Health care reform. New medical reform: latest news, essence, changes

The topic of one of the last boards of the Investigative Committee of the Russian Federation was medical errors. According to the head of the committee, Alexander Bastrykin, in 2015 in Russia, 712 people died from medical errors. As a result, law enforcement officers proposed adding to the Code administrative offenses an article that would provide for responsibility for the quality of medical examinations performed.

In our country, in any situation, everything is attributed to insufficient funding for healthcare. But is this the only reason for the low effectiveness of Russian medicine?

I was prompted to write this article by personal reasons. Now I am in the hospital with my daughter, who was diagnosed with extensive pneumonia. Before this, three doctors at the district clinic could not listen to anything in the child’s lungs, prescribing some drops. Only elderly doctor From the emergency room I wrote a referral for an x-ray. By this time, several segments of the child’s left lung were already affected. What is it – a lack of medical qualifications or a deadly indifference to the patient?

There are even worse cases. Recently, social networks were shocked by a video filmed by a journalist from one of the federal television channels. The man accidentally witnessed how the orderlies of the City Clinical Hospital named after. Davydovsky was rolled out of the hospital by a man in a wheelchair, throwing him onto the side of the road. The orderlies themselves said that they simply removed the homeless man from the hospital. Although it was clear that the unfortunate man was neatly dressed. After the police intervened, it turned out that the man thrown out of the hospital had suffered a stroke. He couldn’t speak, didn’t remember anything, his legs gave out. The incident is now being investigated by a special commission. Officials responsible for supervision and control in the healthcare sector have already rushed to announce measures to strengthen discipline and penalties imposed. However, much more often situations arise when the laws do not seem to be violated, but a person is actually left without a vitally important medical care.

Over 2013–2015, more than 100 thousand beds were reduced in Russia, mostly specialized and located in district hospitals.

Last week, in the city of Dalnegorsk, Primorsky Territory, a doctor was fired from the hospital because he suggested that a girl who had suffered a dog bite go to church. The reason turned out to be trivial: the clinic did not have a rabies vaccine. The news became public, and the regional administration was forced to give an explanation. According to the vice-governor of Primorye Pavel Serebryakov, the Dalnegorsk hospital did not have this vaccine due to an inexplicable failure in procurement.

It is no secret that the budget of the compulsory medical insurance fund does not cover all expenses, and regional authorities save on medicine as best they can. In this regard, in the near future, apparently, people will be sent “to be treated” with the help of church rites from medical institutions more and more often. The Ministry of Finance proposed to reduce healthcare costs by another 28.6 billion rubles next year. At the same time, the budget of the Compulsory Health Insurance Fund, as is known, does not even cover the costs of implementing the “May Decrees” regarding increasing salaries for medical workers. But will increasing salaries solve all the problems of domestic medicine? Indeed, today in Russia the mortality rate from circulatory diseases alone is 6 times higher than in Canada, Germany, Spain and Portugal. Even citizens of Afghanistan and Albania are dying from cardiovascular diseases much less often than us. Also, according to the International Agency for Research on Cancer, Russia ranks 5th in the world in the number of deaths of cancer patients. Reason – low percentage diagnosing cancer in the early stages.

Who is shortening the lives of Russians?

In a ranking of the effectiveness of national healthcare systems published recently by Bloomberg, Russia was in penultimate place. In total, more than 50 countries appear in the ranking. In the top ten are Hong Kong, Italy, Japan, South Korea, Australia, Israel, France, UAE and Great Britain, whose citizens live the longest in the world. According to Rosstat, average duration life in Russia in 2015 was 71.39 years. This is lower than planned by the state health care development program - 72.02 years, and 8-10 years less than in European countries.

Russia has not been a favorite in international health care rankings for a long time. Recently, the authoritative British medical journal The Lancet published a ranking of countries in terms of population health: Russia is in 119th place, next to Syria and Ukraine. However, domestic statistics also do not add optimism: over 2013–2015, more than 100 thousand beds were cut in Russia, mostly specialized and located in regional hospitals. It is not surprising that at the end of 2015 the volume of paid medical services exceeded 500 billion rubles, which is almost 5 times higher than the level of 2013, that is, citizens are increasingly forced to pay for doctor’s appointments.

