Education and health care reform. Creating a competitive environment at all levels

Education and healthcare have some similarities. Both areas are funded by the state. And it should remain that way. A citizen comes to a specialist and receives services. The state pays the specialist a fixed fee per month, regardless of any conditions of his work, and the citizen receives the services that the specialist gave him, practically without being able to choose who to turn to. To whom he was sent, he goes to whom. Such a system forces people who do not care about citizens to work carelessly, and enterprising specialists to either go into paid medicine/education or engage in extortion so that their own services are adequately paid for. The result is low quality of services and corruption. This is what needs to be fixed.

There is a fairly simple, consistent way to fix these two global problems without budgetary injections.

1. Competition within educational/health care institutions.

a) Give the right to every citizen (who applied for educational or medical services at the appropriate government institution) to choose which specialist he goes to every time he applies.

b) Pay all specialists in these areas only for the number of clients on their account. Teachers - for the number of student/pupil participations, and doctors - for a personal list of those who are registered, regardless of the number of appointments. The difference in payment is based on the fact that ideally a person should always be healthy (that is, not go to the doctor, not spend money on medicine), and receive as much education as possible (the student’s preparedness largely depends on the number of classes).

How does this work?

A man came to the clinic: an electronic terminal with doctors. There are photos, profiles, biographies. I chose it and went to the doctor for an appointment. I didn’t like it, I went to someone else. At the same terminal I chose the one I liked the most. At the end of the month (or week - it doesn’t matter) each doctor is paid for the number of clients on their account. Everyone benefits from such a system: it is beneficial for the doctor to work well, show respect for clients, and give them valuable recommendations on how to maintain their health: the less people visit him, the more free time he has, he can do scientific work or something else, after all, not There will be queues, but the personal list will be substantial. And clients will enjoy being treated with respect and will receive professional assistance. Doctors themselves will find ways to raise their professional level: they will listen to a bunch of lectures on psychology and the profile of their specialty, find and read the necessary books. Monetary motivation will solve a lot of issues.

A person came to school or university. Each classroom has a terminal. Before entering, the student leans his personal card and the system automatically records his presence with a specific teacher. I came to a lesson or a class - there the teacher/teacher became rude or started using unknown terms, started talking some kind of prehistoric nonsense and generally told an uninteresting story. The next time the person went to someone else. That one is better. But the third one is very good and interesting. And the fourth one is so cool that students/schoolchildren at the end of each pair give a standing ovation! That's where we're going. And thus - one has a salary of 15 thousand, and the second - 150 thousand. With such a system, there is practically no need for an extra budget (computers are already everywhere, and “sliders” cost pennies), and teachers do not need to go into the commercial sphere. You just need to become the best friend for all students, that inspirer and opener of new horizons that all students secretly want to see and hear.

2. Competition between educational/health care institutions

Medicine is quite simple: in many countries a person can get help not at his place of registration, but at any clinic in his country. This is what we need to do too. Thus, competition between clinics will be based on the same principles as competition within clinics. The situation is more complicated with universities, because they are all specialized.

Certification functions in general have already been removed from schools using the Unified State Exam mechanism; all that remains is to deal with universities. Universities can issue their own internal certificates, but a state diploma of higher education must be issued by an independent commission. At the same time, in order to eliminate corruption, just like with the Unified State Exam or computer testing for traffic rules, an understandable system of tests is needed. And then it goes through the commission, while at each meeting there must be a video recorder, the video recording from which remains on the Internet and can be viewed by anyone. So students will have to teach for real, and commissions will not extort money. The commission should not know who exactly and from which university the person is coming to them (they should only know the specialty), and the student should not know who exactly will be on the commission.

At the same time, quite a few universities have their own specific subjects, and most subjects are available everywhere. Such as mathematics, Russian language, foreign language, psychology, philosophy and so on. In general, a student should be able to choose between all the teachers in the country who teach in the disciplines on his list in his specialty. Do you like mathematics at MEPhI under Ivanov, physics at Baumanka under Petrov, and microprocessors at MGIU under Sidorov? This means in the morning at MEPhI, in the afternoon at Baumanka, and in the evening at MGIU. If there is not enough time to travel, he finds evening classes there or agrees to some teacher within one university. It is up to the student to decide who to go to.

Thus, in education, salaries should be paid according to three headings:

1) by the number of pupils/students who visited the teacher/teacher;

2) by the number of pupils/students who successfully defended their diploma from an independent commission;

3) based on the graduate’s salary based on the results of at least six months of work in the specialty (the report must contain not only documents, but also fragments of video recordings of their work in the organization. Checked by the same independent commission).

Thus, not only speaking abilities, which will be the focus of pupils/students, will increase, but also the real quality of educational services.

Difficulties with archaic commissions are resolved in the same way as the deputy corps in the State Duma. Each commission must contain at least 20% people under 30 years of age. The lack of experience will be compensated by clarity of mind, energy and creative vision for the defense of the diploma.

As a result we get:

- improving the status of higher education in Russia and the Russian state diploma;

- healthy competition in the field of education and healthcare, and hence improvement of quality in these areas;

- the same starting conditions for all universities and clinics;

- the natural withering away of ineffective institutions that have not adapted to new conditions (people will not go where they are rude and do not provide quality services, and the state will get rid of the stigma of an executioner, deciding by administrative methods what should be resolved on its own);

- no need to separate or connect any universities or clinics (people themselves are able to figure out whether they need a merger or connection);

- freedom in choosing medical or educational programs, because the natural competitive conditions created will themselves create high-quality programs that can pass certification (in the case of universities) or provide good health (in the case of clinics).