1. www.debaty.org
THE STATE IS A BETTER PROVIDER OF AND INVESTOR IN HEALTH CARE THAN THE PRIVATE SECTOR
PUBLIC DEBATE BRIEF
PHOTOS - TBD
February 22th, 2011
Teacher’s House, Kiev, Ukraine
The 2011 public debate season was opened by the debate on the motion “The state is a better provider of and investor in
health care than the private sector,” moderated by Mustafa Nayem, a famous Ukrainian journalist.
High-quality medical care is essential to ensuring public health and national economic wellbeing. However, establishing an
effective healthcare system is one of the most controversial and pressing problems in the world today.
In many countries, including Ukraine, government-sponsored healthcare is considered a duty of the state: every citizen is
entitled to a minimum level of medical services, irrespective of his or her disposable income. Most countries have also
established state control over the public health sector in order to reduce the threat posed by low-quality healthcare and
lack of medical education among the population. Speakers from both panels agreed that the state should participate to
some degree in financing and regulating the medical sector. As a result, debate focused on the operational management of
medical facilities: the advocates of private medicine emphasized its flexibility, receptivity to innovations, and financial
accountability, while supporters of public medical provisions emphasized the benefits of the state’s emphasis on national
health rather than profit maximization. Voting results revealed that neither the FOR nor AGAINST panel won an absolute
majority as a result of the debate.
The Public Debates Project promotes constructive public discussion on key issues concerning Ukraine’s economic
development. In partnership with London based Intelligence Squared, The Foundation for Effective Governance has
regularly organized debates in Ukraine over the past two years. These events aim to foster debate culture, increase public
awareness of important economic challenges facing Ukraine, and contribute to the formation of an educated socio-political
consensus concerning further national development.
Speakers FOR the motion Speakers AGAINST the motion
Tetyana Bakhteeva Andriy Palchevsky
MP of Ukraine, Head of the Verkhovna Rada Founder of EUROLAB clinic for
Health Care Committee personalized medicine
Olga Bogomolets Anatoly Zabolotny
Director of Dr. Bogomolets Institute of Director of the Charity Foundation for
Dermatology and Cosmetology Development of Ukraine
Mykola Prodantchuk Henry Marsh
Director of the Medved’s Institute Founder of the International Center of
of Ecohygiene and Toxicology Neurosurgery, member of the British Royal
College of Surgeons

2. Key Statements
Tetyana Bakhteeva: “An average Ukrainian cannot afford Andriy Palchevsky believes that private medicine is more
private medical care.” Ms. Bakhteeva advocates state financed effective because “people vote with their wallets”. He also
medical care, but adds that the private sector can provide noted that the leading private clinics in the US are nonprofit
services via public-private partnership programs. She argues organizations. There are many rich and charitable people
that to secure the influx of financial resources into the sector, willing to support medical care, in Ukraine as well as the US,
universal health insurance must be introduced. but officials do not give them any chance of doing so.
Olga Bogomolets: “The difference between state and private Anatoly Zabolotny thinks that medical care is one of the state’s
medical care lies in their final goals: the state is interested in social obligations. However, at present the state provides only
having a healthy tax payer, while the private sector works for 30% of the necessary budget. Moreover, it fails to control how
profit. This is why I support public medical care but I should the money is spent. As a result, there has been a deterioration
admit that currently it cannot perform its role” partly due to of the medical system and the mentality of medical workers
inefficient distribution of funds. during the last two decades.
Mykola Prodantchuk: “Only the state can control such aspects Henry Marsh: “Both the state and the private sector are
of health care as food quality and working conditions. equally bad in medical services provision. The state is corrupted
Moreover, only the state can create an extensive network of by power and the private sector is corrupted by money. In the
medical facilities and ensure that everyone has access to developed countries, the state guarantees a basic level of
relevant medical services”. healthcare for everybody and regulates the quality of services
in both private and public sectors.”
Q&A Session with the Audience
Q: “One of the main problems is the need to control the quality of medical care. Do you think that introduction of health
insurance can successfully solve this problem?”
A: Mykola Prodantchuk: “One of the advantages of insurance medicine is the control provided by an insurance company
and its appointed medical professional who checks whether the diagnosis is right and the treatment is adequate. So the
answer is yes, this is indeed the case.”
Q: “Which segments of medical care must remain under state control?”
A: Olga Bogomolets: “Health care as a systematic, analytical, and epidemiological approach to estimate risk factors and
ensure preventive measures should be controlled by the state. Medical care (or treatment as such) can be provided by
private clinics, then it will be more economically efficient.”
A: Henry Marsh: “In Great Britain, everybody is entitled to free healthcare in government hospitals and all public health is
organised by the government. However, during the last ten years, we have seen the development of the so-called private-
public partnership and building of hospitals via private investments. The state pays the private investors so that they
provide free medical care for the citizens. There are many mechanisms of how PPP in medicine can work.”
Q: “Are doctors ready to drop out of the black market of medical services and will they support insurance medicine?”
A: Olga Bogomolets: “No, they are not ready. Right now I have three vacancies. I call my friends in public clinics and make
them an offer. But they tell me they already earn three times more.”
Voting Results
Further information and the full version of the debates
are available on:
www.debaty.org and www.feg.org.ua
FEG, 23-F Kudryavskaya st., Kiev, 04053, Ukraine
tel: +380 44 501 41 00
feg@feg.org.ua