The main problems of health care and ways to solve them. Actual problems of modern healthcare and possible ways to solve them
Deputy Chairperson of the Federation Council Committee on Social Policy and Healthcare Lyudmila Kozlova spoke about healthcare problems in Russia and about possible methods of solving them
“I will outline the main problems in the industry.
In March and May of this year, the Federation Council held round tables dedicated to import substitution of medicines and medical devices. I am very grateful to those people who not only responded and took part in the event, but also made their suggestions.
Many ministries and departments are involved in ensuring the protection of the health of citizens. When we talk about this, first of all, we refer to the Constitution of the Russian Federation, which states that every citizen has the right to provide free medical care... Now the volume is growing very much paid services- I believe that they should exist, but as an alternative. In general, people should receive free medical care, as stated in the Constitution.
I will refer to two messages from the President of the Russian Federation. In 2013, Vladimir Putin announced that in last years we have managed to do a lot for the development of health care. He noted an increase in life expectancy and a decrease in mortality from cardiovascular and several other diseases. The president's phrase inspires optimism and allows us to conclude that they know about the problems of domestic health care at the highest level.
Let me remind you that Vladimir Putin proposed to declare 2015 National year fight against cardiovascular diseases. Round tables were held on the platform of the Federation Council, in which cardiologists of Russia took part - those doctors who have achieved high results both in science and in practice. They work well and a lot, they know all the problems, but the mortality rate from this group of diseases in our country remains quite high. I will note that I did not see a single pediatrician among them. We believe that the origins of all diseases in adults lie in childhood and prevention should be started from an early age. And not even when the child was born, but when the family is still planning to replenish it.
Domestic healthcare problems:
. Lack of staff. Despite the general reduction that took place in the country, especially in the capital, this problem still exists. In these conditions, one cannot talk about the availability and quality of medical care.
. The growth of paid services.
... The shortage of drugs and the rise in prices for them ... To avoid corruption and other negative aspects, medicines should be centrally procured and distributed. Residents of all regions of Russia should be equally able to receive them. It is known that there are subsidized entities in which it is very difficult to provide expensive drugs to all who need it.
The state of the material base after the launch of national projects has improved. However, it is the medical workforce that is the main and significant part of the health care resources. As Vladimir Putin said: “Despite all the technical innovations in medicine, the personal qualities of a doctor have always been valued.<…>We must create all conditions for their decent work. "
Ways to solve problems in health care:
. Raising the social status of medical workers.
. Enhancement wages, basic payments.
. Housing provision.
There is a well-known phrase: "Health is not everything, but everything without health is nothing." When everyone understands this, the working conditions of doctors will improve, which will benefit the health of the population. A strong state emerges only when the population is healthy.
Medical education
Another problem that exists is that in conditions of a shortage of personnel, we must have continuous medical education. Now everything is changing very quickly, there are modern devices, new methods of research and treatment. In conditions of a shortage of personnel, it is difficult to let the chief physician go for training, even for 2 months. When developing distance education, it should be used for those who already have work experience and certain practical skills. In the case of graduates, it must be applied very carefully.
Problems of modern medical education
We know that the quality of medical care cannot be higher than the level of education received. Therefore, medical education really deserves close attention and reform. Why did it become worse to teach? The fact is that the social status of teachers, as well as of doctors, is low. There is currently no competition for theoretical departments.
. Integration into the treatment process of employees of clinical departments of medical universities. If the employee is not an employee of a medical institution, then this is very difficult to do. But there are ways to solve it - in conditions of a shortage of personnel, the chief physician can arrange an employee for half or a quarter of the rate.
... Inconsistency of the system of advanced training of medical personnel with the needs of practical health care and international standards.
... The issues with the clinical bases of universities and the management of the staff of the departments of clinical activity on the basis of state and municipal medical formations have not been settled.
A feature of our domestic medicine is its preventive focus... We know that disease is easier to prevent than to cure. Now various proposals are being heard - for example, to work directly with the CHI fund, bypassing Insurance companies, etc. I believe that one should not cut from the shoulder, but analyze the situation and listen to all points of view.
The proposed introduction of additional state guarantees must necessarily be linked to the reciprocal obligations of citizens - maintaining a healthy lifestyle, regularly undergoing preventive examinations and with the implementation of the doctor's recommendations. In my opinion, you need the federal law about stimulating motivation for a healthy lifestyle ”.