Reference

According to Rosstat, since 2015, the number of paramedical workers in Russia has decreased by 22.4 thousand people. Before this, about 90 thousand health workers were laid off. The number of hospital beds has decreased by 100 thousand over the past three years.

Demographers have already sounded the alarm, whose data indicate an increase in mortality among young people aged 30 to 45 years. At the same time, the increase in the number of Russian deaths occurs against the background of a decrease in the number of births. The Minister of Health has already tried to explain all this by the population’s addiction to alcohol: “When autopsying dead patients, alcohol is detected in the blood in 70% of cases. For the first time in last years the number of suicides has increased, alcohol poisoning, no diagnoses of pneumonia made during life in antisocial groups of the population. We are nursing 500-gram babies, and 40% of the deaths of children under 1 year of age are due to drunken mothers who crush them,” said Veronika Skvortsova. However, a report to the government on public health for 2014, prepared by the Ministry of Health itself, spoke of a significant reduction in alcohol consumption and deaths from accidental poisoning. A reasonable question arises: were these assessments premature or biased? As for newborns “crushed” by drunken mothers, then, according to Rosstat data for 2015, out of 6.4 thousand children who died before one year external reasons, which includes accidents during co-sleeping with their mother, only 300 babies died. It looks like we were lied to again.

Prospect – self-medication

Demands to increase the healthcare budget are now heard from different sides. In fact, it would be much more effective to reduce waste and ineffective spending. Hospitals are equipped with good equipment, but due to corruption, it costs many times more than in reality. They purchase complex equipment for rural hospitals medical equipment, but they don’t know how to use it there. They are increasing the salaries of local doctors, but this leads to the fact that cardiologists, ophthalmologists, oncologists and other specialists are en masse “retraining” as local doctors. The result is the inability to get the right medical care at the right time. Difficulties in making an appointment with the right specialist and necessary examination during acute period Diseases are the most common problem in city clinics. The tests that are needed here and now are usually ready in public clinics only after a few weeks. But private laboratories that profit from this situation, like mushrooms after rain, appear within walking distance of city clinics. President of the Health Foundation Eduard Gavrilov says: “According to our data obtained from a survey of patients in the regions, the actual waiting times for an appointment with a doctor or diagnosis today are 2-3 times higher than the normative ones. The problem is especially acute in rural areas, where the supply of doctors is 3-4 times lower than in the city, and mortality is 14% higher.”

There are more egregious examples of wasteful spending. For example, the Russian Ministry of Health paid contractors 15.5 million rubles for allegedly completed and accepted work for modernizing your website, as well as for maintaining updated sections. However, almost a year later, the project still did not work. Medical officials talk about underfunding, and meanwhile billions of rubles are ending up in compulsory medical insurance funds. Thus, according to the results of the checks, it turned out that Insurance companies held with medical organizations as a result of fines about 50 billion rubles - almost 4% of the annual budget of the federal compulsory medical insurance fund. A significant part of these funds “settled” in the companies themselves. At the same time, insurers do not defend the rights of patients in any way, but are focused “on identifying paper flaws in the work of doctors.” Experts have calculated that these 50 billion would be enough to increase the salary of each doctor by several thousand rubles.

What to do and what is the prognosis? Here's how he comments on the prospects Russian healthcare Head of the Health Foundation Eduard Gavrilov: “If the tariff policy remains the same as the last four years, then the volume of paid medical care will increase, medical workers will not see an increase in salaries, and citizens will increasingly self-medicate. All this will affect the morbidity and mortality of the population.” And here is the forecast of narcologist, member of the Public Chamber of the Russian Federation Oleg Zykov: “I think that next year the paid part of medical services will increase. This will especially affect dentistry and physiotherapy. In the future, this part of medical care will generally go to Dobrovolnoe health insurance, I think. The quality of service in the compulsory medical insurance system will deteriorate. Only one indicator will increase – the quality of processing papers and reports.”

