In the past year, the Russian telemedicine obtained legal status, migrant workers – insurance, and passengers of trains – cars-laboratory testing for HIV infection. The government decided to decriminalize violations of rules by doctors extracts of painkillers and a public hearing on the closure of rural hospitals. The Ministry of health has continued to improve the remuneration system, but was not able to reach the level of wages set out in “the may decrees of the President.” “Mednovosti” recall the most significant events of the year.
One of the most important events of the year happened under the curtain: the head of the government Dmitry Medvedev instructed to decriminalize violations of rules of a turn of doctors of painkillers containing the narcotic and psychotropic substances. We are talking about the abolition of criminal liability for mistakes made by doctors and pharmacists when working with narcotic pain-killers, if it did not lead to serious consequences.That is, on their withdrawal from the operation of part 1 of article 228.2 of the criminal code (illegal acquisition, storage, transportation, manufacturing, processing of narcotic drugs, psychotropic substances or their analogues).
Decriminalization of the actions of physicians who work with painkillers opiates, are provided in the adopted year ago the roadmap, providing for increased availability of pain therapy. According to experts, the fact that the country appeared produce a sufficient supply of painkillers, we need at least two years. But the more time it will take to change the mentality that doctors are “old school”. The survey showed the hospice charity Fund “Vera”, half of the patients and their relatives believe that the prescribed painkillers did not help them, and another third of the patients complained of doctors who said that the pain we must endure. The doctors themselves admitted that still have concerns, writing out of potent drugs, almost 38% of doctors said that fear of a criminal case due to the appointment of narcotic substances.
The diagnosis two weeks
As another step toward heavy patients, the Ministry of health has established a new procedure help cancer patients. According to the order, changing the procedure and terms of providing medical care to the population according to the specialty “Oncology”, the diagnosis should be found in 15 working days, and the treatment is to begin no later than 10-15 business days after diagnosis.
In cases of suspected cancer, the patient is in a period of not more than 5 days should receive consultation in the primary Oncology unit. There he should be immediately issued directions to all the necessary diagnostic investigations ordered and performed a biopsy. Deadline is required for histological verification of malignant neoplasm anatomic studies should not exceed 15 working days.
Previously, the time allotted for the staging with cancer, varied by region and ranged from 10 to 30 working days. In practice, however, few people have time and in time.Experts believe that to meet the new standards may at best only in Moscow and St. Petersburg. Ostalnyh regions where acute shortages of modern pathological laboratories and professionals, it is completely unrealistic. And the tight deadlines will lead to regular failure, or hospitalization nedoobsledovannye patients and treatment is not standardized.
Telemedicine across the country
In the past year the authorities have adopted a law that provides the legal basis for developing the country’s telecommunications medicine. It is as remote interaction of experts among themselves (video consultations to treat and refresher training online), and consulting with doctors patients on the Internet. The law shall enter into force on 1 January, but, according to the Ministry of health, these technologies are de facto already practiced in many regions of the country.Importantly, given the legal status of electronic documents, provides for the creation of a Unified state information system in healthcare, the possibility of issuing electronic certificates, opinions and recipes.
According to experts, in Russia, with its territory and population density, the development of telemedicine due to the geography of the country. Especially effective this form of patient management can be for those living in remote communities, pregnant women, the elderly and patients with chronic diseases, whose diagnosis has been made and it is necessary to monitor their condition. The professional community also supports the initiative, but I am afraid that it will break the harsh Russian reality – lack of funds for equipment and technology and issues of intellectual property protection.
As for the electronic hospital, on this account, even was adopted a separate law. And for several months in the country with equal legal force, have paper and electronic sick-lists (while the choice of the citizens). Through e-hospital that will immediately be transferred to the social insurance Fund, the authorities hope to reduce the cost of accounting, to simplify the calculation of payments on insurance claims and reduce opportunities for fraud.
For the design of the hospital, the doctor will have to enter into the electronic patient card, enter information and certify its encrypted digital signature. Then the document via a secure communication channel is forwarded to the employer and to the Department of the social insurance Fund (SIF), which is fixed for the patient. The whole process of passing the hospital from the moment of registration prior to the receipt of payments on it can be tracked through your personal account on the Fund’s website, by registering on the portal of public services. The diagnosis on the certificate is not specified.
