancer Institute. There can be pressure for freedom of speech as well. There can be badly organised provision of medical aid. There can be extortion of bribes for giving medical care. And this is why such checks are conducted.
As to the bribes. Doctors, as is known, gave aid to Maidaners, by the way, not only Maidaners, but law enforcement officers on the otherside, “Berkut” soldiers too. There was no division for you.
The philosophy of the medical service of the Headquarters of National Resistance was that doctors, when doing they professional duty, give medical aid to absolutely everyone: “Berkut” soldiers, “titushky,” homeless people, 98% were, of course, the Maidan participants themselves. Because we created our service specifically in order to give this aid to Maidaners. However we did not refuse anyone.
And the aid was free of charge.
Even theoretically, there was no talk of bribes.
No talk! Not just for free, but all the medication was brought to us free of charge by people from Kyiv, and companies, there was a lot of medicine that we had at our disposal which, by the way, remained until now.
By the way, where is it now?
At Tryokhsvyatitelska, 7. The medical service of the Headquarters of National Resistance remained there. And part of the medicine, as far as I know, according to the head of the medical service Andriy Guk, are still at KP “Pharmacia” company, at their stocks, because the medicine goes bad when the conditions are wrong. Therefore, it goes without saying that right stocks are necessary, that maintain a temperature regime, humidity and so forth, for the medication not to go bad. They definitely have to be used by people.
Those who remained on Maidan still have the possibility to get medical care at Tryokhsvyatitelska, 7 and in several other medical points. And the majority of the medication was transported, for example, to Odessa, when the tragic events happened. Much was given to Kharkiv Oblast. A lot of medication was transferred to Kramatorsk and Slovyansk. We gave medication for the National Guard as well. In sum, to everyone in need. A lot of medication was distributed among the hospitals of the city of Kyiv.
Every citizen of our country, regardless of their age, in one or another has come face-to-face with doctors. Maybe, there are very few who have received the free medical care guaranteed by the Constitution, received it really for free and high-quality.
Yes, without paying. There is nothing free.
Maybe this profanity has to stop? De facto the provision of medical aid is far from free. Maybe, the network of private clinics has to be developed more? Insurance medicine – they have been talking about it for 15 years now, nothing changes. When will the bribery stop, which, unfortunately, is still flourishing among medical workers of Ukraine?
This problem lies not only in the plane of providing medical aid. This is an issue of a new healthcare system for Ukraine, the concept of which will soon be presented by the MOH. It is practically ready.
Further. We have changes in the financing systems. This is compulsory. Besides budget financing, there will be an implementation of a general state social medical insurance. Of course, not now. Because during an economical crisis it is difficult to implement, and to pass a law, build its structures – medical insurance will be implemented in two years.
These are changes in the government system, for the doctors to be free, so that they are able to work on contract with a healthcare institution, and not receive the same salary as everyone else according to the current budget code. There the starting salary is 1,5-1,8 thousand regardless of how the doctor workers. Additional payments for quality of providing medical aid, for the amount of medical services provided. This has already been implemented, for example, in pilot regions, for example, where family medicine is being developed. For instance, in the city of Kyiv family doctors in Dniprovsky district receive five to six thousand hryvnia on average.
There are possibilities and mechanisms. They have to be implemented systematically, as a complex, in the form of construction of a new healthcare system for the entirety of Ukraine. We are ready for this and our MOH team as well, there is also the understanding of the Prime Minister. I think it will be maximally adapted to EU demands and EU resolutions. First and foremost, it is the pharmaceutical industry, for example, with the prices on medicine, with referent price creation, with the adaption of medication registration. It will also regard the adaptation of the entire Ukrainian medical legislation.
I think that before the end of the year we will be able to present a dozen new laws and a new system. We will be building a new healthcare system for Ukraine.
Including insurance medicine?
It’s included. Budget financing will remain, of course, and additionally the funds that we all pay. In reality everyone understands that they are paying out of their own pocket. Unfortunately, it is all from an individual’s pocket. It has to be put on the state through a fund and the funds have to be redistributed. There will be a certain payment from the salary, for example, 7%. But this will be a directed payment for medicine, for a person’s healthcare. Then the people (we have surveyed many) agree to pay not into the treasury, so to speak, they don’t know where, not to pay in a “grey” way to charity funds which have been created or insurance organisations, but to pay a certain sum from their salary but to have a guaranteed level of healthcare provision.
And, of course, article 49 of the Constitution prescribes this free medicine, but this is, unfortunately, profanity. We all understand that it has not been carried out, is not being carried out and it is unlikely it will be carried out in the nearest future. Its changes are needed, we have to write that the free provision of medical aid will happen, but within the limits of the given budget. Then this will be the truth and an honest message to the people. Everyone understands this.
