Ukraine's Health Ministry plan to regulate private MRI, CT centers threatens patient access – experts
The Health Ministry's initiative to ban private MRI and CT centers operating on the premises of municipal hospitals in Ukraine from receiving payments directly from patients threatens patients' access to diagnostic imaging, participants in a press conference held at the Interfax-Ukraine news agency on Tuesday said.
"Modern diagnostic imaging is much more than simply having a CT or MRI machine at a medical facility. Over many years, private diagnostic centers have built strong teams of radiologists. They invest not only in purchasing and maintaining equipment, but also in physician training, developing specialized protocols, consultations in complex cases and quality control. Not every hospital has enough specialists or the necessary clinical experience to perform the full range of complex examinations," said Anna Kravets, medical director of Apparatus Medicine LLC.
She said that "for patients, it is not enough simply to find an available scanner."
"Public and private medicine should not be pitted against each other. They have different capabilities and different tasks that should complement each other. The state's task is to establish uniform, transparent rules. We support the Health Ministry's effort to prevent double payments; at the same time, this issue can be resolved through electronic record-keeping, clear information for patients, a distinction between free and paid services, and monitoring of every examination," she said.
For his part, Oleksandr Haidabas, director general of Expert Medical Diagnostic Center, said that the bill presented by the Health Ministry "harms both patients and businesses."
"During four years of war, we have not stopped developing our network, upgrading equipment and expanding. Over four years, we have invested UAH 203 million, including UAH 60 million in the reconstruction of premises. The premises we leased were neglected; they had stood in disrepair for decades. After we reconstructed them, they became modern buildings with all engineering systems, providing services to people. All our centers are located on property owned by local communities; when the lease term expires, this property remains with the community," he said.
Haidabas noted that private diagnostic imaging centers provide a backup for medical facilities in the event of breakdowns of state-owned or municipal equipment and make it possible to provide medical services without interruption.
"We are also against charging patients twice. Therefore, we need to put things in order and develop a transparent mechanism that prevents corruption. If we are told to conclude a contract only with the hospital where we are located, this could lead to corruption, because the chief physician would decide whether to refer patients to us or not, and whether to transfer funds to us for services provided or not," he said.
Haidabas believes that "a quota could be developed, direct contracts could be concluded with diagnostic centers, tariffs of the National Health Service of Ukraine (NHSU) for diagnostic imaging could be introduced, and quotas could be allocated according to these transparent tariffs and the center's capacity. In this way, the Health Ministry would reduce the waiting list and people would not have to wait in line for months."
"If we scare away investors, no investor will come here tomorrow. Both patients and the state stand to lose from the proposed bill," he said.
Responding to a question from Interfax-Ukraine, Haidabas said that the bill proposed by the Health Ministry provides for no compensation to private diagnostic imaging centers if they are prohibited from operating on the premises of state-owned and municipal medical facilities.
For her part, Anna Kulyk, executive director of the Association of Private Medical Institutions of Ukraine (APMI), said that the Health Ministry explains its legislative initiative by "the need to 'protect' patients from double payments and strengthen control over referrals," while the wording of the bill could effectively block any lawful ways of paying for diagnostic services, from voluntary health insurance and employers' corporate programs to assistance from charitable foundations, international organizations or clinical trial sponsors.
"Many facilities do not have their own MRI or CT machines, and private centers have for years provided communities with the necessary diagnostic services. Restrictions on their operations could lead to longer waiting lists, which already reach several months, as well as loss of access to examinations and deterioration in the quality of medical care," the APMI director said.
Kulyk said that the model proposed by the Health Ministry "makes the hospital administration the sole purchaser of private diagnostic services, effectively depriving patients of the right to choose."
"Without additional funding, there is a risk that public facilities will not be able to provide the full range of examinations. The Health Ministry acknowledges a shortage of modern equipment in public hospitals, but at the same time proposes a model that could effectively dismantle the private diagnostic segment that helps compensate for this shortage," she said.
According to APMI calculations, purchasing one MRI machine and one CT scanner for a hospital costs at least UAH 75 million-107 million, while including the cost of premises reconstruction and servicing, the amount exceeds UAH 100 million.
"If replacing private infrastructure requires even 100 hospitals, this would mean at least UAH 10 billion in additional capital expenditures. The bill goes beyond combating double payments and creates a direct risk that private diagnostic centers operating in hospitals will cease to operate," Kulyk said.
She said that, as an alternative, APMI proposes "monitoring specific examinations and their sources of financing instead of imposing a blanket ban on lawful activities."
"Real control over public equipment, transparent waiting lists, accounting for every examination and accountability for hospital management for inefficient use of equipment must be ensured. The Health Ministry has not provided sufficient analytical data on the scale of double payments, the number of confirmed violations, or a causal link between the presence of a private center and the utilization of public equipment," the APMI director said.
For his part, Viktor Serdiuk, president of the All-Ukrainian Council for Patient Rights and Safety, said that "patients should not lose the right to choose a provider, the time of their examination and a lawful method of payment."
"The bill could increase waiting lists and restrict access to diagnostic services, particularly for military personnel, veterans, people with limited mobility and socially vulnerable patients. The Health Ministry needs to revise the draft so that it can actually stop patients from being charged twice, rather than creating new barriers to access to diagnostics. First and foremost, it should prohibit only duplicate payment for a specific service that has already been paid for by the NHSU, preserve insurance, charitable and private sources of financing without restricting lawful paid examinations, and introduce liability for established violations," he said.
As reported, in July the Health Ministry proposed amendments to Article 18 of the Fundamentals of Ukrainian Legislation on Health Care to prohibit private institutions leasing space in state-owned or municipal hospitals from charging patients directly for diagnostic imaging services. The ministry explained the initiative as part of efforts to combat the practice of forcing patients to pay for medical services that have already been paid for by the state under the Medical Guarantees Program (MGP).
According to the Health Ministry, 235 CT scanners worth more than UAH 3.36 billion have been supplied to Ukrainian medical facilities since 2020. Currently, Ukraine has a higher number of CT scanners per 1 million population than some European countries. At the same time, EU countries have a significantly higher number of examinations per scanner per day.
There are currently 749 CT scanners registered at Ukrainian medical facilities, including 496 used at facilities providing free medical care under the MGP. A total of 396 CT scanners operate at municipal medical facilities, another 58 CT scanners are in use at private facilities and 42 at state-owned facilities.