Boris Mendelevich: “We need to administer huge funding resources properly”
What forecasts for the development of healthcare in Russia can be made based on Putin's answers at the press conference
Russian President Vladimir Putin held big annual year-end press conference. It has been the 15th meeting of the state's leader with journalists in this format. The conversation lasted 4 hours and 18 minutes and broke the record for the number of accredited media representatives. Boris Mendelevich, the deputy of the State Duma from Tatarstan, psychiatrist, commented on what changes in healthcare await us especially for Realnoe Vremya.
The healthcare model stays the same
This means that the basic principles under which Russian medicine functions will remain the same. First, the division into stages will be preserved: primary healthcare, secondary care, technologically advanced assistance, rehabilitation assistance, etc. This system distributes the flows of patients.
Second, the insurance system will remain: all citizens of the Russian Federation are insured under the system of compulsory health insurance. This enables people to receive medical services conditionally free of charge: one should understand that the employer makes contributions to the Compulsory Medical Insurance Fund (5,1%).
Third, in Russia, the share of state and municipal medical institutions prevails over private ones. For the patient, there is an advantage in this: as a rule, non-state clinics, even if they are included in the compulsory medical insurance (OMS) system, take only liquid directions that make a profit. Illiquid medical directions, for which the tariff does not allow to get the maximum profit, remain in state institutions. Most often it is ambulatory care at polyclinics.
These are the three main criteria that determine the model of healthcare in Russia. And it, as the president said, will remain the same but will be modernized.
In my opinion, wage formation should be transparent and comprehensible to all. Besides, basic salary should be expressed in money, not in percentage, so that there is a clear specific amount. Remuneration system of public servants, which has clear principles and formation, could be used as a model
Vladimir Putin acknowledged that the level of salaries in healthcare is quite high compared to other social sectors. But the president also noted that this is “in the ballpark”. There is a request to develop a basic tariff and to create an approach to incentive payments.
The issue of returning to a single job evaluation system is the most important in the sector. Unfortunately, wages are fully regulated by chief doctors yet, which leads to imbalance. It often happens that healthcare workers can receive completely different wages in the same city for the same work. Wage also varies by region. As the president of Russia already noted, it is necessary to create a unified approach both to salaries and to bonus payments throughout the country.
In my opinion, wage formation should be transparent and comprehensible to all. Besides, basic salary should be expressed in money, not in percentage, so that there is a clear specific amount. Remuneration system of public servants, which has clear principles and formation, could be used as a model.
At the same time, it is necessary to encourage doctors to be more engaged in disease prevention and to tie the financing of medical institutions to a number of healthy instead of sick people in the zone of their responsibility.
At the same time, it is necessary to encourage doctors to be more engaged in disease prevention and to tie the financing of medical institutions to a number of healthy instead of sick people in the zone of their responsibility
Another 550 million for primary care
Polyclinics, medical and obstetric stations are the first medical institutions where people turn when they get sick. The president stressed that it is necessary to change the situation in primary healthcare significantly and that in general people should receive medical care free of charge. This is a very important point.
Indeed, much work is underway to modernize primary care. The entire federal project is being implemented in this area within the framework of the national project. Besides, an additional 550 million rubles will be allocated.
To date, the situation is as follows. According to the ministry of healthcare, the number of facilities in primary care increased by 2,000 from 2014 to 2018. In total, there are more than 60,000 departments in the country. At the same time, only polyclinics are experiencing a shortage of more than 25,000 doctors and about 130,000 nurses and other representatives of mid-level staff.
We have considered the issue of primary care at meetings of the working group on monitoring of Healthcare national project, which I lead, in the State Duma. It turned out that there are four main problems — the lack of a license for already built medical and obstetric centres, lack of budget commitments of the subjects of the Russian Federation to buying mobile complexes, lack of medical personnel and poor organization of field work.
Detailed work is underway on each of these points, proposals are being collected, and the experience of the regions is being studied. For example, in the issue of staff shortage, there is a good practice of Tatarstan, where the polyclinic-hospital binding works effectively, and if there is a shortage of specialists in one of the polyclinics — a patient is transferred to a specialist in the hospital the polyclinic is affiliated with.
The president stressed that it is necessary to change the situation in primary healthcare significantly and that in general people should receive medical care free of charge. This is a very important point
The issue of the availability of medicines remains relevant. I think there is no person in the country who would not have heard about the problems with their supplies — this is the actions of law enforcement agencies against people who bought drugs abroad, and the lack of drugs that must be issued free of charge.
The president noted that Russians must have the opportunity to receive drugs of foreign production because patients become get used to certain drugs. He also stressed that drugs for the treatment of orphan diseases should be registered in Russia.
In conjunction with the recently adopted bill in the State Duma in the third (final) reading on the interchangeability of medicines, the problem should be solved systematically. The bill clarifies the terms “original drug” (the drug that was first synthesized and patented) and “generic” (the production of a drug by companies that did not develop the formula but took it as a basis). In Russia, there is still skepticism about generics, but all over the world it is due to them the cost of drugs is reduced — therefore their availability is increased.
Second, there will appear the right to buy drugs not registered in Russia (for life-threatening reasons). But it is too early to say that the problem is close to a final solution: the conclusion about the effectiveness of the measures taken to regulate the pharmaceutical market can be given only after some time.
In summary, I would like to note that the country's top leadership has never paid such unprecedented attention to the healthcare sector. On the one hand, this is a huge trust, on the other — a great responsibility that falls on the medical community as a whole. Now, first of all, it is necessary to organize the whole process properly. I am deeply convinced that all the financial resources that are poured into the industry can and even should be used as efficiently as possible. And in many respects the question is in the proper distribution of finances.
We need people to be involved in solving healthcare problems and, most importantly, in taking measures to preserve health
Another point I would like to draw your attention to: medicine is a two-way road. If only the state moves, we will not get the main result — quality health care. Clearly, we need people's participation in solving health problems and, most importantly, in taking measures to preserve their health.