Description of the presentation Social problems of health care. One of the main slides
One of the main tasks public policy in Russia is to ensure the protection of life and health of the population, the solution of which could contribute to the sustainable socio-economic development of the country. Currently, there are many social risks in Russia that pose a threat to the life and health of the population. By-effects of socio-economic transformation, wasting natural resources as a result of irrational use solely for the purpose of making a profit against the background of an increase in the technical equipment of many state-important objects, lead to the creation of an increasing threat not only to the life and health of the country's population, but to all of humanity. The powerful mutagenic effect of radioactive radiation, electromagnetic fields, X-ray and infrared radiation, and other harmful factors used in industry leads to the destruction of the country's gene pool and human degradation. Social risks for a person are also represented by the consequences of a spiritual and moral crisis. The lack of an ideology of creation among modern youth, their own destructive life activity, the lack of basic medical knowledge and skills, the ability to secure safe work and living conditions for themselves most often leads to catastrophic consequences. The structure of society, depopulation and degradation of the population, the growth of corruption and crime are of concern. Up to 0.5 million people predominantly males die in road accidents, on water bodies, in case of alcohol and drug poisoning, during "showdowns", suicide, law enforcement, while serving in the army. As a result, only 14 million men are able to start a family.
The most tangible loss of population occurs during road traffic accidents. According to the WHO, every year 10 million people die as a result of road traffic accidents in the world, and from 20 to 50 million people become disabled, which brings enormous social and economic damage to the entire human community. According to the World Bank, the global economic losses to humanity amount to about $ 500 billion a year. Due to the unfavorable environmental situation, the incidence rate among the population is steadily increasing (see Fig.). The highest incidence in Russia with a diagnosis established for the first time was registered in Karelia and Altai Territory (over 1000 cases per 1000 population), from 800 to 1000 population - in Arkhangelsk, Tver, Leningrad, Murmansk, Arkhangelsk, Orenburg, Tyumen, Irkutsk regions and in Yakutia. From 500 to 800 thousand cases per 1000 population were registered in Smolensk, Bryansk, Volgograd, Astrakhan, Saratov, Sverdlovsk, Chelyabinsk, Tomsk, Novosibirsk, Chita and Amur regions, Krasnoyarsk and Krasnodar regions, in Buryatia and Tyva. The lowest incidence (up to 500 cases per 1000 population) is registered in the Khanty-Mansi Autonomous Okrug (Yugra), Yamalo-Nenets, Taimyr and Evenk Autonomous Districts.
Morbidity per 1000 population in the regions of Russia (registered patients with a diagnosis established for the first time in 2006) There is a clear increase in psychiatric pathology in Russia. Mental abnormalities are noted in 20% of the population. There is a sharp increase in the number of children born sick or sick during the neonatal period. During the period from 2000 to 2006, this figure reached 40% of the total children born alive. There are 14 million disabled people in Russia, including 523 thousand children. This indicates a low level of quality of medical care and social rehabilitation in the country. The effectiveness of rehabilitation of disabled people in our country is from 3 to 6.5%, and in the USA - from 15 to 20%. At the same time, the health care system, drug and medical services are not working efficiently enough. The main reason for the low efficiency of the population health protection system is the underfunding of this industry from the state. So, in the USA and others developed countries financing of the health care system is considered a task of the state and amounts to 15% or more of GDP. In Russia, the health care system is financed on a leftover basis, expenditure items are cut and mainly industrial and military-industrial sectors are supplied. At the same time, only 2.5 -3% of GDP is planned for health care, which is in no way compatible with the current demographic situation in the country. Funds directed by a targeted order are not always used for their intended purpose, as a result of which the population is forced to turn to private clinics, which most often cannot afford the majority of the population of Russia. In order to resolve this situation in 2007, 328.2 billion rubles were allocated for the implementation of the basic program of compulsory health insurance... At the same time, the compulsory medical insurance system practically does not work. The very system of organizing medical assistance to the population suffers. Currently, medical care in Russia is provided at the following levels: polyclinic, ambulance and inpatient care. Outpatient and polyclinic care is provided in 9620 institutions, including 833 dental clinics. Given the vast territory of Russia, this number is negligible. Moreover, each polyclinic is staffed with local doctors and honey. sisters, on average, only 30%. Low salaries and a huge workload of doctors (up to 1,500-4,000 thousand people per district doctor) leads to a decrease in the efficiency of the treatment process and overload of polyclinics. The sanitary-educational and preventive work is not even mentioned. Dental care is now practically inaccessible to the population. Prices dental care unreasonably high and 3 -5 times higher than their cost. As a result, dental clinics are empty, as the population prefers not to go there for help and visits the dentist only in emergency cases.
