Authorization/Registration
Thu, December 22, 2016
About the newspaper Subscription ARCHIVE Articles Our promotions Information Contacts
Search on the site:
Home | No. 87 of November 11, 2011.
Among the pros and cons
A unique feature of healthcare in Russia is the ideological dual power that hinders the effective development of the medical system and requires scientific permission.
It is based on the confrontation between the North American and Russian (Soviet) medical cultures.
According to the first, medicine is an economic sphere, a kind of business.
The dominance of this approach is fixed by liberal politicians in the insurance model of healthcare.
According to the second, medicine is a sphere of selfless service to a suffering person.
This approach dominates in the souls and minds of doctors, fixed by domestic traditions and textbooks of classics.
The forces of both sides are approximately equal, and which one will prevail depends on society.
We will outline the pros and cons of each.
Between earning money and serving?
In American medical practice, the main incentive for professional development is money.
Work harder and better to become richer.
A doctor is a provider of medical services, a patient is a consumer.
Therefore, the relations between them are based on market principles.
In Russian culture, the determining motive of medical activity is conscience, duty, service - treat the patient the way you would like to be treated.
A priest and a doctor are two specialties before which you can pour out the pain of a suffering soul.
If communicating with a doctor does not make the patient feel better, you are a bad doctor.
Serve people more and better, and your care will be appreciated financially.
The choice of the insurance model of healthcare by politicians was justified by references to Western countries that use this system as more effective.
This statement does not correspond to reality, since both models interact competitively in Western Europe.
Mainly budget funded healthcare exists in the UK, Denmark, Iceland, Norway, Finland, Sweden, Greece, Italy, Portugal, Spain.
The insurance model is mainly used in Austria, Belgium, France, Germany, Israel, the Netherlands, Switzerland, and Turkey.
At the same time, there were no transitions from the first to the second, and a number of countries, including the United Kingdom, moved from the second to the first.
The main argument for introducing the market into medicine was the hope of attracting additional investments to low budget financing with the help of the mandatory medical insurance fund.
But this did not happen.
The reserves of the FOMS are formed not at the expense of its market activity, but thanks to solid deductions from the wages of the working population.
If the FMS disappears, the deductions will not stop.
In fact, this is budget money, which for some reason is sent not to healthcare, but to intermediaries.
To treat more or to keep more healthy?
The transfer to market mechanisms makes healthcare uninterested in preventive work.
Payment for medical services is "short" money, and payment for preventive services is "long" money, the result of the investment of which you have to wait a long time, sometimes for years.
The dominance of the principle of "money after the patient" makes it unprofitable to engage in prevention, because the more patients, the higher the income.
Based on the monetary interest, American healthcare does not engage in preventive work, hiding this bitter truth behind a veil of demagogic statements.
Prevention is declared, but not implemented.
From the very beginning, domestic healthcare has developed in the interaction of medical and sanitary services.
Medical examination, proposed in the 20-30s, was an important part of the health care system.
The priority of the USSR in the development of social and medical prevention was recognized by WHO at the Alma Ata Conference in 1978.
Quality – for everyone or for the chosen ones?
In the American model, the availability of high quality medical care depends on the well being of patients.
Based on market principles, it inevitably differentiates into medicine for the rich and the poor.
High – quality service is provided to wealthy citizens, everything else is provided to the poor.
Therefore, in modern Russia, the ratio of public and private spending on treatment is almost equal.
The domestic school is focused on the free provision of medical services and the fairness of their distribution.
The goal of healthcare is to obtain the maximum health effect per unit of invested funds with a fair distribution.
Creative approach or strict standards?
The basis of the behavior of an American doctor is following the prescribed standards.
In turn, the activities of insurers and supervisors are impossible without strict regulation of medical and diagnostic work.
Here it is required not to think about individually effective ways of treating the patient, but to follow the prescribed instructions.
Otherwise, the doctor risks being punished by insurance companies.
The Russian school uses not only solid knowledge and standards, but also personal experience and intuition, providing the doctor with the right to be a performer and a creator at the same time.
Here it is required to "treat not the disease, but the patient".
Is distrust good or evil?
It was believed that the insurance model would improve the quality of medical work due to the control functions of insurers.
This did not happen, because the control is not subject to the work of a doctor, not the results of his medical activity, but the quality of maintaining medical records.
Doctors are suffocating from the bureaucratization of work, when there is no time left for human relations with the patient, especially for reflection.
The refusal to trust one category of medical doctors raises doubts about the decency of another category the experts themselves.
As a result, it will be necessary to introduce control over the controllers, which will ultimately lead to absurdity.
By creating a chain of intermediaries, the insurance system increases the bureaucratization of the management apparatus.
The same defects also affect the certification of medical institutions, which is carried out not according to the actual state of affairs, but according to easily falsified documents.
Are managers professionals or financiers?
It is argued that the effectiveness of the health care facilities should be evaluated not by medical, but by economic indicators.
Accordingly, it is not doctors trained for administrative work who should manage polyclinics, hospitals, maternity hospitals, but financial managers.
Even the head of the Ministry of Health is entrusted not to a medical professional, but to a financier and economist.
Undoubtedly, money is an important condition for the effective work of medical and preventive institutions.
