Free medicine
In the near future, the bill prepared by the FAS will be submitted to the State Duma for discussion. The deplorable state of Russian free medicine is confirmed by the latest data from Roszdravnadzor. Nevertheless, the relevance and timeliness of the antimonopoly agency's initiative are highly questionable.
The legacy of the "dashing nineties"The main arguments in favor of the proposed ban, voiced by the head of the Department of Control of the Social sphere and Trade of the Federal Antimonopoly Service Timofey Nizhegorodtsev, are given in an article published by the newspaper (GZT.ru ).
According to the official, the introduction of paid medical services in state medical institutions was a forced measure dictated by insufficient financing of domestic healthcare in the 90s of the last century. Now, according to the FAS, such services only bring harm: they "distort the market, support unfair competition, and, finally, "corrupt doctors."
According to the FAS, the availability of paid services in public hospitals creates an unhealthy situation in the market: medical institutions receiving funding, equipment and benefits from the state are in obviously more favorable conditions compared to private clinics. In particular, working conditions in state medical institutions are more attractive for a number of specialists than the field of commercial medicine. In this regard, the FAS proposes to allow private clinics to join the compulsory medical insurance system (OMC), that is, to allow them to receive money for the treatment of patients from the state.
Obviously, the current situation with the financing of healthcare seems to the supporters of the ban to be completely cloudless, and certainly in no way comparable to the "dashing nineties". But the "attractiveness" of working in public health can be judged by the recently published salary table of doctors.
The more free, the more expensiveRoszdravnadzor is also concerned about the unhealthy situation in state medical institutions.
During a four–month inspection conducted by the agency in more than 1.3 thousand hospitals and polyclinics of the country, "widespread and gross" violations of the established rules for providing paid medical care were revealed - patients are increasingly being charged for treatment, which by law should be free.
Money from patients is taken for almost all types of medical care, including emergency. The so-called centers of high-tech medical care are also actively engaged in providing paid services, the commercialization of which, it would seem, contradicts their direct purpose. In accordance with the plans of the Ministry of Health and Social Development, such centers should contribute to the widespread increase in the availability of the latest medical technologies for Russians.
According to Roszdravnadzor inspections in Moscow centers providing high-tech medical care, the share of paid services in them exceeds 70 percent. The cost of paid stay in such institutions is not comparable with ordinary medical institutions: if hospitalization in a district hospital costs several hundred rubles a day, then in high-tech centers this amount increases to several hundred dollars. In both cases, medical and diagnostic procedures are paid separately.
Neither Russian citizenship nor a compulsory medical insurance policy saves patients from solving financial issues in state medical institutions: the hospital administration can always refer to queues and lack of places. It is also no secret that the level of treatment on a commercial basis is usually practically no different from what few "free" patients receive by law.
Not from the good lifeThe head of the Department of priority national projects of Roszdravnadzor, Yevgeny Nikonov, quoted by Vremya Novosti, sees the reasons for the current situation in the same insufficient financing of health facilities, primarily from the mandatory medical insurance program.
According to the official, the needs of the industry exceed the actual financing of medicine by at least two and a half times. For example, the payments that the CHI system offers hospitals for the treatment of citizens are several times less than the real market value of medical services. It is clear that hospitals are doing everything possible to minimize the flow of such patients. Recall also that the actual absence of a functioning health insurance system in Russia was recognized in his recent address to the Federal Assembly by the President of the Russian Federation Dmitry Medvedev.
It won't get cheaperThe increasing commercialization of state medical institutions is quite justifiably worrying the FAS.
At the same time, attempts to remedy the situation with prohibitive measures are unlikely to lead to the desired result. Having lost the opportunity to earn money on paid services, state medical institutions will simply stop making ends meet. In order to survive, they will have to finally move into the shadow sector of the economy. Ordinary doctors, whose surcharges for the treatment of paid patients, by the way, are usually very small, will remain without an additional source of income. This will lead to an increase in the already obscenely high level of corruption in domestic medicine.
The involvement of commercial clinics in the state order for medical care of the population will not save the situation either – the rules of the game that the state offers are simply unprofitable for them. The transition to real, not symbolic, financing of medical care within the framework of compulsory medical insurance can normalize the situation. Such a measure will certainly save medical institutions from having to close holes in the budget at the expense of patients. However, whether the state has enough funds for this in a crisis remains unknown.
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17.11.2008