Ecomedservice: War Against Private Health Care in Belarus?

On 23 April 2013 Belarus witnessed a terrible death. 25-year old Yulia Kubareva passed away after undergoing an unfortunate nose reconstruction surgery at Ecomedservice — one of the largest private medical centres in Belarus.

By now, almost every Belarusian knows about the accident, and the government has launched mass inspections of private medical services providers in Belarus. The Ministry of Health has already revoked seven licences for anaesthesiology and resuscitation services. In addition, the Ministry of Health has appointed a state representative for administering the completely privately owned Ecomedservice.

Is such reaction to this incident adequate? The state has a particularly heavy hand when it comes to regulation of private businesses. In this case, the emotions related to the death of a young woman who was getting ready for her wedding make the case even more complicated.

The Fatal Surgery 

On 26 March 2013 the surgery of young Yulia Kubareva from Hrodna began. The same night, her condition deteriorated severely and she lapsed into a coma, which lasted for about a month. The woman never regained consciousness again.

Yulia’s wish to correct the shape of her nose, injured by a snowball in childhood, became one that would prove to be fatal to her.  Besides cosmetology purposes, she needed the operation for health reasons: due to the defect, she had trouble breathing.  Though the investigation of the case has lasted for more than a week already, the direct cause of Yulia's death remains unclear.

The two individuals charged as a result of the accident are the anaesthesiologist and the clinic's main engineer.

In defiance of the professional instructions, the former left Yulia after the operation and before she came to her senses.

The engineer failed to ensure due quality of the artificial ventilation of breathing apparatus used during the operation.

The apparatus requiring semi-annual examination by specialists and had not been checked since 2007. Representatives of the Committee of Inquiry of Belarus have revealed that during the sorrowful operation the artificial ventilation of Yulia's lungs, the apparatus malfunctioned for about 40 minutes.

State v Private Health Care

The news about Yulia Kubareva’s death shocked everyone: the seeming simplicity of the operation, the young and beautiful victim, and most importantly — the prestigious and expensive private medical centre, which carried out the operation. 

The last factor revived the old and sharp debates between advocates of state and private medicine in Belarus. Though currently private medical services make up only about 5% of all the total of medical services in Belarus, their popularity has steadily been growing. The absence of queues, polite staff, and modern equipment appear to be clear advantages for many Belarusians. 

Paying relatively big money for private medical services, Belarusians expect a higher quality of medical care. Some people, however, primarily the older generation, trust the state and, therefore, state-provided medicine. Moreover, many services are provided for free by state hospitals, which make them even more attractive. 

Kubareva’s death has made supporters of private medicine think twice, all the while strengthening the position of its opponents. But both advocates and opponents of private medical care have agreed that the level of medical services in Belarus remains below their expectations. It is no secret for a Belarusian that most doctors having a private practice also work in state hospitals.

Of course, sad stories happen not only in private hospitals. Recently it became known another plastic surgery left a woman in coma for about half a year.

That is not to say that Belarus has not achieved some good results in medicine. For instance, the level of infant mortality in Belarus saw a twofold decrease during the last five years and is not lower than than in some EU member states. Still, average life expectancy — one of the most important indicators of healthcare quality remains too low: 64 years for men and 76 years for women.  

Perhaps increasing the reach and quality of private medical services in the Belarusian market could help alleviate this problem.

Battle Against Private Medicine?

But instead of a dialogue the government of Belarus often prefers confrontation. The nominally socially-oriented Belarusian state turns a blind eye on problems in the state sector and is often too willing to crush the private sector with an iron fist. Instead of listening to the society’s dissatisfaction about the adequacy of state services in general, private medical centres become a scapegoat for officials. Plastic surgeon Dr Nikolay Kurilovich told Belapan news agency that "the war against private medicine has already started".

One of the first Lukashenka’s moves was to demand that the Ministry of Health take ​control over privately-owned Ecomedservice. Other moves included mass ispections of all private medical centres which resulted in the revocation of seven licences for rendering anaesthesiology and resuscitation services. 

However, the state’s critics should consider these actions in a broader context.

First, non-private medical centres have also become subject to the Ministry of Health examinations (for instance, the Clinical Centre of Plastic Surgery and Medical Cosmetology, a municipal unitary enterprise).

Moreover, it appears that there were good grounds to revoke licences in some cases. Failures to carry out planned examinations of medical equipment safety, as well as the absence of nurses-anaesthesiologists are among the most common breaches’ listed. According to Mikhail Niadzvietski, Director of Minsk-based Medical tourism agency, LLC, these violations are indeed quite severe and are mainly explained by the banal wish of medical centres to cut costs.

Even if the state’s actions with regard to private medical centres amounts to a war, it may benefit Belarusians and even save lives. However, it is important not to overreact.  

Rule of Law Does Not Rule

Once the the case of Yulia Kubarova came to Lukashenka’s attention, his press service commented to Interfax-Zapad that “the future of this organisation will be decided in the nearest future.” The press service, however, did not to explain who will be making the decision and why the claim comes from them and not from the legal system.

The appointment of a state representative to run Ecomedservice does not seem to have any lawful grounds. Ivan Ryzhko, the Head of the Main Department of Medical Assistance Organisation of the Ministry of Health, has no right to run Ecomedservice’s, as neither the state, nor the Ministry financially holds any shares or interest in the company. Taking control of a private company is just one stop away from expropriation. 

The scenario of expropriating private companies after fatal accidents has already worked in the case of Pinskdrev. In October 2010 an explosion in one of the factory’s buildings killed its 14 employees. As a result, Lukashenka decreed that the company had to be taken over by the government.

The case of Yulia Kubareva taught an important lesson to Belarus: its medicine needs urgent improvement. The best way to achieve would be to have a continuous constructive cooperation between the state and the private sector within the limits of the law. 

Darya Firsava is a Minsk-based lawyer working on her PhD and leading a number of educational projects in Belarus.

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