As to the investigation of the Cancer Institute in Kyiv… These horrible illnesses (unfortunately, their number is growing in Ukraine year by year) – oncology and, of course, heart and vessel diseases. As far as I know, according to statistics, two out of three deaths, 66% are caused by heart and circulatory system diseases…
Of course. And the biggest problem with life expectancy lies within the plane of cardiovascular diseases.
But the number of oncological diseases, unfortunately, is growing as well.
Oncology is in second place after cardiovascular diseases. This is also true.
What is a way to decrease deaths?
The best way is, as usual, prophylaxis and a healthy lifestyle. The new system for healthcare prescribes a prophylactic component, which has not been prescribed anywhere, that the person has to care for their health and cherish it starting childhood.
And this is a big part for family doctors and health centres which we are planning to renew as an institution that will teach the people to be healthy. Why treat it later? This is what we have: I won’t go to the doctor because it is expensive, I will abuse everything because I like it. And then, when one gets so sick that they have to be saved in the ICU, only then do they go to the doctor. This is an incorrect approach. We will be changing the philosophy of the Ukrainians and the Ukrainian society’s attitude to their health through a long-term informational campaign.
This is Western experience. As developed world countries – they have fewer deaths due to oncology and cardiovascular diseases than in Ukraine, right?
Of course. These causes are much rarer. There are other problems there, for example, psychological or some other ones, or suicides. However Ukraine has to walk the civilised way, which our neighbours have taken. And they have gone the way of a healthy lifestyle, prohibition of smoking, alcohol abuse, abuse of other things. And to pay more attention to one’s own health. And we will also choose this way.
We have a question from a radio listener.
Listener: I buy “Azopt” eye drops for my wife. In Bereznyaki, where we live, in one of the hospitals they cost UAH140, in another 190. Why is there such a strange price range?
Another example is made by the visitors of Radio Svoboda website. The medicine “Plavix” costs USD12 in Poland, and in Kyiv – 700. Why so? These are not individual instances in pharmacies.
Unfortunately, they do exist. This is connected with the rapid growth of the dollar exchange rate, which happened three months ago. Because the medicine that was imported on the past exchange rate is still being sold for old prices, and those that have been imported by the exchange rate of UAH12 per dollar in the last month, then, they will, of course, unfortunately, become more expensive.
However the government has developed a certain anticrisis program regarding this issue. And now this has been taken up by the Ministry of Economics, the State Price Inspection. The proposals of MOH have been made regarding so-called referent price creation. This is when we compare all prices with five of our neighbours, and in Ukraine the medicine will be sold for the price average between the five countries.
And what neighbours?
Poland, Slovakia, Moldova, the Czech Republic and Bulgaria.
In the state budget you have inherited from Raisa Bogatyryova for the provision of medicine within the framework of realisation of the program for the centralised purchase of medicine, UAH2,2bn are prescribed. Is this in enough? Or is this just “a drop in the ocean”?
No, this is “a drop in the ocean.” This is half of the need practically in the prices of last year. If now we will manage to break corruption during state purchases, this will be a lowering of 40%. This dollar exchange rate growth will provide such an amount. Therefore if we are not able to influence the producers, though they have all declared the lowering of prices in the dollar equivalent, then about 40% of the needs will be satisfied.
And the necessary budget for today’s prices, it around five billion UAH in order to fully satisfy the needs of the state programs. These are oncology, diabetes, orphan illnesses, stenting, prosthetic joints, HIV-AIDS, tuberculosis and so forth. The state has been giving 40-50% for the needs all these previous years.
But there’s an interesting detail. Before, the state only gave half. But, as you say, if there were no corruption with tender purchases and so forth, you could manage to renew these 40%.
More or less.
De facto, in comparison. So corruption takes away half!
These are prices on medicine, medical aid and so forth.
Yes, these are prices on medical aid. These are all the permits given by the Ministry and the State Medicine Service.
Of course, all of these permits and bribes, high rent, for example, for pharmacies – all of this goes to the price in the end. We understand this, that all this “false” money coming to some officials, all of these numerous investigations that the institutions buy off, all of this is part of the price. And in the end it makes some medicines more expensive.
This is the absence of long-term contracts, for example, for purchases in the West which are practiced in other countries. During talks with pharmaceutical producers when signing the contract for 3-5 years, they guarantee that the price will be 30% lower. Because they are planning their production for the longer term. And so forth. There are many mechanisms, how to make medicine less expensive.
The western experience is very useful.
We will be implementing it, of course.
For example, the new law “Regarding medicine,” which we are working on and are planning to finish throughout the month, is fully adapted to EU directives. This will also be a know-how for Ukraine, that the registration of medicine made in Europe will be fully adapted to Ukraine.
Gradually. We want to do all of this today. Unfortunately, we need some time.
But the movement has started.
But the movement has started, of course. And we are very optimistic.
Well, let’s keep this optimism.
Source: Radio Svoboda
Translated by Mariya Shcherbinina
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