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Ukraine an interesting moment with the recent (as in less than 10 years ago) health reform. The change was not in the ownership regime, but in funding (preallicated fixed amount vs post payment for itemised coded services).

Once the incetives got changed, a lot of doctors opened up their own practices as PE. The government still foots the bill, but the corrupt middleman of the local variety got cut from the flow





> funding (preallicated fixed amount vs post payment for itemised coded services)

Could you expand on this?


Sure. The situation before:

The hospital has 100 beds, 30 in personnel and some amount of equipment to maintain, repairs to make, etc. They get funding from the ministry based on that. Then the head of the hospital pockets some of the allocated money on repairs and gets some percentage off bribes that doctors get from patients. If nobody ever visits the hospital, no surgeries are performed and no x-rays are done, they still have the same funding. People mostly can only go the hospital in the locality where they have their registered address (which you don't get if you live in the privat rental, but it's a different problem), unless they pay a bribe (see above).

After: the hospital is still government (or city) owned, but it has to generate revenue by proding actual services. Since health is a basic constitional right, the government still pays for most of the stuff, but only after they get the itemized bill of services and materials provided. Itimized services and materials have fixed prices set by the government too. Government or a city can still give the hospital a subsidy if they want for some capital heavy stuff, but they then see how good it's utilized.

Now the best part -- if you are a doctor and head of your hospital is a cunt, who still does the habitual stuff, you can get from your ass and open your own one-person practice, sign a contract with the government and they will pay the same amount to your directly. The patients can choose freely where they get the service and will not pay for it anyway. In practice it also means not having to pay bribes to actually have it provided.

You can think of it as a government operating an insurance company that is funded directly by the taxpayers and then dealing with health providers on a regulated, but open, market.




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