Ambulance services are provided by about 3268 stations. They are insufficiently equipped with reanimation vehicles and medicines and are absolutely not protected from encroachments by criminal structures. As a result of the huge number of traffic jams on the road, the ambulance cannot get to the call at the right time, and the patient often dies, or his further treatment is complicated. About 1.8 million people die every year due to more than 24 hours delay in admission to the hospital. Ambulance teams are insufficiently staffed with qualified personnel, there is no one system communication between different ambulance stations. In this regard, it is necessary to ensure that 2-3 ambulances are on duty for each microdistrict, so that the speed of rendering honey. aid did not depend on the condition of roads and traffic jams. The system of protection of mothers and children suffers. Despite the widespread government programs that stimulate the birth rate, the perinatal service in Russia is currently ineffective. It is noted low level health of pregnant women, 80% of pregnant women have concomitant pathology: anemia, cardiovascular disease, kidney disease, edema and proteinuria, diabetes, etc. As a result, only 24.6% of births are proceeding normally. Basically, childbirth is pathological, as a result of which 30% of children are born sick or get sick in the first days of life. The system for the prevention of infectious diseases in children is also ineffective. At present, in Russia the so-called compulsory "vaccination calendar" includes 10-15 compulsory vaccinations. In European countries, the number of compulsory preventive vaccinations for children has reached 150 or more. The issue with the production of Russian baby food products, dietary baby food for children with phenylketonuria and various types of fermentopathies has not been resolved, the range of baby food is extremely poor, its production in Russia is not envisaged.
Thus, ensuring the protection of life and health of the population, the formation of a healthy lifestyle should be carried out in the following areas: · In the field of ensuring the safety of life and health of the population, it is necessary to continue developing a system for protecting and improving the environment; creation of ensuring access of the population to daily monitoring of the state of the environment. In the field of ensuring health care and high quality medical services for the population, it is necessary to increase funding for health care, medical services and social sphere up to 15% of GDP; develop strategies to improve the quality of health care services, reduce premature, especially preventable mortality, and reduce morbidity. In the field of protection of motherhood and childhood, due to the increase in the number of concomitant pathologies during pregnancy and childbirth, to increase the period of prenatal maternity leave and to issue it from 16 weeks, placing a pregnant woman in a day hospital, creating an "incubator" for nursing pregnant women in order to prevent pathology in childbirth, school for mothers and treatment. In the field of the formation of the ideology of a healthy lifestyle among the population, it is advisable to obligatory introduction of health-saving pedagogical technologies and medical and hygienic disciplines in institutions of preschool, secondary and higher education with the aim of fostering a culture of health and a healthy lifestyle in children, adolescents and youth, the widespread introduction of anti-alcohol and anti-nicotine projects in schools, colleges and universities, at work, the fight against drugs and the introduction of a system of fines for drinking and smoking in public places; creation of motivation by employers for a healthy lifestyle.
1A. A. Belovodsky
The proposed article examines the problems of the Russian healthcare sector. A brief analysis of the main problems is given (low efficiency of healthcare, stagnation of the pharmaceutical industry, high prices for drugs for the population). And also describes the ways to solve them, proposed by both experts and the author of the article.
Introduction
The wealth of any state is its population. People create the state and are the source, the engine of its development and prosperity. But in order to be active, a person must be healthy. Therefore, one of the most important functions of the state is to maintain the health of its population. This support is provided through the health care system.
Health care is a set of measures of a political, economic, social, legal, scientific, medical, sanitary-hygienic, anti-epidemic and cultural nature, aimed at preserving and strengthening the physical and mental health of each person, maintaining his long-term active life, providing him with medical assistance in case of deterioration health.
According to the Constitution of the Russian Federation, “The Russian Federation is welfare state", In which" labor and human health are protected. " But in practice, everything is far from what it is written.
Most experts agree that the health care system of the Soviet Union was one of the best in world practice, since it performed all the functions assigned to it in terms of quality, availability and provision of medical services, medicines and materials. But after the collapse of the USSR, it entered a phase of stagnation: funding was greatly reduced, highly qualified specialists in the field of medicine went abroad, scientific research in medicine ceased, the production of drugs and devices for diagnosing and treating diseases was greatly reduced.
In the early 2000s, when the situation in the country began to gradually improve, the authorities turned their attention to the healthcare sector. But there are so many accumulated problems that they cannot be solved at once and in a short period of time.
So, essential condition further development of the healthcare sector is a transition to an innovative path of development, in connection with which the implementation of the following principles should be ensured:
- government regulation combined with effective competition in the innovation sphere;
- preparation and transition of industry to increase the output of high-tech and science-intensive products that meet the needs of the market and the prospects for its development;
- creation of long-term conditions for increasing labor productivity;
- concentration of resources on innovations that will ensure positive structural changes in the economy;
- stimulation of business and investment activity in the field of scientific, scientific and technical and innovation activities through tax, credit and other economic benefits;
- integration of investment, scientific and technical, educational and industrial activities;
- ensuring legal protection of objects of intellectual property and copyright in the dissemination of scientific and technical knowledge and information;
- cooperation of all levels of government, as well as the state, subjects of the federation and municipalities on the issues of modernization and technological renewal of the basic sectors of the economy and social sphere;
- publicity and discussion of priority innovative programs and projects during open competitions.
