We are developing concept of full-cycle clinic – director for development of Adonis medical group.

The director for the development of the Adonis medical group of companies, Vitaliy Gyrin, in an interview with Interfax-Ukraine spoke about the plans for the development of the Adonis medical network, competition in the market of medical services and peculiarities of the development of private medicine in the regions.

Text: Hanna Levchenko

- How did the development of the Adonis network begin?

- The Adonis Clinic is a family business. It began with the fact that my mother, Olha Mykolaivna Gyrina, opened two reception rooms in 1997: her own, as a cardiologist, and a gynecologist's office. Then we started the construction of a maternity hospital, we now have two maternity hospitals, at the same time we were developing a network of polyclinics, opened a reproduction clinic. In 2020, we planned to open a reproductive clinic abroad. Unfortunately, it didn't work out due to the pandemic.

- How do you assess competition in the market of private maternity hospitals, where there are actually three private companies? Is that enough or is there room for someone else?

- Today the market for private maternity hospitals is relatively saturated. If you ask whether it is difficult to find a client, then I will say this: to be a successful maternity hospital, you need to create a network of successful antenatal clinics. Currently, about 700 pregnant women are being observed in our antenatal clinics.

- And will everyone give birth at your clinics?

- No, not all, but we plan that about 65-70% of these women will give birth here. We have about 150 births a month.

- Last year, clinics that specialized in reproductive programs, especially international ones, on medical tourism, were very hard hit by the pandemic. Is it so?

- Many have closed down altogether, and those that have survived are working at 20% of their capacity. Plus, indeed, there are fewer foreign patients. We have resisted because we are a multidisciplinary medical center. In addition, we drew attention to the Ukrainian market: there is something to do here, it is developing, taking into account the situation in which the state medicine is. We can say that we have now received an incentive for growth.

- What are your plans for 2021?

- Our plans for 2021 are the opening of four branches in Kyiv region - in Podil, in Sofiyivska Borschahivka, in Pozniaky and in Bucha. These will all be multidisciplinary clinics, although they will have their own specializations. Another important project of ours - we want to create an ambulance service for four cars. We are developing the concept of a full-cycle clinic so that the patient in our clinic receives the maximum of services. For example, in the field of reproductive medicine, a woman can get prenatal care here, can treat infertility, can give birth with us, we will provide pediatric care for her child, we will provide medical services to all family members. We have a concept - the health of a woman and her family.

- What is your total bed capacity now and how do you plan to increase it?

- Now we have about 60 beds, including maternity hospitals, we want to increase the bed capacity to 150.

- How many beds is it profitable to have on average in a private clinic in Ukraine?

- It depends on the specialization of the clinic. That is, if this is a clinic that deals exclusively with plastic surgery, then it will cope with five wards. But on average, perhaps, the best minimum number for the clinic to be fully loaded is 12 beds plus one operating room. Nowadays, clinics practically do not open with small operating rooms. Operating rooms are difficult to load, they are often rented out, there is demand for this, since now there are many surgeons who have been denied access due to the COVID-19 epidemic and the re-profiling of clinics.

- Do you have plans for development in the regions?

- It would be interesting. While we are looking for an opportunity to do this. But this is definitely an interesting market. I believe that the Kyiv market is more or less saturated, although the number of residents of the capital is increasing, the paying capacity of clients and patients is growing. In principle, we have something to do in Kyiv and Kyiv region, but the prospects are definitely a market outside Kyiv region.

- Why don't private medical companies develop networks in the regions? What is the problem?

- The first thing is management. Even in Kyiv, it is difficult to find adequate management, whom you will trust and who can do something, all the more difficult it is in the regions, in the localities. The second one is the team, the doctors. It is very difficult to get a team. In principle, this problem stems from the first - if there were strong management, it would be possible to recruit a good team of doctors, but finding a competent head of the clinic is incredibly difficult.

- Is there an effective demand for the services of private clinics in the regions?

- Each city has its own specifics of the development of private medicine, directly related to the state. For example, in Kyiv only recently private angiographers have appeared, and in Odesa there are several private clinics that do angiography, and they do it more than the state ones. If somewhere private medicine can create a worthy competition for state medicine, development begins there, and where the state has monopolized everything, it is difficult there.

- It turns out that private clinics have to compete not with each other, but with state medicine?

- Certainly! The main competitor is public medicine. This applies to doctors, management, and operations. For example, in a public hospital, the state pays utility bills, regardless of how this clinic works, what kind of patient flow it has, what is the effectiveness of treatment. But in a private clinic, if it works poorly, no one will pay utility bills, no one will give a loan. We must fight for a doctor who, working in a state clinic, receives up to 70% of his income in the form of informal payments, and we must fight against the state clinics themselves, which in fact do not bear any financial costs.

