Czech Republic vs Ukraine Healthcare Comparison

A comparative analysis of the
Czech Republic and Ukraine
A presentation by East To West Marketing Inc.
Real Patients,
Real Patience
Thursday, 9 June, 16

UkraineCzech Republic
Brief Country Stats

603,628 square km
Kyiv
Russia, Belarus, Slovakia,
Hungary, Romania, Moldova,
Black Sea and Sea of Azov
1991 from USSR
78,866 square km
Prague
Poland, Germany, Austria,
and Slovakia
1990 from Czechoslovakia
Total Area
Capital City
Neighbours
Independence
Brief Country Stats

Brief Country Stats

€126.8 billion/yr
45.6 million
63 male, 74 female
Ukrainian
Hryvnia
€ 1 = UAH 10.6
€218.6 billion/yr
10.5 million
74 male, 80 female
Czech
Czech Koruna
€ 1 = CZK 19
GDP
Population
Life Expectancy
Official Language
Currency
Currency Value
Brief Country Stats

Czech Republic
Healthcare Structure

Ukraine
Healthcare Structure

Quick Healthcare Facts

‣ Public/Private system
‣ Tax supported
‣ Reforms target primary care
‣ Complex insurance, covers dental
and contraception in addition to
physicians
‣ Free basic coverage, but specialized
equipment and other costs extra
‣ 87% of hospital costs paid by
patients
‣ No health reforms in 20 years,
reforms promised for 2014
‣ Great reliance on hospitals instead
of primary providers

‣ April 2012 will bring drug coverage
reform
‣ New funding for Western European
drugs
‣ Achieved near-universal healthcare.
Citizens, workers and visitors
covered
‣ Insuﬃcient ﬁnancing segregates
population by income and location
‣ About 1% of population on private
health insurance
‣ 80% of medical services consumed
by top 20% of earners
‣ 18.5% do not have any access to
medical care

Insurance and Co-Payments

‣ 199 hospitals
‣ 176 health institutes (psychiatric
treatment, etc)
‣ 51 medical spas
- Full/partial/no coverage for spas,
depending on insurance plan
‣ Of all hospitals, 45% are local, 45%
are regional
‣ Private insurance provides quality
care to those who can aﬀord it
‣ Low private insurance penetration
due to:
- lack of aﬀordability
- lack of trust in the private
system
Insurance and Co-Payments

Czech Republic
Hospital Statistics

Czech Republic
‣ Regional & Central Hospitals:
- account for 1,000 beds
- serve as centres for teaching/
training
- provide full range of services
- owned by the Ministry of Health
‣ A few small hospitals are privately
owned
‣ Hospitals increasingly run by managers
and economists
- previously run by senior
physicians
The “Na Homolce” hospital in Prague
Hospital Statistics

Ukraine
Hospital Statistics

‣ 3,258 hospitals (2001)
‣ Approximately 466,000 beds (2001)
‣ Lack of patient associations
‣ Largest private health fund dedicated
to HIV/AIDS
Ukraine
The “Oleksandrivs’ka” hospital in Kyiv
Hospital Statistics

Current Healthcare Challenges

1,264 cases overall
8.4 cases per 100,000 ppl
5 cases per 100,000 ppl
Health insurance seen as a tax
4% of Czechs experienced
bribery over a medical
examination
Average: €1,700 per month
Private pays double public
HIV/AIDS
Tuberculosis
Maternal Mortality
Financial
Corruption
Doctor Wages
1% prevalence, highest in Europe
87% of hospital costs covered by
patients
Bribery very prevalent
Average: €230 per month

Ukraine

Ukraine
‣ “Chernobyl Disaster” aftermath felt
very strongly
- Worst nuclear disaster of all
time
- Occurred in 1986
- Cancer rates in Ukraine 3 times
average
- Over 9 million people aﬀected
by the disaster
- Newborn defects highest in
the world
- Eﬀects will be felt for
thousands of generations

‣ Healthcare is guaranteed by the
constitution, but lack of funding results
in lack of care for those unable to pay
- “Sink or Swim” system based on
income
‣ Extremely low wages limit staff’s
professional development
‣ Lack of university funding result in
shortage of qualified new staff
‣ A patient cannot know if:
- the service/procedure they are
receiving is properly priced
- cost and necessity information
is reliable
- non-performed procedures/
non-supplied drugs are billed
to their insurer

