Russian syndrome of tomographic immunity
24.12.2010 — Analysis
What is most essential in quality medical care? Good personnel and equipment. The Sverdlovsk Region has no luck with either of these - high-caliber professionals are almost non-existent; as for equipment, the situation is quite opposite - it is plentiful, but it is idle and just gathers dust. The "RusBusinessNews" reporter made an attempt to find out what prevents the doctor from curing the patient.
In November 2010, in Makhnevo, a settlement in the Middle Urals, a 9-year-old boy died. When sliding downhill on the sledge he crashed into a tree, hit his head and sometime later died. The experts are sure that the child could be rescued. "This death could have been prevented", Maxim Starodubtsev, President of the Association of Regional Medical Insurers, states.
Makhnevo does not have any hospital. Local residents seek medical help in the first-aid station where general practitioners work. The only ambulance car is assigned to it. It took the ambulance two hours to get to the boy - when the call was received it was in Alapayevsk district center. It took another two hours to get to the district hospital; however, the hospital did not have the required equipment. They had to wait for a specialist accident-assistant squad from Ekaterinburg for about one hour. By that time the boy died. M. Starodubtsev says that such a situation is not singular - similar cases take place in the Middle Ural hinterland all the time. For example, early in 2010 the ambulance came too late to save two men in the Nizhneturinsk Region.
The Makhnevo tragedy can hypothetically be split into components. On the one hand, the ambulance failed to arrive on time. The blame lies with the territorial administration that did not provide financing to implement the program of government guarantees. During follow-up examinations, municipality executives tend to refer to lack of money, which made it impossible to optimize vehicle fleet and personnel; however, it does not release them from responsibility. The ambulance is on the balance sheet of municipalities, which are not able to support it; ii will be a long time before the ambulance is transferred to the financial system of compulsory health insurance.
On the other hand, there are claims to the general practitioner. The medical institute graduate who opted for general practice must be competent in all basic illnesses that may be encountered within the area he/she assigned to, including acute injuries. The doctor should have made every effort to diagnose the injury received by the child and to help him. He could even have called air ambulance from Ekaterinburg. "It is very important to conduct thorough and professional investigation. I am very afraid that this case can be put through red tape, because it may turn out as very indicative", Maxim Starodubtsev pointed out.
As for the equipment that was not available in the Alapayevsk hospital, it is rather exception to the rule. Most of the hospitals in the Sverdlovsk Region do not experience any shortage of equipment, sometimes having it in excess. However, the distribution of equipment among medical care institutions is inappropriate. Furthermore, part of the expensive equipment purchased through the Health National Project stands idle. There is no one who would operate it - either there are no payroll jobs, or specialists are not competent. M. Starodubtsev says that there are quite a few cases when the required spare part is missing and cannot be found or bought, and the expensive equipment has to "move" to the storage facility. There are situations when medical equipment is not used due to lack of funds for its installation or consumables.
As Alexei Kamenev, President of the First All-Russian Association of Private Medical Practitioners said, the Health National Project was brought to life in 2005. Essentially, the made decision was right and adequate: saturate hospitals and clinics with equipment and medications. However, it turned out wrong.
"The quantity of paid services increased, and availability of free medical care decreased. The saturation of health care institutions with equipment resulted in higher prices for medical services. Sometime ago American health care experts argued that the number of computer tomography scanners was not a problem: diagnostics will be better, but affordability of medical services will decrease. Therefore, cost effectiveness will be incommensurable. Today, we are facing the same situation", A. Kamenev remarks.
Analysts think that the main problem is not in availability or absence of equipment, but in the lack of well-developed strategy adopted by government authorities for development of the medical care system. This statement is convincingly illustrated by the incident that took place at the October meeting summoned by the Sverdlovsk Region's Health Ministry. The Minister Arkady Belyavsky criticized executives of municipal and regional health care departments for irresponsible approach to preparation of municipal requests for equipment. The requests served as the basis determining the relevant section of the regional program of health care modernization. It turned out that what medical institutions need first of all is a washing machine, cabinet oven, and refrigerator for a mortuary!
A. Belyavsky said angrily: "You will receive exactly what you have asked". The ministry, in its turn, decided that municipal hospitals needed much more: 5 magnetic resonance imaging devices, 6 angiography units, 18 apparatuses for computer tomography. The officials did not want to think what they are going to do with this sophisticated equipment without qualified specialists. Based on provisional estimates, during the next two years 18 billion rubles will be allocated for health care improvement in the Sverdlovsk Region. Out of them, 7.5 billion is planned to be spent on equipment.
"The situation with medical personnel is deteriorating steadily", Maxim Starodubtsev stated. The level and qualification of doctors are decreasing rapidly. Lack of proper supervision is one of the reasons. There is a growing number of doctors who become operators, and even there they are not able to work decently. The population that has been tired of low-quality medical care does not mind even such doctors, having only one request: they should perform their functions in dispatching centers more diligently. Here, we mean that they should ensure timely arrival of patients at higher level hospitals that still have skilled professionals. However, event such basic objectives are not fulfilled by dispatcher doctors.
The Middle Ural Ministry of Health admits that there is 50% personnel shortage. The Deputy Minister Dilyara Medvedskaya notes that the personnel shortage is one of the main problems in the Russian health care; the shortage of first-aid medical personnel, including specialists working in villages, is most pressing. Graduates of medical higher schools do not want to work in small settlements. In 2006, the ministry launched target programs attracting applicants from hinterland and paying for their studies from regional budget funds. The first graduates of the program will start working in municipal hospitals in three years. Let's hope that over this time the tomographs covered with dust will not fall apart in hospital warehouses.
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