A year of work of the Ministry of Health - summing up the results

This past week, an event that was significant not only for doctors, but also for all residents of the country - the anniversary of the formation of the Ministry of Health of the Russian Federation - passed very quietly. No, I was not mistaken when I spoke specifically about the formation of the ministry. It was on May 21, 2012 that the Ministry of Health was re-established in its current composition - not as part of the Ministry of Health and Social Development, but as an independent department.

A year ago, many enthusiastically accepted the arrival of a person with a medical education and, as it is fashionable to say now, a medical background (i.e., medical practice in the past), to the position of head of the ministry. It was assumed that Veronika Igorevna Skvortsova, familiar first-hand with the problems of the industry entrusted to her, would finally be able to cope with the stalled healthcare reform. And now a year has passed... Let's sum it up?

To be honest, in my fairly long memory there are not many years that were so rich in events that took place in medicine. Last year was perhaps the most memorable among them. So, in order.

Since the New Year, all medical institutions in the country have switched to single-channel financing. This meant that for all the needs of a healthcare institution (hospitals, clinics, ambulance substations) - salaries, medicine, household needs - money would be allocated only through the compulsory health insurance fund. It was in vain that the experts argued that the project was ill-conceived, crude, and needed improvement ... no, why should we listen - the Ministry of Health decided, we ourselves are not born... The consequences of the transition were immediately felt by the ambulance staff. It's no secret that Ambulances in our country not only provide pre-hospital treatment, but also often perform a transport function - delivering women in labor to the maternity hospital, transporting patients for invasive procedures, for example, hemodialysis. So, all these calls where medical care was not provided (drugs were not administered, medical procedures were not performed), the ambulance was no longer paid. A new term “zero” calls has emerged among employees. In addition, false calls also fell into the zero category, and in the Chelyabinsk region alone during the New Year holidays, such calls accounted for 4% of the total number of ambulance calls. The new rules primarily hit the pockets of doctors and paramedics - for example, in the Moscow region, the salaries of ambulance employees immediately fell by 30-40%. Employees were faced with a choice - either lose wages or register a “zero call” as a “medical call”, that is, record on the card a treatment that was not actually carried out.

Another ill-conceived step was the “optimization” of rural health care. Under the pretext of economic inefficiency and care for women in labor (they say it is impossible to provide qualified care in old regional maternity hospitals), maternity hospitals were closed in a number of districts of the Yaroslavl, Volgograd, and Tambov regions. It was in vain that experts drew attention to the fact that without good roads and an established system of sanitary evacuation, the closure of maternity hospitals in rural areas could turn into a tragedy. No, considerations of economic efficiency turned out to be more significant than fears for the condition of women, who during childbirth (!) will have to be transported on passing transport for many tens (or even hundreds) of kilometers. The result did not take long to arrive - after one of the February mega snowfalls, a woman in labor had to be taken to the maternity hospital in a fire truck ; she was the only one able to overcome meter-long snowdrifts. What if I couldn't? Would you have to give birth in the snow like your distant ancestors?

In February, tests became public knowledge, on the basis of which the Ministry of Health and the State Drug Control Service proposed testing schoolchildren for drug addiction. Their content shocked not only doctors, but also all sensible parents. The test questions provoked any inquisitive teenager to expand the boundaries of their knowledge about narcotic and psychotropic substances. Only after the problem was covered in the media and the intervention of the Prosecutor General's Office was the option proposed by the ministry rejected.

The project of universal medical examination raises no less questions. Veronika Igorevna in her interviews often emphasizes the need to read modern medical literature, including foreign ones, and preferably in the original language. Let me suggest that she herself does not follow this rule. Otherwise, a recent article in a reputable American medical journal would not have escaped her attention, where the ineffectiveness, either from a medical or an economic point of view, of the general medical examination of the population aged 0 to infinity according to the principle “the more consultations and research, the better” is scientifically substantiated. . But why should we listen to the opinion of Russian scientists - adherents of evidence-based medicine, and even more so to world experience ? "The Soviets have their own pride..."

Well, at the end of the day there is a scandal with doctors’ salaries, which differ so strikingly from the official figure of the average salary of 34 thousand rubles per month announced by the Ministry of Health. Receipts sent to the editorial office of Novaya Gazeta from various regions of the country clearly demonstrate the miserable existence of doctors. "Where is the money, Zin?" - this phrase has become one of the most popular headlines of the month in many media and online blogs. We have yet to find out in what “kind of accounts” the salaries of doctors will be found.

Here are just some of the most memorable initiatives of the renewed Ministry of Health during the first year of its work. And what’s ahead - even more interesting - is the development of a law on medical malpractice insurance, which is already being sharply criticized by lawyers working in the healthcare sector... 2016 is not far off, when the Ministry of Health proposes to conduct universal certification of doctors... Will there be more? .

And yet there are encouraging trends. Outraged by such unscrupulous deception and exploitation, not inferior to the situation of the workers of the era of “initial accumulation of capital” (this is where political economy and the history of the CPSU, which seemed unnecessary at the institute, came in handy - yes, yes, I still remember those times), doctors began to unite. Not having confidence in the official trade unions, doctors created their own independent trade union “Action ”, one of the actions of which was the Italian strike of Izhevsk doctors. Pickets and rallies of solidarity with doctors, who for the first time were not afraid to consistently, despite enormous pressure and even provocations from the leadership, defend their rights, are taking place in many cities of Russia. For the first time, doctors switched from individual protests, which usually ended in filing resignation letters and going “nowhere,” to organized actions. Where will all this lead? Let's wait and see, because, as one of the founders said, “a flame will ignite from a spark...”