The Public Private Collabroation model, eZdorovya, and the transformation of the healthcare system in Ukraine

17 million of people joined the eHealth in less than 6 months, which is every third Ukrainian. Such growth determined by the Public Power Corporation model of organizational process of the eHealth implementation in Ukraine. It was developed by the state-owned enterprise eZdorovya in cooperation with the government, business, IT and civil society. It enables to create a national highly secure eHealth system fast, effectively and transparently. Today, the eHealth in Ukraine is one of the key anti-corruption initiatives.

Innovation Summary

Innovation Overview

Until 2016 the medical system in Ukraine was stuck in the 80s - old, poor infrastructure, enormous amount of paperwork, endless queues, the Ministry of Health lacked data to make strategic decision. More than a half of payments were done out of pocket in to the health system. In 2016 Ukrainian government started the financial reform of the healthcare system aiming to substitute the outdated one with the result-based model. The eHealth system was determined as the main tool to make these changes happen. State-owned enterprise eZdorovya was defined as the main institution that would lead the process of the eHealth implementation.

Firstly, eZdorovya team together with the Ministry of Health, business and international consultants analyzed the strengths and weaknesses of Ukrainian economy in general, and the healthcare system in particular. In terms of weaknesses, there were three main challenges:
- The whole Ukrainian healthcare system worked on paper.
- Government had not enough human and financial resources to develop all the necessary software.
- The question of time was very critical due to the electoral cycle.

One of the main strength is the IT sector. IT industry in Ukraine is among the top three industries with the largest share of GDP in the country. IT products make more than 3% of the state's GDP. The total income of the industry in 2017 amounted to $ 3.6 billion. So, the working team decided that the growing IT will help to digitalize the healthcare system using best IT solutions, that is the reason the Public-Private Collaboration model was developed.

In April 2018 the Public-Private Collaboration model was introduced and there have been already remarkable results. Almost every third Ukrainian joined eHealth system in 6 months. The model made the process of transformation effective, transparent and fast. This model of organisational process of eHealth implementation in Ukraine was developed by government, business IT, civil society, and the eZdorovya team.

The cornerstones of the Public-Private Collaboration model for eHealth implementation are:

1) Open source and open code. All repositories should be publicly available. This minimizes the risk of vendor lock-in (binding to a particular developer), and gives the possibility of developing the system by other teams, including volunteers and small and medium enterprises. Such open data approach demonstrates the highest level of transparency and allows a wide community to contribute to the National eHealth project.

2) Developing the eHealth together with business. The state didn’t have enough resources, so the Ministry of Health and other state bodies decided to share the responsibility of the PPC model development with business. Moreover, business in Ukraine is more experienced in using new technologies, providing customer support and dealing with sales, on this wise the eHealth system can only benefit from it.

3) Two-component system. The government saves the necessary data and provides the business with the tools to cooperate with the Ministry of Health and the National Health Service in Ukraine.

Business enables the medical institutions to interact with the Ministry of Health and the National Health Service providing the IT platforms for them. Respectively, the new markets emerge, respectively. The free competition within these markets encourages businesses to improve the quality of service in such manner this is the end-users (patients) win.

4) Autonomy of the system. The involvement of business keeps the system stable regardless of the political situation in the country. Government determines the policy and strategy and works as a partner with business in order to digitalize the healthcare system in Ukraine.

5) Minimizing the burden for taxpayers. Everyone pays for what he chooses depending on which Medical Information System (developed by various certified business enterprises) the medical institution working with. Business creates the user-interfaces so that state spends less budget money for the development of the eHealth.

Three main components are crucial to the model. The newly created National Health Service in Ukraine is responsible for all the purchase, cost-analysis, and fraud prevention. The Ministry of Health is responsible for eHealth strategy and policy in the health sector. SOE eZdorovya is responsible for digital transformation of the health sector.

In 6 months more than 17 million Ukrainians joined the eHealth system. The newly created National Health Service has received its first funding (8.6$ million) and has already financed the medical institutions around Ukraine. The medical facilities are starting to get more money from the National Health Service.

eZdorovya helps Ukraine to take a huge step to European integration. eZdorovya is being financed by international organizations and governments donors to implement the public private collaboration model.

Innovation Description

What Makes Your Project Innovative?

The innovation that was developed is the public private collaboration model. It Can be described as following :
- facilitates the process of eHealth implementation in Ukraine. In 6 months every third Ukrainian joined the eHealth system
- сreates the open source and the open code in the way that the ecosystem of eHealth is 100% open and any programmer, SME and volunteer from IT community can contribute to it
- assists the cooperation among the state, business, IT and civil society that makes the process transparent, fast and effective
- uses all the innovative IT tools to fight corruption in the healthcare sector that was never done in Ukraine

What is the current status of your innovation?

