The concept of healthcare development: the voice of the people

Healthcare: having no pants, we order a tie"Tyumen News", 27.11.2008

The State Duma is finalizing work on the concept of healthcare development until 2020, designed to define a long-term state policy in the field of public health and ways to modernize the industry.

The concept assumes both the legislative consolidation of the constitutional right to free medical care, and the active expansion of medical services on a fee-based basis. You can get acquainted with its text on a special website opened at the beginning of the year by the Ministry of Health and Social Development of the Russian Federation. The most interesting thing is that the Ministry of Health did not just submit the draft for discussion to the general public, but invited "mere mortals" to contribute to the development of the document. The interactive discussion turned out to be very active. By October, the site had received 564 requests and more than two thousand comments. Among the people who have their own opinion and want to express it are doctors, patients, suppliers of medical equipment, experts, health care organizers, students... They are all concerned that, despite the increase in funds allocated from the budget, medical services have not become either better or more accessible, the patient still remains in the humiliating role of a petitioner, and most doctors cannot make ends meet... Tatiana Golikova's additional appeal to the participants of the discussion allows us to hope that the voice of the people "above" is heard. The statements are contradictory, often hot-tempered and harsh (it hurts so much!), but this is a living testimony to the indifference of our society, the active citizenship of our people and an undimmed sense of humor.

I will send an SMS to the patient and... mummify myself

— I recently read on the Internet that doctors were imprisoned in Samara for taking a person without a fixed place of residence ("homeless") to the street after treatment. And what should we doctors do? It is clear that they are the same people and, perhaps, are not to blame for being in such a situation, but should a doctor really think about it, or should our authorities? Winter is coming soon, and there will be even more such patients in hospitals, and what — to register them in hospitals?

— It is impossible to ignore the complaints of doctors about the insecurity of the doctor from the patient. From about 22 o'clock to 5-6 o'clock in the morning, such a contingent is brought to multidisciplinary "emergency" hospitals, which not everyone will dare to touch even for a high salary. Lice, frostbite, complex injuries, in drug or other intoxication — and so on, so on. Such a patient will receive medical care, warm up in the warmth, curse everyone, shit — and run away from the hospital! I propose to oblige the leadership of the constituent entities of the Federation to ensure the operation of a stationary police post at least at night.

— We talk a lot about protecting the rights of the patient, but who will protect the rights of the doctor?! Now only a lazy person will not sue a doctor, drawing information about medical errors from the media! There are situations when neither an experienced doctor nor God can foresee the outcome of an operation or illness, so why does a doctor, being subjected to constant stress in his profession, then go to the investigator?!

— In municipal polyclinics, the workload standards for the work shift of a district general practitioner at a rate of 30 to 55 patients. It is not possible to provide high-quality medical care at a 5-hour reception with such a load.

— The "standard" of 55 patients in 5 hours, that is, a little over 5 minutes per patient, is an official offense. 45 patients per ward nurse is also a crime!

— The greater the load, the lower the quality of treatment. As a result of chronic fatigue, indifference to patients occurs...

— Doctors have become like turners at a factory: the more nuts, the higher the salary. Even for forensic doctors, the salary level depends on the number of corpses examined. In Soviet times, an expert was not allowed to work for more than 1.5 rates (15 studies per month), but at the same time, about 240 rubles were obtained for these 1.5 art., which was decent money. Plus, getting housing in district centers. Now forensic experts in some regions are examining 40-60 corpses a month, because you can't live on 1.5 rates.

— With a salary in the department of 10-12 thousand rubles , our director says: "You get four subsistence minimums, and everything is not enough for you. I will leave 1.5 doctors and a manager in the department for 0.5 rates." And you say "reform"! You can't make it work well, you need to stimulate work based on quality criteria.

— An hour of work of a doctor of the highest category in the provision of emergency sanitary and aviation care costs 19 rubles. 72 kopecks. An appointment with a general practitioner in a polyclinic cost 4 rubles two years ago, an examination at home - 6 rubles. And the authorities shouted at us: "If the patient doesn't open the door, you should call from your mobile." For 6 rubles, I can only send an SMS to the patient, and then walk to work, eat nothing and mummify myself. We walk scary and miserable — there is nothing to buy shoes for... And I'm 29 years old, I want to live...

— A cardiologist of the highest category (pulmonologist, endocrinologist, hematologist) is obliged to stay in the hospital twice a month (one for 5-6 departments) and receive 150 rubles for 12 hours of work. How much does an hour of work cost?

Humiliating for the citizens, insulting for the country!