- In a competitive struggle, there is such a technique - to weaken a competitor. Is it profitable for private medical market operators to weaken public medicine?

- Not. There are many areas that private medicine does not want to do at all. And so in all countries. For example, disaster medicine. Private medicine wants only one thing - to be on an equal footing with the state. We want transparent, understandable tariffs so that doctors do not have payments in an envelope or that they are somehow minimized, so that medicine comes out of the shadows and everyone has transparent conditions. To play by the same rules, we understand that co-payment is required. As soon as it appears, investments will immediately go to private medicine, including foreign investors.

- How do you assess the tariffs offered by the National Health Service of Ukraine under the medical guarantees program?

- Yes, they are interesting, but they are out of touch with real life.

- For example, radiation therapy is UAH 54,000? Is it out of touch with reality?

- I cannot comment on this question. Although we are a multidisciplinary clinic, there are things that we do not do for various reasons. For example, for oncology, you need to make a specialized clinic, this requires a lot of investment.

- What do you think about medical tourism?

- This is definitely a very interesting direction. It is very promising, and for me this is the most interesting direction in business development. We have some of the lowest prices in the world for medical services, but our medical services are of sufficient quality. In developed countries, there are a huge number of people who find it difficult to get medical services due to queues, high prices or lack of insurance. We have a large international department, about 40 people. We work with platforms and agencies, we have representative offices in various countries. This is a big area of our business.

- What share of your income comes from medical tourism?

- In the pre-pandemic time, it was about 35%. When COVID-19 began, we tried to maintain this direction, we are pulling it at the expense of other businesses.

- What can you say about domestic medical tourism?

- It exists! What is a regional hospital? This is, by and large, domestic medical tourism for the districts, for the region - these are hospitals in Kyiv. By the way, this also has the problem of the development of medical networks in the regions: if Kyiv clinics open their branches there, they recruit local doctors, and people want to go to Kyiv doctors, capital doctors, especially if they have some serious problem. They don't want to go to the Kyiv branded hospital with local doctors.

- How viable is the direction of family medicine?

- It is 100% viable, this is the model that exists in almost every civilized country in the world, and we also need to follow this model. But personally, I don't understand how much a medical center can earn from family medicine. This is a slightly different business model. I believe that the main beneficiary in this model is the family doctor.

- What do you think about the work of family doctors in private clinics through the National Health Service of Ukraine?

- I think this is good for a family doctor, but to be honest, I don't understand how such a clinic, which has several family doctors and an agreement with the National Health Service of Ukraine, can earn money. If he fully collects the maximum client base available under the law, he is unlikely to have time for another job, he will only be busy with patients according to the declaration. Plus the tariff, it remains a mystery to me. But if this is good for family doctors, if someone succeeds, then I am happy for them, however, I do not see myself in this system. But that doesn't mean it's a bad model. We can cooperate with family doctors, do tests and diagnostics for them, take their patients to the hospital. But at the moment we are not interested in doing family medicine ourselves.

- Do you admit a model in which a family doctor will rent an office from you and at the same time refer his patients to your specialists?

- An interesting option. Maybe yes. Thought about it, but haven't done it yet. The fact is that there are still no family doctors who would need it. There was no request for such services.

- What do you think about medical education today?

- This is a big problem. When police reform began, new police officers graduated. It takes eight years to graduate new doctors. It is necessary to completely change the entire system of medical education and the system of entering medical universities, it is necessary to increase the scores. There are more medical universities, but the quality of education is not growing. This is a huge problem, there is a shortage of personnel, although a lot of doctors graduate every year. I don't think there is a great demand for them abroad, because they need to confirm their diplomas there, but the main problem is that our medical education is divorced from real help. In Ukraine, doctors are taught using books from the 1980s and 1990s of the last century: it is not clear how young doctors will apply this in practice.

- Can private medicine act as a stimulus for medical education?

- There are examples of private clinics that open an internship. We also have an internship, there are interns, there is a training center. And we want to engage in postgraduate education, while these are plans, we are moving towards this. But private clinics cannot teach hundreds of interns, education is definitely not a cost-effective story. This is an opportunity to choose a good specialist, it is difficult to make money on this.

- Do you think it is necessary to introduce an individual medical license in Ukraine?

- Naturally, it is 100% needed. Let the doctor be responsible for his activities, and not the clinic where he works, no matter if it is a public clinic or a private one. Why, if the doctor made a mistake, should the institution where he works be solely responsible? This is strange.

- Do you have part-time workers in your clinic who combine work at your clinic with state clinics?

- Of course, there are about 25-30% of them. The remaining 70% are on the staff.

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