The loot wins the mouth

The procedure for providing beneficiaries with drugs is changing according to Rosstat, the number of the permanent population of Russia in 2006 decreased by 561.2 thousand people. The maximum population decline (the difference between the number of born and the dead) was recorded in the Nizhny Novgorod and Rostov regions - 29.8 thousand and 27.9 thousand people. The number of residents of the Altai Territory and the Voronezh region decreased by more than 20 thousand, and in the Volgograd, Kirov, Tula, Tver, Chelyabinsk regions and the Perm Territory the population decline is approaching this figure.

In the whole country, the dead are one and a half times more than born. How to change statistics? The answer is simple: to give birth more, but to die less. To stimulate these processes, the state must spend money. In particular, in order for citizens to live longer, they must be treated. So, we need medicines, sometimes expensive. The program of additional drug support (DLOs), designed to partially solve this problem, has been operating for more than two years. But there are still not enough drugs. Unable to cope with the problem of DLOs, the government decided to shift responsibility in the fall to provide beneficiaries with medicines on the shoulders of the regional authorities. Whether the beneficiaries themselves will benefit from this - the question is still open.

Amendments to the Law "On State Social Assistance", providing for the transfer of funding for the DLO in the jurisdiction of the constituent entities of the Russian Federation (now the government is preparing these amendments), as expected, will be made to the State Duma by September 2007. This was announced yesterday by the chairman of the State Duma Committee on Health Protection Tatyana Yakovleva. “Now everyone will do the subjects,” she said. And she explained: it is about the fact that after the entry into force of amendments to the procurement of drugs and the conduct of auctions among suppliers of pharmacological products, regional officials, and not the federal center, as is happening now, will be engaged in directly. According to Yakovleva, such a decision was made after meetings with representatives of the regions. “We consulted, gathered large territories, and they said yes,” she said. Moscow Mayor Yuri Luzhkov already stated that “the Moscow government considers it right to stop dividing beneficiaries into categories of federal and regional, as well as transfer resources and the fullness of the social security of preferential categories of local regional authorities.”

A cure for greed

The DLO program began to operate in 2005 as part of the National Project "Health". The declared goals of the DLO program were the most good: it was assumed that a poorly functioning system for the existence of preferential pharmacies will replace the centralized release of drugs for beneficiaries.

The essence of the program is that every year the Ministry of Health and Social Development is developing a list of preferential drugs, after which a competition among suppliers was held at the federal level. Thus, the DLO market turned out to be divided between four large distribution companies: Protek, SIA International, Biotek and Growth, which, according to experts, today hold about 70% of the total boat market.

Meanwhile, the most profitable DLO program was for manufacturers, since in the approved list of drugs it was initially laid out which of the manufacturers would receive an order for the production of a drug. Thus, manufacturers received guaranteed volumes of the sale of their drugs, while marketing and market promotion were significantly minimized.

“In the first year, there were no problems with financing, because after the monetization of benefits, many people left the program. Thus, it turned out that the funds were allocated even in abundance, ”says Alexander Kuzin, general director of DSM Group. The fact is that when leaving the program, beneficiaries can receive no more than 400 rubles per month, while initially the cost of drugs released within the DLO could reach up to 100 thousand rubles. However, according to some analysts, such a successful work of the program in 2005 is explained by the fact that not all market participants joined it.

As a result, in 2006, two times less funds were allocated from the federal budget for the implementation of the DLO program. The calculation of the officials was incorrect. According to market analysts, the DLO budget deficit was approximately $ 1 billion in 2006. And according to the Ministry of Health and Social Development, in some subjects, the share of recipes located on delayed maintenance (in other words, the line for preferential medicines) still reaches 20% of the total number of prescribed recipes.

It is not surprising that the DLO program began to lose its attractiveness for beneficiaries: expensive original drugs began to be replaced by generics (analogues of original drugs), and the daily market in natural indicators decreased by 21%. Some regions were forced to attract new distributors, as a result of which problems began to arise with timely supply of drugs.

Some analysts believe that the uncontrolled extract of certain drugs in the regions was the cause of the crisis in the DLO market. “According to the documents, it turned out that some patients were prescribed ten times more drugs than necessary. At the same time, it turned out to be impossible to find those responsible for some reason, ”explains the analyst at Farmexpert, David Melik-Guseynov.

Cheap and angry

The essence of the new proposal of the distribution of funds for DLOs is actually reduced to the fact that the regions will receive live money, based on which will finance the supply of drugs for beneficiaries (the money has already been laid down in the draft three -year budget). The exception will be only expensive drugs, which are supposed to be highlighted in a separate list and a competition for the supply of which will, as before, will be carried out at the federal level (we are talking about seven diseases: multiple sclerosis, hemophilia, cystic fibrosis, goshe, pituitary glanding (lillipus), leukemia, and rehabilitation after organs transplant).

