Why “free” heart attack costs so much

Heart attack. Scary phrase that everybody is terrified of. Diagnosis that has to be dealt with in a matter of hours or even minutes, not days.

A lethal diagnosis for some, a lucrative income for others.

In the first few hours, patients with acute myocardial infarction must have surgery – to have a small metal mesh – stent – inserted into their coronary vessel. The procedure is known as stenting. It enables to restore blood flow to the heart. Otherwise, a patient may die or remain handicapped.

Annually over 40 thousand Ukrainians suffer infarction, 25 thousand of them need stenting.

In the first few hours, patients with acute myocardial infarction must have surgery – to have a small metal mesh – stent – inserted into their coronary vessel. Photo czgur/Depositphotos
In the first few hours, patients with acute myocardial infarction must have surgery – to have a small metal mesh – stent – inserted into their coronary vessel. Photo czgur/Depositphotos

The Ministry of Healthcare
claims that all Ukrainians in critical condition needing this surgery should get stents free of charge.

When patients are brought in by ambulances, stents and surgery are paid for by the state, not patients themselves or their relatives.

In the previous year alone, the state procured over 23 thousand stents through British international organization Crown Agents. This number almost completely covers demand for stents for all Ukrainians calling the ambulance.

One stent manufactured in the USA and procured by the state costs from 2 to 4 thousand UAH (on average from 75 to 150 USD).

Additionally, stents are procured by regional clinics, regional cardiology clinics, the Academy of Sciences clinics and Kyiv Institute of the Heart, albeit in much smaller quantities.

Only 23 hospitals that receive stents from the state procure them additionally with the money allotted for this purpose. The problem is that they procure these stents at twice or even four times the prices offered through international organizations. Often they deliberately avoid ProZorro state procurement system.

Actually, sidestepping ProZorro by breaking down procurement package into smaller ones has become common practice for the hospitals; it concerns medicine procurement as well as stents.

Often even in case when procurement is conducted via online platform, companies are connected and compete in name only, thus keeping procurement prices up.

Curiously, regional procurement budget is practically on a par with the central one, last year the former was 4 billion UAH – compare with 5.9 billion spent by the Ministry.

To clarify, an regional oncology dispensary manages 20-25 million UAH on average. Moreover, while centralized procurements are conducted through international organizations and constantly monitored by the public and mass media, on regional level they procure whatever, wherever and however they please.

Most regional oncology clinics get a lion’s share of what they need to procure through below-threshold procurements.

For instance, Kirovohrad regional dispensary, previously managed by Kostiantyn Yarynich, MP of Poroshenko’s Block, now headed by his father, held 65% of last year tenders on below-threshold levels.

The total of this oncology dispensary procurements reached 20 million UAH and only 5 million UAH was spent on true competitive tenders.

In Zakarpattia region, the situation is alike, as regional oncology clinic is headed by the doctor convicted of embezzlement in 2012. The clinic conducted almost 25 million UAH worth of procurements – 84% – without fair competition and contracts were made directly with suppliers.

No wonder that medicine prices in regional clinics can be up to 4 times higher than those procured by international organizations for the Ministry of Healthcare.

If stent procurement by regional hospitals is compared to medicine procurement for cancer patients, one cannot help but see striking similarities.

For instance, Chernivtsi regional clinical cardiology dispensary procures stents circumventing online tenders.

In practice, this clinic signs contracts directly with pharmaceutical distributors at 3 times the cost of internationally procured stents: 6 thousand UAH is paid by Chernivtsi cardiology dispensary instead of 2 thousand.

In order to circumvent Prozorro and to make a direct contract, the procurement was simply split in two. They procured 3 stents for nearly 18 thousand UAH, and then 32 more for 191 thousand UAH. Thus, instead of holding a tender worth 207 thousand UAH the hospital signed 2 contracts – for 18 and 191 thousand UAH.

Chernivtsi regional dispensary is headed by a millionaire, and this is no exaggeration.

