Andrey Yurin: Since 2011 people will feel health services improvement
From next year Federal fund of obligatory medical insurance, as well as all off-budget funds, passes to new system of work - instead of the tax employers will pay insurance payments for the workers. Whether
Means it, what shortly we will receive public health services with which it is not a shame? What will change for physicians, employers and the main thing - for patients? All is our correspondents found out from head FOMS Andrey Yurin.
: Andrey Vladimirovich, on January, 11th, in the first working day of new year, we come to polyclinic and what we see? Turns are not present. Doctors attentive, nurses tender. All necessary researches spend in no time and even money does not extort. So?
Andrey Yurin: So will be, but only not at once. Really, since January, 1st social insurance becomes on - to the present insurance. The pension fund, social insurance Fund, Fund of obligatory medical insurance by a source of the means will have first of all insurance payments from employers. Aloud on themselves people will feel it, by my estimation, since 2011. Why? Because since 2011 there will be an increase in the rate of obligatory medical insurance about 3,1 percent to 5,1 percent - more than in one and a half time. And in 2010 the rate while remains at former level. This decision is co-ordinated with employers, with the Russian business and, naturally, connected with a today`s situation in economy. Employers should to give the chance leave crisis.
RG: 5,1 percent is enough for worthy health services? Or in the future all - taki it would be necessary to raise this rate?
Yurin: Today the share of the means directed from the budget of all levels on public health services, makes about 3,3 gross national products of the Russian Federation. The European level - 7,2 percent. And in the basic lines of activity of the government on intermediate term prospect it is established that the share of the means directed on public health services, should increase at us to 5 percent of gross national product. There is enough of it or not? Let`s look.
Today on one insured in our country it is necessary 3 thousand roubles a year, and as a whole on system of obligatory medical insurance approximately 450 billion roubles. Thus the specification established by the government for current year for system of obligatory medical insurance, - a little more than 4 thousand roubles on the person. That is today system OMS is not filled even to this specification. It is clear that the financing increase approximately in 1,6 times for public health services will be, of course, essential help. And then people really on themselves will feel health services improvement.
RG: we Will specify: 3 thousand roubles is only that money which go through system OMS? But after all the public health services are financed also by local budgets.
Yurin: Quite right. Budgets of all levels, by our estimations, will direct on public health services during the current year about one and a half trillion roubles. From them 1,1 trillion - money of subjects and territorial funds OMS, the rest - money of the federal budget which go on the maintenance of federal institutions of public health services. And so, a share of system of obligatory medical insurance in public health services of subjects this year - an order of 47 percent. And the government a task in view: to 2012 70 percent of means of public health services should pass through system OMS. The others - through budgets.
RG: And how your idea of single-channel financing?
Yurin: In what idea of single-channel financing? And why we say what is today`s and tomorrow of public health services?
There is a certain group of diseases, socially significant, there are certain kinds of medical services which on - former remain exclusively on budgetary financing. Well for example, everything that is connected with mediko - social examination. Or blood service. Or sanepidnadzor. That is thing which by the nature cannot be in system of medical insurance. The rest can.
But today the medical institution receives money from several sources. The cores - the budget and system OMS. OMS is a salary of the medical personnel, payment of a food, medicines and expendable materials. The budget finances all the rest: utilities, transport, communication, repair, the equipment and etc. And here if we want to create the competitive environment in public health services if we want that really money followed the patient then it is necessary for us that the tariff was full that it was sufficient for medical institution not only regarding separate articles and expenses, but also as a whole. And then among medical institutions, we hope, the competitive environment will be generated.
RG: it is not very clear Yet, at the expense of what.
Yurin: If today system OMS pays to medical institution of 50 percent of expenses, and the rest pays the budget the medical institution which is not municipal or subektovym, cannot receive second half of money which goes from the budget. That is the private or departmental medicine cannot enter into this system, because the tariff incomplete.
For example, now many stomatologic polyclinics are ready to participate in system OMS even for those small means which follow the patient, but they are limited by that does not pay utilities OMS, repair of a premise and etc. is not paid When financial streams will go on the uniform channel and the tariff for medical service will be full, not state medical institutions will have a real interest to compete to the state.
RG: And still if the person does not need to pay from own pocket and it has a choice possibility, he will choose that polyclinic and hospital, where the best conditions. And municipal will gradually lose financing.
Yurin: Departmental and private hospitals at us it is far not so are extended, as municipal. Actually the municipal hospital or polyclinic is unique establishment, especially on village more often. But to render in it - let`s face the truth - the qualified specialised help at modern level today difficultly. Therefore on village primary medical aid is extremely important, presence of the general practitioner which is equipped by the necessary equipment for primary diagnostics and treatment at this stage is the extremely important.
RG: When in 2011 the tariff for medical insurance will raise, on what additional money will go?
Yurin: Now in Ministry of health and social development priorities on which these means will be directed are defined. There are some directions on which it would be possible to make today such decisions. For example, loading decrease on the local doctor. Today the specification makes 1800 persons, and in megacities it reads off scale for 2000 persons. Certainly, it is the biggest loading on the divisional. It should be lowered at least to 1500 persons.
Other direction - the most various kinds of early diagnostics. The third - prophylactic medical examination, at least time in three years. The fourth - conversion training and improvement of professional skill of medical workers. One more direction which can be considered at definition of priorities of distribution of additional means, - expendable materials for highly effective diagnostics (for example, a computer tomography).
RG: And a computer tomography it will be possible to make free of charge? It is hardly trusted, when for the most simple analysis from you try to tear off money.
