State of the healthcare sector in Rivne region (November 27

Press

16.12.2019

State of the healthcare sector in Rivne region (November 27 – December 9, 2019)

According to the results of the survey conducted by the Rating Group, the level of public optimism in the region has improved over the past year. Thus, 44% of respondents believe that affairs in Ukraine are moving in the right direction (17% in 2018), 40% speak positively about the situation in the region (20% in 2018), and 43% about the situation in their city or village (27% in 2018).
About half of respondents (53%) are dissatisfied with public healthcare services over the past five years, while 35% report being satisfied with public healthcare services. Over the past year, the share of those satisfied with the state of public healthcare has slightly increased (23% in 2018). As in previous studies, the level of satisfaction with public healthcare services is somewhat higher among those who visit doctors more frequently.
Almost a third of respondents (29%) believe that over the past two years the overall quality of public healthcare services in the region has improved, while 25% noted an improvement in the overall quality of medical services they personally received. Compared to last year, the share of those who observed positive changes in this sector has increased both at the national and personal levels. Frequency of visiting doctors correlates with a more positive assessment of services.
Over the year, there has been a significant increase in the share of respondents who positively assessed the work of public medical institutions: 47% assess the quality of services positively, while 28% do so negatively. Younger and more affluent respondents, as well as those who visit doctors more often, provided better evaluations of these institutions.
At the same time, as in previous studies, almost half of respondents were unable to assess the quality of medical care in private healthcare facilities at all; 42% assess it positively and 9% negatively. Younger respondents, more affluent individuals, urban residents, and those who visit doctors more often are more inclined to evaluate private healthcare positively.
The share of those who stated that they had witnessed reconstruction or renovation of hospitals over the past two years increased (from 46% to 56%), while 31% stated the opposite. Reports of positive changes were equally frequent in cities and villages.
As last year, a quarter of respondents reported changes in the quality of medical services received (37% said the quality had not changed). Changes in quality were more often reported in rural areas. When assessing various criteria of healthcare quality, 62% reported improvements in the conditions under which medical care is provided (44% in 2018). Attitudes toward patients by doctors, professionalism and competence of doctors, and treatment effectiveness were considered to have improved by 50–60% of respondents (34–39% in 2018).
About 40% of respondents noticed changes in the cost of services received (27% believe prices did not change). Over the year, the number of negative assessments across various cost-related criteria decreased: more than 47% believe that the cost of consultations, examinations, and medical procedures worsened (71% in 2018), while 17% believe the situation improved (only 5% in 2018). Deterioration in the cost of medical services using specialized equipment and consultations was reported by 50% (72% in 2018), while 16% observed improvement (6% in 2018). Seventy-four percent reported worsening prices for prescribed medicines (88% in 2018), while 10% believe the situation improved (5% in 2018).
For 19% of respondents, territorial and time accessibility to medical institutions changed (58% did not notice such changes). Urban residents and those who visit doctors more often reported changes more frequently. Fifty-eight percent noticed improvements in the ability to choose a doctor (54% in 2018). Fifty-five percent positively assessed changes in the possibility of making appointments in advance at a convenient time (35% in 2018). Forty-seven to forty-eight percent reported improvements in waiting times or doctors’ schedules (31–33% in 2018), and 43% in territorial accessibility of healthcare facilities (38% in 2018).
Seven percent of respondents are well informed about the changes proposed by the healthcare reform, 42% have heard something about it, 29% know very little, and 20% know nothing about the essence of the reform. Awareness is higher among women and people with higher education. Over the year, the share of those who know something about the healthcare reform has not changed.
Thirty-nine percent believe that the healthcare reform has brought improvements to the healthcare sector in the region. Thirty-seven percent reported no changes, and only 7% spoke of deterioration. Younger respondents and those better informed about the reform more often reported positive changes.
