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You need 100 billion to bring the material base in order
Director of the Primorsky Territory Health Department Viktor Fisenko shared his observations on how the medical field is organized in the region
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.
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.
- Is the lack of funding the main cause of problems in seaside medicine?
- Financing of medicine in the region is not fundamentally different from other regions: the part received by the CHI, we have a deficit, as in all other regions; the regional part, on the contrary, is scarce, just like all other subjects. Although the deficit in 2016-2017 decreased: previously it reached 50%, it has now decreased to 20-30%.
In the health sector, there are logistical problems. Most medical institutions in the region are 1950-1970-s built, there are a lot of departments, where over the years there has never been a major overhaul. This also applies to sanitary and epidemiological security, communications, sewage, ventilation, all of which need to be repaired. This is largely due to the fact that a number of organizations have problems.
Many buildings, especially in areas that do not meet modern safety requirements or modern standards for the area. Today it is sometimes cheaper to build a new building than to reformat an old one. We monitored and, according to our estimates, for the construction of buildings required by medical facilities of the region, more than 80 billion rubles are needed. 10 new buildings need to be built only in Vladivostok. And the total amount needed to put the material health care base in order is more than 100 billion rubles, of which at least 6 billion is needed for major repairs.
This year, the governor allocated medical facilities for the repair of 600 million rubles, a lot of money. The federal and regional budget is helping our clinics to upgrade their equipment, this year we will receive a total of about 3 billion for the purchase of new medical equipment.
- Explain, please, how is the medical field organized in the province?
- In Russia, the health care system is divided into 3 level. The first is ambulance, FAPs and polyclinics, which provide primary medical care to the population, monitor the state of health and identify diseases. The second level - district and city hospitals, including interdistrict centers, the third - these are clinics that provide high-tech and specialized medical care. They are concentrated in the regional center, and, basically, get expensive equipment purchased now, as they have qualified specialists who are able to work on it. All three levels in Primorye are formed, but a routing system is needed: the lack of well-established communications sometimes makes it difficult to hospitalize the patient on time and send him to the right clinic of the next level in the disease profile. Logistics indicators are considered one of the most important in the organization of medical care. For example, if a patient has a stroke, then it is extremely important that he is ischemic or hemorrhagic. With the wrong logistics, they will not even be helped in a specialized clinic, if it turns out to be a profile that is not required.
- What is the situation with the staff for health care?
- Provision of personnel is one of the priorities in the health care of our region and the country as a whole. In Primorye, the lowest availability of doctors among all regions of the Far East, especially in rural areas. What does it mean to bring a doctor to work in the area? This does not only provide a specialist with a decent salary, it is an opportunity to develop professionally, to provide good social conditions and more. For a real specialist, what his workplace looks like is of great importance. And here our task, and the task of the chief physician, is to exert maximum efforts so that medical institutions become modern, comfortable, patient-oriented. Now we are working in the project "Lean Production". This year in the region we open 20 "thrifty" polyclinics. Polyclinics should change, including visually. There should be an appointment on the Internet and through terminals, electronic queue, patient comfort. A physician, especially a young one, should know that he will work at a computer, in an information system where he can find the necessary information, compare, analyze, be sure that he can develop in his field.
To increase salaries and increase the prestige of the medical profession this year, several social support programs for health workers are being implemented at the initiative of Governor Oleg Kozhemyako from this year. These are several types of surcharges, as well as preferential mortgages and compensation for rental housing and utility bills. It should be noted that the governor has taken measures to support health care, which had never happened before. In the 4 month of this year alone, more than 20 million rubles have already been sent to medical institutions for these payments.
In order to attract personnel to the industry, we actively work with the Pacific State Medical University and two medical colleges. Together we hold job fairs for young specialists, send them to the practice of university students, and develop mentoring. One of the important areas of work is the target set in TSMU. I hope that an integrated approach will produce results, and by the end of the year we will see a reduction in the outflow of medical graduates from the region.
- What caused the payables of medical institutions of the region?
- This is one of the most acute problems in our area. This is mainly arrears: as of October 1 2018, it was 1017 million rubles, while the total debt was 2366,9 million rubles. In 2018, 850 million rubles were allocated from the federal budget to pay off overdue payables. By 1 in May of this year, it fell to 623,7 million rubles.
The reasons for the emergence of debt are the failure of medical organizations to fulfill the volume of medical care (government assignment), low staffing with doctors and paramedical staff, and insufficient financial literacy of the head physicians. Institutions need suppliers of drugs and medical devices - what causes the question: how does a retail pharmacy sell drugs at 20% cheaper than a district hospital that buys them in large quantities? How do head doctors control their purchasers? At the same time, some regions of the region are working normally, while others, side by side, under the same conditions, are in debt. In a number of cases, we have to make personnel decisions: as a result of the work of the new head physicians, the debt decreases. We introduce face-to-face hearing of head physicians on anti-crisis plans and express training.
As shown by the KSP edge checks, there are managerial reserves, and competent organization of medical care allows clinics to earn money. The head physicians for the year ahead are counting on how much patients will be able to receive patients. If the plan is executed on 60%, then the missing 40% is unearned money, and plans need to be adjusted. According to the clinical examination, the region did not earn 338 million, as a result, the population was under-examined and money was lost. This is a flaw in the whole system. Since this year, we have calculated the rating of the municipalities of the region, which includes three indicators: the mortality rate, the dynamics of the influx of personnel into the district's industry and the coverage of the population with clinical examination. According to the rating results, all municipalities of the region were instructed to pay attention to the clinical examination and more actively involve the population for the early detection of diseases.