Ukrainian physicians tour Canadian health care institutions (09/08/96)

Ukrainian physicians tour Canadian health care institutions

by Maureen Johnson

OTTAWA - When there is inadequate information available, it is difficult to determine if a country's health system is delivering effective care at acceptable levels of quality and cost.

That's one of the problems facing Ukraine right now. In the midst of changing from a Communist to market-based system, Ukraine is having to find ways to cut costs and improve effectiveness and quality of care - and quickly.

For example, the death rate from lung disease in Ukraine is high. Tobacco is one cause; other causes are environmental or tuberculosis-related. If reliable statistics were available, Ukraininian authorities could decide where to concentrate their efforts - on anti-smoking campaigns, environmental clean-up or TB control. The focus could be moved from treatment to prevention.

"Information systems for monitoring patients' health status and the population's health status were launched in the years of the Soviet Union, and it was a very costly program," noted Dr. Anatoly Mischenko of Ukraine's Ministry of Health, who was in Canada recently. "They had to be abandoned. What is left in place is the examination of patients for certain diseases and those subjected to the radiation from the Chornobyl disaster."

Dr. Mischenko, director of Ukraine's Center of Medical Statistics in Kyiv, was one of eight Ukrainian physicians involved in health information who recently spent a month in Canada examining the Canadian system from top to bottom. The doctors represented six Ukrainian regions.

"This visit is remarkable in that not many Canadian health professionals would have had the chance to look at the health information system in Canada so comprehensively," said Myroslaw Kohut, who developed and led the study tour for the host agency, the Canadian Society for International Health, as part of its Partners in Health Canada-Ukraine linkage.

Mr. Kohut, an international health sector consultant from British Columbia, is of Ukrainian parentage and grew up in Canada. He has worked in the health care field for 20 years, speaks Ukrainian and has visited Ukraine 14 times on health care issues since 1992, including heading a team contracted by the World Bank to assess the health sector and develop directions for reform.

He pointed out that all Ukrainian health care institutions have defined systems for reporting health statistics such as number of beds, physicians, nurses, cases handled, diagnostic categories and financial information. The quality of supply side information is reasonable, but information on the use of resources and costs is poor.

The databases are not set up for managing the health system, and there is significantly less computerization in Ukraine than in Canada. Although Ukraine is computerized to some extent and some cities are connected to the Internet, there is a lack of software to develop standard data collection. Records are still kept on paper and most data is tallied manually. Thus, Ukraine's systems cannot compare with the sophistication of Canada's computerized health information systems, Mr. Kohut observed.

Some regions are connected via telecommunication lines, but the Center of Medical Statistics does not have computer links with the regions.

The Ukrainian delegation spent the first two weeks in British Columbia visiting hospitals, the province's Cancer Control Agency, the Vancouver and Simon Fraser Region Health Boards, the provincial Ministry of Health, the University of Victoria Health Information Sciences Program and the Greater Victoria Hospital Society.

The visit gave the group an overview of a provincial health system in Canada and the methods used for data collection.

The second week was spent in Alberta, looking at data collection in the Crossroads Regional Health Authority based in Wetaskiwin and visiting the Southern Alberta Institute of Technology, the University of Calgary's Faculty of Medicine, the Calgary Region Health Authority and the Alberta Shock Trauma Air Rescue program.

The third week was spent in Ottawa, visiting Health Canada, Statistics Canada, the Canadian Institute for Health Information and SHL Systemhouse International.

The four-week visit ended in Toronto with meetings at MediaLinx, a new provider of health information on the Internet, and the Health Information Research Unit at McMaster University in Hamilton.

Dr. Mischenko said at the end of the visit that, having learned about the Canadian experience, Ukraine would not "translate the pattern blindly." He added, however, "Having seen your health care system we already have formed an idea of how we are going to reorganize the health care system in Ukraine. We realize the funds that are available are not being managed or used in the best possible way at present."

Ukraine first has to reorganize inpatient, acute health care, reducing the number of beds and the period of stay, as that is the most costly. After that, the polyclinics will be reformed and the Canadian family doctor concept may be introduced. "In order to resolve these issues, we shall have to change the information systems in the hospitals and polyclinics," Dr. Mischenko added.

Where patient information is required, the Canadian system may be used as a basis, said Dr. Mischenko. "Once we get back from Canada, we shall get our experts together to see what has been done so far and how we can incorporate the Canadian experience into the system. We can't really replicate the Canadian 'average stay' model or approach automatically because there are different circumstances, such as transportation, for example."

Study tour coordinator Mr. Kohut said: "The people visiting Canada are in the position to influence change in Ukraine and the direction of reform. They wanted to know more about what we do and how we do it. This was their chance to find out. We made sure the doors were open for them to see a broad spectrum of health information methods and technologies."

Mr. Kohut added that the Ukrainians themselves will decide how best to capitalize on the knowledge that exists in Canada and noted that he expects institutional partnerships to result.