Getting Treated

‣ PHPs in regional policlinics
prescribe drugs, treat acute illnesses,
and in some cases provide patient
education
- All paperwork done by hand
‣ Prescriptions not needed for
pharmaceutical drugs
‣ Outpatient care provided by
primary care physicians or
specialists
‣ Specialist visits allowed without GP
referrals
‣ Physicians cannot refuse treatment
for essential or urgent care
‣ Publicly billed care must be
registered with a primary care
physician
Getting Treated

Ukraine
Patients and the Internet
Czech Republic

‣ Prague Declaration created to
comply with EU’s goal of adopting
information technology in
healthcare
‣ E-Health documentation to replace
paperwork
‣ Electronic prescriptions to replace
paper for drugs
‣ Consolidation of ministry
information in e-databases
‣ Technology is hoped to improve:
- public awareness of the health
service system
- enable active involvement of
the patient
- to improve the quality, and
ability of education
Ukraine
Internet market
penetration too low
and expensive for
realistic IT
modernization
Patients and the Internet
Czech Republic

Trivia Question 1

The capital of Czech Republic is situated by a river.
Which one?
Trivia Question 1

The Vltava River
Answer 1

Trivia Question 2

What was Czech Republic called 25 years ago?
Trivia Question 2

Czechoslovakia
Answer 2

Trivia Question 3

The capital of Ukraine is situated by a river.
Which one?
Trivia Question 3

The Dnieper River
Answer 3

Trivia Question 4

If you plan to run a study in Ukraine,
which languages can you use?
Trivia Question 4

Ukrainian, Russian
Answer 4

Trivia Question 5

Trivia Question 5
All of the former Soviet block countries and most of
the East European countries used a system that was
providing more in-patient care, with a higher
emphasis on building the empire of hospital beds. A
typical hospitalization period in both CR and UKR
was 14-21 days. As opposed to the Bissmark
Healthcare System, what is this one called?

Answer 5
The Semashko Model
Nikolay Semashko was a Russian Commissar of Public
Health from 1918 to 1930, and a friend of Lenin.
He was one of the organizers of the healthcare:
centralized, integrated, hierarchically organized, and
wholly ﬁnanced from general government revenues.
This system was used in all republics of the former
Soviet Union, and in all countries of East European
socialist block.

Trivia Question 6

Which of the two countries — Czech
Republic or Ukraine — changed from Latin
alphabet to Cyrillic for a brief period of time,
and then settled back to Latin?
Trivia Question 6

Czech Republic
Answer 6

Trivia Question 7

Which country is a more popular medical
tourism destination for patients from
Western Europe, Czech Republic or Ukraine?
Trivia Question 7

Czech Republic
Answer 7

Researcher’s Notes

Kyiv
3 facilities in Kyiv
Kharkiv,
Dnipropetrovsk,
Odessa, Donetsk, Lviv
Prague
2 facilities in Prague
Brno, Ostrava, Liberec,
Plzen, Kladno
Best facilities
are located in
Focus Vision
Web Streaming
Available
Best Cities for
Doing Research

Sample
‣ Low role of GPs in prescribing
‣ High role of pharmacists: can change prescription or sell any other drug
‣ Low role of nurses: mostly in charge of cleaning services
or organizing records
‣ Technical engineers are Lab directors are suspicious about market
research studies and rarely participate
Recruitment
‣ When interviewing specialists, do not tell them who else is participating
or they may quit if they know that SOMEONE they do not like TAKES
PART in your research

Researcher’s Notes (continued)

Methodologies that work
‣ CL,TDI, F2F, On-line questionnaires self completion,
ethnography research
‣ with physicians, pharmacists and patients
Methodologies that are difficult
‣ Diary studies/chart info collection (personal connections with physicians)
‣ Interviews with KOLs and MOH oﬃcials, Payor - TDI preferred
‣ Web-assisted telephone interviews
‣ Creative studies are not understood very well
‣ Physicians would be reluctant to play role games
‣ Mixing of senior and younger physicians is not always recommended
Researcher’s Notes (continued)

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Czech Republic vs Ukraine Healthcare Comparison

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