«We will lose doctors and patients»: MP and doctor Shaposhnikova opposes merger of primary healthcare centres in Mykolaiv

Olena Shaposhnikova, a deputy of the Mykolaiv City Council from the party «Proposal». Photo: Facebook

Olena Shaposhnikova, a deputy of the Mykolaiv City Council from the party «Proposal» and a doctor at family outpatient clinic №4, opposed the reorganisation of primary healthcare centres. In her opinion, the merger will not yield the expected savings, but instead may lead to a loss of funding, as well as patients and doctors.

She made this statement on 20 June during a meeting of the city commission on housing and communal services, according to NikVesti.

According to Olena Shaposhnikova, the announced savings of 7.9 million hryvnias on administrative staff do not correspond to reality. A significant part of this amount is the salary of doctors who perform administrative duties but also see patients.

«I do not agree with your position. Having conducted my own analysis, I want to clarify something. First, let's find out why this reorganisation is needed. Due to changes in the NHSU's payment terms, the capacity of institutions has indeed decreased slightly. The main requirements now are to update declarations and examine patients who have not visited a doctor for more than three years. The data you have provided relates only to 1 January 2025, but six months have passed and there are some positive developments. What do we have next? You say that the savings will be about 7.9 million hryvnias. But here's the thing: the doctors who perform administrative functions — the director, deputy director and their assistants — also work as doctors. If we exclude their salaries as administrators, the real savings will be only about 3.6 million hryvnias. In addition, funding has decreased due to the introduction of the NHSU adjustment coefficient: if in 2024 it was 1, now it is 0.8. Each doctor is working on updating their declarations on their own,» she said.

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She calculated that in order to update the declarations in time, each doctor will need to re-register 45-50 patients every day. This, in her opinion, is physically impossible, even with a simplified procedure.

«If we merge the centres now, we will lose part of the money for patient verification and for examinations of those who have not visited a doctor for more than three years. After all, we will have to update or re-register declarations in the newly created institution, and the records made earlier will become invalid. Also, the declarations that are currently «hanging» for doctors on maternity leave, or for those doctors who are on unpaid leave or on duty, will be lost, because these doctors will not be able to sign the declarations on time,» said Olena Shaposhnikova.

She explained that in case of problems with communication with patients, change of phone numbers or errors in identification data, the process will be delayed, and about 40% of declarations may be cancelled.

«In addition, we run the risk of losing doctors who do not support the reform — they may resign or move to other medical institutions. You are taking a big risk, because you can lose doctors because of this. For me, it is important that the opinion of doctors is heard — every team has the right to work freely, and we must support their will. Because doctors often have only duties but few rights. I really, really ask you not to support this project and not to destroy what is already working,» she added.

Olena Shaposhnikova added that if the centres unite, a certain financial buffer is needed to compensate for the losses from the reduction in declarations. Currently, this buffer for the three centres is approximately 7.5 million hryvnias.

«According to my calculations, the average monthly income of the first centre is about 2.3 million hryvnias, and they currently have 791 thousand hryvnias left in reserve. The second centre has about 4 million hryvnias in revenue and a reserve of 5.3 million hryvnias, and the seventh centre has about 3.2 million hryvnias in revenue and a reserve of 1.3 million hryvnias. If the merger process is delayed, the centres will not receive the funds on time, there will be a default on the declarations, and an additional buffer of about 16 million hryvnias will be needed for 3 months. The question is where to get this money, it is not available, and it should be included in the city budget to compensate for the difference. In the worst case scenario, if the restoration of the declarations takes up to 6 months, the amount of compensation will reach 26 million hryvnias. Where can we get these funds?» asked Olena Shaposhnikova.

In her turn, Tetiana Dmytrova, Deputy Head of the Department of Communal Property, assured that the merger of the centres would optimise costs and increase salaries for doctors. According to her, administration costs are excessive. Therefore, it is wrong to leave the primary healthcare network insolvent and dependent on the city budget, which is already in a difficult state.

«We have heard you, so we are now submitting this issue to your commission for approval and are very grateful for your opinion. This is the first thing. Secondly, we have already said that, like surgeons, we always hurt first, and then everyone gets better. That is, it is still very wrong if the network is a primary healthcare system that is insolvent and financially dependent on the municipal budget, which is already bursting at the seams. We also understand this. Look, we have calculated, for example, the first centre. If we cut 8 units there, we will lose 4 million hryvnias a year. If the administrative staff in the seventh centre is reduced, 3 million 800 thousand hryvnias will be released. In addition, I want to say that I looked at how much money the director receives. The positions are as follows: director, medical director, deputy medical director, deputy director for economic affairs, deputy director for human resources, chief accountant, deputy chief accountant and secretary. Well, dear friends, in my opinion, this is a very large waste of budget and even of the funds for each hospital, if we keep them as centres. So I still think that something needs to be done in this process,» added Tetiana Dmytrova.

In response, Olena Shaposhnikova clarified that the director, medical director and deputy director are paid as doctors.

— Excuse me, the director, medical director, and deputy director are paid like doctors. You agree, right? And it's about two million hryvnias, they work as doctors and have declarations. There is a certain percentage for administration, but otherwise they work as doctors, she replied.

—Do you mean to say that your primary healthcare doctors receive a million hryvnias a year? asked Tetiana Dmytrova.

— No, on average it is about 600 thousand hryvnias, replied Olena Shaposhnikova.

— I'm not going to get into your pocket and comment on everything you said. I really respect your opinion. If you don't want to support it and you think it will be better for you, you are probably right. There is an opinion of your authorised body that provided us with these calculations, we did not make them ourselves. These documents were given to us, and that's why we made this draft decision. If you don't support it, I can't force the city council members to support it, and time will tell which of us is right, added Tetiana Dmytrova.

However, the commission did not support the decision to reorganise, as six deputies abstained from voting.