Meanwhile

In early October, the Nobel Assembly of the Karolinska Institute in Stockholm announced the name of the 2016 laureate in physiology or medicine. It was a professor from Tokyo, Yoshinori Ohsumi, who received an award for research that may provide the key to understanding the causes of malignant tumors and diseases nervous system. Since 1901, when the Nobel Committee began awarding the prize for achievements in the field of physiology and medicine, representatives of Russia have received it only twice. In 1904, this prize was awarded to the famous Russian physiologist Ivan Pavlov, and in 1908, one of the founders of immunology, Ilya Mechnikov. After this, none of the Russian scientists were recognized for fundamental research on a global scale in the field of medicine. Why?

I asked this question to a famous Russian narcologist, candidate medical sciences, member of the Health Commission of the Public Chamber Oleg Zykov. "Current Russian medical education“Nominal,” he explained. – It does not educate a doctor and a scientist. Just one example: there was a Center for Narcology in Russia. It was merged with the Center for Psychiatry. As a result, the Narcology Center ceased to exist. Why did they do this? This is not a clinic that can be merged with a neighboring one. In the same way, thoughtlessly, a merger of institutions occurs as a result of the reform of the Russian Academy of Sciences. Entire scientific fields and schools are being destroyed. At the same time, the issue of saving is more than doubtful.” It is appropriate to recall that the process of merging institutions during the reform of the Russian Academy of Sciences was initiated “from above”: it was personally supervised by the Deputy Prime Minister for social issues Olga Golodets.

Because about what global scientific achievements in medicine can we talk about when a decision has even been made to eliminate the internship? According to many experts, as a result of this reform, we risk being left without specialist doctors in the near future. Judge for yourself: after receiving a diploma, a graduate of a medical university will immediately, without undergoing an internship or passing a professional exam, go to work as a therapist or pediatrician in a clinic, where he will treat patients at least three years. Only after this will he have the right to enter residency to obtain a narrow specialty. That is, after 25 years, when most already have a family and children, the doctor will again have to go to a salary of 20 thousand rubles. Can everyone afford it? This is how an oncologist and doctor comments on this innovation highest category, Doctor of Medical Sciences Alexander Kogan: “The cancellation of the internship is accompanied by a reduction in hours in microbiology, biochemistry, physiology and other disciplines at universities, that is, future therapists and pediatricians will lack not only practical, but also theoretical training. Future ophthalmologists, surgeons, neurologists, and oncologists risk forgetting everything they have been taught over the previous six years. When they finally gain the right to work in their specialty, they will have to spend a long time restoring their knowledge base. The only ones who will benefit from the abolition of internships are private clinics: the flow of graduates will flow there.”

Moscow healthcare reform will not lead to a shortage of hospital beds and massive reduction medical staff. This was stated by Deputy Mayor for Social Issues Leonid Pechatnikov.

The goal of the reform is to modernize clinics and optimize healthcare costs

Leonid Pechatnikov said that hospitals will not be closed, but transformed and enlarged. Some small clinics will simply join multidisciplinary centers. As a result of the reform, about 35 multidisciplinary hospitals will remain in the city, which will be able to provide qualified services to all city residents who seek help. Optimization will increase the efficiency of financing the medical industry.

Bo linen bedsenough for everyone despite the reduction of hospitals

There will be no queues for hospital stays as a result of the reform. After all, the bed capacity is planned to be reduced by 30% not out of a desire to save money, but solely due to an increase in the efficiency of diagnosis and treatment.

“Now the average length of a patient’s stay in hospital has decreased by approximately three times. By accelerating treatment, approximately a third of the total bed capacity of the city network is freed up, which is almost 20 thousand places,” Pechatnikov said.

According to the capital's authorities, hospital beds are now being used ineffectively: on average, patients stay in hospitals for too long, and clinics often send patients to hospital for treatment in cases that do not require mandatory hospitalization.

The total number of jobs in the medical field will remain unchanged.

The total number of jobs in the medical field will not change. Doctors with redundant specialties (for example, dermatologists, urologists, proctologists and gynecologists) will be offered to change their profile by retraining at the expense of the city.

The Moscow Health Department allocated 1.5 billion rubles for retraining.

The capital requires:

• 5300 therapists
• 2000 surgeons
• 7,000 pediatricians.

The bed capacity will be divided into social and intensive, which will be financed from the budget.

