what will be discussed at the meeting of the State Council – Vademecum magazine

what will be discussed at the meeting of the State Council – Vademecum magazine
what will be discussed at the meeting of the State Council – Vademecum magazine

ANO “Agency for Strategic Initiatives to Promote New Projects” (ASI), on behalf of President Vladimir Putin, has prepared a Concept for Improving the Russian Healthcare System. The multi-page document proposes, among other things, to introduce a clearing system in the country for inter-territorial settlements in compulsory medical insurance, establish a minimum salary for doctors in the amount of four minimum wages, and launch a program of preferential treatment for patients at risk of developing cardiovascular diseases (CVD). The ideas, the implementation of which the ASI estimates at least 700 billion rubles of additional funding each year, will be discussed at the upcoming meeting of the State Council Commission on Health.

The strategy was sent to the members of the commission of the State Council for familiarization, as well as to the participants of the National Medical Chamber. The latter had to prepare comments and proposals for the document before September 19.

The fact that the report with such a concept was indeed developed and sent to the State Council was confirmed by Vademecum in the press service of the ASI.

When exactly the meeting of the Council will take place, at which the proposals of the professional community should be discussed, is not specified. The committee last met in January 2022.

The introduction to the Concept states that in Russia, especially in connection with the COVID-19 pandemic, there is a high mortality rate, low life expectancy among men, as well as a general underfunding of medicine, therefore, a set of measures has been developed “in order to ensure national security in the field of health protection citizens and increase the effectiveness of the implementation of the policy of people-saving”. The document was prepared on behalf of Vladimir Putin No. Pr-2491 dated December 16, 2021.

The authors of the strategy clarify: some of the proposals have already been approved by the Russian Ministry of Health and can be put into practice with a high degree of probability in the coming years. Among them:

• exclusion of the practice of reducing incentive payments by clinics if the health worker did not work the standard number of hours reflected in the standard industry norms for the performance of work (for this, the Ministry of Health will need to prepare explanations and send them to the regions);

• lowering the maximum permissible level of part-time employment of medical workers to 0.25 of the rate, but only after the shortage of personnel in the country is eliminated;

• the ability to hire non-medical personnel to assist doctors in filling out documentation (this decision will require annual additional funding of 35 billion rubles, specify the ASI);

• the need to develop a methodological recommendation for managing the psycho-emotional state of physicians;

• introduction of elements of career guidance in medicine during schooling;

• Increasing the volume of English language learning by students of medical universities and colleges.

A number of proposals, on the contrary, have not yet been discussed on public platforms and in the government, but, according to the authors of the Concept, it is necessary to do this, as well as to work out a budget for their implementation.

In inter-territorial settlements, according to the ASI, it would be advisable to change the payment system from the current one, when compulsory medical insurance funds pay the bills of clinics issued to each other, to a clearing system, when the debt of another fund would be offset against the debt of one fund. This would help to avoid a cash gap in the budgets of the TFOMS of different regions, the agency’s experts say.

Implementation of the idea is possible through the reformatting of 326-FZ “On Compulsory Medical Insurance” and the Rules of Compulsory Medical Insurance, and, according to the agency, will not require additional budgetary funds.

One of the main restrictions on the active inclusion of private medical organizations in the system of providing medical care, ASI specialists consider a rigid structure of allowable expenses for compulsory medical insurance, which does not allow companies to compensate for their investments with insurance funds. It is proposed to eliminate the requirement for private clinics operating in MHIs to comply with the tariff structure. An identical proposal from the New People party is now being considered in the State Duma.

In addition, the ASI wants to recommend that commissions for the development of compulsory medical insurance programs distribute volumes to non-state clinics that provide the most expensive treatment, “packages” with related medical services. For example, to give volumes not only for the IVF service itself, but also for the subsequent management of pregnancy.

Among other things, the authors of the document mentioned that the Ministry of Health is preparing a draft amendment so that private clinics can manage compulsory medical insurance funds “only after the completion of the annual contract.” What exactly is meant is not explained in the document.

According to the Accounts Chamber of the Russian Federation, 56 entities do not participate in the financing of territorial CHI programs due to insufficient funds in the regional budgets. Due to the low level of financial involvement of the subjects of Russia in the fate of regional networks of clinics, it is stated in the Concept, it is necessary to develop a list of cases when a medical organization with large accounts payable and a low level of income can, at its discretion, use the CHI funds allocated to it.

The authors of the Concept propose to change at the federal level the ratio of the structural elements of the salaries of medical workers with a fixed salary of 70% (at least four minimum wages for doctors and 2.5 minimum wages for paramedical staff), compensation payments – 10%, incentive payments – 20%. “The indicated salaries correspond to the salary expectations of medical workers and can increase their motivation,” the ASI explains.

Such changes are estimated at 353 billion rubles of additional funds annually.

The ASI believes that these programs should be considered not as an incentive for the physician to move to the countryside, but rather as a mechanism for shift work where the employee is most needed.

It is proposed, together with a lifting permit, for a specialist who has gone to work in settlements with a population of up to 50 thousand people, to issue a housing certificate for 30 sq. m for the purchase of housing in any region.

In addition, as indicated in the Concept, the Zemsky Doctor and Zemsky Paramedic programs must be expanded to work in settlements with a population of 50,000 to 100,000 people.

This block of proposals will require an additional 60 billion rubles from the state budget annually.

To reduce the mortality rate associated with cardiovascular diseases, it is proposed to expand the program for providing drugs for the prevention of CVD to people at risk of developing such diseases, as well as to develop rules for maintaining a regional register of such patients. The new program, according to ASI estimates, will have an annual budget of 240-500 billion rubles.

The predicted coverage of such a program may be from 11 million to 21 million people, and the cost of a set of medicines per person is tentatively estimated at 12.5-20 thousand rubles per year in retail prices. Such a program, if developed and adopted, will reduce mortality from cardiovascular diseases by 10–12%, and indirect medical costs by an average of 63–70 billion rubles, according to the ASI.

The article is in Russian

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