— I don't understand why, taking a percentage of my salary for the state health care system, the state transfers money to a commercial structure (a fund where salaries are such that I never dreamed of). And when I come to the clinic, I can't get normal treatment. They are trying to explain to me that there is a program of state guarantees... But if I am ill, it should be beneficial for the state to cure me, since I pay taxes!

— The Soviet healthcare system was recognized as the best in the world. Instead of bringing it to the modern level of achievements in medicine, refusing to finance on a residual basis, medical pseudo-reformers, having broken through to power, "mastered" the 320 million dollars allocated for healthcare reform, causing the current chaos.

— Having lost the USSR, it is not worth crying about Soviet healthcare. Unfortunately, many of those who in the early 90s came out with posters "Down with socialism!" had no idea what capitalism was. I will not forget my neighbor, who received 120 rubles of pension and shouted "Down with the commie killers!" Now her pension is barely enough not to die. The people must be responsible for their choice...

— The structural problem of healthcare is the weakness of the primary care and the emphasis on specialized care. Supercenters are being created that can serve a maximum of 0.01-0.05% of the population, while the majority does not have access to qualified primary medical care.

— The primary link should function as the main link of medicine, and not as some kind of underbelly. The overwhelming majority of the population uses the primary link, and it should be accessible and diverse, assistance should be provided continuously and professionally.

— Given the huge revenues of the state from the sale of oil and gas, I propose to legislatively provide funding for the treatment of children with cancer without limits. Respectable citizens should not beg for money to save their child on the Internet, newspapers and TV. It is humiliating for the citizens and insulting for the country!

— I think it is unethical, inhumane, and antihuman to provide humanitarian assistance to other countries when children die in their own country because their parents do not have funds for their treatment.

Healthy is not the one who has no problems, but the one who has learned to solve them

— The "Wave of Health" held this summer, in my opinion, is an unproductive and expensive action. "Chasing the wave" is not respectable. Waves are a fickle phenomenon, after excitement comes calm. It is naive to resist such actions of the powerful international tobacco industry, which is freely located on the territory of Russia. Solid money was allocated from the state budget for this promotion of the harm of smoking, with which it was possible to build sports facilities for children, equip schools with sports equipment, hire professional physical education teachers in schools for decent money, and much more. Amendments to the law "On Consumer Rights Protection" have now been proposed, according to which tobacco producers, instead of the incompetent inscription "The Ministry of Health and Social Development warns", will be required to indicate on the packaging that cigarettes contain 4 radioactive isotopes and more than 1,000 chemical ingredients that adversely affect health...

— Every year the level of alcoholism is growing at a furious pace, and the number of graves of victims of poisoning by alcohol surrogates and alcohol itself, from complications of alcoholism, from accidents caused by drunk drivers, etc. is growing in cemeteries. Is this really how it should stay in our lives?

— If we are talking about the decomposition of morality and spiritual roots in the state as the root cause of all the troubles, then corruption, bribery, and alcohol advertising (they thought of advertising beer at sports competitions!), tobacco are all links in the same chain for further soldering and decomposition of the population. Especially the most sensitive part — the youth, who then foolishly beat and kill each other in stadiums or squares...

— Alcoholism and drug addiction is the ability to make unbearable conflicts temporarily tolerable. People who drink alcohol tend to get away from one reality, which seems painful to them, to another, more "pink". And this cannot be ignored. The only effective approach I see is the education and improvement of psychological literacy of people, the culture of their relationships, the development of their ability to cope with the inevitable difficulties in a different way. "Healthy is not the one who has no problems, but the one who knows how to solve them."

— As long as the wild rampage of capitalism continues in the country and the difference between the poor and the rich increases, no concepts will be able to eradicate social diseases. About our alcohol, drug and other barons. Read the classics: "Provide capital with 10% profit, and capital agrees to any use, at 20% it becomes lively, at 50% it is positively ready to break its head, at 100% it tramples on all human laws, at 300% there is no crime that it would not risk, at least under pain gallows" (Karl Marx, "Capital", volume 1, p. 764)...

Let the optimists find out the truth

— The so—called preventive medicine is very often an empty and high-cost business. Sometimes it's just a PR campaign, sometimes someone's business, very often it's an imitation of violent activity. The most striking example is mass medical examination.

— The question is that health and health-saving settings, installations are primarily needed and beneficial to the person himself, and are not only the responsibility of doctors. It is necessary to arrange our social life in such a way that the health of a particular person is primarily his personal problem, and not the problem of the whole society.

— Previously, in the East, a doctor was paid as long as his patients remained healthy. Therefore, they were more focused on maintaining health. Life expectancy is 45% dependent on lifestyle.

