By Yevhen Meshko, chief doctor of the Communal Non-Profit Enterprise “Primary Healthcare Centre of Mukachevo”,

regional coordinator of the U-LEAD with Europe Programme for healthcare reform support in the Zakarpattia Oblast

With the transition to the capitation system of primary healthcare financing and autonomisation of healthcare institutions providing primary healthcare services, I hear a radically different views of healthcare workers. Some of them admit fantastic changes, someone is sure that nothing has changed in terms of remuneration. There are even isolated cases of claiming that the situation has become worse compared to targeted subventions.

So what affects salaries?

I want to distinguish two concepts – financing and payment. Financing is about where from and how much money to get, how to increase money inflow. Payment is how we spend this money: what for and in what amount, etc.

Funding is roughly the same in all medical institutions, but the payment options vary greatly. The leadership of primary healthcare establishments plays an integral role in this process.

Why, with relatively homogeneous wage funds (since they fluctuate within 70-100% of revenues), does the average salary in different institutions range from UAH 5 to 25 thousand? To do this, I would introduce another coefficient – the ratio of doctors’ posts to other medical staff. Why doctor’s posts? These are the employees who bring income to the enterprise, since patients sign declarations on the choice of a doctor.

I know a vivid example when proportion of doctors and nurses in the Pereyaslav-Khmelnytskyi Primary Healthcare Centre is 80/80 – and the ratio of doctors to all other posts is 1 to 1.7. At my enterprise, this proportion is 1 to 3.

In conclusion, I would like to note that financing will always be insufficient, as with each subsequent hryvnia, needs will also increase. And it is up to you to choose how to use the funds.

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