Healthcare in a mousetrap
"Free" medicine: who are we kidding?
Especially touching were the shots of recently commissioned children's medical institutions, where top officials of the state communicated with mothers and children who had found hope for recovery. (However, such PR moves with the use of children on the eve of the elections did not cause anything but a feeling of rejection.)
Alas, none of the motley deck of candidates ever reached the usual district polyclinic, not only in distant Uryupinsk, but even in Moscow. Apparently, because stories from the hinterland on healthcare topics would hardly add points to the contenders for the main Kremlin chair.
In fairness, it should be noted that the degradation of the Soviet-Russian healthcare system began not today and not yesterday, but under the fathers of new liberal reforms after the fall of the USSR. It should be noted that in the Soviet Union, 50% of all money allocated for health protection went to the needs of the so–called Fourth Directorate of the Ministry of Health of the USSR, that is, to provide patients with a closed part of the industry - workers of party organs in thousands of medical clinics, polyclinics, hospitals, sanatoriums, rest homes, etc. Then, in the 1990s, the managers who conducted shock therapy for the population assured that the market itself would smooth everything out and fix it. However, this did not happen. Already in 1998, the share of funds allocated to healthcare was only 2.8% of GDP.
All this could not but affect the demographic picture of Russian society. According to Vasily Ivanchenko, Doctor of Economics from the Institute of Economics of the Russian Academy of Sciences, in 1996, compared with 1987 (the beginning of Perestroika in the USSR), the death rate of the population increased by 34%. Only in the period from 1992 to 1995, a population decline of 2.7 million people was recorded. Russian men began to live 15-17 years, and women – 7-10 years less than in the countries of the "golden billion", having reached the 135th and 100th place in terms of life expectancy, respectively. It turned out to be even worse than in some African countries. Ten years after the collapse of the USSR, only 10% of Russian children could be considered healthy, 40% were chronically ill.
In general, over the past 20 years in Russia, according to various sources, an average of one and a half to two million people have died annually. The real picture, apparently, we are not supposed to know. Official statistics, as a rule, give crafty figures of the total population of the country, taking into account the migrants who arrive again every year, who somehow "cover" our blood losses. It is clear that a person is not eternal, but it is also clear that with the level and organization of medical care for the population that is practiced everywhere in the new Russia, ordinary citizens live their lives less qualitatively and finish them faster than it could be with effective healthcare. Or, in Solzhenitsyn's words, with "saving a person."
The myth of free medicine, which has been fed to us for many years at various official levels, has turned out to be quite tenacious. But at the next collision it becomes obvious: free medicine has long been paid. This year, the share of healthcare in Russia will be 3.8% of GDP, in the USA – 16%, which in absolute terms is expressed as $2.26 trillion, or $7439 per person. In Russia, the system of rendering services is designed to encourage a person to give their (often the last) money – in the same free state polyclinic or medical center, but through a paid department.
The casket opens simply: if you are ill, then you should not contact a free doctor – there are no coupons for months ahead. If you want, die, and if you don't want, go to the doctor (often in the same medical institution) on a paid basis, but immediately. According to surveys of Moscow patients conducted on the Internet, from 70 to 95% of them spent their money on so-called "free" medicine.
But even with a paid visit to a doctor, patients often face not so much with medicine itself as with the business of medicine. Examples are a dime a dozen. Here is one of the most striking: recently, my relative had to go to the Moscow clinic to a well–known professor in medical circles - about allergies. Everything seemed to go well: the professor asked, looked at the results of the studies (also conducted in a paid laboratory, because in a free one you have to wait up to two weeks for the results) and offered to take more tests for almost eight thousand rubles. But always in the laboratory that he himself will name. The doctor immediately issued a form with the tests of this laboratory, ticking off which examinations should be passed. Strange, isn't it? For many years, if necessary, a relative took tests in the same laboratory (I will not name her, so as not to be suspected in advertising), which is correct. And here is such a professorial whim.