You can’t leave
By the end of the year was adopted the law on the consideration of the views of residents at the closure of rural hospitals. The draft law appeared in the year 2015, in the midst of “optimization” regional medicine and after the adoption in the first reading two years was discussed in the Duma. During this time the Committee on health do many complaints from more than 40 regions of the country: only in Zabaykalsky Krai in five years, reduced to 16 local hospitals.
Close, what remains would only be possible on the basis of the positive conclusion of a special Commission to assess the consequences of such a step. Such a Commission would be established in each region, will be included in her officials, deputies, medical and patient community. In addition, the law obliges to hold public hearings if we are talking about the only moderanization rural areas. How it will take into account the opinion of local residents, not specified (the format of the public hearing does not imply decision-making).
Meanwhile, optimization of health not a whim of local officials. Eliminating “unprofitable” medical institutions, the leaders are trying to save money and pay off debts. According to the accounting chamber of Russia, the debt load of medical institutions of the first level is 530 billion, and hopes the situation will improve not much.The health Ministry, however, claim to have managed to stop the wholesale decline of rural clinics and health centers.In 2017 the open 400 new 55 up medical cabinets and diagnostic rooms equipped on the car. And if at the beginning of 2017 lacked tasacion and rural clinics, then now this figure has decreased by half.
Policy for migrant
The health Ministry decided on the treatment of migrant workers: migrant workers from the countries of the Eurasian economic Union (Armenia, Belarus, Kyrgyzstan and Kazakhstan) will be provided in Russian policies full medical insurance within the base program of obligatory medical insurance. According to the interstate agreement, these policies not only cover the internal costs of employees for medical services, but will extend to members of their families. It is assumed that the pay policy for migrant workers is the employer, as is done for citizens of Russia.
To date, the condition of obtaining patents for labor migrants is the acquisition of VHI. But buying such a patent a few.According to official figures, now on the treatment of foreigners and the sick without the policy in Moscow spent nearly 2% of all health expenditures of the city.
HIV-lab on wheels
Last year, the Ministry of health has continued to expand testing for HIV. Among the know-how attached to the trains, following in the regions with high prevalence of HIV infection specially equipped cars, which can pass this test and get advice. The campaign is financed at the expense of the state strategy of combating the spread of HIV in Russia.
A late free-kick mayhem
Nice gift received in the past year physicians are already accustomed to the endless sanctions by the insurance companies. More they cannot penalize medical institutions for bad handwriting of doctors: “a defect in the documentation reviewed and fleshed out”, said Ffame.In addition, the imposition of sanctions on the results of examinations of the volume, timing and quality of medical care is now possible only after settlement of all disputes with hospitals. Reduced the list of grounds for carrying out of target examination of quality – now it is only in the most significant cases.The next step it is planned to unify the very examination of the quality of medical care that will ensure the objectivity of this examination.
Last year in the regions again made changes to the remuneration system. First, entered into force amendments to the Labour code of the Russian Federation has set a limit on the level of correlation between the salary of the administration and core staff of medical institutions. Determine the figure of the local authorities “on the basis of economic indicators of the subject.” And his breach became the basis for the dismissal of the head physician.
Secondly, the Ministry of health held the “work on mistakes”, admitting the imperfection of the existing remuneration system in which salary of employees with similar qualification, experience and position seriously vary and do not depend on the quality of work, and proximity to the boss. Regions are required to change the ratio at which the basic salary of a doctor was only 40%, and the rest was accounted for by incentive payments, to the opposite.
However, the administration of LPU have learned to circumvent the recommendations of the Ministry of health to reallocate payroll to fit into the new requirements, but did not change anything essentially. In the end, most of the regions, led by Moscow, we went by the same scenario: a bit of raising the minimum wage, sent under the knife of allowances to them for academic degree, experience, individual specialization, hazardous working conditions. Thus the management of medical institutions received more freedom in the assignment of incentive payments for performance and quality of work.
In General, in the five years since the “may decrees” of the President, officials and failed to reach the goals – to raise by 1 January 2018 the income of doctors to 200% of the average wage in the region. Not helped the consolidation of health facilities, no staff reduction, nor the development of paid services. According to the official statistics of Rosstat, this indicator depending on the region ranges about 151% to 174%, the surveys of independent experts show twice smaller numbers.