Source: delo.ua.
In Ukraine, the medical system financing reform, which allows private doctors to apply for the state budget, started. It may happen that this fact will encourage physicians to open their practices.
Since the beginning of April, every Ukrainian can independently choose a primary care physician – a pediatrician, a therapist or a family doctor as part of launching the first stage of the medical reform implementation. Such doctors can work both in state (polyclinics, in-patient departments, first-aid and obstetric centers) and private institutions. It is planned to create private offices of family doctors as well.
Delo.UA wrote earlier that there is a recommended number of patients for each physician – 900 children for pediatricians, 1,800 – for therapists and 2,000 patients for family doctors.
The basic tariff is already known as well. In 2018, a doctor will receive 370 UAH for one patient (an able-bodied person aged 18-39) per year. Next are the coefficients. A child aged 0 to 5 years has a coefficient of 4. From 6 to 17 years – a coefficient of 2.2. From 40 to 64 years old – 1.2. And 2 for people aged 65+.
In order to make this new financial system working, doctors and patients should sign a declaration. The data will be entered to the eHealth system, on the basis of which a new body – the National Health Service of Ukraine (NHSU) – will calculate whom and how much to pay.
Patients themselves will make a choice of what kind of doctor to choose and in what institution (private or public) to go for help. It is more or less clear with state institutions – a declaration is signed with the doctors of polyclinics, which everybody has got used to visit. However, they will work in a new way, according to the above-described algorithm. But the question of who such private family doctors are, where they are, from where they should come and why is still open.
Private family doctors – who they are
Private family doctors are individual entrepreneurs or legal entities working under the KVED code “General medical practice” (86.21). The press service of the Ministry of Health explained: now private family doctors do not work with the state, and there is no specific license to provide primary health care. There is just a general medical practice license. Both large private clinics and individual doctors who want to start own practice can obtain it.
” From the middle of the year, signing the contracts with the NHSU will show us to what extent private institutions and physicians who are individual entrepreneurs adapt to the system. Representatives of private institutions declare that they are ready to enter the market aggressively – but we will see the results,” the Ministry of Health specified.
How to start a family doctor’s private practice?
You need to have the will power and perseverance to register this type of economic activity. This is evidenced by the experience of those who have already coped with this task. By the way, it is quite simple to register as an individual entrepreneur. It is more complicated to go through the procedures necessary to create appropriate conditions for the doctor’s activity.
Iryna Heraschenko, a private family doctor practicing in Kharkiv, shared her own experience related to opening a non-state-owned doctor’s office.
By the way, Iryna is a displaced person. She worked at Shyrokino. Prior to the military conflict, she agreed to participate in the pilot project on the introduction of family medicine, which began in 2012.she has graduated with the specialty of a therapist. Having attended courses at the Donetsk Medical University, she received a specialty family medicine. By 2015, she worked as a family doctor in Donetsk.
” At first, in the pilot project, patients reacted on family doctors with hostility and distrust. But everything has changed in the process. The state allocated funds, for which we got a new car, physiotherapy equipment, a cardiograph, a telecardiophone for telemedicine, by using of which it was possible to make a cardiogram directly at the patient’s home and send it to the clinic by phone,” the doctor said.
In 2015, when active military operations started, the doctor moved to Kharkiv. Being a high level certificate physician and having a great experience, Iryna thought that she would easily get a job in Kharkiv.
As it turned out – this was not the case. There are no vacancies of doctors in Kharkiv, even in the suburbs. Therefore, she decided to create a workplace by her own.
“She applied to the Information and Analytical Department at the Kharkiv Regional Health Department looking for a vacancy in a public hospital, and then asked how to open a private family doctor’s office. They provided all the information,” Iryna Gerashchenko said.
You should first register as an individual entrepreneur (IE). It takes just one day. In Kharkiv, in the Center for providing administrative services, this is done in a well organized manner. You just submit documents – your passport, code and application – and the next day, you will receive a certificate that you are an IE. Immediately after submitting documents to register as an IE, is necessary to apply to a tax office and register there. In the Iryna’s case, this is a simplified taxation system, the 2d group of taxpayers.
Then you need to rent a premise. If you firmly decided to do this – you need to think about it first of all. Because there is a number of requirements and recommendations to such a premise – it should be remote from other medical facilities and located conveniently for patients.
