Ukraine is one of ten countries with the highest incidence of multidrug-resistant tuberculosis in the world. One of the main causes of the strained tuberculosis situation in Ukraine is the low level of treatment effectiveness. The causes of this problem are gaps in the organization of early detection of tuberculosis and diagnosis of resistance of mycobacterium to anti-TB drugs, shortcomings in ensuring adherence to the prevention, early detection and treatment of tuberculosis in the population. These reasons are due to the low level of public awareness of tuberculosis, the lack of sufficient psychosocial support services for patients with tuberculosis, and the lack of rapid implementation of new drugs and regimens recommended by the World Health Organization (WHO) 2019 the ability of physicians to prescribe an effective treatment regimen for patients with advanced resistance to tuberculosis.
On November 27, 2019, the Cabinet of Ministers of Ukraine adopted the Decree “On Approval of the State Strategy for the Development of the System of Anti-Tuberculous Medical Assistance to the Population”.
Reform of the second link has raised many questions and overgrown with untrue information. Therefore, the Ministry of Health provided answers to the most common questions regarding the reform of the TB service.
- Is it possible to treat tuberculosis outside the hospital?
The average duration of inpatient treatment in Ukraine is an average of 82.8 days among adults. While in most countries of the world in a hospital the patient is treated for up to 2 weeks, and then transferred to outpatient treatment. The need for hospitalization arises only when certain specific clinical reasons arise.
After starting an effective treatment regimen, the bacteriological load decreases rapidly and within a few days the patient ceases to be contagious. After treatment, patients do not pose a risk of infection to other people. For a patient with tuberculosis who is forcibly placed in a hospital for such a long period, there is a risk of developing a multidrug-resistant form of tuberculosis.
- Does Tuberculosis Treatment Fee?
The rate for tuberculosis medical services is set at a global rate of 9 months for willingness to provide tuberculosis treatment services. It is calculated on the basis of the cure rate rate, which is UAH 20 663,68, to which the correction coefficients apply.
The correction coefficients, depending on the ability of the institution to perform surgery, are: for readiness to carry out surgical interventions according to additional conditions of purchase - 1,056 and 0,956 for unwillingness to perform surgical interventions according to additional conditions of purchase;
A common manipulation is the claim that UAH 20,000 will not only be enough to buy medicines, but also to feed the patient. And if we talk about the treatment of multidrug-resistant tuberculosis, the drugs will cost more than 100 thousand. In fact, the cost of treatment at the hospital does not include the cost of drugs. Tuberculosis drugs are purchased under a separate program - centralized by the Ministry of Health of Ukraine.
- Will a change in the funding system reduce the budget of the health care facility
Tubdispensaries are funded based on how many beds they have. Going for a paid service will allow you to optimize your budget and distribute it to where this medical care is actually provided. All medical facilities that will provide services under the “tuberculosis treatment” package will receive money from the NSA according to the tariff. It is important to note that the NHS tariff includes diagnostics, outpatient and inpatient treatment. The tariff does NOT include anti-TB drugs and test systems for diagnosis. The MoH buys them centrally.
The overall health budget has been increased by 10% this year, so fears of funding cuts are unjustified.
- Will tuberculosis dispensaries continue to operate?
If the healthcare facility does not have enough patients to cover its funding needs at the rate, there are several options for the local authority.
- Co-finance the institution under the regional program from the local budget;
- Repurpose institution
- Combine multiple services. This is what the Odessa Regional Center for Socially Significant Diseases did, which combined the treatment of patients with tuberculosis and tuberculosis and HIV.