Cancellation Of Internship, Import Substitution And Opening Doors Of Intensive Care: What Will Be Remembered For

Cancellation of internship, import substitution and opening doors of intensive care: what will be remembered for 2016

In 2016, a roadmap for pain relief, insurance attorneys and an administrative article for doctors appeared in the country, accreditation of medical workers began to be introduced, internships were canceled in universities, and foreign manufacturers of medicines and medical equipment were actually suspended from public procurement.

Shutterstock / In 2016, a roadmap for pain relief, insurance attorneys and an administrative article for doctors appeared in the country, accreditation of medical workers began to be introduced, internships were canceled in universities, and foreign manufacturers of drugs and medical equipment were actually suspended from public procurement. Compulsory import substitution: from textiles to moleculesThroughout 2016, the government refined restrictions on access to the Russian market for state purchases of imported drugs and medical products. Government agencies have been banned from purchasing imported textiles. The list of foreign medical products was expanded threefold, the suppliers of which cannot bid for a contract if there are at least two bids from domestic manufacturers. At the same time, the restrictions do not apply to manufacturers from the member states of the Eurasian Economic Union, and the quality of products in this case does not matter - only the place of production. Another decree of the Cabinet of Ministers directly provides preferences for domestic goods: for a Russian company to receive priority at the auction, the electronic trading system must automatically reduce the price of the contract proposed by it by 15%. If the supplier of imported goods wins the tender,the contract will be concluded for an amount 15% lower than the price offered by him. In the pharmaceutical industry, import substitution has reached molecules. The next amendments of the Ministry of Industry and Trade to the “third extra” rule (RF government decree No. 1289 of November 30, 2015), which provides preferences in the process of state procurement for Russian drug manufacturers, already contain requirements for organizing the production of a pharmaceutical substance in Russia. If there are no applications from domestic manufacturers of full-cycle drugs, priority should be given to drug manufacturers whose finished dosage form was produced in Russia. According to the government's plan, "the decisions made will contribute to the development of domestic production of medical devices." Experts fearthat very soon the few domestic producers left without competition will turn into monopolists and dictate to the Ministry of Health what to buy and how much. "The hard-won social contract": affordable pain relief and visits to intensive careLast year was a turning point in solving the problem of pain relief in Russia. The Government of the Russian Federation has approved a roadmap for increasing the availability of pain relief therapy, including expanding the list of narcotic and psychotropic drugs and simplifying the procedure for their prescription. To relieve pain, modern approaches will be used, which will be trained by medical workers. But the main thing is that the actions of doctors who work with opiate painkillers will be decriminalized. Ekaterina Chistyakova, director of the Gift of Life charity foundation, called the Road Map a kind of social contract, which has been hard through suffering and now must be fulfilled. Now only 75% of Russian patients are provided with the necessary invasive drugs, and analgesics in tablets are available to 50% of patients. For thatit takes at least two years for the country to produce enough painkillers. It will take even longer to change the psychology of old school doctors. Another victory of civil society is the opening of the doors of intensive care. The Ministry of Health has issued a record number of leaflets and guidelines regulating visits by relatives of critically ill patients in intensive care and intensive care units. They are about both the requirements for visitors (they must be healthy, follow the rules of hygiene and not interfere with the work of the medical staff), and the obligation of medical institutions to organize conditions for visits. And most importantly, parents have the right to be with their children around the clock. Unfortunately, no one gives guarantees that these recommendations will be implemented. In most Russian health care facilities, there is simply no technical capacity for this, and the regional authorities have money for their creation. "Renewed" CHI: Transparent Hospitalization, Regional Equality and Insurance AttorneysIn 2016, for the first time, the financing of the basic compulsory medical insurance program was "leveled" for all subjects of the Federation. For many years, different amounts of state guarantees for territorial compulsory medical insurance programs have become a consequence of the different financial situation of Russian regions. However, now, thanks to the centralization of insurance premiums, all funds are accumulated in the Federal Compulsory Medical Insurance Fund and are distributed according to a single per capita standard, taking into account regional coefficients. As stated in the MHIF, now in the CHI system there are no rich and poor subjects. But they admit that the problem of uneven funding remains for tuberculosis, psychiatry, venereology, narcology and other socially significant diseases, for which regional budgets are responsible. In addition, the Ministry of Health of the Russian Federation has updated the rules of compulsory health insurance, concerning both the technical side,and fundamental issues - disclosure of information by clinics and insurers. In particular, hospitalization has become "more transparent" - now clinics have to enter into their information system on a daily basis information about issued referrals for hospitalization, the number of vacancies for the next 10 working days, as well as planned patients hospitalized per day. According to experts, this should stop corruption during hospitalization, as well as stop the practice in which the administration of a medical facility requires doctors to dismiss patients early, including those who have not been treated, so that two or three people can be hospitalized for the time allowed for one patient and receive money for everyone. In the outgoing year, an institute of insurance attorneys appeared in the country, who will personally monitor the process of treating each patient. And also engage in prevention, for example,inform about the need for timely medical examination using SMS messages. During the "transitional" 2016, according to the Ministry of Health, about 3.5 thousand such specialists were trained. 2016 for doctors: admission to the profession, cancellation of internship, new fines and old salariesSince 2016, the accreditation of medical workers has been introduced in Russia - checking the readiness to “carry out activities in a certain medical specialty”. The procedure provides for primary accreditation (for university graduates who want to immediately start their professional activities), primary specialized (for graduates of residency, and doctors who have improved their qualifications) and periodic (for practicing doctors in the course of continuing professional education). We started with graduates of universities in the specialties "dentistry" and "pharmacy". In 2017, accreditation will become mandatory for all other graduates of medical universities, and from 2021 - for all practicing doctors. The Ministry of Health calls the new system a form of continuing medical education necessary to improve the quality of medical care. However, experts saythat the Ministry of Health is changing the "sign" without affecting the principle of issuing admission to the profession: in order to work, a doctor had to have a specialist certificate before. But the cancellation from September 1, 2016 of the internship will really affect the quality of medical care, not for the better. Immediately after graduation, graduates will be admitted to work in three basic medical specialties - a district therapist, a district pediatrician and a general dentist. The elimination of internship (like the 7th year of study) is designed to solve the problem of staff shortage in primary care. Three-year work of graduates as general practitioners will, in fact, become mandatory. Only after that will the young specialist be able to enroll in residency in other medical specialties. And so that the doctors do not relax,the government has developed sanctions for violating patients' rights and the procedure for providing medical care. Until now, the Code of Administrative Violations did not contain many "medical" articles, and they only dealt with the donation of blood and counterfeit drugs. Now, violations detected by Roszdravnadzor will be followed not by ineffective "instructions", but by specific fines. You will also have to pay with your own ruble for charging fees for free medical care, violation of the rules for conducting medical examinations, the procedure for prescribing and prescribing drugs. Only the incomes of medical workers remained unchanged. According to the Health Foundation of Independent Monitoring, only 4.5% of Russian doctors receive the salary officially declared by the Ministry of Health of 48 thousand rubles. And a significant number of their colleagues receive up to 20 thousand rubles a month. In the Ministry of Health,Despite the statements about the growth of average salaries in the industry, they also admit that their true size depends not on the quality of work, but on the proximity to the boss. Today, a doctor's base salary is only 40%, and the rest comes from so-called incentive payments. Recommendations were sent to the regions on amending the structure of doctors' salaries so that its basic part was at least 60%. Whether this will give any results, we will find out next year.so that its basic part is at least 60%. Whether this will give any results, we will find out next year.so that its basic part is at least 60%. Whether this will give any results, we will find out next year.