It is not without reason that state regulation is placed in the first place among the principles. Without him innovative development it will not work, since private business is reluctant to get involved in the innovation process. Regulation and support in the field of innovation by the state should be as follows:
- development of regulatory legal acts in the field of innovation, organization and control over their implementation;
- determination of priorities in the field of innovation, development and implementation of innovative programs and projects;
- creation of an innovative infrastructure and conditions for innovative activities (incentives through preferential taxation, subsidies, subsidies from budgets);
- formation and placement on a competitive basis of a state order for the creation of science-intensive products and technologies;
- protection of the rights of investors and creditors;
- training and advanced training of personnel employed in the field of innovation;
- coordination of actions of subjects of innovation activity;
- support for the creation of subjects of investment activities with the participation of foreign capital, with the provision of appropriate state guarantees for activities.
Thus, the purpose of this essay is to characterize the problems of the healthcare sector in Russia and ways to solve them.
The following tasks were set:
1) a description of the problems in the health sector;
2) a description of the measures taken in Russia to eliminate the problems;
In the abstract, information was used not only from various sources, but also the observations of the author himself.
1. Problems of the Russian healthcare system
First of all, one should dwell on the low efficiency of the entire health care system, which gives rise to the low quality of medical services provided. The reasons for this state of affairs are as follows:
1) a shortage of specialists, medical equipment, hospital facilities, which generates long queues of patients during admission hours. Doctors have to work in an emergency mode, which automatically reduces the quality of services provided;
2) short admission schedule. Visiting hours often end before 2 pm. Those who did not have time to get to the appointment are forced to come on another day, that is, to ask for leave from work again, therefore, not to fulfill a number of their duties. Such distraction of employees negatively affects both the company itself (the degree of negative consequences will directly depend on the position of the employee and the possibility of replacing him), and on the employee of this company (decrease in wages);
3) inability to timely receive the required medical care. This is a consequence of the lack of specialists, equipment, high cost of medicines and medical services;
4) low qualification of doctors. It often happens that in two different clinics, doctors make different diagnoses for the same symptoms. Accordingly, the treatment does not give the expected effect;
5) absence or aging of medical equipment. In most hospitals, patients are examined and treated using Soviet equipment. And undergoing treatment or examination on new equipment (if available) often costs a lot of money;
6) low wages and lack of mechanisms to stimulate quality work.
The shortage of specialists and hospital facilities is especially noticeable when comparing cities both within one region and between regions. So, if in the regional center or the capital of the republic, most hospitals and clinics have been repaired, have new equipment, then in simple cities, especially remote from the center, there are often few polyclinics in which people cannot receive required volume medical services. How often in the hospitals of the capitals of the subjects of the federation one can see people from other cities and hear about the lack of the necessary apparatus or specialist in their city.
The low efficiency of the health care system strongly “hits” the country as a whole, especially its economy.
The next serious problem is in the production of pharmaceuticals. The modern population of most countries cannot live without antibiotics, vaccinations, and many different drugs. And if more than 80% of the drugs required for its population are produced domestically, then there are practically no problems. But if the country imports most of the drugs, then there is a "threat to national biological security." Russia also belongs to such countries: imports of medicines make up about 80% of their consumption. Most of the domestic drugs are either Soviet era developments (brought to industrial production) or generics (a drug with proven pharmaceutical, biological and therapeutic equivalence with the original, but does not have patent protection; that is, it is a copy of the original third-party drug). New developments in this area are funded by the largest companies in the pharmaceutical market (Pharmstandard, Otechestvennye mediciny, Nizhpharm, Veropharm, etc.), while the rest receive grants from abroad and occasionally government orders.
Also, the reasons for the stagnation of the pharmaceutical industry were:
1) the outflow of specialists abroad. The so-called "brain drain" has long become a national disaster in Russia. Scientists move to other countries because they are offered high pay, guaranteed orders and provided with all the necessary research equipment;
2) underinvestment. Pharmacology is a specific area of health care with its own concepts and patterns. Few of the potential investors are able to understand the meaning of the development and assess its prospects. Also discouraged by the uncertainty of the payback period and the high medical risks of manufactured drugs;
3) the inability of scientists to "sell" their ideas. Russia has always been famous for its people. Today there are groups of enthusiasts developing new drugs. But the matter does not go beyond the idea and the initial developments, since they do not know how to properly present their development to investors in order to further test it and launch it into production;
4) the high cost of developing new drugs. According to experts, investments in the development of a new drug amount to at least $ 600 million. Of this, 10-15% goes to the development of the molecule, 25-30% to preclinical trials in animals, 50-60% to clinical trials in humans. If we are talking about the development of a fundamentally new formula, then the costs for the entire cycle (from research to market launch) can reach more than $ 1 billion;
5) long term. The minimum development time for a new drug is 3 years;
6) insecurity of intellectual property. This problem is not specific to the pharmaceutical industry only. It is typical for Russia as a whole. Only in 2006 began to take shape the legislative framework for the protection of intellectual property. In particular, on December 18, 2006, part 4 of the Civil Code came into force. Russian Federation dedicated to intellectual property;
7) availability of generics. Large modern pharmaceutical companies have little interest in the development of new drugs also due to the large number of generic companies. Generics in most cases do not differ in quality and properties from the original, but they cost an order of magnitude cheaper, which reduces the profitability of a new drug from the developer.
