Profit at any cost!
Vladimir Putin recently, just over a week ago, He spoke about the state of affairs in our health. And if you remember, nothing good about it, he did not say. Especially got primary link, position which recognizes, to put it mildly, unsatisfactory. In his article on the "IN" I have tried to briefly analyze the situation, and with some of the conclusions you can see for yourself. But, as it turned out, more in-depth study reveals the real abyss "common sense" and management "genius". What we have today and we'll talk ...
As usual, look at the problem from the inside, though not devoid of a certain subjectivity, still much more accurate and better reflect its characteristics. And often, and allows you to see all the, the outside, Unfortunately, general almost indistinguishable. And it is the opinion of some doctors allow me to say today, that one of the biggest health challenges of our (and, not only primary care) a system of compulsory medical insurance.
First, let's focus our pretty obvious thing: Insurance companies, which are now assigned to mediate between the government and the health care system, are commercial organizations. their goal, Alas, not our health, and the personal gain of their owners. And, this goal is by no hiding, she is registered in the constituent documents of the company, and for its successful achievement of the management of the companies receiving the award, bonuses and other "buns". It would seem, Nothing wrong with that, after all works well on this principle all (nearly) west, and in principle a private initiative on the long stretches of history turns out to be more successful than government regulation.
Still, and yet not quite ... First, let's understand, that the example of Western countries is not entirely correct: where insurance companies in an evolutionary way, in a fierce competition with each other, achieved its current position. They just happen to be the best possible alternative to the almost complete absence of public health (It is not quite so, in many countries, some forms of government involvement there, but it was in the period in the formation of Western health care, it was almost exclusively private). Yes, formed a system, He survived and even some proven its effectiveness, but the problems there are still many, can not say, it was obviously the best option for copying.
We have the same system was formed artificially, when insurance companies have appeared out of nowhere, their level of competence was appropriate (matching "out of nowhere - no"), all done on the fly, but with the expectation of profit - it, as the saying goes, holy. Besides, constant for our country in recent decades, corruption component has left its mark on the process: everywhere, where insurance companies were appointed responsible for the allocation of public money (and that all social security, of the poor and the disabled to the emergency, etc.), them for sweet cake had to share a part of it.
I.e, want to insure those, who himself can not provide, and on whom the government spends a lot of money? Motherboards! And, the same year. And now many insurers budget for years to come because it is painted: to place responsibility for the appointment, reward checking, please approves the decision, etc.. But you need more and pay dividends to the owner!
Of course, possible without this, but then access the stream you are guaranteed to lose your public money. And have, finally, not "share and balance", and really work: generate customer base, offer discounts to companies and firms, pay insurance agents, etc.. And in the US, as you know, I do not like to work, when there is an opportunity to "scoop up a mouthful of flow ..."
APU fired OSCE Task Force representative DNI in the south
Bureaucracy and arbitrariness – synonyms for medical insurance?
No, it was not written for, that you regret the poor insurers - is! And they are not poor at all ... But you should at least understand about the current list of priorities of the insurance business and the, that for its successful operation is necessary not just profits, and a solid profit.
It generated this profit not only from the difference between the allocated money on the patient and actually spent on it. more precisely, excuse me, because of this, but you actually spend on the patient can be a thousand, and a hundred rubles. you feel the difference?
Confess, I myself was quite naive in this matter and believe, that the insurance company pays all meekly hospital bills. After all, they are signed by doctors, It is the result of serious medical studies and appointments. Pryznaytes, because you think so too?
In fact, all, to put it mildly, Not certainly in that way. Alas, in this case, bureaucracy reigns, much more terrible, than the state, and arbitrary, what to look for ... more
idea, that the doctor prescribes the patient a blood transfusion. It would seem - a process routine in many clinics, sometimes urgent. But little appoint - it is necessary to fill a five-page document. And what is most interesting - for each blood donation!
