Tatarstan recognized as the model of primary health care organization

The exemplary primary healthcare

Kazan has been chosen as the venue for the Russian public hearings on the modernization of health care for a reason. As it turned out, it is the Tatarstan experience that is expected to be adopted in the near future and extended to other Russian regions. At a press conference before the hearing, Chairman of the State Duma Committee on Healthcare Dmitry Morozov spoke out not just approvingly but enthusiastically on the level of organization of primary healthcare in Tatarstan, not yet cooled down after a tour around the newly opened outpatient clinic in Peschanye Kovali:

It is pleasant to immerse yourself into this space — the space of Tatarstan healthcare... That medical outpatient clinic that we have visited — it is even difficult for me to dream, what else can I add?! What we have seen I believe to be a worthy response to the challenges of the time in terms of primary care.

According to the second participant of the press conference, State Duma Deputy from Tatarstan Boris Mendelevich, the basis in the national project Healthcare is the programme of modernization of primary healthcare:

Without primary healthcare, our healthcare will definitely not move forward. The national project has already allocated about 62 billion rubles to improve primary care for six years. And the programme that is being discussed goes beyond the national project... There is already a movement, and I think that it should join the national project and its funding can seriously increase.

Mendelevich said that there are a lot of complaints about the quality of medical care in the Russian regions, but if you look closely, it turns out that 90 per cent of complaints about health care concerns the primary care. And it is fair to improve it in the first place to relieve this tension.

A hundred times to tell and at least one time to show

Dmitry Morozov noted that Tatarstan is one of the few subjects [of the Russian Federation], which not only did not destroy the system of medical and obstetric stations but was even multiplying it all the time, which testifies to the correctness of management decisions taken in the republic.

We well understand that the decisions taken at the federal level are implemented, first of all, at the local level, and for each our citizen living in a town or in a small settlement, village, those changes are important that occur at the local level, personally for him or her, Morozov emphasized. He immediately proposed the idea that had just come to his head, as he said: to hold in the State Duma an exhibition of healthcare of Tatarstan — the ins and outs, from primary care to the HTMC (High Tech Medical Care — editors note). Colleagues can really show this practice in a complex, let other subjects look…

As it turned out, the head of the Duma Committee on Health Protection considers, first of all, the work with people as the zone of responsibility, that is, considers it important and necessary to tell the population about modern opportunities and achievements of medicine, and at the same time, about how all this can be used by an ordinary citizen:

The explanation of the programme of state guarantees, explanation of rights and obligations, healthy lifestyle — without this, the problem cannot be solved.

The fate of the resident

Both at the press conference and later, during the public discussion of the aspects of modernization of primary medical care, it was repeatedly stressed that against the background of large-scale state programmes, which provide for multi-billion-dollar spending on re-equipment of medicine, the main problem of state medicine is still a personnel shortage.

On the question of Realnoe Vremya why, despite all the efforts to attract cadres and, first and foremost, specialists to primary care, the same clinic in Peschanye Kovali, like many Russian institutions, remains underequipped, Morozov said that he could not be delved into the subject in advance» with this particular lab, and therefore, cannot be responsible for it.

It's a difficult situation across the country, he agreed. There are about 25,000 doctors and about 135,000 middle-level workers lacking. This situation did not appear today or yesterday, we constantly tell about it. The president of Russia has set the task to eliminate this deficit by 2025. The subjects have been instructed to ensure an annual increase in the training of secondary medical personnel by at least 30 per cent of the required volume. But we have to make flexible personnel decisions based on the fact that the system is changing. Many of the tasks of primary care absolutely adequately and competently can be addressed by paramedics. The president has set the task for the regions to provide housing conditions for medical workers so that a decade later they could privatize these apartments.

Morozov also pointed out that targeted training can solve the problem of personnel shortage. He did not give figures but assured that the number of target students in Russian medical schools is very low, and said that now the president has given the Russian ministry of healthcare the right to maintain their register to track them and introduce the residency institute.

How they do it abroad — a doctor, graduating from college, comes to the clinic for 3 years to get experience, to become a doctor, the head of the Duma Committee actually explained the Soviet scheme of postgraduate distribution, when a medic trained for the state account, no matter whether he or she wanted or not — had to work for established law term at the place where he or she had been distributed. And then, I believe, from next year, we will have a significant level of staffing [in primary care setting].

The problem is the lack of information support

Earlier, Boris Mendelevich told the correspondent of Realnoe Vremya that in order for the primary care to work in full force, we need not only equipment and personnel, but also a reasonable organization of work, which would exclude duplication, for example, when delivering medical tests for hospitalization. The first time they deliver them in a polyclinic, the second — in a dispensary, twice paying for the procedure from CHI funds just because the hospital do not believe the results others laboratory (or feel the need to bite off their part of the pie of the CHI). There were also situations when patients lose precious time waiting for a diagnosis, for which it is necessary to wait for weeks for a planned appointment with a therapist, who appoint to a specialist, and so on.

But having listened to the question of Realnoe Vremya whether it is supposed during modernization of primary care to exclude duplication and to reduce this passing move, Dmitry Morozov started talking that in the West the patient even to the therapist gets only through the nurse who writes out the direction to laboratory for analyses — without them the doctor simply won't see you. Although today the Russian model is not a bit like the rational Western one. They have an economical way of spending money: tests and examinations — a therapist — a narrow specialist. In Russia, it is an extremely uneconomical and three times longer way: therapist — analyses and examinations — therapist — specialist — again analyses and examinations — again specialist.

According to the chairman of the Duma Committee, the main problem lies in another plane:

We 50 per cent failed information support of work. Because we don't explain to people how it should be!

He promised that in 2-3 years, when a single information system works, in which the results of analyses and surveys will be loaded, they will be legitimate everywhere and then there will be no duplication.

Deceitful statistics

The participants of the public hearings — representatives of different Russian regions put the personnel shortage in the first place among the problems of the primary level of medicine and dedicated the most time on the analysis of its causes.

Most often, they pointed out that, assessing the provision of outpatient personnel, statistics are deceitful — take into account both vacationers and women on maternity leave and those on sick leave. And the burden on them — the population — is not counted by the number of people, that is, the real number of patients in the area, including migrants, and, as they say, on the residence permit. As a result, the shortage of personnel is downplayed, and the situation is embellished.

The same happens with the salaries of physicians, which in the public sector is much lower than in private clinics, which predetermines the outflow of medical personnel in paid medicine. As confirmed, answering the questions of the participants of the public hearings, Deputy Director of the Department of Remuneration, Labour Relations and Social Partnership of the Ministry of Labour of Russia Sergey Gorbarets, statistics takes into account the remuneration of doctors regardless of labour costs — by overall result. As a result, the average salary in the statistical reports looks decent, and the doctor gets these amounts at the cost of incredible overtime, despite the fact that working full-time, without overload, he would get paid peanuts.