What is changing in our medicine?
Has medical care become quality and affordable? How and for how much will they treat us? Let's try to summarize some of the results.
We traditionally try to make the December issue festive, in this vein and we wanted to have a conversation with State Duma deputy Oksana Genrikhovna DMITRIEVA, a politician and economist, and an expert in the field of budget and social policy. But the problem of medical care is so acute and painful that it is impossible to maintain an optimistic tone. Although, of course, hope always remains ...
DO: If we summarize the official speeches on the topic of healthcare, it turns out that in recent years a lot has been done in this area, important projects have been implemented. In this regard, the question: what do we, potential “consumers of medical services”, get in the bottom line? And what has really been modernized in the field of medical care? OD: In general, there are some positive results in the framework of the national project "Health". But, unfortunately, this process is uneven: somewhere good undertakings do not find support, somewhere funding is cut ... Therefore, this cannot be called a stable positive trend. We can note the saturation of the primary link - district polyclinics and hospitals with new, quite expensive medical equipment. But at the same time, in some cases, there are not enough specialists who know how to use it. The introduction of a special item of expenditures in the budgets for high-tech medical care has somewhat increased the availability of these types of treatment by quotas, but, nevertheless, the need for expensive treatment is still often not even covered by 50%. The increase in salaries for district doctors partially solved the problem of staff shortages. But the construction of medical centers "in the open field" in the country led to the fact that they are idle. A high-tech medical center in a region where there is no appropriate medical school, qualified teams and so on cannot work.
Russia's entry into the WTO
The question that excites everyone: what will happen to prices, especially with drug prices?
The director of the department of the Ministry of Economic Development Maxim MEDVEDKOV on the air of Ekho Moskvy radio said that with the entry of Russia into the WTO, drug prices will decline quite quickly. “On the one hand, the duty will be reduced, on the other, the system for registering medicines according to international standards will be cheaper. This means that the manufacturer will spend less and will be able to lower the price. "
However, other experts advise not to flatter themselves: there will be no noticeable reduction in prices in pharmacies. First, customs duties will be reduced gradually and for a long time. Secondly, it will only affect production. And more than half of the final cost of drugs falls on distribution and the pharmacy chain.
According to the Federal State Statistics Service, in August, when Russia officially entered the WTO, drug prices for the month increased by 0.3%, and from the beginning of the year - by 4.5%. But in what direction these prices will change, we will notice very soon ... (source www.doctorpiter.ru)
DO: That is, everything rests on the lack of qualified doctors? OD: Much rests on medical scientific and medical school. It has been formed for decades, it cannot be created by order from above, even if you invest a lot of money. It would be better to invest the same money not in building “from scratch”, but in expanding and re-equipping existing clinics.
DO: On the one hand, the state guarantees us the right to free medical care, including high-tech, on the other hand, from the pages of newspapers and magazines, in social networks and TV programs, people constantly cry for help: people collect money for operations, mainly to children. These are those who were denied free assistance because quotas are over. How to understand this, initially too little money is pledged? OD: The fact is that high-tech medical care is provided according to quotas, is not included in the system of compulsory medical insurance and does not cover the need for expensive treatment, complicated operations. After all, what is the point of a health insurance system? When an insured event occurs, you must be provided with treatment. For example, we can cure a cold ourselves, for this it is not necessary to even take a sick leave. And in the case of a serious illness, when we need a high-tech examination and, possibly, an expensive operation (if it is an oncology, a serious injury due to an accident, a difficult fracture
DO: So, this time-tested “vertical” - without a local doctor’s referral, the specialist will not accept you (for free) - remains? OD: The law on protecting the health of citizens gives you that right, but the law on compulsory health insurance doesn’t. The fact is that insurance medicine can function only with sufficiently large deductions from the budget, starting from 6-7% of GDP (now it is allocated half as much). It even requires a certain excess in comparison with the old distribution system, which can operate with any amount of funding. Let's compare: earlier, when the Soviet system was in operation, they gave you directions, and the clinic, taking into account its budget estimates, carried out the maximum possible. Suppose the hospital’s capacity is designed for 100 operations, but if it is really necessary, the doctors (they are still not housing and communal services workers, they are aware of their mission) provided this assistance. And now, with the quota system, it happens like this: there is a clinic, specialists, equipment, medicines, and finally, there is a huge queue of patients, and doctors are ready to accept them, but the quotas are only enough for two months. They end around March. That is, the hospital has potential, but it is no longer possible to provide assistance for free, because the quotas are over. And if the doctor begins at his own risk and risk taking free patients, he will immediately be let down in violation of financial discipline.
medical quotas For the provision of complex and expensive treatment, the term “high-tech medical care (VMP)” has been introduced, provided using sophisticated medical technologies based on modern achievements of science and technology, by highly qualified physicians.