— We do not have a healthcare system in our country, since neither the author of the concept under discussion, nor the Minister of Health, nor the participants in the discussion have formulated the very concept of "healthcare" since February of this year. In their view, healthcare is a repair base for restoring the lost health of Russian citizens, bringing profit to entrepreneurs from healthcare who do not even have primary medical education.

— At the moment, we only deal with patients, more often chronic, and working people who are ill for the first time cannot receive high-quality treatment and examination, because it is impossible to break through the ranks of chronic patients. And why is there no benefits for a person who has not used a sick leave for a year when applying for medicines?

— "Chronicles" are beneficial to a manager who is far from both healthcare and the ideology of WHO. The sicker the patient, the more budget money for him. Therefore, he is in "honor", this chronicler. Don't envy him! In the USSR, more than 16 million able-bodied people were engaged in heavy manual labor. The consequences are no less severe. And even now, who is laying rails, who is dragging bags of cement and potatoes, who lives in the capital without a passport, behind a fence, spends the night in basements, eats garbage?..

— A large group of the population, when using a mobile phone, voluntarily and for a long time exposes their brain to electromagnetic radiation. It is extremely necessary to develop a state program to prevent the negative effects of electromagnetic radiation on health in connection with scientifically proven data on such consequences of exposure to EMF as borderline neuropsychiatric disorders, premature aging, oncological pathology, negative effects on offspring.

— It is necessary to change the concept of countering HIV. The HIV vaccine itself can cause an immune deficiency. In the USA and the EU, it is going to ban HIV vaccine testing, in Russia - the reverse process! Consortia, scientific groups, etc. are being created. The conclusion about "money laundering" suggests itself...

— Let's show on TELEVISION the operation of amputation of a smoker's leg, the collapsed nose of a syphilitic, an alcoholic yellowed from cirrhosis of the liver, covered with ulcers of an AIDS patient!..

The minimum level of medical care is euthanasia

— At a government meeting, Kudrin was asked a question: say, do you agree that there is little money going into healthcare? Kudrin replied with the dignity of a finance minister of a Great Power: "I agree, very little, but we need justifications to finance more."

— In 2004, former Minister M. Zurabov voiced the slogan: "My task is to make healthcare of the Russian Federation the locomotive of the Russian economy" (that is, to make healthcare a earning industry). L.M. Roshal has been fighting for more than one year to increase GDP to 7% for healthcare needs. Therefore, the industry for the state should be costly. Otherwise, why do we need the state at all if it distances itself from its main task — saving its own people? And who will get the territory of the country, its bowels, if today the theory is increasingly popular in the West that when there are less than 5 people per 1 sq. km of territory, then it is nobody's property, it is not the property of a separate country, but of "all mankind"? Which way will the state go: cost-wise, increasing the share of the national product per capita? Or market-based, emptying the personal budget of a poor person, minimizing the quality of his life and medical care and, as a result, ridding the government of its own people?

— Let me quote our former President V.V. Putin. "Are we going to chew snot here for years? How long have we been talking about this topic — since '99? Almost nothing happens, just some conversations. All this is being shuffled there without ceasing, in huge quantities. And nothing has been done to stimulate processing on the territory of Russia," he said in March 2006 at a meeting with members of the government. Nothing has changed until today. As they were fooling around, so they are fooling around. As they drove raw materials abroad, so they drive. Gorbachev at least had the political will to start fighting alcoholism. I didn't have enough strength to finish, unfortunately.

— To stop the closure of FAPs, maternity hospitals, district hospitals. To develop a program for the revival of health care in rural areas!

— In March 2007, Mikhail Zurabov stated from the rostrum of the State Duma that the current funding of free medical care is sufficient for men to live no more than 59 years (it is not designed for a longer life expectancy).

— The State Duma Committee on Health and Sports has repeatedly held parliamentary hearings on the demographic situation in Russia. Discussions about the family planning program, adolescent sex education and the benefits of contraception were pronounced with particular delight. The opinion was seriously expressed about the forced sterilization of women in order "not to breed beggars.".. From the explanations of the Permanent Representative of the Sustainable Development Program (UN, UNDP) in Russia, Philippe Elguayel, it followed that the family planning and sex education program was developed for the semi-literate population of the resource-poor countries of South Africa, the Caribbean and Latin America, where there is an ultra-high birth rate. What does Russia have to do with it? The demographic reserve (losses on the roads, from alcoholism and drugs, murders, including in military clashes and terrorist acts, suicides), the preservation of which depends entirely on the authorities, was not given attention at these hearings. In my opinion, such a thing could never have happened if there were legally fixed evaluation criteria for the effectiveness of the government...

