“Oncologic Dispensary Officials Offered To“reduce Their Appetites”

“Oncologic dispensary officials offered to“reduce their appetites”

The availability of medical care in Russia directly depends on the financial situation of the regions and the priorities of local authorities. Both patients and doctors are becoming hostages of this situation. In Smolensk, the head of the only oncological dispensary in the region was dismissed, who did not agree to keep his patients "on starvation rations" and treated them according to world standards, accumulating debts of the medical institution.

Photo from the personal archive of Sergei Gulo /

In terms of the availability of medical care, Russia is like a patchwork quilt and directly depends on the financial situation of the regions and the priorities of local authorities. Both patients and doctors are becoming hostages of this situation. At the end of last year, the head of the only oncological dispensary in the Smolensk region, Sergei Gulo, was dismissed - the head physician did not agree to keep his patients "on starvation rations" and treated them according to the standards, accumulating debts of the medical institution. The oncologist spoke about his vision of the problem in an interview with MedNews.

Sergey Lvovich, why did the oncological dispensary have problems? After all, now, as they say in the Ministry of Health, the financing of the basic compulsory medical insurance program is "leveled" for the whole country, and funds are centrally distributed according to a single per capita standard, taking into account regional coefficients?

- Regional officials actually deny cancer patients full treatment that meets state standards. The territorial CHI fund claims that the funds are distributed according to the number of insured citizens in the region. However, in the Lipetsk region with a population of 1.156 million people, 540 million rubles were allocated from the compulsory medical insurance funds to the oncological dispensary in 2015, in the Bryansk region with a population of 1.23 million - 620 million rubles, in the Novgorod region with a population of 650 thousand - 350 million rubles. And in Smolenskaya with a population of 958.6 thousand people - 319 million rubles, and in the first nine months of 2016 - only 244.3 million rubles.

In 2016, the tariffs for round-the-clock hospital services decreased by more than a third: if in 2014 the average tariff was 57.3 thousand rubles, and in 2015 - 61.5 thousand rubles, then at the beginning of 2016 it was cut to 38.4 thousand rubles … In addition, the oncological dispensary did not receive funds (additional tariffs) for conducting studies on a computer and magnetic resonance imaging machine using contrast agents. Treatment in the radiology department was not funded. No funds were allocated for the maintenance of the apparatus with a radioactive source

And how did you get out of this situation?

- We continued to treat patients strictly in accordance with international standards and protocols for oncological diseases, which cannot be violated. These standards prescribe the methods of treatment necessary for each patient, the scope of the study, drugs and schemes for their use. And today the stocks of medicines and medical devices are sufficient to carry out continuous treatment of our patients. But since this was not supported by adequate monetary content, in 2016 the dispensary's accounts payable reached 120 million rubles.

The problems did not start immediately. I have headed the dispensary since 2010. Until 2013, medicines for the privileged category of patients were paid for from the federal budget as part of additional drug provision, but then this responsibility was transferred to the territorial compulsory health insurance fund (TFOMI). In addition, if earlier drugs were purchased by the regional health department, now the dispensary itself is obliged to do it at the expense of the compulsory medical insurance. We held auctions, bought medicines worth 74 million rubles and treated patients with them, but we did not receive full compensation from TFOMS. In particular, the dispensary was not reimbursed for the costs of the anticancer drugs Avastin and Herceptin, which are not included in the medical care tariff. This is how the first debt of 13 million rubles was formed.

During 2015-2016, the oncological dispensary accumulated 21 million rubles of debt for targeted drugs prescribed to our patients in federal centers. The money spent on this was not returned to the dispensary either. In addition, the purchase of expensive equipment has caused an increase in maintenance costs. And, finally, we were accused of the fact that in 2015 - early 2016 the oncological dispensary exceeded by 6.3 million rubles “the volume of medical care financed from the compulsory medical insurance funds” - that is, it treated as many patients as asked for help, and not as much as planned by the territorial CHI fund.

But for such a case, TFOMS has a reserve fund, can you apply to the federal CHI fund?

- Can. Only, the Smolensk TFOMS chose a different path - by more than a third cut the tariffs for medical care and the purchase of drugs. And he tried in every possible way to reduce payments to the dispensary. For example, the duration of hospitalization in the chemotherapy department was, on average, 3.7 days. This is the optimal time to shorten the hospitalization queue without prejudice to each patient. This duration of treatment is accepted throughout the country. However, the regional TFOMI insisted on its treatment period of 10 days, that is, in fact, it provoked an artificial queue among patients, and paid the dispensary money not for a completed case, but for the so-called bed-days, that is, three times less.

What position did the health department take?

- During all this time, I sent several letters to the governor of the region, about 40 inquiries with economic justifications to the health department of the Smolensk region and 27 letters to the TFOMS. And he received only one answer in 2016 from the department that "there are no grounds for increasing the size of subsidies for financial support of the state assignment." But they decided to discredit me as a leader. Checks began at the oncology center - the department and the TFOMS accused me of deliberate bankruptcy. But three audits of the control and auditing department did not reveal any embezzlement or embezzlement. On the contrary, they confirmed my correctness. In the act of the first inspection, carried out in April 2016, it is written in black and white,that "the size of the current CHI tariffs and the size of the subsidy for financial support of the fulfillment of the state assignment do not allow the institution to carry out financial and economic activities in accordance with the current legislation."

But I was still accused of inappropriate spending of funds and causing damage to the regional budget in the amount of 39.7 million rubles. The treatment of patients on the basis of a hospice (instead of a chemotherapy department) and the purchase of drugs for them in 2015 and for nine months of 2016 were named as inappropriate spending of funds. According to the logic of officials, we had to line up 500 patients in need of urgent treatment in a months-long queue for hospitalization at the "correct" address. Only here someone could not wait for this line.

By the way, this is not the only problem with the premises of the oncological dispensary. In February, the building of the endoscopy department was declared unusable, but we were never provided with a new room. As a result, modern expensive equipment is idle and patients do not receive the help they need. And the chemotherapy department of the dispensary has already been transferred to the Departmental hospital at the Smolensk station of Russian Railways. Chemotherapy is a capital-intensive type of medical care, and this department practically provided other types of treatment and diagnostics for which we did not have additional tariffs. Now these funds will go to the JSC. And the oncologic dispensary was offered by officials to “reduce their appetites,” that is, to pay off their debts at the expense of patients.

Have you tried to apply to the federal level?

- Of course, I began to "ring all the bells" and I hope that this will give results. In our region there are more than 22 thousand patients with cancer, and I am not indifferent to their fate. The Prosecutor General's Office forwarded my request to the Ministry of Health of Russia, and from there the first answer has already come. In particular, it says that the reason for the accounts payable is the deficit of territorial programs (in Smolensk it was 42%) and the crisis in the regional economy. And also the fact that the regions do not set correction factors that take into account regional specifics in tariff agreements. The response of the Federal MHI Fund also says that the latest check revealed in the Smolensk Fund "the absence of a systematic approach to the formation of tariffs for paying for medical care under the MHI." And in 2017, there will be a check on how these violations are eliminated.

Read more: "So that there is nothing to compare with"

How the scandal began in the 62nd hospital