A little more detail should be given to the problems of financing drug development. The high cost of the full cycle of drug development (from idea to production) makes such developments impossible for medium and small companies. But they participate in the development as "generators of ideas" or the first stage of research (creation of a drug formula). In the future, they sell their developments, most often, to foreign companies due to the high payment. In addition, according to experts, sometimes domestic companies do not need new developments, which is explained by the lack of Money on the continuation of development, either by the availability of a large number of our own medicines, or by the successful release of generics for imported medicines.
Foreign grants are another way of survival for representatives of a medium-sized pharmaceutical business. According to Rosprom's estimates, the average grant is $ 100,000, with 30-50% of Russian companies working on them. Development is carried out until the stage of obtaining the formula, then it is sold abroad.
Also, companies have a chance to receive the necessary funds by contacting special funds. Now entrepreneurs are helped by the Small Business Support Fund, which issues money on the condition that the entrepreneur has a patent. The amount of funds allocated at the earliest stage of development is 1 million rubles. In the future, if it is possible to attract an investor, the Fund will allocate another 3.75 million rubles. Also, there are 3 venture funds operating in the country, and in the future they will establish 7 more. Their capital will be formed at the expense of private and public funds. The money will be given to entrepreneurs on the condition of entering the capital of the company being created and receiving a share of the profit in the future.
Another way to solve the problem of financing is government procurement of drugs and orders. But so far this mechanism is ineffective, since 89% of the required drugs are purchased from foreign companies during government purchases. But the priority should be given to Russian developments.
The next problem associated with drugs is their high cost to the population. No, there is no malicious intent from drug manufacturers (as many people think). This is facilitated by a number of reasons:
1) fluctuation of the ruble exchange rate. Since October 2008, a gradual devaluation of the ruble began in Russia, as a result of which the dollar grew against the ruble by almost 40%, which affected the rise in the cost of imports. And since 80% of the drugs consumed by the residents of the country are imported, the end consumers received the main blow from the devaluation;
2) high cost and duration of development. Therefore, all fundamentally new drugs entering the market are available only to a limited circle of consumers (either the rich, or those to whom the developer company allocated them for free). One example is the modern development of a vaccine against "swine flu" by the British company GlaxoSmithKline Plc. The development of the vaccine took 5 years, more than $ 3.2 billion was spent. The price of the finished vaccine is $ 10. 50 million doses were donated to the World Health Organization. And now let's present some calculations on how much the imported vaccine against "swine flu" will cost for the population of Russia:
The dollar exchange rate established by the Central Bank of the Russian Federation, as of 13.10.2009 - 29.5 rubles;
The cost of the drug is $ 10;
Import duty on medicines - 10%;
Thus, the cost of this vaccine when crossing the border is 324.5 rubles. (10 * 1.1 * 29.5).
The final cost will consist of extra charges retail chains, delivery and promotion costs. It can be assumed that the cost for the population will be about 500 rubles. for 1 dose. It is obvious that the majority of the Russian population will not be able to afford such a vaccine due to low incomes, which increases the risk of morbidity and mortality from the "swine flu" virus.
3) unreasonable prices for medicines. Recently, during a visit to Zelenograd, the problems of the high cost of drugs were raised by V.V. Putin, focusing attention and misunderstanding that foreign medicines are often sold in Russia at prices many times higher than in other countries.
The population is often afraid to buy Russian drugs, preferring imported ones, since there is no confidence in the quality of domestic drugs. In addition, most of the imported drugs have no analogues in Russia.
The same situation (as in the example with calculating the cost) is observed in the whole pharmaceutical market, which puts the Russian state under serious threat due to high risk morbidity of the population and reducing opportunities for its rapid recovery.
2. Ways to solve health problems
How can Russia get out of such a deplorable situation with health care? The main thing is reforms. But not pinpoint according to the principle "find the decisive link, pull on it - and everything will be resolved." A set of reforms is needed to address all elements of health care. They must be thoughtful and complete, otherwise, as is often the case in Russia, they will only make matters worse.
