Schemes in medicine during the war
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. About it recently declared VR Commissioner for Human Rights Dmitry Lubinets. During this time, each of us has faced the fact that a family doctor, pediatrician, oncologist, surgeon or caring nurse are outside the country. Since, in addition to treating us and doing the necessary medical manipulations, they are also mothers or young grandmothers who took their children and grandchildren abroad, writes ZN.
A huge number of medical workers turned out to be outside Ukraine. Some have found jobs in European countries. Some are still thinking about returning. We wanted to evaluate and understand how many medical workers Ukraine lost during the war. And we had no doubt that the NHSU, a key agency in the transformation of the healthcare system, which, among other things, is called upon to monitor the quality of medical services provided and is the owner of the register of medical workers, will help us in this.
So, at the beginning of November last year, ZN.UA sent a request to the NSZU with a request to provide information on the number of doctors and paramedical personnel by months (from January 1 to November 1, 2022) by region.
The NSZU responded to our request with a long sheet of data, apparently hoping that we would drown in them and not understand the bureaucracy and casuistry of indicators. But we brought in professionals who, at odd times, helped us figure it out and reduce the data to a clear table with obvious results. Imagine our surprise when we saw that over this period in the country as a whole the number of specialist doctors … increased by 4% (+4467), primary care physicians (PHC) – by 4.2% (+1080), and nurses — by 5.7% (+8961). We saw negative indicators only in Donetsk, Lugansk and Chernihiv regions. And this is despite the fact that even the Minister of Health Viktor Lyashko, back in early June, on the air of the national telethon, said about schemes in medicine: “In Ukraine before the war there were about 143,000 doctors and 261,000 nurses. Now, according to our registers, 2,273 health workers have left Ukraine, including doctors and nurses, excluding nurses“.
Schemes in medicine during the war
It is clear that the situation has hardly improved since then. Even with the margin of error, we assume that some hospitals in the occupied territories cannot make entries in the EHS (Electronic Health System), so it is quite possible that the data from there may not be up to date. But, if we believe the figures provided by the NSZU, then the medical staff from Ukraine from January 1 to November 1, 2022 not only did not leave, but, on the contrary, arrived. How can this be?
Why we are only providing this data now, I will explain later. Now let’s try to figure out what these numbers mean.
And they mean that either Minister of Health Viktor Lyashko is lying, declaring a shortage in Ukraine at this time of doctors and paramedical personnel due to their travel abroad. Or lies NSZU. All these are schemes in medicine. That is, the department does not have information, does not know how many doctors actually exist in the country, and therefore cannot correctly form the Medical Guarantee Program for the population of Ukraine (PMG).
This, in turn, means that contracts are awarded to hospitals that obviously do not meet the terms of the procurement. That is, medical institutions, stating that they have the necessary medical staff to provide a particular medical service, in reality they do not have it, but receive payments by packages. At the same time, the NSZU has a wonderful opportunity to contract hospitals manually: everything is for its own, the law is for others. As a result, the patient does not receive quality medical care. And if, for example, a patient with a stroke was brought to a hospital that provides services under the package “Medical Care for Acute Cerebral Stroke” and receives money for this, it may well turn out that there are no relevant specialists who can help the patient, in fact, in the hospital. The scheme works, but the system loses the patient. In all senses.
Schemes in medicine during the war
At the same time, some hospitals receive funding under the “Ensuring the retention of human resources” package. (PKMU No. 1440, art. 132 (1). This is the so-called salary package, introduced to support those medical institutions that are unable to pay the salaries of their doctors and medical staff in the amount determined politically.
And here is the question: if the NHSU does not have reliable data on the number of doctors and nurses in the country, how does the NHSU verify such data? Are these funds allocated to those non-existent health workers that we see in the numbers provided by the NHSU? Is there another diagram here? How are the information submitted to the NHSU by the regional health departments (DH) verified? Can it be argued that among the latter there are no those who receive kickbacks for registering medical workers?
Hoping to clarify the situation with the help of additional questions, in particular, about what is the source of data on the staffing of institutions when contracting, as well as how the verification of the accuracy of information and documents entered in the ESZ is carried out, on November 15, ZN.UA sent another request to the NSZU. A week later, we received a letter that our request concerns the provision of a large amount of information, therefore, the NHSU extends the consideration period to 20 business days. Meanwhile, all deadlines have long passed, but ZN.UA has not yet received a response and intends to file a lawsuit against the NSZU.
And now back to the question of why we provide this information now. Experienced people – chief doctors of state medical institutions and private clinics – advised us, saying that, in addition to the schemes on the registry of doctors, there is another one. These are registrations of medical services that are allegedly provided by medical institutions (in fact, they are not) and for which they receive money from the National Health Service.
Unfortunately, the work for the NSZU and for us (since we did not have the initial data) was performed by the Office of the Prosecutor General, exposing a private clinic in Bukovina that embezzled millions of hryvnias from the NSZU. (By the way, Natalia Husak, before her appointment as head of the NSZU from January 2020 held office Deputy Head of the Chernivtsi Regional State Administration, coordinator of the medical direction.)
According to the investigation, the Office of the Prosecutor General reports, the head of a private clinic, his wife, an FLP, and three other employees of the medical institution have established a mechanism for taking possession of budgetary funds received from the state as compensation for providing services to the population.
During 2022, physicians entered false information into the e-health system about services that the institution did not actually provide.” The vast majority of patients did not receive these services, and the state unreasonably allocated more than UAH 8 million to the medical institution for these services. Representatives of the medical institution legalized illegally obtained funds by transferring them to the accounts of controlled business entities.
Under the procedural leadership of the Chernivtsi Regional Prosecutor’s Office, five persons were informed of suspicion under Part 5 of Art. 191, part 2 of Art. 209 of the Criminal Code of Ukraine.
Another similar case got publicity in November in the Dnepropetrovsk region. The director of one of the medical institutions involved the head of the department, the head of the department and four doctors and developed a large-scale scheme for misappropriation of budget funds. The defendants entered information about the provision of medical services to non-existent patients into the relevant databases and unjustifiably received UAH 67 million of budgetary funds from the National Health Service.
And all this – during the war, when the state asks for help from international donors. And how many other such dealers are there in the country, while the NSZU does not own the data and does nothing to correct the situation? We are afraid to even suggest – perhaps he does nothing consciously, because such schemes are protected? And that’s why it doesn’t respond to queries that might make it obvious?
The volume of uncontrolled financing of “dead souls” from among the medical staff who left, and “dead (unrendered) services” to patients who do not even realize that budget funds are written off on them, in fact, can be calculated not in millions (criminals from medicine caught by the hand), but billions and tens of 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 “in the know and on shares”: from the family doctor to the chief doctor, from officials of mayor’s offices and regional DZs to the Ministry of Health and the NSZU?
Alla Kotlyar