Iryna Makoviichuk along with her husband, also a doctor by training, declared over half a million dollars. The family owns a 400 square meter flat the size of a three-storey house, a BMW, plot of land, elite watches and jewelry.

By the way, when this chief doctor’s daughter married the local council member, singer Olha Poliakova entertained at their wedding, and the artist is usually paid 10-15 thousand USD for her performance.

Even though Makoviichuk’s husband owns a private medical practice, his annual income of 127 thousand UAH cannot account for the hefty family fortune. Therefore, we can speculate that either the spouses evade taxes from the private clinic or have additional income they did not declare – from the state clinic.

Interestingly, Natalia Turubarova-Leunova, tender committee head of Chernivtsi regional cardiology dispensary and her husband are also quite well off. The husband works at the hospital as well. The medical spouses declared 4 flats of nearly 300 sq.m in total.

Another hospital procuring stents at higher prices than international organizations is Odesa regional clinical hospital: they pay 5 thousand UAH for a stent instead of 2. After receiving 428 stents from the state last year, Odesa hospital procured 200 more stents at twice the price.

Even though the stents were procured through ProZorro system, the tender can hardly be deemed competitive and transparent, as two related companies participated in it – “Fifth Element Medica” and “Amarcord”.

“Fifth Element Medica” LLC  is owned and managed by Iryna Zymbalevska. Before the firm was owned by Maia and Oleksandr Moroz, who now own “Amarcord” LLC.

Odesa hospital chief Hulchenko Yurii Ivanovych and his retired wife are quite well-to-do. Hulchenko declared 2 houses 150 square meters each, 2 Mercedes’s, plots of land and even a private motor yacht.

About a year and a half ago one of the department heads in this hospital, quite an affluent type as well, judging from the photo of his house, was arrested for demanding a bribe from a lady in labour. Curiously, the head doctor then refused to cooperate with the law enforcement.

Kyiv Heart Institute is no exception to the sky-high prices rule, though they received 820 stents from the state. The stents procured at 3 thousand UAH each by international organizations are procured by the Institute of Heart at a whopping 12 thousand.

Same with other types of stents. The ones that the state procures at 2 thousand the Institute of Heart procures at 5 thousand UAH. Coincidentally, from the same related companies – “Fifth Element Medica” and “Amarcord”

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Everything is covered, as they say, in the Heart Institute – loyal people are in all places. Borys Todurov, is the head of the Institute; he declared an estate of 700 sq.m, 6 ha of land, several flats, and 400 thousand USD.

Viktor Shevchenko, former business partner of Todurov’s wife, is head of Institute’s tender committee. Charitable Foundation of the Institute “Heart in the Hand” also leads to the Todurovs: it was founded by Borys Todurov’s daughter and her husband.

Vasyl Lazoryshynets, head of Amosov National Institute of Cardiovascular Surgery, another Kyiv institution, was also once involved in a scandal. Journalists found out that Lazoryshynets wife’s firm was not only situated on the third floor of the public institution, but it took away the most affluent customers – foreigners – from the Institute.

Meanwhile, on the territory of Amosov National Institute of Cardiovascular Surgery three private pharmacies are operating, being under control of Lazoryshynets and his business partner Hennadii Knysh. They are “UMED”, “Likar” and “Apteka 58”.

Should it be mentioned that Lazoryshynets declared 3 cars, about 200 thousand USD, and precious metals worth of 2 million UAH?

By the way, the previous week, Kostiantyn Yarynich, MP, held a round table with the cardiologists, where they discussed shortage of funding and “lack of comprehensive actions by the Ministry of Healthcare“.

I wonder if public hospital chiefs and their deputies ever discussed a remote possibility of decreasing public procurement prices in their hospitals to save public money, which could then be used to treat more patients?

Olexandra Ustinova, member of the board of the Anti-corruption Action Centre, exclusively for UP.Zhyttia

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