Yurin: We consider that the situation with platnostju medical services will change. For the first half of the year in system OMS 25 947 justified complaints of citizens about medical aid rendering are registered. More thirds from them - on illegal collection of money resources. It when the person should receive medical aid under the policy of obligatory medical insurance, and it instead receives the receipt on which it should go to cash desk and to pay these medical services. As a result of control from territorial funds OMS these things are stopped severely enough. And money has been completely returned almost all applicants - in a total sum of 11 million 402 thousand roubles.
We understand that medical institutions at all illegitimacy of the actions often go on similar steps from - that on the person in a year is not enough 3 thousand roubles for qualitative treatment. In this connection the decision on increase in the rate of payments in fund OMS to 5,1 percent that filling of obligatory medical insurance by resources was comparable to also was accepted what expenses are born by medical institution. It is impossible for hospital to pay 50 copecks and to demand services on 1 rouble.
And if the public health services establishment under policy OMS receives tomorrow any more 3 thousand, and 7 thousand roubles, it already absolutely other filling. And then this extortion, first of all, will leave.
And the second that will change, is a quality of medical aid, its availability will raise, loading on the doctor so, turns will decrease will decrease, the new equipment will take root.
RG: you where - nibud in our state or municipal medical institutions saw the list of free services which are given under the policy at the stand? We did not see never.
Yurin: We now give particular attention to a problem of protection of the rights of patients. By the way, in St.-Petersburg there are such lists - I saw. Other question that together with territorial funds should work and the insurance medical organisations. The first accumulate means and then transfer to their insurers. And those already in turn should watch, how medical aid appears to the patient in concrete medical institution, and to protect its interests. Today we are engaged in legislation perfection, putting in it the right of the patient most to choose medical institution and the insurance company which will serve it.
RG: As the service " is financed; first aid “?
Yurin: When we speak about transition to single-channel financing, we mean not simply on one channel to finance a primary link, or hospitals, or “ first aid “. In this case at us “ first aid “ will choke with calls, the hospital will be overflowed, and the primary link would like, that to it went the people less. Therefore it is a question of deeper reforms.
I Will tell so: the primary link should become the manager of means OMS. The local doctor receives the certain sum of means depending on quantity of the population. And real health of the population entrusted to it should become stimulus for increase of the base salary. That is he should be interested to carry out preventive actions, to invite the patient to inspection, say, to show the initiative in relation to the patient. And the less often patients will have a necessity to address in a hospital, to cause “ first aid “ the it will be better both for the patient, and for the general practitioner. Here the system of controls and counterbalances is very important. That is it is impossible to suppose in no event the started cases in a hospital and it is impossible to do so that “ first aid “ unreasonably refused. The reasonable combination of all these three kinds of the help will allow and it is more rational to use public health services means as a whole.
RG: whether Correctly we understand, what this mechanism for the present is not developed?
Yurin: It in a working out stage. Accuracy Here is required. We will tell, to the local doctor it is absolute without a difference, how many time to its patient has left “ first aid “. From it nobody asks that it has made that “ first aid “ to the patient did not leave every night. Interest of the local doctor in it is not present any. Therefore we also speak: let`s allocate the divisional with resources, but it should be absolutely other divisional, is perfect other quality.
I Can tell that now the new economic mechanism is fulfilled in the Perm edge. Very accurately, carefully, vzveshenno. Also it turns out very effectively.
RG: the Typical situation: the person has gone to other city and was ill. Under the law if it has policy OMS, him are obliged to accept in any point of the country. Really it undertake treat only for money. This practice will change?
Yurin: There is such problem. Unfortunately, today some territorial funds OMS consider that sometimes it is possible to wait a little with treatment payment in territory of other subject. It is absolutely wrong. Therefore now minzdravsotsrazvitija and FOMS are engaged in perfection of mechanisms vzaimoraschetov. We have accepted a number of the statutory acts defining rules and accurate terms of interterritorial calculations. As to sanctions for their non-observance now they are in relations between the insurance and medical organisations. The following stage will define penalties for infringement of rules of calculations between territorial funds.
RG: Andrey Vladimirovich, this year in connection with crisis volumes of the uniform social tax have decreased. Both in the Pension fund, and in social insurance Fund - deficiency of budgets. In system OMS too deficiency?
Yurin: Current year at us uneasy. If all previous years fund incomes grew approximately on a quarter in a year in 2009 - m system OMS lives at level of last year. The government of Russia has made this year the unprecedented decision - 12,3 billion roubles of budget money are directed on indemnification of reduction of incomes of territorial funds OMS. And first of all these means were received by subjects at whom incomes of unified social tax were reduced.
In this plan for stability of social guarantees and system OMS very important responsible behaviour of regions. And a singular element of financial support in system OMS are payments for the idle population which list authorities of subjects. For us it is important, that they have not been reduced.
If for the employer the rate is fixed 3,1 percent from payment fund for the regional authorities the size of payment legislatively is not established, and it too one of the reasons of why in a number of subjects medical aid appears on a low level. Here all depends on priorities in concrete territory.
In Moscow this year have increased payments by the idle population for 33 percent, in St.-Petersburg - on 31, in Voronezh - on 12, Tver - on 34, Ulyanovsk - for 33 percent. But in Kursk have listed only 86 percent to level of last year, in Arkhangelsk - 83 percent, Irkutsk - 87. And we very much would ask heads of regional authorities at budget planning the next year not to reduce level of financial support of system of public health services that people have not felt medical aid deterioration.
RG: it is possible to Ask, of course, and to influence as - that will be, if regional expenses on the idle population decrease?
Yurin: Yes, for the first time at budget planning the next year we have provided norm: Grants from federal fund OMS will be allocated to those regions which monthly, without delays and in full will carry out of obligations on payments. It should serve as stimulus for regions at least not to reduce financing volumes.
RG: your forecasts for the next year?
Yurin: you know that next year gross national product growth is predicted, and we count that at least budget reduction fonda should not to occur.