Forty-nine percent are confident that the change of government in the country will positively affect the implementation of healthcare reform in Ukraine. Twenty-seven percent believe no changes will occur, and only 6% speak of possible deterioration. Younger respondents and those who believe the country is moving in the right direction are more optimistic.
Support for the implementation of healthcare reform in Ukraine has increased sharply (from 35% to 65%). Seventeen percent expressed the opposite view, and 18% could not provide an assessment. Support is higher among young people, rural residents, those aware of the reform, and those who positively assess the country’s development trajectory.
Unlike last year, when only 17% were confident that the healthcare system would improve as a result of the reform in the next two years, this year 51% spoke of possible improvement. Only 6% believe it will worsen, while 26% think it will not change. Optimism is higher among younger respondents, reform supporters, and those who view the country’s situation optimistically. The share of those who foresee improvements in the long term (5–10 years) has also increased: 62% believe the situation will improve (52% in 2018, 35% in 2017), 4% believe it will worsen, 14% expect no change, and 21% could not answer. As before, the greatest optimists are young people and those with higher education. Almost half of those who believe there will be no change in the next 1–2 years expect improvements in the longer term.
Thirty-two percent of respondents consult a doctor or medical specialist about their health less than once a year, 17–18% once a year or every six months, 16% at least once every three months, and only 13% use such services monthly.
The share of those who know who their family doctor is increased (from 75% to 85%). Awareness is slightly higher among women and those who use medical services more frequently. Eighty-four percent have already chosen a family doctor and signed a declaration; 16% have not.
Seventy-five percent of all respondents fully or partially trust their family doctor (69% in 2018). Trust is higher among women, rural residents, and those who visit doctors more often. Importantly, almost 90% of those who have chosen a family doctor trust them.
The vast majority of respondents (84%) trust medical recommendations from healthcare professionals, 62% trust pharmacists, and 58% trust relatives and acquaintances. Twenty-seven percent trust medical recommendations on the internet, 17–18% trust television and print media, and 13% trust information from folk healers. Only 12% trust such information from radio. Young people are more inclined to trust healthcare professionals, the internet, and close contacts, while older respondents trust television, print media, radio, and folk healers more often.
When choosing a healthcare facility, 44% primarily consider trust in doctors at that facility, 41% professionalism and experience of doctors, 27% attitude of doctors and staff toward patients, 18% availability of modern medical equipment, 17% speed of service, 9% comfort of treatment conditions, and 6% availability of preferential services. Compared to last year, demand for better communication and faster service increased significantly, while demand for preferential services declined. Rural residents and younger respondents more often emphasize trust in doctors, attitude, equipment, and service speed, while urban residents and more affluent respondents place greater emphasis on professionalism.
Sixty-two percent receive medical information from doctors, 21% from friends and family, 20% from the internet, 13% from television, and 6% from pharmacists. Four percent or less receive information from other sources.
One-third of respondents reported never having problems with blood pressure, 24% experience such problems several times a month, 7–12% every 3–6 months, 8% less than once a year, and 10% daily. Blood pressure problems are more common among women and older people and are more frequent among poorer respondents and those experiencing stress.
Twenty percent measure blood pressure daily, 28% several times a month, 8–10% every 3 or 6 months, 8% once a year, and 22% less than once a year.
Nine percent measure body weight daily, 24% several times a month, 9–13% every 3 or 6 months, 16% once a year, and 21% less than once a year. Young people and women measure weight more often.
More than 40% undergo electrocardiograms less than once a year, 32% annually, 9% every six months, and only 3–4% every three months or several times a month. Those who visit doctors frequently or have blood pressure problems undergo ECGs more often.
Forty-two percent check blood sugar levels less than once a year, 20% annually, 8% every six months, 5% every three months, and 2–5% several times a month or daily.
Forty-five percent check cholesterol levels less than once a year, 17% annually, 8% every six months, 4% at least every three months, and 3% several times a month. Those who visit doctors frequently or have blood pressure problems check sugar and cholesterol levels more often.