Of course, Part of this work can be shifted to a nurse, and many do. But even if we leave aside the, that the nurses in the hospital without cause does not usually sit and it is to them a lot of extra load, still the bottom line remains the following: the doctor still has to personally check the completed forms. Why? And that is why - if at least one of them will be some kind of mistake, the employees of the insurance companies have the right not to pay for the treatment. And, attention - fully! I.e, doctor or nurse mistyped, inaccuracy, even some unfortunate blot, and the insurance company on this basis can refuse to pay for all patient care! days, of the week, or even months, spent in hospital, become shareware - that is,, obtained, doctors for his treatment did not receive money, and the hospital will pay for out of pocket medical supplies, the necessary tests, research, equipment depreciation, etc.. The money is, of course, do not take the air - they will be deducted from the salary fund hospital.
clear, that in such a situation, the head physician requires staff strict compliance with all formalities. And because these situations happen in medical practice on a daily basis and more than once, just imagine, how many additional bureaucratic burden placed on physicians.
Of course, It can be assumed, that the chief doctor of the hospital will hire lawyers, sue the insurance company and make it all the same pay for medical assistance. But here's how: money from the insurance company, it gives or does not give them to address their experts (her for this judgment is not required), and the entire burden of proof in court lying on a hospital, a budget and without, how Trishkin coat, constantly demands more and more patches. That's why I'm talking about the arbitrariness, which doctors, Unfortunately, We have to contend.
by the way, for, to insurance companies it has been easier to earn profits, such a phenomenon exists in Russia, as "medical and economic standards". Is our, can say, revolutionary know-how, because even in the West, did not think of this before, I use a much more flexible concept of "clinical and statistical group".
briefly, the medical-economic standard is an attempt to standardize the treatment of each disease at a cost. I.e, if you have a sore throat, you are supposed to cure, not go beyond a certain amount, prescribed in this standard. If your doctor, done this, He missed the smaller amount, part of the saved money will get to the hospital and will affect the already mentioned the salary fund. Well, if it is outside of the standard was released, the insurance company does not pay anything at all, either pay the amount prescribed in the MES.
made it, last but not least, for, to prevent abuse among physicians. And like, at first sight, It seems reasonable. But only so long, until we remember, that person can not be standardized. And the only attempt a "standardization" was the work of the ancient Greek robber Procrustes, which lured travelers into his home, then either cut off their feet, if his bed was it too small, or pulled their, hanging at the feet of the huge loads, if the bed was it great.
Deputy Prime Minister Borisov said, that SU-35 and SU-57 may actually be interested in Turkey
properly, MES in its modern sense, and there is a "Procrustean bed" – If your illness is no complicated, you will be cured. But if you, eg, intolerance to antibiotics, hormonal problems, renal insufficiency, or even millions of individual characteristics of the organism, that interfere with standard treatment in the framework of MEAs, the "possible options" ...
The scope of services or the primary duty of the state?
Strictly speaking, attempt to make health part of the service sector, in principle, it looks quite controversial. Why? Well, not least because, that the patient does not need US, I do not need an X-ray, We do not need other tests and counseling as separate services. he needs, if anything, only one service - recovery. And analyzes, consulting specialists, ultrasound, MRI and many other things needed, how service, doctor, that without them can not deliver accurate patient diagnosis and management.
Large criticism is itself the mandatory health insurance system. we, each working Russians, We are obliged to give to the HIF around 5% their salaries. As a result, the fund, acting solely as intermediary structure, It is pumping money to private companies-contractors. On the content also requires a lot of money, especially, HIF office that is in almost every major city. How do the "Contractors", slightly above. And there is also huge, across the country, states, thousands and thousands of "effective management", experts, lawyers, etc.. All this requires a lot of money, are properly taken from our pockets.
Notably, that price formation in the health care system rather arbitrarily. for example, a number of services price increases, provided under the MLA, at 2017 I have made 26-30%. Good outstripping growth, agree? With such growth, no inflation is not terrible, and for caviar is always enough money.
Interesting, that insurance companies legally can keep no more 2,3% from funds, that pass through them. But in reality this figure sometimes reaches 14%! true, This question is rather to the prosecutor and TFR, why it happens, but I would like to understand.
Not surprising, that even the main Russian Senator Valentina Matvienko as early as last year suggested to abandon the compulsory health insurance and move to direct budget financing of the healthcare system. And the whole idea is to give up pretty useless, as the practice, "Spacers" between public money and health is gaining more and more supporters.
However, it is obvious, that struggle is still ahead, and combating serious. After all, money is at stake, such, that for them will come to blows.
strictly come to blows. Maybe - the blood of ...
Victor Kuzovkov