To improve the efficiency of the healthcare sector, experts propose to develop a mechanism to stimulate competition between physicians and medical institutions. It is required to create a mechanism that will interest medical professionals in improving the quality of their services. For example :
1) creation of a database of doctors and their patients (who are constantly served by him). Such a system operates abroad, where health care is free (USA, Western European countries), and makes it possible to identify highly qualified doctors;
2) provide financing to medical institutions for the effectiveness of the services they provide. That is, the less a person spent within the walls of the hospital, and if he did not have a relapse of the disease, then the medical institution that provided him with assistance will receive more funding than the rest. This mechanism is used in most developed countries (Great Britain, etc.);
3) it is necessary to adopt a number of laws to promote competition in healthcare;
4) it is necessary to change the organizational and legal form of medical institutions. Today they are all state-owned. This means that the arising financial results from their work they go to the state: the surplus of funds is taken away, the arising debts are extinguished. This situation is demotivating. medical institutions relatively efficient work. They should be given more freedom in their activities;
5) one should take a differentiated approach to the development of the health sector in different territories of the Russian Federation due to their unequal development. Somewhere it is only necessary to increase the efficiency of healthcare by stimulating competition to develop and improve the quality of medical services, since the region (city) has the necessary medicines, equipment, and specialists. And somewhere, first it is necessary to resolve the issue of the shortage of drugs, medical equipment, specialists, and only then introduce mechanisms to stimulate competition in the healthcare sector.
The issues of remuneration of medical specialists should be approached from the point of view of the development of the region (city), rather than increase wages by the same amount throughout the country. Due to the strong differences in the level of development of the subjects of the Federation, municipalities, the amount of the increase in wages will be perceived differently everywhere. So, in Moscow, 10 thousand rubles. the allowance for the district doctor means very little, and in Dagestan the same amount is a lot of money.
It is also necessary to create mechanisms, thanks to which free medical care would first of all be received by those who have nothing to pay with, and those who have something to pay with, in the presence of a shortage (equipment, specialists, medicines) could pay for the medical care required for themselves.
Another way to develop competition is to use modern information achievements in the healthcare sector. In particular, experts propose the idea of creating a personalized database of individual accounts. On its basis, it will be possible to scientifically substantiate the required number of specialized beds in a particular region.
Improving the quality of medical care will also be achieved through the development of intensive care units (intensive care units of various specializations). In the West, each hospital has 20-25% of intensive care beds. In Russia, this figure does not exceed 5%.
The next problem in the healthcare sector is tariffs for medical services- should be resolved through civilized state intervention. Medical rates should include all cost items. They should take into account the required profitability and the level of projected inflation.
To attract funding and stimulate new developments, it is proposed to establish venture funds (with the participation of different capital), to allocate government grants for research. Business cooperation with universities and science cities begins. Today there are biotechnological laboratories on the basis of Moscow State University, Stavropol State University, and a science city in Pushchino. Their task is the first stage of development. In the future, the resulting formula will be sold to a private company.
The state needs to stimulate the innovative development of the entire economy in general and the health sector in particular. As noted earlier, there are practically no new developments in drugs and medical equipment in Russia. To rectify the situation, the state, first of all, needs to develop an innovative infrastructure, change tax law(increasing tax incentives and introducing tax holidays for companies implementing new developments). It is envisaged in the near future the creation of several research institutes for conducting scientific research in medecine.
But there are already real shifts in this situation. So in 2008 19.4 billion rubles were allocated from the budget. for the construction of new medical technology centers in Penza, Khabarovsk, Astrakhan and other cities. With the support of the state, the medical direction is developing in technoparks (Kurchatovsky, Zelenogradsky, Obninsky), where new methods of treatment, medicines, and equipment are being developed.
In early 2005, the Supplemental Drug Supply program was launched. The essence is the free provision of medicines to privileged categories of the population. For these purposes, funds were annually allocated from the budget for the purchase of medicines. 89% of purchases in monetary terms account for foreign companies... In this regard, experts advise to shift the focus to drugs from domestic manufacturers.
All of the above is what the experts suggest. In general, the author agrees with their suggestions. But after analyzing the problems of the healthcare sector in Russia, he proposes an additional series of measures aimed at improving the situation.
The most important thing is innovative development. The state should become the initiator of the innovation process. It must create incentives for businesses to be motivated to invest in costly, risky projects. To do this, it is necessary to change the legislation in terms of innovative activities of companies. For companies that are developing new drugs or medical equipment, tax breaks should be introduced for the first few years (up to 3 years) of development. In the future, they should reduce their income tax at the stage of promoting a new drug (equipment) on the market. As soon as the sales volume reaches the target and continues to grow, such companies should be transferred to the general tax regime.
At the initial stage of development, the state should actively help companies financially, especially young firms with promising developments. To do this, you can use the funds of federal target programs, government orders, grants, the creation of joint ventures with private business, the creation of various venture funds.
