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The crisis of seaside medicine puts pressure on the population

The reason why medicine in Primorye Territory is in a protracted crisis, says EastRussia expert

The crisis of seaside medicine puts pressure on the population
The so-called “social block”, including health care, education and social welfare, as well as the eternal housing and communal services, is the main subject of regional and municipal authorities. For municipalities, the costs of it constitute the main expenditure part of the budget. This is the main thing that local officials are responsible for: if “development” is an elusive thing and depends, besides the local administration, on the business and the federal budget (and therefore it may not happen (as lucky), then the social sphere should always be working, flesh and blood of regional society. If hospitals and schools are closed somewhere, then there will definitely not be life in this place. It is not by chance that in many villages these institutions are considered city-forming enterprises.

The Far East part of the social sphere looks worse than the central or southern regions of the country: there are more distances (and therefore logistics costs), staff salaries are not much higher, they are not enough for the high cost of living, therefore there are always not enough staff, etc. . Strangely enough, in terms of health care, the southern Primorye Territory looks very unpresentable against the background of even other subjects of the FEFD, where the healthcare system has been experiencing a real crisis for several years, especially noticeable against the background of the success of the FEFU medical center and plans to create a nuclear medicine center on Fr. Russian.

EastRussia help: Outpatient polyclinic care to the population of Primorsky Krai in 2017 was provided by 94 medical organizations. First aid was provided at the feldsher-obstetric outposts. The total capacity of the outpatient polyclinic service is 357 36 visits per shift.

The crisis manifests itself in detentions industry leaders, in the huge payables of local hospitals, in the constant staff hunger of medical institutions, dilapidated buildings, lack of equipment and other familiar symptoms. Here are some data from the report on the results of the audit of healthcare institutions conducted in 2018 by the Chamber of Control and Accounts of the Primorsky Territory.

As of October 2018, the payables of medical institutions of the region were 2,76 billion rubles, mainly due to the compulsory medical insurance funds - 2,3 billion (84,6%). Vladivostok City Hospital No.4 (104 million), Arsenyev Hospital (133 million) and Nakhodka (429 million) had the largest debt. Vladivostok city hospitals No.4 (89 million) and No.1 (132 million), Nakhodka (253 million), Kavalerovsky District (92,6 million) and Kirovsky District (72,6 million) had significant overdue payables. The delay was formed as a result of the institutions not paying for housing and communal services and the supply of drugs and supplies under contract.

Debts lead to paralysis of the institutions: for example, the bank accounts of Plastun in Terney district were frozen by the bank for some time until the debt was repaid. The hospital was able to continue work only when it was possible to pay off the debt at the expense of the regional budget.

The main jump in growth of creditors occurred in 2017 year. The reasons for this phenomenon are attributed by auditors to a change in the financing system at the expense of OMS funds and the transition to 2017 - 2018 for the new pricing scheme based on the clinical and statistical group model (KSG), which required a restructuring of hospitals in terms of optimizing the level and structure of hospitalizations. These measures were not taken, as a result of which payment from the MLA of a number of services decreased significantly.

The second reason is the per capita principle of financing outpatient facilities (polyclinics) adopted in the country, which is critically dependent on a lot of factors not controlled by the chief physicians: the number and density of population attached to institutions, its age and gender composition, the availability of specialists and others. If the volumes of outpatient care declared by the clinic are not fulfilled for any reason (for example, going on leave to one specialist), the planned indicator of the entire institution is not achieved, which ultimately loses part of the funding. Also mentioned are factors such as a reduction in the state assignment and optimization of bed capacity, a shortage of medical workers, an increase in expenditures of institutions as a result of increasing wages to the minimum wage, taking into account the regional coefficient and northern allowances not provided for by the MMI tariffs, and others.

In many clinics and hospitals there are problems with equipment: old X-ray machines, ancient operating tables, which are idle because of the lack of spare parts, expensive devices, and even a refrigerator car used as a morgue by the Artyom City Hospital.

The health care sector in Russia is difficult. In general, the state of affairs in it is still unclear, and research on this sore subject  very few. Recall that the financing of medical institutions has changed since the 2015 year: then it was transferred from the municipal level to the regional level, then to the territorial funds of compulsory medical insurance (TFOMS), the proceeds from which constitute the main part (more than 80%) of clinic income.

In parallel, payment for treatment was introduced according to the above-mentioned model of the CAG, which is now calculated using a complex formula that includes the base rate of the average cost of a completed case of treatment, the relative cost-intensity ratio, differentiation factor and correction factors (managerial, level of medical care and complexity of treatment).

The differentiation coefficient, which has a significant effect on the amount of the MHIF payments, is set differently for the country's regions depending on the salary level of the population and the budget expenditure index, in the Khabarovsk Territory it is 0,5410, on Sakhalin - 0,6570, in the Magadan region - 0,8343. In Primorye (as well as in Buryatia), this coefficient is the lowest in the DFO - 0,5087, which is lower than in the Moscow Region (0,5200). This circumstance gave rise to the deputies of the Legislative Assembly of the region to declare it as one of the causes of chronic underfunding of the regional health care, and raise the question of the need to increase the coefficient, which requires the help of the governor and systematic work with the Ministry of Health.

According to Sergey Slepchenko, a member of the Social Policy Committee of the Legislative Assembly of Primorye, the existing financing system is relatively successful in running clinics in more populated areas, but is inefficient in the northern regions with low population density: the lack of patients reduces income, because of this, the equipment becomes old and the doctors leave , clinics have chronic debts for repairs and utilities, services deteriorate, as a result, patients' trust in local hospitals decreases, and they, along with per capita with money, they leave for treatment either to the regional center, or generally go abroad, as a result, a vicious circle is formed. At the same time, it cannot be said that there is no money: tens of billions of rubles are allocated for the purchase of high-tech equipment for regional hospitals, but most of them do not reach the districts, remaining at the level of regional clinics and specialized medical centers.

Obviously, the problems of seaside health care lie not so much in the lack of money as in poor-quality management - which, in turn, should be understood not only as a lack of managerial competence in the management of clinics, but also as low efficiency of the regional medical system as a whole. The ongoing reforms of the industry, let's hope, indicate that the Ministry of Health was looking for an acceptable model of its structure that is effective in terms of “cost - result”, especially since in some regions of the federation the existing model works quite successfully.

Viktor Fisenko, appointed to the position of director of the regional health department only four months ago - in January 2019 of the year, and before that worked in the Roszdravnadzor of Moscow, was called upon to establish the management of seaside medicine. Nevertheless, the new leader was already deeply immersed in local problems, about which we asked him a few questions.

EastRussia interview with Viktor Fisenko Read the link
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