Thoughtful consideration of the form on the subject of what kind of blood tests were prescribed by the luminary, led to confusion: it seemed that they were not needed at all with the patient's problem. However, it had to be solved, and the woman went to the laboratory indicated by the doctor. There she was asked if the doctor had explained what kind of test it was. No, the doctor didn't explain anything. It turned out that I would have to drink soy protein. On an empty stomach. And she has an allergy, it's not safe. To make sure if this is the case, I went to another laboratory. There, the nurses said that such a blood test, even in paid ones, is done exclusively in the direction, on an official letterhead with the seal and signature of the doctor. And they were completely shocked to learn that such an analysis was prescribed to her by a doctor with allergies. For you, they said, it may well end in resuscitation.
So the professor is illiterate? Or is there something else here? After all, the doctor, irritated by the patient's misunderstanding of why she should take tests in the laboratory indicated by him, insisted that the test results would immediately be in his computer. That's where the dog is buried. It turns out that the patient was in the hands of a certain mafia (and what else to call her?) a group working under the contract "doctor-laboratory-doctor". The question arises: why can the laboratory, without the knowledge and consent of the patient, send the results of his tests to anyone by e-mail? This already, in my opinion, smacks of crime.
But the problem with allergies had to be solved. And my relative turned to another doctor – on the recommendation of friends, asking her at the same time about the "resuscitation" analysis. It turned out that the woman's suspicions were not groundless. This analysis (like others), the allergist said, is simply useless in this situation – for the patient herself. But not for the professor: some percentage of the amount paid for the tests would have fallen to him. (A familiar gastroenterologist, having learned from me about this case, was quite surprised to notice that such a serious test can only be prescribed by a specialist – patients with an atrophied stomach.)
According to both experts and patients themselves, the reason for the plight of the national health service lies in the new financing system, more precisely, the guaranteed underfunding of the industry, which occurred during the transition from a centralized to a decentralized system. According to the new rules, hospitals, polyclinics and other medical institutions must fill in the missing part of funding themselves. And how? There is only one way – to open paid branches. Thus, the state, represented by the native government, accustoms citizens to a new state of affairs and pushes the entire healthcare system to switch to paid services for the population.
At the same time, another myth is being created that under capitalism in the West, too, everyone pays for medicine. Yes, they pay, but not at all in the way that it happens with us. In the West, there is insurance medicine, and a person does not take a cent out of his pocket. Pensioners in the USA, for example, are also provided with free transport every time they visit a doctor. We also have insurance policies in Russia. Formally. It is impossible to use them in case of going to a paid branch. So all this is profanity. With the current healthcare system with its semi-gray business zone, many temptations are created for doctors: you can also take a patient past the cash register. And in a free state clinic – without waiting in line for several weeks or months, and also for a fee. After all, the salary of doctors is still a subject for complaints on their part.
Another burning problem is medications. I'm not talking about the price anymore – it's just exorbitant. Seven antihistamine pills – more than $10. One (one!) antiparasitic pill – more than $4. What pensions and salaries is this calculated for? But the worst thing is that often we don't even pay for pills at all, but for God knows what. According to some reports, up to 80% of medicines are forged in Russia. (Everyone remembers the recent uproar with the fake "Arbidol", the advertising of which still does not come off the screens of "zomboyashchikov".) In China, such "businessmen" are doomed to be shot. And that's right. In our country, I do not remember such a case when for counterfeiting medicines (after all, this is a direct threat to life!) at least the attackers were tried.
Now almost every day citizens are informed that Putin and Medvedev are consulting on the new composition of the government. We have already been promised three boxes of changes. But which ones? One of the most unloved and odious ministers in the country, as you know, is "Miss Arbidol", as patients affectionately nicknamed Tatiana Golikova, the head of the national health service. Even Putin's fans at a meeting with him asked to thank her and send her to retirement, not to mention open letters from professionals. However, Vladimir Vladimirovich, judging by the information breaking into the press, is not ready for such a turn yet. Apparently, Tatiana Golikova, who has been rotating in ministerial circles since 1990, like many others from the battered government (and the entire Kremlin) deck, is irreplaceable. Russia is great, but it turns out there is no one to choose from.
Probably, that's why the White House is breaking its head over new "squiggles" in these post–election days - Tatyana Golikova, insiders say, is being read the chair of the Minister of Economic Development. Is it not on the principle that we have finished off healthcare, we will finish off the economy?
Portal "Eternal youth" http://vechnayamolodost.ru
19.03.2012