The Public Private Collaboration model is in the process of implementation, it is flexible and adaptive for any changes. Some of the IT solutions are already in place, and some of them still need to be designed. Since the beginning of 2018 doctors and patients are signing the declarations to be able to work in the eHealth system. This is the transformation of primary health care with the introduction of capitation. So far more than 17 million citizens have signed the declarations with the family doctors. This is the first step to automatization of the medical process. Till the end of 2019 medical events are going to be included in the eHealth system so all the data on this issue will be available online. Also, the data in the eHealth Сentral Сomponent database will be supplemented by the description of the patient’s complaint, diagnosis, and electronic prescription. Also, later we are going to introduce fee for service and DRG-based payment for the entire scope of medical services in the country.

Innovation Development

Collaborations & Partnerships

The minimum viable product of the Central Component of the eHealth was designed by NGOs and the Ministry of Health specialists. Right now it is state-owned and is administered by eZdorovya. The main eHealth stakeholders are eZdorovya, the Ministry of Health, National Health Service in Ukraine and Medical Information Systems.

Users, Stakeholders & Beneficiaries

Our users are medical institutions, doctors and patients. Business partners are Medical Information Systems. For the moment there are 15 Medical Information Systems which cooperate with the eHealth. Our main stakeholders are eZdorovya, the Ministry of Health of Ukraine, National Health Service, and international partners (Transparency International, USAID, WHO, The World Bank, the governments of Canada, Germany and the United Kingdom, the Global Fund, Deloitte, All-Ukrainian Network of PLWH).

Innovation Reflections

Results, Outcomes & Impacts

Each of the 1500 medical institutions, that have signed contracts with National Health Service, has received its funding proportionally to the amount of declarations that have been signed between doctors and patients. This data collected and stored in Central Component database controlled by eZdorovya. Medical institutions began to receive more money from the state. For example, centre of primary healthcare of Mizhyhiria, Zakarpatya region, received twice the amount of fundings in July 2018. Implemented system helped to reveal the most and the least effective medical institutions and to allocate fundings and salaries accordingly to the number of patients who have already chosen their doctors. For example, the medical center in Poltava region increased the salaries by 30%. They also used money to buy new software and medical equipment. Also, eZdorovya achieved good results in business developing establishing business relations with 15 private Medical Information Systems and creating the new market.

Challenges and Failures

The main struggle for us is to overcome the skepticism and the mentality of Ukrainian society.Ukrainian medical system hasn’t been reformed for a long time and mired in corruption since the 1980’s until now, so the trust in the healthcare system was vanished.That’s why, one of the challenges of the eHealth is to build solid loyalty from citizens.For now, after 6 months since launching the eHealth in Ukraine, we can confidently say that we’re going in the right direction.

Recent studies show that the support for all the healthcare government initiatives significantly increased. More than 50% of Ukraine’s population supports the ongoing changes in the healthcare system.

Another challenge for eZdorovya is to keep the public private collaboration model stable.Each novation should be coordinated with stakeholders on a business-negotiation level. Although the process is complicated and requires a lot of efforts and resources, it’ll provide solid stability and inviolability to the whole system in a long-run perspective.

Conditions for Success

The conditions for such a rapid success are:
- Unique Public-Private Collaboration model which made the process of transformation effective, transparent and fast.
- Open source and open code as the part technological implementation demonstrated the highest level of transparency and allowed a wide community to contribute the National eHealth project.
- The effective cooperation with all the key stakeholders.
- International partners provided the project with all the essential financial and human resources
- The implementation of eHealth is the prominent part of the whole healthcare reform and one of the key anti-corruption initiatives that majority of Ukrainian put as high priority

Replication

The designed public private collaboration model can be replicated by other countries. The developed solutions based on the open code can be used worldwide. We follow the idea of sharing technologies with other countries to make eHealth the global trend. Recently, Ukraine joined the Global Digital Health Partnership Summit to be involved in the constant exchange of best practices with 18 member-countries and WHO and the successful introduction of digital services in the health sector.

Lessons Learned

In 6 months, Ukraine managed to start the transformation of its devastating healthcare system. Without a well-thought-out public private collaboration model and well-organized cooperation among the key stakeholders such results could not be reached. eZdorovya played a leading role to facilitate all the necessary steps were taking. 17 million of declarations between doctors and patients have proved that the digitalization of healthcare services is the key to the overall transformation of the medical system in which every citizen feels involved.

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