” My advantage – my office is located on the Kharkiv fringe, it is a quiet bedroom district. The nearest clinic is far away, it requires to change twice to get it. It doesn’t seem convenient for people. And there are high-rise buildings, many schools, kindergartens, and children. There was a premise for rent that I’ve got in one of these high-rise buildings,” the private doctor said.
The compliance of the selected premises with standards should be confirmed by the Department of the State Service of Ukraine for Food Safety and Consumer Protection (previously the sanitary and epidemiological agency performed these functions). You also need to apply to them. Representatives of this department should make the necessary measurements: radiation, illumination level, water analysis. Iryna spent 2,300 UAH on these “services”. If everything is fine – they will give you the act.
Next, you need to get a certificate on the material and technical status of the family doctor’s office. The Ministry of Health has developed and approved equipment schedules, which specify the basic equipment necessary for such an office. These documents are freely accessible on the the website of the Ministry of Health.
“Then I sent a package of documents – an IE certificate, a lease agreement, a certificate on the office’s sanitary and epidemiological analysis, a material and technical status certificate – to the department of administrative services at the Ministry of Health (by courier). And within two weeks, I’ve found out that “a medical practice license in the field of general practice, family medicine was issued for my IE by the order of the Ministry of Health” on the MoH website,” Iryna summed up.
Our heroine made her way to opening a private medical office by her own. Instead, you can make life easier by using the Platform for Effective Regulation and learning here about all the necessary procedures and documents to open a doctor’s office. You will not need even to visit advisory centers of the Ministry of Health or state administration agencies. In this service, just select the section “For business”, then – “How to start a business”, find a case ” How to open a family doctor’s office” and respond to a small survey concerning your intentions and available resources to understand what else you need to register to start your own business.
BRDO experts defined the opening of a family doctor’s office as of the “middle complexity”. Depending on the premise availability, a contract on payment for utility services, taxation type, use of hired labor, a doctor will need to go through about 7 procedures, collect from 15 required documents and, as a result of registration, obtain about 9 documents.
How much does it cost to start a family doctor’s private practice?
In total, a doctor will need at least 26 thousand UAH to start a private practice.
“The basic equipment will cost at least 20 thousand UAH,” Iryna said and added that it was not difficult to buy it. You can buy something online, since there are various online stores selling medical equipment, something can be bought even through the online OLX platform. Searches and purchases took about a month and a half, along with repairs in the leased premise and registration with state bodies.
A set of medicines provided for in the list of material and technical equipment will cost another 1,000 hryvnias.
All official registration fees will amount to 5 thousand UAH. ” 26 thousand, this is the minimum amount required. But everything depends on the equipment, rent of premises and so on,” Iryna said.
Specific aspects of medical private practice
It is not enough just to register your business – you need to get it started. It is necessary for patients to know about you. What can you do for this?
Firstly, it is an eye-catching signboard, in the Iryna’s case, it is “Home Doctor”.
Further, she said, she distributed a lot of leaflets with information that there is the doctor’s office opened, its address and contacts. The leaflets were placed on information boards in the entrances of buildings and other special places. Another possible way is to advertise on OLX and other similar Internet platforms.
It also will be helpful to create your own website, because many people are looking for information on the Internet.
Prospects for private family doctors
The Ministry of Health emphasizes that now doctors workings as IEs are paying a UST (unified social tax) and have the same pension rights as all other workers in Ukraine. But the tax burden on employees working as IEs is much lower – this means that more funds are allocated for doctors, because the taxes are lower.
Iryna Heraschenko, already practicing as a private doctor, is thinking about whether it is necessary to sign medical care contracts with patients that will be financed at the expense of the state budget.
” Many people are wondering whether it is possible to sign such a medical care declaration provided for by the medical reform with me. On the one hand, it is very profitable for a private family doctor like me. If I hire even 500 people, instead of 2,000 as provided for public doctors, this money for their medical care will come to my account, to my office. I, as an IE, can decide myself what funds to spend on renting, on my salary, for analyzes, medicines, etc ,” she explained.
But at the same time, the doctor has doubts whether these funds will really come with patients.
“I will take responsibilities to people, but it is not clear how everything will turn out. Therefore I doubt it. As a private entrepreneur, I take money from people for my services now. But if I sign a declaration or a contract, I won’t take money from people, these funds should be transferred by the state. But the questions is whether the state will do it or not,” the doctor specified.
However, if the system works as it is foreseen by the reform, there should be no payment problems.