Insurance, labeling of medicines and the new rules of medical examination: where will we be in 2018

In 2018, the Ministry plans to launch pilot projects on medical insurance and start a total labeling of drugs. Doctors are waiting for the new specialty and the help of artificial intelligence. Patients access to electronic medical records, the return of the practice of dispensary observation and treatment in private clinics in the OMS.

New state guarantees

In the government-approved Program of state guarantees free medical care for the year 2018, there were some fundamental changes. So, the local budget comes the responsibility of transporting patients with chronic renal failure to dialysis and back. The region that gives the patient will have to reimburse the region in which it actually resides, the costs associated with its provision of narcotic drugs and psychotropic substances.

In the framework of the MLA starts financing of follow-up, which was abolished with the advent of health insurance. Put on record of patients suffering from chronic,socially significant and representing danger for surrounding diseases. And available medical care for the first time related the number of visits the visiting palliative service at home and the proportion of women who underwent in vitro fertilization.

“Pilots” of drug insurance

Next year the country will start pilot projects to test the possible schemes for drug insurance. The Ministry of health is developing several models for such insurance, but the main purpose of the system is that will not average of purchases, and each person with a prescription can Poluchite what he needs. Often regions are not able to calculate precisely the demand, and part of purchased drugs remains unclaimed, at the same time, some other drugs on the contrary is not enough. A more rational системалекобеспеченияпредполагает waiver of procurement and compensation of cost of purchased drugs by patients.

Today subsidised medicines receives 12.3% of Russians. Most patients have to buy medicines at their own expense, but often do not buy and are not treated.Thus, almost all developed stramongate doctor of medicine are included in health insurance. Somewhere they are completely free for patients, somewhere in there is a fixed co-payments or payment percentage of the price. But most importantly, the patients receive adequate treatment. “Next year we will resolve the issue with the monetization, subliminally benefits and of course financial sources – promised, speaking at the VIII all-Russian Congress of patients the Director of the Department of drug provision and regulation of circulation of medical products of Ministry of health Elena Maksimkina. – Gradenumber to understand that they should jointly be responsible for the quality of provision of medicines of the total population of the Russian Federation, even if they don’t need it”.

Labeling of drugs

In 2018 will start labeling medications that will last, according to the recently adopted law by 2020. Introduced new system will be in stages: first promarkers the most expensive drugs, and then cheaper. Medication lower price range (it costs less than 50 rubles) will receive the mark of the end of 2019. Private labeling need to monitor the movement of drugs from the manufacturer to the end user and can be considered as an analogue of excise stamps. Due to this each package of medication that belongs to a particular party, can be tracked from the date of issue up to the pharmacy counter. In the future, marking 100% of the manufactured medicines, the monitoring system will keep track of about six billion packages per year and will cover more than 350 thousand participants of turnover, among which more than 1,000 domestic and foreign manufacturers of medicines, more than 100 thousand medical and 250 thousand drugstores.

New in the clinical examination

From 1 January 2018 changes the order of the clinical examination of the adult population. In which approved a new Procedure for the order of Ministry of health dated 26 October 2017 N 869н seriously to adjust the list of clinical examinations. In particular, the first stage of clinical examination, which revealed the risks of a disease will be excluded urinalysis, clinical and biochemical blood analyses, ultrasonography (us) in order to exclude tumors of abdominal cavity organs, small pelvis and abdominal aortic aneurysms and some other studies. “Optimized”, and the second stage of dispanserization. For example, from the list of tests removed determine the concentration of glycated hemoglobin in the blood or a test of glucose tolerance for patients in the first stage showed increase in the level of glucose in the blood.

Other innovations include the assignment of high cholesterol to risk factors of chronic noncommunicable diseases. Moreover, the identification of hypercholesterolemia as a risk factor named as one of the purposes of the examination. Mammography for women aged 51 to 69 years and fecal occult blood for citizens aged 49 to 73 years will now be carried out more often – once in two, not in three years. Paramedics, health posts, or FAPs ordered to further define cardiovascular risk and conduct individual preventative counseling patients.

Patient rate

Next year the Finance Ministry plans to reform the system of mandatory health insurance so that insurance could be used in both public and private medical institutions. The main task, which is proposed to solve the reform –partial payment of commercial medical services. If the owner of the insurance wants to undergo treatment at a private clinic, then the costs will be for insurance to cover the state, and the rest of the patient to pay for it. Currently, any private hospital can join the medical insurance system and start of the reception of citizens on the policies, however, co-financing of the expenses of citizens and the state from within the system is impossible. And patients consulting in private clinics, are forced to pay for treatment completely out of pocket, despite the presence of medical insurance, according to the Finance Ministry.

Previously, the Agency has repeatedly offered to patients to participate in treatment, stating that for the full insurance model, financial risks have to share the insurance company and patients. The government instructed the Ministry “to study” proposals for the reduction of free medical care. But neither the health Ministry nor FFOMS such drastic measures are not supported. This time the Ministry of Finance decided to go to the other side and found understanding.

Everyone should know

Starting in 2018, the Russians will be able to know the cost of provided medical services in the personal Cabinet of the patient on the portal. Still it was possible to get information about themselves free of charge (to the patient, but not the state) medical services and make an appointment to see a doctor.

Nothing new in this, however, is not to inform patients about the cost of their doctor visits and services that a medical institution was obliged three years ago. Each patient after a visit to the clinic or discharge from the hospital were given certificates of spent treatment media. It was assumed that this system will allow you to get away from the “additions” and citizens who do not think about the real cost of treatment and takes him for granted, finally realizing that the government takes care of them. In fact, with these unnecessary and completely senseless paperwork was so much hassle that eventually all come to naught. Now, however, if the system will work co-financing of treatment from private owners in the insurance, this information can be useful.

In addition, all registered users will receive access to their electronic medical records. Planned a series connection of several modules of the personal account, which will allow you to get into e-map and obtain a discharge summary and to access via the discharge summary to the medical records.

New medical specialties and artificial intelligence to help the doctor

In 2018 will be four new medical specialty. The first MSMU named after I. M. Sechenov will start to prepare experts for professions: network physician, IT physician, a specialist in tissue engineering and molecular nutritionist. Four “specialties of the future” will be introduced in the course of post-graduate training from next academic year, and in the future they will be formed in individual areas of training in a bachelor degree. “Specialists of the future generation”, which will appear after 5 years, will have to own the tools of genetic research and analysis of large databases is required, including for the early diagnosis of preclinical manifestations of the disease.

And now to help the doctors plan to connect a system to support medical decision-making. Artificial intelligence using clinical protocols and large amounts of data, will help in diagnosis and choice of algorithm of examination and treatment, not allowing the doctor to make a mistake. It is planned to start with two disciplines – Oncology and neonatology.