Half of respondents reported normal blood pressure at last measurement, one-third higher than normal, and 13% lower. Sixty-two percent reported normal body weight, 24% higher than normal, and 4% lower. Nearly two-thirds reported normal blood sugar levels, 34% could not answer, and 6% reported elevated levels. Cholesterol was normal for 45%, unknown for 47%, and elevated for 7%.
Forty-seven percent never sought medical care related to cardiovascular diseases, while others did so at varying times in the past. Recent care was more common among women, older respondents, and poorer individuals.
Almost 60% do not take medication to normalize blood pressure, while 38% do. Eighty-seven percent do not take medication to regulate blood sugar or cholesterol. Among those with blood pressure problems at least once every six months, 66% take blood pressure medication, and 9% take medication for sugar and cholesterol respectively.
When blood pressure problems occur, more than a quarter take medication based on personal experience, while a similar share follow doctors’ recommendations. Nine to ten percent use folk remedies or immediately consult a doctor, and 5% do nothing.
Eighty-six percent walk outdoors daily, 8% several times a week, and 2–3% several times or once a month. Rural residents spend more time outdoors.
Sixty-one percent consume fresh fruits and vegetables daily, 30% several times a week, and smaller shares less frequently.
Forty-two percent eat meat daily, 41% several times a week, and fewer less often or never. Men and younger people consume meat more frequently.
Almost 30% consume confectionery and baked goods daily, 39% several times a week, and fewer less often. Daily consumption is more common among young and middle-aged respondents.
Twenty-two percent consume fried or fatty food daily, 39% several times a week, and fewer less often or never. Daily consumption is more common among men, younger and middle-aged respondents, and rural residents.
Fifteen percent consume non-alcoholic carbonated drinks daily, 22% several times a week, and 31% never consume them. Non-consumption is more common among women and older respondents.
Almost 40% consume alcohol once a month or less, 20% several times a month, 6% several times a week, and 3% daily. One-third do not consume alcohol at all, more often women, older people, and urban residents.
Only 15% exercise daily, 22% several times a week, and 27% do not exercise at all. Non-participation is more common among middle-aged and older respondents, women, and rural residents.
Twenty percent experience stress daily, 19% several times a week, 31% several times a month, and 30% never. Women, urban residents, and those with blood pressure problems experience stress more often.
Seventy-four percent are aware of symptoms of high blood pressure, and 67% know treatment methods; awareness is similar for low blood pressure.
Twenty-three percent recently received information on cardiovascular disease prevention from family doctors, while others cited media, the internet, or medical facilities. Fifty-five percent did not receive such information recently, more often young people.
Thirty-one percent positively assess the quality of cardiovascular care in their locality, 11% negatively, while 48% have not used such services. Positive assessments increased slightly compared to last year.
At the regional level, 26% positively assess cardiovascular treatment quality, 6% negatively, and 59% have not sought such care. Positive assessments increased compared to last year. Seventy-one percent did not seek such services in other Ukrainian cities.
When cardiovascular problems arise, respondents most often turn to city or district hospitals, family doctors, or regional hospitals. Forty-five percent report no blood pressure problems. Compared to last year, more respondents turn to family doctors.
The best quality assessments for cardiology services were given to family doctors, followed by city or district hospitals, regional hospitals, and other facilities.
Thirty-seven percent believe there are enough cardiovascular care facilities in their locality, while 45% believe there are not enough, particularly among rural residents.
As last year, most respondents (80%) know nothing about the World Bank and Ministry of Health project “Improving Health Care at the Service of People,” though 83% consider its implementation important.
Despite low awareness of the project, many respondents encountered related information in the media, such as ambulance transfers, equipment purchases, and facility renovations.
Seventy percent believe that implementation of this project will improve the situation with cardiovascular diseases in the region, 10% believe it will not change, and 4% expect deterioration.

Methodology

The survey audience consisted of residents of Rivne region aged 18 and older. The sample is representative by age, gender, and type of settlement.
The survey was conducted through face-to-face interviews.
The margin of error does not exceed 3.5%.
Fieldwork dates: November 27 – December 9, 2019.