Translated material
“You don’t even know how to issue invoices”
Mikhail Zurabov outlined to regional officials the basics of paid medicine
Russian doctors and patients need to learn to think in Marx’s formula “commodity-money-commodity”. This is the only way they will be able to survive in the conditions of new medicine, which the head of the Ministry of Health and Social Development, Mikhail Zurabov, intends to promote. Last Friday, the minister conveyed this idea to health officials in the Northwestern and Southern federal districts. The meeting with representatives of these two regions completed a series of meetings on the annual results of the national project “Health” .Regional officials, health and social insurance workers received answers to the most intimate questions of the last few months from the Ministry of Health and Social Development. And the most important of them: “Will Zurabov be removed?” The minister himself is confident that they will not remove him, and he will remain in his post for at least two or three years. In any case, he has a clear action plan for this period. “We are absolutely calm and confident that we are following the right path, and no one will lead us astray,” he said before announcing his long-term plan.
Judging by the minister’s words, the biggest problem in our healthcare is ideological. Doctors, nurses and nannies are still working in some old formally “free” medicine, and Mr. Zurabov has long been improving other medicine, firmly based on a commercial insurance basis. The Minister sincerely does not understand how a brand new X-ray machine can rot for years in the courtyard of a county clinic just because there are no consumables. Or how doctors can see patients without insurance - they won’t be paid for their work. Doctors consider insurers to be swindlers and absolutely do not want to understand why they forbid them, for example, to send a patient to two specialists on the same day.
The low level of remuneration leads to the fact that doctors do not hesitate to “take from patients.” “When you come there, you have to give your last,” is how Mikhail Zurabov described current Russian medical institutions. And he emphasized that even the President of Russia knows about this. According to the minister, doctors need to learn to take money from completely different people, from the same insurers. “You don’t even know how to issue invoices!” - the head of the Ministry of Health and Social Development was indignant. Representatives of regional medicine only looked blank.
Mr. Zurabov himself is preparing to issue regular bills to the budget. Today, industry financing amounts to 3.2% of Russia's GDP, but this is clearly not enough. Mikhail Zurabov did not rule out that “to a certain extent” the need for funds could be satisfied through new injections from the treasury. True, medicine can still count on only partial satisfaction of its needs. Today, it would be possible to maintain the healthcare sector at a level close to self-sufficiency if the minimum wage were 4,500-5,000 rubles per month. And taxes would be collected from all migrant workers and self-employed citizens. The minister believes that this fairy tale will come true as soon as medicine is fully covered by insurance. The employer will treat an uninsured employee at his own expense, which means it will be many times more expensive.
“We finance the provision of medical care, like in Peru, but we make promises, like in France,” Mr. Zurabov assessed the financial situation of the industry entrusted to him. In practice, it looks like this: a transplant operation costs 1.5 million rubles, and 700 thousand are allocated. “This is a very convenient model for the financier: he gave the money, fulfilled his obligations,” says Mr. Zurabov. But the patient often has to choose between selling the apartment and having an operation. That is, there is an independent assertion of the practice of co-financing in medicine. “There is such a model in the world. But nowhere in such wild forms,” complained the head of the Ministry of Health and Social Development. And he proposed making this practice legal, since there is no way to avoid it now.
The introduction of market mechanisms is planned in other areas. Modern medical centers will be built, real “factories,” as they say in the Ministry of Health and Social Development. There will be excellent, expensive equipment there, but they won’t let anyone stay there - five to seven days on a bed and give way to someone else. Officials are going to fight the dominance of “elderly people” in hospitals. The minister did not rule out the possibility of taking 10% of the treatment bill from those who abuse hospitals. In general, the Ministry of Health and Social Development plans to divide all potential patients into groups according to health status and introduce differentiated payment for compulsory health insurance.
For their part, doctors promise to formalize work as much as possible. All medical services will be standardized. Among other things, it is planned to bring the equipment of medical institutions and personnel selection to common standards. Any violation of standards will be a reason for legal proceedings, of which in Russia over time there will be no less than in the United States. “This future... is not far away,” Mikhail Zurabov concluded ominously. Mr. Zurabov gives his industry only a few years for all these changes. “In two or three years, we can launch a balanced system that can work without us,” the head of the Ministry of Health and Social Development emphasized.