To stimulate new developments, it is necessary to create research centers (at least one in each federal district), under the roof of which to gather scientists and provide them with funding for their ideas. In the future, it will be possible to either sell the developments to private companies, or organize their industrial production and market promotion within the framework of joint ventures, or use the rental or leasing form of the development implementation. When the development is sold, the forms and terms of payment should be specified in the contract. Optimal would be a step payment (an initial payment, then a fixed or percentage deductions from the proceeds from the sale of a new drug / equipment). With the lease form, the acquirer (lessee) will only pay royalties for using the formula or industrial design of the device without transferring ownership of the leased development. Moreover, this development can be leased to other companies. In the case of a leasing form, the acquirer (lessee) will use all the advantages of the leasing scheme.
To facilitate the transition to an innovative path of development, it is initially possible to create generics based on Western samples, but on their basis to produce our own developments. But it is necessary to strengthen control over generics, which will automatically increase public confidence in them and reduce the number of side effects.
To have an opportunity for innovative development, highly qualified personnel are needed. It is necessary to look for and encourage talented students, to involve them in work in research projects. It is also necessary to stop the outflow of domestic scientists abroad. To do this, it is necessary to create all the conditions for their research activities: provide laboratories, allocate funding. But such measures should be taken in priority scientific areas, as well as promising areas. You should not waste resources on dubious research (of which modern world you can find many).
One of these key areas (in addition to the use of nanotechnology in medicine, the creation of new drugs and medical equipment) should be diagnostics. The development of this area of medicine will significantly reduce the duration of treatment and the number of patients of moderate and high severity, since it will be possible to identify and treat diseases at an early stage, when it is much easier to do than later.
To solve the problem of the cost of drugs, the pricing should be monitored along the entire chain (from the manufacturer to retail). And to punish those who unreasonably raise prices.
Conclusion
Based on the results of the work carried out, it can be concluded that, despite the huge volume of accumulated problems, the Russian health care system is beginning to change towards improvement.
But there is another serious problem that cannot be solved only with new ideas and funding. This problem is not highlighted by experts, but every person faces it. We are talking about consumer confidence in Russian medicines, medical equipment, and doctors. And the reason for the named problem lies precisely in those flaws in the health care sector, named in the work. In addition, since Soviet times, people have had the idea that all imported goods have better quality, characteristics, and are safer than Russian counterparts (if any).
Lost trust is always very difficult to regain. But if all the problems identified in the work are solved, if their solution does not drag on for a long time, then people will switch to domestic drugs and medical equipment, they will cease to consider the maximum withdrawal of money from the patient as the main goal of doctors. The number of days spent in hospitals will be reduced. Mortality will decrease and life expectancy will increase. All this will immediately have a positive effect on the country's economy. Only then can it be said that Russian system health care is effective.
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The transition from the paternalistic (total guardian) system of the Soviet state to the liberal model in the healthcare sector had negative consequences. The changes have had a very negative impact on the health of Russians - it has become worse in comparison with the Soviet period. In recent years, a vicious circle has emerged in which domestic healthcare: the more funds are invested directly in medicine (in specialized inpatient care and high technologies), the less funds are left for prevention and early detection of diseases. The lack of prophylaxis predetermines an increase in the number of patients, the detection of diseases at late stages, and the chronicity of pathologies. This, in turn, requires even more investment. A number of complex social problems of Russian health care follow from this:
- - the transition from mass health-improving and preventive measures to individual treatment, i.e. dominance of clinical medicine;
- - an increase in the cost of health care does not increase its effectiveness;
- - an increase in the payment for medicine, a constant shortage of funds, non-transparency of financial flows;
- - deformation of humanism and medical ethics, which now makes it possible to see in the patient another source of income;
- - a sharp economic stratification of Russians, which predetermines an unequal attitude towards health and the possibilities of receiving medical care;
- - inequality in the incomes of doctors themselves;
- - Shifting responsibility for health only on the population itself.
The main thing negative consequence of these problems - a decrease in the number of population unprecedented in peacetime. Today it is not as destructive process as in the previous 18 years. There are tendencies towards stabilization of the number, but the "quality" of people's health, degradation of the environment, a critical decline in the labor and defense potential of the country are urgent threats. Demographic situation in the Russian Federation is still unfavorable, although the rate of population decline in recent years has significantly decreased - from 700 thousand people annually in 2000-2005 to 213 thousand in 2007. In 2008, the rate of natural decline in the population was 2.7 per 1000 population. As of 2010, the resident population in the Russian Federation was 141.9 million people. The decrease in the rate of population decline is mainly due to the birth rate and the decrease in mortality. In 2007, 8.3% more babies were born than in 2006 (1 million 602 thousand). In 2006, for the first time in 7 years, life expectancy began to increase - from 65.3 years to 67.5 years. Nevertheless, the average life expectancy in Russia is 6.5 years less than that of the "Young Europeans" (countries that have joined the EU since 2004) and 12.5 years less than in the countries of "Old Europe". A big difference in Russia remains in the life expectancy of men and women - 13 years. The main reason for this is the high mortality rate among men of working age. The life expectancy indicator is a generally accepted indicator of the quality of life and health and a correct measure of the mortality rate. The main causes of death in Russia are:
- - circulatory diseases, from which, for example, about 1.2 million people died in 2007 (56.6% of the deaths);
- - neoplasms (13.8%)
- - external reasons (11.9%).
