The Main Thing For The Week

2023 Author: Abraham Higgins | [email protected]. Last modified: 2023-11-27 23:16

The main thing for the week

Last week, the government included abortion in the list of services that require an additional medical license, FAS proved in court that a generic drug should be cheaper than the original drug, and ONF proposed including palliative care in the compulsory medical insurance. MedNews provides an overview of the latest developments in health care.

Additional license for abortion

Prime Minister Dmitry Medvedev signed a document obliging medical institutions to obtain a separate license for performing abortions. Decree of the Government of the Russian Federation of 08.12.2016 No. 1327 removes abortion from the general license for medical care.

The clinics were given a year to prepare for work under the new rules - the document comes into force 12 months after its publication. Until then, a license for medical activities in the field of "obstetrics and gynecology" will be sufficient to perform abortion operations. In principle, additional licenses do not change anything. But for medical institutions this will result in additional bureaucratic red tape.

There has not yet been an official explanation as to why abortion is a separate activity. But this can be regarded as a small concession from the authorities after the refusal to withdraw these operations from the CHI system. Earlier, the government's expert working group rejected a public initiative to withdraw abortions for non-medical reasons from the compulsory medical insurance system. The corresponding petition was posted on the website of the Russian Public Initiative and received more than 100 thousand votes required for consideration at the federal level. Patriarch Kirill also signed the appeal calling for the prohibition of abortion in Russia.

Now these operations in Russia are regulated by the legislation on the protection of the health of citizens, according to which every woman has the right to independently decide the issue of motherhood. An abortion only at the request of a woman can be performed at a gestational age of up to 12 weeks, for social reasons - up to 22 weeks, and if there are medical indications - regardless of the gestational age. And, as doctors note, in recent years these operations have entered a civilized course.

Firstly, any interventions on an outpatient basis were prohibited (including those that led to many complications of mini-abortions in polyclinics), and secondly, strict regulations were established - mandatory examination before surgery, a three-day hospital stay, full anesthesia (intravenous anesthesia). Ethical requirements are also observed - an abortion is carried out no earlier than 48 hours from the moment of going to the doctor, the woman is given time to think over and change her decision. Psychological assistance services have been established at antenatal clinics and maternity hospitals.

In addition, according to the Minister of Health Veronika Skvortsova, the preventive measures taken have reduced the number of abortions. This is also confirmed by official statistics. The absolute figures for the number of abortions in Russia are still large, but the number of abortions has halved over the past 10 years. So, according to Rosstat, in 2004 there were 1.61 million abortions, in 2008 - 1.23 million, in 2013 - 881.4 thousand, in 2015 - 848 thousand. According to the capital's obstetrician-gynecologist With Olga Petrova's many years of experience, modern women have become wiser about their health and, thanks to sex education and the development of contraception, the number of abortions is actually decreasing. “There is such a form of reporting - how many abortions are there per childbirth,” Petrova said.“And if 15 years ago there were up to 5 abortions per childbirth, now it is 0.3-0.5”.

Generic drug did not pass FAS control

The Federal Antimonopoly Service (FAS) did not allow the creation of a precedent in which the price of a generic drug would exceed the price of the original drug. The Ninth Arbitration Court of Appeal upheld the position of the FAS, which refused to agree on the maximum selling price for the antipsychotic drug Sulpiride, which was five times higher than the cost of the original drug. As explained in the FAS, the manufacturing company did not apply a reduction factor from the price of a reference (original) drug, despite the legal norm in effect from October 1, 2015.

“When conducting an economic analysis, the FAS Russia established that the cost of the generic drug Sulpiride (oral solution) is 4.7 times higher than the reference drug Eglonil in the form of tablets,” said the Deputy Head of the Social sphere and trade Nadezhda Sharavskaya. The decision of the antimonopoly department became the basis for the refusal of the Ministry of Health to state registration of the maximum selling price for Sulpirid. The manufacturer tried to appeal this decision in court, but to no avail.

FAS insists that generic drugs should not be more expensive than reference drugs. Generic manufacturers don't need to invest in developing a chemical formula. In addition, unlike original drugs, generics do not undergo clinical trials, on which companies spend fabulous funds.

The statistics on the use of generics in different countries vary greatly depending on the amount invested in health care. Despite the fact that the initiative to promote generic drugs belongs to the United States, at the moment in this country generics occupy only 12% of the drug market. In Japan, their share is 30%, in Germany - 35%, in France - 50%, in Russia - 70%.

According to the director of the Russian Oncology Center. N. N. Blokhin, academician Mikhail Davydov, these figures are justified. “The fact is that there is a huge industry of original drugs in the United States,” the academician explained. - Russia, which creates it with a delay of 30 years, has only two options - to buy fabulously expensive original drugs, which, unfortunately, is impossible. Or follow the path of generics that close this issue."

Compulsory medical insurance palliative

The Moscow headquarters of the All-Russian Popular Front (ONF) proposed to include palliative care at home in the compulsory medical insurance system. The organization came to the conclusion about the need for such a measure after conducting a study of the quality of palliative care in the capital. In the course of the study, experts from the Children's Palliative Foundation interviewed about 400 respondents - health officials, representatives of specialized NGOs, doctors and families of palliative patients.

The ONF experts have prepared recommendations to improve the situation with the provision of palliative care in the capital. “In particular, it is necessary to regularly inform doctors of children's clinics about the produced narcotic painkillers and their children's forms, to oblige hospitals to enter information on the pain treatment regimen and provide patients with a supply of drugs for five days, - says the message of the ONF. “The experts propose to significantly expand the possibilities of providing palliative care at home (to increase the number of teams and geography of coverage by districts), as well as to include palliative care at home in full in the CHI system”.

However, as experience shows, “immersion” of any types of medical care in the compulsory medical insurance system only results in a decrease in their funding. “Colleagues do not understand what they are proposing,” said David Melik-Huseynov, director of the Research Institute of Health Organization. - By including palliative in the CHI, we will have to pay for a completed case. The process of waiting for this completed case on the part of doctors and relatives of patients will be sad. In an outpatient cushion, palliative also does not get along. There were calculations and simulations. So far, the budget model is the most justified in palliative. I think that such a proposal should be returned back."