June 15, 2017

Crucial health care reform begins, NATO membership becomes priority

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Ukraine moves closer to Europe

KYIV – Ukraine’s acting Health Minister Dr. Ulana Suprun flew to the U.S. this week to meet with the World Bank and the International Monetary Fund, as well as the Ukrainian Medical Association of North America to further garner support for health reform.

Ukraine’s Parliament on June 8 passed the American physician’s set of bills in the first of two required readings. The bills are designed to completely overhaul the country’s inefficient, Soviet-era health care system.

Two weekly plenary sessions remain before the Verkhovna Rada goes on summer break in mid-July. If passed, some of the measures could go into effect as early as that month and would validate the tenacious advocacy campaign that the Health Ministry has conducted via social, digital and print media.

“We say that in our country treatment is free, but it is not. We all pay for everything,” Dr. Suprun told the National Reform Council last week, speaking of the failing system. “We must stop lying.”

The Detroit-area native wants money to “follow the patient,” whereby physicians are paid by the number of patients they see instead of hospitals receiving state funding for the number of beds they have.

Currently, the system encourages waste by emphasizing excessive in-patient care instead of specialized outpatient care, and is more focused on curative and less on preventive treatment, according to a note that the World Bank published on health reform in Ukraine on April 4.

“Health outcomes in Ukraine today are poor,” the World Bank reported. “Life expectancy at birth in Ukraine is 71 years, more than 10 years less than the European Union average.”

Dr. Suprun has publicly stated that 136,000 Ukrainians die yearly – lives a normally functioning medical system would’ve saved. Indeed, with 15.6 deaths per 1,000 people, Ukraine had the third highest death rate in the world last year after South Africa and Russia.

Although the Constitution stipulates that medical care should be free, the acting minister has lamented that young Ukrainians start paying bribes as soon their first child is born in delivery rooms. The usual price in Kyiv is $1,000 to $3,000.

Palliative, emergency and primary care services, which account for over 80 percent of treatment, are free under Dr. Suprun’s plan. Patients can choose their family doctor – the first point of treatment – and everybody would be covered by national health insurance as in Great Britain. Co-payment would be introduced for other treatment, while certain medications would remain free. Those who can’t afford co-payment, would be subsidized by private insurance, local budgets as well as the mandatory social medicine insurance program.

Dr. Suprun also wants to update medical education to bring it into line with international standards and to introduce licenses for doctors, who currently need only a diploma to practice medicine.

The World Health Organization, the European Union and the ambassadors of the Group of Seven industrialized nations all support her bills.

NATO accession a policy goal

Also on June 8, the Verkhovna Rada passed legislation to make membership to the 29-member North Atlantic Treaty Alliance a policy goal. It justified the move by citing “Russian aggression” – mainly Russia’s illegal annexation of the Ukrainian territory of Crimea and its de facto occupation of certain parts of easternmost Donetsk and Luhansk oblasts.

As a collective defense alliance, “NATO is the most effective and the only organization that can stop Russian aggression,” Parliament Chairman Andriy Parubiy, one of the bill’s co-authors, said in the legislative chamber.

He was in Washington this week to advocate for additional sanctions to punish Russia for its continued war-mongering and to lobby for lethal weapons to counter Moscow’s modernized army and weaponry.

President Petro Poroshenko said on June 9 that he will sign the bill.

Call for a new war strategy

Secretary of the National Security and Defense Council Oleksandr Turchynov said that the country’s current approach to countering Russia’s hybrid war makes it impossible to liberate more occupied territories.

Called an anti-terrorist operation (ATO), the current “format” is obsolete, he told the Interfax-Ukraine news agency on June 13.

“Hostilities in the east of our country have lasted already for three years and have outgrown the ATO format both in duration and scale,” Mr. Turchynov said. “At the same time… It is within the ATO that we stopped the aggressor, managed to hold presidential, parliamentary and local elections, and liberated a significant part of occupied territory.”

He offered few details about the re-configuration, but emphasized that legislation needs to be adopted to refine approaches to countering hybrid, or asymmetrical, warfare. Current laws, he noted, are geared towards “conventional” fighting.

“The time has come to not only recognize some areas of the Donetsk and Luhansk regions as occupied, but to clearly define by legislation the principles of state policy concerning their liberation,” he said. “We need an effective technology to protect the country, and for this we should give the president the legislative right to use the armed forces and other military formations against Russia’s hybrid aggression.”

The national security chief added that a revised bill on restoring Ukraine’s sovereignty will be presented to the president and, after that, “I hope it will be promptly submitted to the Verkhovna Rada.”

The latest United Nations report on the Donbas war published on June 13 states “conservatively” that nearly 10,100 people, including at least 2,777 civilians, have died in eastern Ukraine since April 2014.

Fighting takes place every day, and 36 civilians were killed and 157 injured in the past three months, the report stated.

More than 350,000 people face acute water shortages in eastern Ukraine due to the fighting, the International Committee of the Red Cross said in a news release on June 12. And a local state of emergency has been declared in the frontline industrial town of Avdiyivka in Donetsk Oblast by Pavlo Zhebrivsky, chairman of the Donetsk Military and Civilian Administration. Posting on Facebook, the regional chief said the town has been without a supply of natural gas for six consecutive days as of June 13.

Visa-free travel to EU starts

Exactly 59,627 Ukrainians crossed the European Union border on June 11 when visa-free travel rules first went into effect, according to the Foreign Affairs Ministry of Ukraine. However, only about 3 percent didn’t have visas.

Ukrainians possessing biometric passports can visit any EU member country, except the United Kingdom and Northern Ireland, without a visa. They can also visit Norway, Iceland, Liechtenstein and Switzerland – countries that are also part of the so-called Schengen Zone. Stays are limited to 90 days, and visitors are not allowed to work during that period (a separate visa is required for employment).

Quoting acclaimed Russian writer Mikhail Lermontov, President Petro Poroshenko characterized Ukraine’s foreign policy breakthrough as another step towards breaking free from the Kremlin’s grasp.

Saying first that the “Ukrainian democratic world is abandoning the authoritarian Russian world,” Mr. Poroshenko then cited the writer’s words: “Farewell, unwashed Russia, a country of slaves and their lords. Goodbye you blue uniforms of gendarmes, and you, their obedient people.”


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