''Everyone needs public money'': healthcare business asks Ministry of Health for support
The implementation of a united information system in Tatarstan health care might result in mass dismissal of doctors
At a meeting of entrepreneurs from the health care business with Vice Health Minister of Tatarstan Ayrat Garipov on 9 February, it was discussed how private medical establishments can approach the ''pie'' of compulsory medical insurance, what the Ministry of Health can do to help local medical equipment manufacturers and why checks of supervising agencies are not always evil. Realnoe Vremya's correspondent observed the dialogue.
Not the one they expected
Entrepreneurs had been waiting for a meeting with the top figure in the ministry. And when it became clear that urgent business impeded Marat Sadykov from coming, the participants' faces ''became angry'', like organiser of the event, Entrepreneurs' Rights Commissioner for the President of the Republic of Tatarstan Timur Nagumanov said.
The ice was broken when in the course of the dialogue Ayrat Garipov began to clearly and frankly answer questions. But he obviously was out of his depth in some issues. However, he offered:
''If somebody still has questions, the minister asked to communicate he is waiting for everyone in the Ministry of Health today at 3 o'clock.''
National project as obstacle
''We've made the first step – this year we've tried to adopt a territorial programme on compulsory medical insurance on time,'' Garipov defused the tension. ''The programme was adopted later and later year after year. I've brought a book with the programme, it has never been born in January… This also indicates that things are put in order.''
''Money probably is the first question. Everyone needs public money, transparency and specificity are needed here,'' Timur Nagumanov opened the ''talks''. ''The first part of questions is about compulsory medical insurance.''
''We wanted to try to take part in the CMI programme,'' director of Dent Master clinic and diagnostic centre from Bugulma Lilia Khakimov stood up. ''We collected necessary documents, but we were said we first needed to agree with officials of the State Autonomous Health Care Institution on it… We know they can't nix in general. But they don't provide with volumes! Minister Vafin cited that private clinics accepted only profitable volumes of help, which is well paid. And why not? State clinics receive state support, while we don't. How can we develop?''
A colleague supported Khakimova from his place:
''We want to work, but we can't. An admission ticket in private medicine is expensive: rent of space, equipment – everything is at our expense… We wanted to apply with infant orthopaedics, did screenings last year. It turned out that only 14% of children are in good health. We did it through schools. It's very hard for us to enter schools because we go for money. And the prosecutor's office is working seriously now – no fees at schools…''
''He means this could be done through the CMI free,'' Khakimova specified.
''When creating the territorial programmes, the volumes [of funding] are distributed in accordance with regulations per capita,'' the vice-minister replied. ''This is who the CMI's fund is formed, a certain sum of money is raised… Everything seems simple – distribution by volumes and so on. But national projects have appeared, and we have been set certain indicators. The most important thing in medical help is life span, mortality. When creating a programme, the needs of primary health care are met first of all. As for the agreement with the State Autonomous Health Care Institution on participation in the CMI programme, it's not needed, of course.''
Garipov promised to consider the issue on screening of children, but didn't promise to do it quickly.
Surplus isn't profit yet
Ophthalmologist Aleksandr Raschyoskov asked a question about the use of CMI money to purchase equipment – no more than 100,000 rubles can be spent on this a year, while equipment costs millions:
''How can this sum be raised?''
''The list of costs is defined by federal legislation. Legislative initiative is a long road, and once can face some obstacles at the top,'' the vice-minister noted and enumerated areas where, in his opinion, there is room for private clinics to participate in the CMI programme. He also showed a bypass when funding equipment purchases. ''Ophthalmology is a very interesting sphere for public and private partnership, oncology, IVF, dialysis, traumatology are closer to business. The concessionary scheme has a possibility to compensate costs on equipment because you didn't get this money through the CMI. This, for example, would allow to reduce the for cataract surgery queue.''
''What should I start with?''
''I think with your proposals, you are applying not for one kind of help, for instance, cataract surgery but fully – outpatient examination, the whole range – and help to service a certain flow of the population.''
''I understand the position of the Ministry of Health. As it's said, after dinner comes the reckoning. But what is dinner and what is the reckoning? There must be a clear list. What if he does five things out of ten?''