The goal should be to improve the quality of diagnosis and treatment.
Forcibly turning into businessmen, doctors are forced to subordinate their actions to market logic, realizing the unethical primacy of monetary interests in relations with patients.
Commercialization forces doctors to be interested in increasing the number of patients, since their work is paid according to the number of treated patients.
It is beneficial for the doctor that the disease is more severe, and the patient has more concomitant diseases, since this increases the cost of the service provided.
The doctor is not interested in curing an acute illness, but in transferring it to a chronic state so that the patient goes to him all his life.
Evaluating the success of a doctor by the amount of money earned, market healthcare forces to carry out more diagnostic procedures, perform more operations, prescribe more expensive medicines.
Every year, surgeons around the world remove hundreds of thousands of healthy organs: uteruses, mammary glands, prostates, etc.on the false assumption of the presence of neoplasms.
In Russia, a cesarean section is now performed on almost every fourth and fifth woman in labor, whereas before it was a rarity.
The declared free choice of a doctor is a demagogic phrase, behind which there is no mechanism for its implementation.
In order to correctly choose a doctor or a medical institution, the patient must know all their advantages and disadvantages.
He does not have such an opportunity due to the lack of a mechanism for collecting full fledged information.
It's like offering air passengers the freedom to choose an airplane pilot according to the criteria of a good voice and a smart uniform.
As a result, a courteous dilettante from medicine will be considered a good doctor, and a rude person, but a great professional, will be considered a bad one.
The mistakes of choice also extend to the preference for expensive medical institutions, because more expensive services are not necessarily better.
Even accounting for complications in hospitals does not serve as a universal criterion for the effectiveness of their activities.
If the institution accepts more serious patients, complications and deaths are more likely to occur there.
Therefore, in the pursuit of monetary profit, hospitals will stop taking difficult patients.
Which model is preferable for the population of Russia, if each has advantages and disadvantages?
The main advantages of health insurance are higher technical equipment and greater responsibility of the doctor to the patient.
The disadvantages include less fairness in the distribution of services, dehumanization of the doctor - patient relationship, pronounced bureaucratization and corruption of the system, high financial costs, low level of professional solidarity, interest in increasing the number of solvent patients and a shift in emphasis from health promotion and disease prevention to medical activities.
The advantage of budgetary healthcare is the availability of medical care to the entire population, fairness in the distribution of resources, equal opportunities for health promotion, broad administrative powers for mass preventive work, professional solidarity on a disinterested basis.
The negative features are less responsibility to the patient, insufficient level of funding and technical equipment, less quality service, greater inertia to the perception of innovations.
Based on the analysis of the pros and cons, taking into account the mentality of the Russian population and doctors, it seems optimal for Russia to combine the advantages of both models and minimize their negative properties on the basis of budget healthcare.
This decision complies with the provisions of the Russian Constitution on free medical care.
If the state needs health care, it must pay for it, as it pays for the maintenance of the army, police, court, fire protection, etc.
The amount of payment is determined by the quality that society needs.
And not in the form of national projects, but as a fixed expenditure part of the budget, with the justification of the calculation technology in relation to the required quality.
The salaries of doctors and nursing staff should be linked at purchasing power parity to the payment of similar labor in the countries of the European Community.
At least at the transitional stage, the salary of a doctor should be determined in the amount of three times the average salary in the country, the salary of a paramedic 70%, nurses 50%, orderlies 40% of the medical rate.
The funds allocated by the state should be directed not to the FOMS, but directly to healthcare.
The volume of medical services guaranteed to the population should be developed by the Academy of Medical Sciences.
In such conditions, no more than 5% of the total number of doctors will be engaged in private practice.
Instead of licensing, which turned out to be unable to influence the level of qualification of specialists and medical institutions, it will be necessary to introduce standards.
The accuracy of their compliance will be ensured by a system of ongoing monitoring, including patient assessments, and periodic checks.
Managers are financially and administratively responsible for violating the standards.
The application of penalties to universities and institutions of postgraduate education for gross mistakes of their graduates will contribute to improving the quality of student education and postgraduate training of doctors.
The professionalism of the doctors ' activities is most effectively controlled through production meetings.
Analyzing mistakes in the presence of colleagues is a more severe punishment than formal checks by insurance companies.
Controversial issues are submitted to the National Medical Association for consideration.
The criterion for the effectiveness of health care activities should be the compliance of the results obtained with the advanced achievements of medicine, taking into account specific equipment and funding.
Igor GUNDAROV,
head of the laboratory
Research Institute of Public Health
and health management
The First Moscow State Medical University named after I. M. Sechenov,
doctor of Medical Sciences.
"With an eye to the future Up
Log in or register to be able to send comments|: Medicine and Society
SUBSCRIBE NOW
N 96 of December 21, 2016
Articles
Healthcare Medicine and Society Clinical Recommendations Pharmacist's page Science and Practice World and Health Science Abroad Time and we Autograph for " MG"
Healthcare Medicine and society in the center of attention Clinical recommendations Pharmacy Science and prakticaMir and Health
Science Abroad Time and we are an autograph for " MG"
About the newspaper | Subscription | Archive | Contacts Copyright © 2006