It is very significant that oncological diseases
in Russia are characterized by a high proportion of deaths during the first year after diagnosis: for example, the percentage of deaths from lung cancer is 56, from stomach cancer - 55. This suggests that people go to the doctor late, when treatment is very costly, and the risks of death great. Working-age men die from cancer 2 times more often than women, although the incidence among women is higher.
In Russia, mortality from external causes is 4.6 times higher than in the countries of old Europe and 2.6 times higher than in "new" ones. These reasons are mainly:
- - excessive consumption of strong alcoholic beverages;
- - road accidents;
- - suicide.
The most important indicator of the effectiveness of health care in any country is the average life expectancy of people suffering from chronic diseases. In Russia it is 12 years old, in the EU countries - 18-20 years. Disability in the Russian Federation has not decreased, including among the able-bodied, there are 14 million of them in the country, of which 523 thousand are children. This indicates the low quality of medical care and inadequate social rehabilitation.
The percentage of risk factors (high blood pressure, high cholesterol levels, tobacco smoking, alcoholism) in the structure of mortality among Russians is 87.5%. The first place among these factors is occupied by excessive alcohol consumption. This is a major public health problem in the country. Every day in Russia, 33% of boys and 20% of girls, about 70% of men and 47% of women consume alcoholic beverages (including low-alcohol ones).
In 2006, the priority national project"Health" with four main areas:
- - development of primary health care;
- - strengthening of preventive activities;
- - increasing the availability of high-tech assistance;
- - introduction of the generic certificate system.
In 2007, a pilot project to modernize healthcare was carried out in 19 constituent entities of the Russian Federation. In 2008. programs to improve care for patients with cardiovascular diseases, victims of road traffic accidents, and a program to develop blood services began. In 2009, programs were launched to improve the organization of oncological care for the population and activities aimed at promoting a healthy lifestyle.
As a result of three years of efforts to implement projects, there was an improvement in demographic and health indicators of the population:
- - the birth rate has increased by about 16%;
- - life expectancy increased by 2.2 years;
- - the overall mortality rate has decreased by 10%.
State intervention, increased funding, and finally, the personal control of top officials in this situation can be converted into a figure of 500 thousand saved lives of Russian citizens.
What systemic problems await Russian society and healthcare in the near future? First, demographic: the share of the elderly population in the Russian Federation will increase from 21% to 28%; secondly, a decrease in the birth rate due to a decrease in the number of women of childbearing age. Today, girls 10-14 years old, expectant mothers, are 2 times less than women of childbearing age. Finally, there is an increase in the prevalence of non-communicable socially-caused diseases. The necessary response to these challenges should be investments in the development of pediatrics and neonatology and an increase in the retirement age by 10 years. The first provision only requires funding. The second will not be immediately implemented, since according to the Federal State Statistics Service, only 48% of men survive in our country until the age of 65. It is necessary to extend the life expectancy of men by at least another 5 years, and then it will be possible to discuss the issue of extending the retirement age.
Two serious government documents were approved by the President and the Government of the Russian Federation - "The Concept of the Demographic Policy of the Russian Federation for the Period up to 2025" and "The Concept of Long-Term Socio-Economic Development of the Russian Federation for the Period until 2020". The latest document concerns all sectors, including healthcare. It sets goals: to reduce the mortality rate by 1.5 times by 2020 and to increase life expectancy to 73 years. The main principles of this strategy should obviously be:
- - solidarity (the rich pays for the poor, the healthy for the sick);
- - equality of urban and rural residents, wealthy and depressed regions;
- - pluralism of opinions, openness and evidence of decision making;
- - lack of corruption.
The main direction of this strategy is the adaptation of the Semashkov system of organizing medical care to modern conditions, improving management efficiency. To solve this kind of problems, health at the national level should be the object of research. The efforts of sociology, medicine, hygiene, and management economics will make it possible to determine trends in the health of individual regions and the country as a whole. To build an effective social policy to optimize the health of various groups of people, it is necessary to differentiate and determine the significance of the influence of the environment, lifestyle, and biological factors.
- With the help of such a criterion of social development as the successes of science and technology, it is possible to show the progressive nature of
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