As part of the reform, hospital beds will be divided into intensive care beds in multidisciplinary hospitals operating within the compulsory medical insurance system, and social treatment beds outside the compulsory medical insurance system. Intensive beds will be provided for hospitalization of patients with acute diseases and exacerbations of chronic diseases.

Patients with psychiatric, infectious and tuberculosis diseases will be treated in hospitals that are not equipped to provide high-tech assistance. This is due to the fact that expensive equipment is not required to treat such patients.

“The buildings that will be released in the process of this modernization - some of them will be used for social beds, some will be transferred to the city treasury, and the city will dispose of this as it sees fit,” explained the deputy mayor of Moscow.

Oncology and hemodialysis will become compulsory health insurance from 2015.

IN next year Compulsory insurance will cover not only emergency care, but also oncology treatment and hemodialysis.

“Since 2015, oncology and hemodialysis have been covered by compulsory medical insurance. We will see how they will exist - this is complicated story, but I must say that we have reserved funds for chemotherapy drugs,” Pechatnikov said.

Nine will be created in Moscow modern diagnosticlaboratories

High-tech equipment (analyzers) and modern reagents have already been purchased for hospital laboratories. In addition, the head centers of all 46 adult and 40 children's outpatient associations are already equipped with such equipment. They will conduct all research according to uniform standards. And laboratories in clinics with old equipment will be closed. But nothing will change for patients - they will continue to donate blood and other tests in the usual clinics, and the studies themselves will be carried out in modern laboratories.

The salary of metropolitan doctors will increase to 140 thousand rubles

The reorganization of hospitals and the reduction of doctors of narrow specializations is connected with the implementation of the “May decrees” of the president, in particular insofar as it concerns increasing salaries for doctors.

By 2018, Moscow doctors who own modern methods treatment and regularly taking advanced training courses will receive a salary of at least 140 thousand rubles.

"If now the average wage doctors in medical institutions of the city is 60 thousand rubles, then by 2018 it could already be 140 thousand or more. Of course, only good doctors, whose work has no complaints from patients and management, will receive such a salary medical institutions"- said Pechatnikov.

The reform of the healthcare system assumes that only highly qualified personnel will remain in medicine, who will work on completely different equipment and using different technologies. total amount, spent from the Federal and Moscow budgets is 105 billion rubles, of which 45 billion rubles were spent on equipping medical institutions with medical equipment.

Constitution of the Russian Federation, Article 41
1. Everyone has the right to health care and medical care. Medical care in state and municipal health care institutions is provided to citizens free of charge at the expense of the corresponding budget, insurance premiums, and other revenues.
2. B Russian Federation Federal programs for the protection and promotion of public health are financed, measures are taken to develop state, municipal, and private health care systems, activities that promote human health and development are encouraged. physical culture and sports, environmental and sanitary-epidemiological well-being.
3. Concealment by officials of facts and circumstances that pose a threat to the life and health of people entails liability in accordance with federal law.

If the declared goals and actions to achieve them contradict each other, then what is happening can hardly be called a reform. The situation described fully applies to the situation with the “reform” of healthcare in Russia, which has been taking place over the past few years (the current stage began in 2014, everything continues in 2016). Sometimes they like to use the word “optimization” to describe what is happening, which also contains a noticeable element of deceit - in the classical view, optimization involves modifying a system to improve its efficiency. IN in this case, we're talking about only about reducing the costs of maintaining the system of providing free medical care to the population, the limiting case of “optimization” according to the criterion of minimizing costs is a complete rejection of free medical care for the majority of the population. In fact, what is happening is reminiscent of this particular case, the authorities are “reducing the financial burden on the budget”, they do not have sick people, but “a burden on the budget”; if they can, they themselves are treated abroad. Moreover, I am not against treatment abroad; I am surprised by the crafty behavior of the authorities. And by the way, if the disease cannot be treated in Russia, then in theory the possibility of treatment abroad is declared for ordinary citizens at the expense of the state (or rather, it was definitely declared several years ago, I have not monitored the current state of affairs).

As introductory material to the topic, a text from the Vedomosti newspaper is offered; it describes in detail what is happening in practice with healthcare in Moscow. You need to understand that quality (availability and quality of various medical procedures) medical care in Moscow is on average higher than in other regions, while over the past few years the situation here has managed to worsen significantly (in some areas reaching catastrophic). The incomes of doctors and health workers in Moscow are also significantly higher. The situation even in the Moscow region (several kilometers from the Moscow Ring Road) is noticeably worse.