“The new system of distribution of funds is good in that now the responsibility for the supply and payment of drugs is entirely transferred to the regions. And the authorities of the subjects will be able to calculate in advance how many and what drugs they need to be purchased. In addition, the authorities of the regions will be able to allocate additional funds from local budgets to finance the program, ”said David Melik -Guseynov. The problem, however, is that only donor regions will be able to master additional financing. “In other regions, local authorities (90% of Russian regions are donors), in order to meet the funds allocated from the federal budget, will limit the discharge of drugs,” says Alexander Kuzin.

“If the region is rich, he can afford to increase the list of preferential drugs. If there is no extra money, then this can also be done by saving already provided funds and competent administration, ”the Director of the Department of Regional Policy on Health and Social Development of the Ministry of Health and Social Development Yuri Krestinsky explained.“ The doctor should think about which medicine to his patient, given the amount of funds that the state has. Let it be not the most expensive, but high -quality and proven drugs, ”he explained. According to experts, in fact, this may result in the fact that the regional authorities will simply put pressure on doctors so that they either simply reduce the number of prescribed prescriptions for expensive medicines, or replace them with recipes for less expensive generics. It is clear that in this situation, not all patients will be able to get a really effective treatment. And therefore, the poorer the region, the less chance to recover.

The new system can fail in quite prosperous regions. What is not excluded in the Ministry of Health and Social Development. According to Krestinsky, "malfunctions may again be caused by drugs of preferential categories of citizens." He explained that this will happen if the region incorrectly calculates its needs for drugs. True, Krestinsky immediately made a reservation that the amount allocated to the regions from the federal center would be revised quarterly and will depend on the number of beneficiaries living in this subject, and therefore the subjects will have the opportunity to correct the situation.

It is more convenient to be poor and sick on federal or regional subsidies?

Victor Maslov, Governor of the Smolensk region:

Still, it is better to be sick at the regional level, since the federal is far away. To transfer money to the regions - the decision is correct. The local authorities can respond more quickly to needs, assistance to a particular person will reach faster, and it will also be possible to localize those shortcomings that periodically open during the provision process. It is no secret that there are malfunctions in the supply, nomenclature and the list of drugs, and the specific need of the region is not always taken into account at the moment. And if the resource is in the hands of the region, then the region will be more promptly and dynamically respond to arising situations.

Three years ago, I said that at the regions level they would leave that which does not apply to expensive drugs and diseases that require a particularly qualified approach. And now they returned to this, and absolutely right.

Alexander Mikhailov, Head of the Department of Interdepartmental and Information Activities of the Federal Drug Control Service:

And what's the difference, what subsidies, because the medicines themselves are expensive, but the treatment process. Therefore, you don’t always know what is better: either to contact poor medicine, where you are not initially needed, or in the rich, which your money is interested in?

But the fact that budget money for additional medicinal support will go to the regions, I think, right, because it will be easier to control there. And it is quite obvious even from the point of view of the professional sap: in the field they will order the volume of drugs that they really need. And along the way, these funds will not be sprayed.

The only question is how they will be used in the field. But, in my opinion, the moment of truth has now come for many leaders, and the state began to seriously deal with where the budget money is going.

Victor Shershunov, Governor of the Kostroma Region:

Being poor and sick is bad in any case. The whole question is the capabilities of our citizens to acquire. If additional drug security is transferred to the regions along with the financial support of the needs that we have, then, of course, it will be no worse. Moreover, our needs are almost completely calculated.

And if only the right is transferred without financial support, it will not be great. Naturally, the amount does not change from the change of places of terms, but sometimes the mood spoils.

Mikhail Delyagin, Director of the Institute of Problems of Globalization:

It is more convenient that this money remains at the federal level. Now they are not enough because of errors in planning and because of prices of prices for those who sell medicines.

The regional authorities can do nothing with merchants of medicines that work throughout the country. If my memory serves me, the Ministry of Health left a little more than 10 companies, and the regions will not cope with them (if this, of course, is not Moscow). In addition, when the federal government issues money, it is responsible for them. If they go somewhere, then the extreme is known to everyone. And if they go to the regions, then a bureaucratic game in the pass may begin: "Where is the money?" - "And they did not give us!" And from the showdown between federal and regional authorities, ordinary people can suffer.

Evgeny Yasin, Scientific Director of the Higher School of Economics:

It is equally bad to live on all subsidies, and it is better not to be poor and sick. If budget money goes to the regions for additional drug security, this is legal and normal. This money will be fulfilled by state powers.

07/09/2007 / Olga Pavlikova, Kira Remneva, Galina Lyashenko, Alexei Dadevich, the survey was prepared by Alexander Sargin Material published in the newspaper No. 123 of 07/10/2007.