In the end, they agreed to analyse the situation with the example of Raschyoskov's clinic.
Private dentists complained about the impossibility to keep honestly earned money – a surplus that clinics working with the CMI programme have at the end of a year – to spend to purchase equipment. However, the vice-minister cited the frames federal legislation sets and noted that public establishments had the same problem.
Most importantly, not to discredit medicine
''I support making all medicine private because this would favour competition,'' Ayrat Garipov expressed a ''disruptive'' thought, as he said himself. ''But this is impossible because there is no public leverage. Any environment has people who discredit other people.''
''Are your colleagues in the ministry aware of it?'' even Timur Nagumanov was slightly taken aback.
''Yes, but the ministry doesn't consist of a minister and a vice-minister… It consists of a big number of people who influence decision-making.''
''Some clinics offer services with CMI to patients who come for IVF, bypassing the Ministry of Health's commission. Will such a service be paid by the CMI?'' representative of The Nuriyevs Clinic Rustem Khamitov asked.
''Of course, quotas aren't enough, but it's impossible at the moment to additionally allocate money on this,'' Garipov replied choosing words. ''Let me report to the minister, and we will meet separately.''
''In the republic, we have one queue in the Republican Clinical Ophthalmologic Hospital,'' representative of Prozrenie vision correction centre Rustem Latypov joined the conversation.
''Compared to neighbouring territories, in Naberezhnye Chelny, there were allocated much fewer quotas on cataract extraction. And this happens systematically. Our questions arise because of the non-transparency of the territorial programme. We don't understand how money is allocated. And ordinary citizens can't see which establishments have such-and-such quotas. In other regions, for instance, in Petersburg, this programme is in public domain, while we're sent a line from the table. This is done consciously: the information is deliberately hidden. I understand why this is done, but this isn't fair.''
''The question is clear. Perhaps, yes, it would be more convenient because we understood there was an established system when a state order needed to be, first of all, distributed among public establishments,'' Garipov admitted. ''But the situation is changing now. The creation of the Waiting List united information system in ophthalmology will probably become a solution. We understand we have a long queue. But it's hard to evaluate it accurately because there is ambiguity – one and the same person can be supervised in two cities, while he can undergo surgery and don't leave the queue. We hope we will have an open system from a perspective of money in the first half.''
The vice-minister also stressed that a big number of Tatarstan patients underwent surgery in neighbouring regions, while the ministry wants money to remain in the republic.
Terms of reference impede a local supplier
Director General of the Kazan Medical Instruments Factory JSC Nur Shakirov asked the vice health minister for special support. He complained that foreign doctors recognise his enterprise's products have a good quality, but local medical establishments don't buy them.
Ayrat Garipova disagreed that terms of reference decide everything in state procurement that a manufacturer should ''fit''.
Part-timers, go out!
The news about the creation of the united information system in the republic's health care became painful for medical entrepreneurs. As it turned out that doctors are afraid that officials of public clinics will be aware of their employees' second job in their free time in commercial establishments.
One of the participants of the meeting explained the cause of this fear to Realnoe Vremya's correspondent on condition of anonymity. According to him, head physicians of state autonomous health care institutions were given an unofficial order from the top to dismiss such part-timers, and they rigorously comply with it – also under threat of losing the post.
''Head physicians forbid part-time jobs, and now they will know everything,'' vice-director of Avitsenna-Endocrinology Olga Konovola said this to the vice-minister of health care, and colleagues supported her.
Garipov's assurances that ''if an amazing doctor has a part-time job without violating legislation, the head physician won't want to lose him'' didn't sound convincing.
A two-edged check
A speech during which the meeting's participants asked how the ministry of health was going to solve the problem of dishonest rivals – private dentists, narcologists, paediatricians, beauticians, masseurs and others specialists working from home and dumping in the market due to the absence of serious costs – became a cause of a heated discussion.
''The Ministry of Health isn't responsible for the grey narcology market,'' Garipov kept at bay.
While head of the regional agency of the Federal Service for Surveillance in Healthcare Lyubov Shaikutdinova who participated in the meeting promised test purchases and mass checks in the short run. But a part of businesspeople has already taken a back seat and started to say that checks impede from working, as they are aimed at collecting fines, not preventing violations.