eHealth project

eHealth is a step-by-step digitalization of all interactions in the medical sphere up to the latest technology, interoperability & requirements. With a bottom-up approach civil society, state and business are creating an effective IT tool to fight corruption in healthcare before all legislation is in place. GoU sets up the rules and standards, while business creates final interfaces for users.

Innovation Summary

Innovation Overview

eHealth system will fight pervasive corruption in the health sector by means of step-by-step digitalization of all interactions in the medical sphere – providing transparent and checkable information on all budget spending in the sector. Background:

• The average life expectancy in Ukraine in 2015 was 71.1 years

• Public health facilities receive financing based on existing infrastructure (number of hospital beds, staff, and building size)

• Such a financing system very inefficient

• 4th country in the world for the number of hospital beds per population (879 hospital beds per 100,000 people)

• 1/3 hospitalizations in Ukraine are unnecessary

• Hospitals are outdated, poorly maintained and equipped

• According to the Constitution of Ukraine, health care services should be free of charge

• Total health spending constituted 7.4% of Gross Domestic Product (GDP) in 2014

• Only 46% of health spending coming from public sources

• Doctors often have to “buy” their position (doctor’s formal salary appr. $200/month, some positions cost $10,000 to $25,000)

• 9/10 Ukrainians have a fear of financial hardship in case of an episode of illness.

Health Care System has not been reformed since the independence of Ukraine. Corruption across healthcare is a pervasive and persisting problem in Ukraine. It results in the loss of a significant portion of limited health care resources and ultimately contributes to poor health outcomes. The victims of the current situation are patients, required to “contribute” to semi-formal hospital “charity funds”, prescribed brand name drugs to receive a kickback from pharmaceutical companies, asked to buy and bring necessary drugs and materials into the hospital, while still receiving substandard care from a run-down facility with obsolete medical equipment and unhappy medical personnel.

To solve this problem, the current team of the Ministry of Health of Ukraine (MoH) has started the fundamental change of the payment principles in the system - financing reform. It will replace outdated Soviet planning system with transparent and highly motivated “money follows the patient” system for doctors payroll. It will take into account doctor's’ efficiency, real involvement, patient satisfaction, and reliable data. It will change the entire logic of the relationship between the state, hospitals, doctors, and patients. First it will be implemented for the primary health care with the introduction of capitation. Later introducing fee for service and DRG based payment for the entire scope of medical services in the country.

According to the Cabinet of Ministers of Ukraine resolution (November 2016) there is a state program “Affordable Medicines”. It provides a range of reimbursed drugs, but the provision is completely paper-based. The distribution process is uncontrollable and there is no control whether the patient really received the drugs for free. MoH realizes a high risk of failure of any reform with paper-based implementation due to the enormous risk of data falsification (Experience of other countries shows that paper-based reports may lead to the budget overruns in 2-3 times). Consequently, it was decided to start off the reforms that are backed up by the digital support. MoH has set an inquiry to start creating an efficient and transparent eHealth system with the following objectives:

• Creating the fundamental services for eHealth system that simultaneously will support reforms implementation in health care • Enhancing transparency, accountability, and responsiveness of the health care system

• Improving health sector governance

• Supporting evidence-based decision-making on every level of health care

• Boosting the health system as a significant sector of Ukraine’s economy

• Improving instruments for policy making and governance in health sector for all actors

• Fighting corruption in the sphere of health care.

Key principles laid the foundation of the system are:

- Safety and security of information is a priority

- Customer-orientation

- utility, and value for all actors

- Integrity and continuity of health records

- Convenience and reliability

- Management and financial transparency

- Information and knowledge management

- Interoperability and standardization

- Free market and fair competition

- Possibility for further expansion of system

- Equal access across Ukraine.

Beneficiaries:

All citizens: ability to chose a doctor regardless of age, gender, social status and registration - ensure equal access to higher quality medical services.

Medical personnel: higher wages depending on the number of patients – strong intention to be “patient-oriented” and provide better services.

Business: open market and fair competition: conditions for medical eServices development. Government: to be capable of meeting the health needs of the Ukrainian people, tackling corruption.

NGOs: transparency by mean of digitalization: control over efficient budget money spending.

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Year: 2017
Level of government: National/Federal government

Status:

  • Implementation - making the innovation happen

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