The second text from the Vedomosti newspaper is a quote from an interview with the dean of the Faculty of Economics of Moscow State University, Alexander Auzan, which states that the very concept of healthcare “reform” is flawed, the problem is not in implementation.

“Cognitive dissonance begins in Russia”

Dean of the Faculty of Economics of Moscow State University Alexander Auzan on overcoming the inertia of development and why we will have to look 25 years ahead (quote about ongoing reforms)

– But people probably need to offer something now? About “in 20 years there will be a complete victory of communism” - we have already gone through this.
– If people want to move in a certain direction, you are right that you cannot tell them: wait 10 years and in 10 years something will happen. We need what is called close-hanging fruit. I’ll tell you where, in my opinion, such results need to be looked for: we need to get out of the impasses in which we now find ourselves in education, healthcare and the pension system. Because this is the shell in which a person lives, and he sees that reforms there are leading somewhere in the wrong direction. Yes, they built a building, brought in equipment - but in fact everything got worse and worse. It seems to me that we have been moving in the wrong model in healthcare, education and the pension system. Let's take healthcare - the insurance model is very expensive, the super-rich America has a hard time living in it, spending 2.5 times more per unit of good than England or Germany, which have good healthcare, or Israel, or Cuba. Let's take a look: it turns out that there are many models of good healthcare, and this is important for people. Do you know why else it's important? It’s somehow not customary to say out loud that we are an aging nation, our human potential lives in an increasingly fragile shell and, no matter how hard we try with demographic growth, to be honest, nothing really works out. And it won't work. Everyone except Americans - this is the only historical exception - is moving to a plateau: demographic growth is ending, the nation is aging. This means healthcare is becoming more important and more sensitive. We are a fairly educated, aging country that needs fine-tuned healthcare. But he’s not there. The same goes for education. We are no longer the most reading country, as Zhvanetsky said about the USSR - in this sense human capital It's already starting to collapse. Because education now in many ways is not working in the direction it should, but again according to the old Soviet joke: the struggle of the system with the natural talent of a person. The system is starting to win. In education, we have created a market-service model, in which we evaluate, as in a continuously operating supermarket, the quantity and quality of services provided per unit of time. Listen, in general, education is a long-term investment, and the result is a person, not a report. After all, we have huge transaction costs in education and healthcare, because teachers and doctors do not so much treat and teach as they write and write. As soon as you can't formulate a real goal, you end up with a huge amount of reporting. And since it still doesn’t work, let’s add some more indicators. We have fallen into worsening selection. The model needs to be changed. I think that for people, the transition to setting realistic goals [in these areas] is a tangible thing that can be achieved, well, not in a year or two, but in five years the turnaround can already begin to be felt.

We are talking about the systemic degradation of medicine (health care) in Russia

Problems in healthcare are systemic; doctors are increasingly saying that our medicine is turning into a fake. Clinics can receive patients, refer them for research, provide medical examinations and provide preventative care, but the diagnoses often do not correspond to reality. Lab tests done incorrectly, and the prescribed treatment is very different from the methods used in most developed countries. Details at the link (text Lenta.ru 03.11.2016)

Published 5/19/2016, version 1.3 dated 11/07/2016
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In Reorganization of healthcare in Moscow: who benefits?

Well, dear fellow Muscovites? What the newly appointed head of the Moscow Department of Health L.M. warned about two years ago. Pechatnikov, it’s done! Reorganization of Moscow healthcare is full on the move! In a hasty manner that defies any logic, clinics and hospitals are being merged and disaggregated, hospital departments are being closed, transferred and reopened (only in other territories and with other states), doctors and nurses are signing the third notice of the year on the transition to new system wages, still not imagining what their new salaries will be... vanity and chaos...

At first, it seemed that the purpose of merging several health care facilities into one structure was to reduce the number of “freeloaders” - accountants, personnel officers, etc. near the top. However, in reality the opposite happened.

Thus, the ongoing “reform” will not benefit either doctors or patients. So who benefits from it?