A list of types of high-tech medical care can be found on the website of the Ministry of Health (www.minzdravsoc.ru). The list is quite large, but first of all it is heart surgery, organ transplantation, neurosurgical operations of brain tumors, treatment of hereditary and systemic diseases, leukemia, severe forms of endocrine pathology, surgical procedures of a high degree of complexity.
The types of assistance included in the federal list of VMP are directly funded by the state under the so-called regional quotas for high-tech medical care.
DO: And what do you think should be done to change the situation in healthcare for the better? OD: It seems to me that either the fully insurance principle should work with an increase in funding at times, or the restoration of the old Soviet system is necessary.
BEFORE: Amount of health financing really cut, as they say? OD: Yes, and just that part of it that provided expensive and high-tech types of treatment in federal clinics, in federal universities, medical science is being reduced.
DO: Now small clinics in small towns and rural schools are closing and moving to regional centers. Who benefits from depriving people - even if only a few hundred of them live - of the opportunity to study and be treated at their place of residence? OD: This is also a consequence of the notorious 83rd federal law (“On the Commercialization of Budget Institutions” - Approx. Ed.) - the closure of small hospitals and schools. It is fundamentally wrong to transfer medicine and education to commercial footing. These areas are not subject to commercialization either from a moral point of view or from an economic one. In addition, this will have the most serious consequences in the demographic and social plans, in terms of marginalization of the rural population. Because the school teacher and the village doctor are the people who shape society. When I encounter the adoption of such ill-conceived, unreasonable decisions, I get the feeling that now the bureaucracy in different ministries is often absolute non-professionals, with a complete lack of state thinking and interest. Of course, they have an interest, but a completely different one. It turns out that they do not serve the people, but are at war with the people.BEFORE: Since the summer, all polyclinics and hospitals are switching over to electronic cards and a remote appointment with a doctor; large funds have been allocated for this, as reported. Is this an example of modernization in action? OD: What are electronic cards and records over the Internet ?! In some clinics you are not only remotely on the phone, you cannot make an appointment with a doctor. You see, all these innovations are born somewhere up there, but they are not related to our real life. Here is a case: my mother recently described how she came to the district clinic of the city of St. Petersburg. She was recorded, having stood the queue in the registry, her doctor took 5 minutes. Then she waited 45 minutes for her sister to give her a prescription for medicine and a referral for tests. Then she had to get permission for the procedure at the department. This is a consequence of the 83rd law: the most common clinical blood test requires permission from the authorities.
DO: Since we have a New Year’s number, what would you wish our readers? OD: Try to take care of your health! You know, in many ways the lifestyle itself cures. The recipes are simple, well-known to everyone: to strengthen the immune system, eat right, observe the regime of work and rest. In fact, simple and affordable things help us maintain our health - do morning exercises, at least ten minutes.
DO: Do you do it yourself? OD: I do it, be sure!
From July 1, 2012, hospitals and clinics are transferred to the state procurement system
Critics this decision suggests that the law “On the commercialization of budgetary institutions”, adopted in 2011, will lead to the transition of medical institutions to self-sufficiency, and that as a result, free medicine will remain in the past.
Supporters Transition, in turn, argue that the new law will allow clear boundaries between free services guaranteed by the state and additional paid ones. In each medical institution, a list of types of medical care will be posted, and the prices for paid services must be accurately indicated. This will allow the person who has applied for medical care to know exactly what he can pay for and is not obligated to pay for. How the adopted law will prove itself in practice, time will tell.
strictly in direction Starting January 1, 2013, Russians will have to pay not only for “medical products not provided for by medical care standards and additional comfort”, as officials had previously promised, but also for independent visits to specialist doctors. That is, if a person decides on his own initiative to turn, for example, to a cardiologist, surgeon or optometrist. Only primary health care and emergency medical care will be provided free of charge in such cases.