— What should be the level of medical care provided to a citizen of a Great country? The bill establishes a norm unknown to the medical world — "the minimum acceptable level of satisfaction of citizens' needs for medical care." I note that the most minimal "level of satisfaction of citizens' needs for medical care" is euthanasia...

Who treats the President of France?

— Health services should be provided within the framework of one model for all citizens, regardless of their status, social and financial situation. If we really want a fair distribution of medical care, we need to start with this.

— It's good that the regional committee hospitals have sunk into oblivion, but how many departmental medical institutions, departments, special hospitals are still left! There are such hospitals for various elites except in corrupt African countries. Nowhere in the developed world will you find a hospital for employees of the Ministry of Internal Affairs, railway... This all leads to the complication of organizational bureaucracy, to different standards in treatment and, ultimately, to social injustice.

— The President of France is being treated by his family doctor, who serves the most ordinary citizens along with the president.

— Such a number of "feeders" and "brothers-in-law" that are now in Russia in high and not very high positions, such a number of "false teachings" and dissertations, ideologies and beliefs, when the country, like rotten meat with worms, is teeming with leaders and ideologists, prophets and philosophers, academics and magicians, did not know not only soviet, but also world history.

— Since the 90s, a selection of managers has been carried out according to the principle: "if you ask less, then you lead better." This generation of managers is not able to work in a situation of sufficient funding. They are not interested in the work of federal programs, because they are afraid of additional control.

— Maybe the Ministry should compile and post on the Internet a constantly updated unified database throughout Russia with a list of all the necessary specialists for each region (city, hospital, village) with a full description of working conditions: availability of housing, salary, the possibility of internships.

— The presence of commercial insurance companies in the state social insurance system is nonsense and completely absurd, unless, of course, someone in the government is going to continue to breastfeed the private insurance sector.

— The apparatuses of local health departments and the Department of Health simply need to be abolished. This is the firm opinion of 99.9999% of practicing doctors.

Look at how much financial resources are spent on their maintenance. Ask any medical practitioner: how do the department and health departments assist in the work of a doctor? There is no help. How much can you keep an army of idlers and pay them huge salaries!

Why, without pants, order a tie?

— Recently, my son said that according to statistics, the Russian population spends the most money on food. From my own experience, I was convinced that there is another big expense item — diseases. For example, I often have to buy expensive foreign medicines. The same, but ours and more accessible, I do not see.

— Every sovereign country should have its own production of vital medicines. The list of such drugs consists of only 300-400 drugs. He was also in the USSR. Today, none of the newly formed sovereign states (CIS) has medicines included in this list. It is replenished with medicines produced in States with which relations cannot be permanently stable. Any aggravation of international relations and the termination of the supply of drugs can lead to the death of people without the use of military force. It is difficult to imagine a warring army with medicines purchased from the enemy in its medical arsenal. The production of vital medicines should become a matter for the state, and the enterprises producing such medicines should only be state-owned.

— Russia is becoming increasingly dependent on imports. One Chinese company produces laboratory equipment several times more than the entire Russian industry. There is a need for an active policy on the part of the state aimed at the development of the domestic medical industry.

— And what kind of medicines are included in the list?! The hyped dummy "Arbidol"... A mixture of "neurotropic" vitamins from Germany at wild prices (under the commercial brand "Milgamma"). The local anesthetic lidocaine is in the group of drugs that "affect the cardiovascular system" (which leads exclusively to thoughts about anaphylactic shock, or does someone in the XXI century still believe in its "antiarrhythmic" qualities?) Useless vinpocetine is adjacent to liquid pork (sorry, "Cerebrolysin"), with extremely questionable efficacy and unproven safety for the transfer of pathogens of prion diseases. The heirs of the dietary supplements "Antipokhmelin" and "Yantarit" — "Reamberin" and "Cytoflavin" — managed not only to get into the sphere of guaranteed purchases, but, having the same main metabolite, were distributed into different groups of the list. I'm not talking about the murderous miracle of the pharmaceutical industry "Surfactant-BL", which turned out to be worse than a placebo...

— Acetylsalicylic acid in any form acts the same, but the difference in price between our aspirin and the German "Aspirin-cardio" is 100 times! We come back to the need to provide the doctor with objective information about the effectiveness of a particular drug. And why introduce an expensive alteplase (about $ 1000 per bottle) into the list? As John Reed said, "these Russians don't have pants yet, but they've already ordered a tie."

Portal "Eternal youth" www.vechnayamolodost.ru
27.11.2008