War and Schemes in Medicine
Since the beginning of the full-scale war, more than 14.5 million Ukrainians of various professions have left Ukraine in search of safe places for their families. This was recently stated by human rights ombudsman Dmytro Lubinets. Each of us during this time faced the situation when family doctor, pediatrician, oncologist, surgeon, or caring nurse are outside the country. In addition to treating us and performing the necessary medical manipulations, they are also mothers or young grandmothers who took their children and grandchildren abroad.
A huge number of medical workers ended up staying outside of Ukraine. Some of them got jobs in European countries. Some are still considering returning. We wanted to ballpark and understand how many medical workers Ukraine has lost during the war. And we had no doubt that the National Health Service of Ukraine would help us here as a key agency in the transformation of health care system, which, among other things, is to monitor the quality of the provided medical services and posesses the register of medical workers.
So, in early November last year, ZN.UA submitted a request to the National Health Service of Ukraine to provide information on the number of doctors and mid-career medical personnel month-by-month (from January 1 to November 1, 2022) for every region separately.
The National Health Service of Ukraine responded to our request with a long datasheet, apparently expecting that we would drown in the information and fail to understand the bureaucracy and casuistry of indicators. However, we invited specialists who, in their spare time, helped us understand and compile the data into an understandable table with obvious results. What was our surprise when we saw that during this period the number of specialist doctors in the country as a whole... has increased by 4 per cent (+4467), first aid doctors – by 4.2 per cent (+1080), and average medical personnel – by 5.7 per cent (+8961). We saw negative indicators only in Donetsk, Luhansk, and Chernihiv regions. And this is despite the fact that even Minister of Health Viktor Lyashko stated on the air of the national telethon in early June: “There were about 143,000 doctors and 261,000 mid-level medical personnel in Ukraine before the war. Now, according to our registers, 2,273 medical workers, including doctors and nurses, have left Ukraine, not counting medical attendants.”
Obviously, the situation has hardly improved since then. Even considering the possible inaccuracy, we assume that in the occupied territories some hospitals cannot enter records into the Electronic Health Care System, so it is quite possible that the data from there may be irrelevant. However, if to believe the figures provided by the National Health Service of Ukraine, medical personnel from January 1 to November 1, 2022, not only did not leave Ukraine, but, on the contrary, arrived here. How is this possible?
Why we are providing this data only now, I will explain a little later. Now let’s try to figure out what such figures can mean.
They mean that either Minister of Health Viktor Lyashko is lying, declaring that there is currently a shortage of doctors and medical personnel in Ukraine due to their departure abroad, or the National Health Service of Ukraine is telling lies. That is, the agency does not have information, does not know how many doctors there actually are in the country, and therefore cannot correctly draft the Program of Medical Guarantees for the Population of Ukraine.
This, in turn, means that contracts are awarded to hospitals that deliberately fail to meet the procurement conditions. That is, medical institutions, claiming that they have the necessary medical personnel to provide various medical service, actually do not have them, still they receive payments for packages of services. At the same time, the National Health Service of Ukraine has an excellent opportunity to contract hospitals in manual mode following the principle “for my friends, everything; for my enemies, the law.” As a result, the patient does not receive quality medical care. And if, for example, a patient with a stroke is brought to a hospital providing services under the “Medical care for acute cerebrovascular stroke” package and receiving money for it, it may well turn out that the appropriate specialists who can provide care to the patient are not actually in the hospital. The scheme is working, but the system loses the patient. In all senses.
Meanwhile, some hospitals receive funding under the package “Ensuring the preservation of personnel” (under Resolution of the Cabinet of Ministers of Ukraine No. 1440, Article 132 (1). This is the so-called “salary” package introduced to support those medical institutions that are unable to pay salaries to their doctors and medical staff in the amount fixed politically.
And here is the question: if the National Health Service of Ukraine does not have reliable data on the number of doctors and medical staff in the country, how does the National Health Service of Ukraine verify such data? Aren’t these funds allocated to those non-existent medical workers that we see in the figures provided by the National Health Service of Ukraine? There is another scheme here, isn’t there? How is the information, submitted to the National Health Service of Ukraine, verified by the regional health departments? Can we be sure that among the latter there are no such people who receive kickbacks for the sham adding of medical workers to general statistics?
Hoping to clarify the situation with the help of additional questions, in particular, regarding what is the source of data on the staffing of institutions during contracting, as well as how the reliability of information and documents entered in the electronic health care system is checked, on November 15 ZN.UA sent another request to the National Health Service of Ukraine. A week later, we received a letter saying that our request refers to the provision of a large amount of information, therefore the National Health Service extends the consideration period to 20 working days. Meanwhile, all deadlines have long since expired, but ZN.UA has still not received a response. The media outlet intends to file a lawsuit against the National Health Service of Ukraine.
Now back to the question of why we are providing this information now. Experienced people, head doctors of public health institutions and private clinics, have consulted us, saying that in addition to the schemes relating to sham adding of doctors to general statistics, there is another one. This is a sham adding to general statistics of medical services that are supposedly provided by medical institutions (in fact, they are not) and for which they receive money from the National Health Service.
Unfortunately, the Prosecutor General’s Office did the work for the National Health Service and for us (since we did not have the original data), exposing a private clinic in Bukovyna that embezzled millions of hryvnias from the National Health Service. (By the way, Nataliya Husak, prior to her appointment as head of the National Health Service, held the position of deputy head of the Chernivtsi Regional State Administration, coordinator of the medical department, from January 2020.)
The Prosecutor General’s Office reports: “According to the investigation, the head of the private clinic, his wife, an individual entrepreneur, and three other employees of the medical institution have established a mechanism for illegal appropriation of budget funds received from the state as compensation for providing services to the population.
Throughout 2022, the doctors entered false information into the electronic health care system about services that the institution did not actually provide.” The vast majority of patients did not receive these services, and the state unjustifiably allocated more than UAH 8 million to the medical facility for these services. The representatives of the medical institution legalized the illegally obtained funds by transferring them to the accounts of controlled entities.
Proceedings were conducted by Chernivtsi Regional Prosecutor’s Office; suspicion was reported to five persons under Part 5 of Art. 191, Part 2 of Art. 209 of the Criminal Code of Ukraine.
Another similar case became public in November in the Dnipropetrovsk region. The director of one of the medical institutions, involving the chief manager, the head of the department and four doctors, developed a large-scale scheme for the illegal appropriation of budget funds. The defendants filled the relevant databases with information about the provision of medical services to non-existent patients and unjustifiably received UAH 67 millions of budget funds from the National Health Service.
All this happened during the war when the state asks for help from international donors. How many such other “smart guys” are there in the country, while the National Health Service of Ukraine does not have the data and does nothing to fix the situation? We are afraid to even assume anything – maybe it is consciously avoiding acting, because it is patronizing such schemes? Is that why it doesn’t respond to queries that might make it obvious?
The amounts of uncontrolled financing of “dead souls” from the number of medical personnel who have fled and “dead (unprovided) services” to patients who do not even guess that budget funds are written off on them, can actually be calculated not in the millions (of rogues caught in the medical sphere red-handed), but in billions of hryvnias. And if this is true, then during the months of the war, a criminal pyramid has been built in the country, where all levels are equal: from family practitioner to head doctor, from officials of city halls and regional health departments to the Ministry of Health and the National Health Service of Ukraine?
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