Vadim Shekman, CEO of Dobrobut Medical Network, Ukraine, was invited to speak at the UEHP Board and Council meeting in Warsaw on September 14 and 15, organized by the Polish Association of Private Hospitals (OSSP).
What role does the Dobrobut group play in Ukraine’s healthcare system?
Comprising two major general hospitals and fifteen smaller clinics spread across the country, the Dobrobut Medical Network is currently one of the largest private healthcare operator in Ukraine. Its expansion began fully in 2015, with the opening of a multidisciplinary hospital in Kyiv. This was followed by multiple acquisitions and the construction of new centres, and Dobrobut was the only private player in Ukraine to treat Covid patients at the beginning of the pandemic.
Today, we welcome more than 120,000 patients visits a month and offer more than 75 medical and surgical specialties, as well as an emergency department. We also have a fleet of 22 ambulances, 14 of which were deployed for the war effort on the second day of the conflict.
Before the war, we had very ambitious development plans to become a leading national healthcare provider. In February 2022, we had to put our plans on hold and react so that we could continue to provide care to all Ukrainians from the very first days of the conflict.
How did you manage the first months of the war?
From April 2022, we reopened most of our outpatient clinics and began working with international NGOs. We also opened health centres in Lviv and Ivano-Frankivsk, in the west of Ukraine, to accommodate displaced people. Since then, we have been providing humanitarian healthcare to the most seriously affected patients, with the support of charitable funds.
Thanks to donations to our сharity Dobrobut Foundation, set up by a network of doctors, we are able to provide free care to civilians and veterans. More than 20,000 patients have been admitted free of charge since the start of hostilities, for emergency and scheduled operations, consultations, medical analyses and rehabilitation. Donations to Dobrobut Hospital benefit patients only.
How do you envisage your group’s future in wartime?
Resilience is the only way forward in such circumstances. Stopping our business was never an option. In September 2022, we took the decision to rebuild one of our hospitals in Kyiv (Left Bank, formerly Boris Hospital) and to maintain our services despite missile attacks on civilian infrastructure and hospitals. By June 2023, 240 health centres and hospitals had been hit and 39 completely destroyed. We have invested in diesel generators to ensure our energy supply in the event of a power cut.
We are currently developing new rehabilitation hospital projects in Kyiv, as well as new outpatient care centres.
Could you describe the health care system in Ukraine?
The organisation of public health care in Ukraine has its origins in the Soviet Union; in other words, a free public system, with its weaknesses, because no country in the world can provide totally free and unlimited care, certainly not a country as ‘poor’ as Ukraine.
At present, 90% of health establishments are in the public sector. Underfunded and inefficient, they are officially free, but “extra payments” are required to obtain treatment. The value of unofficial out-of-pocket payments made within the public system has been estimated at between 25% and 40% of total healthcare expenditure*. With the introduction of a new financing mechanism based on a single payer, a comprehensive healthcare reform began in 2017. Only primary care benefited from a partial reform. Progress was swept away by the pandemic, then by the war…
Between 2010 and 2021, patients’ quest for quality care was the main driver of growth in the private sector. Between 2015 and 2021, the increase in healthcare spending in favour of the private sector is estimated at over 20%. However, private healthcare provision remains limited, excluding Dobrobut, mainly due to a lack of investment and a fragmented private sector.
What has happened to the health system since the start of the war?
The Ukrainian healthcare system has withstood the devastating war relatively well. In 2022, the government ensured stable funding for healthcare thanks to financial and technical support from abroad. Today, new challenges are emerging as a result of unequal access to medical care in the occupied and war-torn territories, the destruction of healthcare infrastructure, the disruption of the supply chain and the lack of data. These tensions are exacerbated by migratory movements. Ukraine is facing unprecedented depopulation, including of health workers. It is estimated that the number of medical staff has fallen by 14%. What’s more, diseases such as strokes and heart attacks are on the increase. This phenomenon is partly due to the ageing of the Ukrainian population.
*Source: Pro-Consulting, HC estimates