The health situation is increasingly tense. This conclusion stems from a comprehensive sociological study commissioned by the All-Russian Patients' Union. Half (50.2%) of citizens say the health care situation will worsen in 2021.
Experts surveyed in the same study say the system is starting to acquire a reactive character – patients who are willing to spend their time on complaints and appeals to various authorities receive the best help. However, as survey data shows, complaints to government agencies often do not work. & Nbsp;
The most effective practice for contacting insurance companies
According to the survey, the most effective was the practice of appealing directly to the management of the medical organization where patients' rights were violated, to insurance companies and to the prosecution. The chief physicians and department heads succeeded in solving the problem in most cases (52.1%), in 17.9% they gave valuable advice, but in 30% of the cases they refused it. # 39; help. The most responsive were the insurers & mdash; & nbsp; they had the lowest share of refusals (24.6%). At the same time, they were able to help in 35.2% of the cases, in 40.2% of the cases they helped with explanations and sent them to the right organization. The prosecution was also able to help in 35.2% of cases, but the refusal rate is higher than & mdash; & nbsp; 32.3%. Regional ministries of health were effective in 34.1% of cases with a high failure rate & mdash; & nbsp; 36.6%. Patient organizations close the TOP-5 in terms of share of issues resolved & mdash; & nbsp; 32.9%, but the refusal share is lower than & mdash; & nbsp; 30.7%. Rospotrebnadzor and the Federal Compulsory Health Insurance Fund (MHIF) & mdash; & nbsp; only about 20% of those who asked these agencies said their issues were resolved, twice as many & mdash; & nbsp; more than 40% & mdash; & nbsp; was refused. Only around a quarter of those surveyed managed to resolve their issues through a court or the Children's Rights Ombudsman.
Answers to the question “ where would you advise a person whose rights to receive medical care have been violated? & # 39; & # 39; were distributed similarly: first, patients name the head of a medical organization (68.3%) and a representative of an insurance company (46.6 %). The specialized departments of the state Rospotrebnadzor and MHIF occupied the last places (respectively 2.7% and 2.1%).
So where should the patient with his problems go? According to experts, it is necessary to use the benefits of compulsory health insurance in the form of three responsible parties: the management of medical institutions, government departments and independent insurance companies of 39; them.
“ The effectiveness of the work of chief physicians with patient complaints is clear, & mdash; & nbsp; says the general secretary of the Russian Society of Surgeons, Professor Andrey Fedorov. & mdash; & nbsp; It is important to note that some patient complaints are simply unfounded. Some patients demand the impossible & mdash; & nbsp; to restore health lost over many years of smoking, alcohol abuse, unhealthy lifestyle. There is also a misunderstanding with a doctor who, due to scribbling, simply does not have enough time for a patient. Competent administrator, the chief doctor solves such problems simply by speaking: it is enough to speak calmly, without emotion, to the patient, to listen. For real, not fictitious, issues this is a very reasonable way for patients to contact insurance companies. They really work a lot with patient complaints and calls, help find the right specialist, a suitable hospital, and resolve conflicts with health workers. True, many patients have yet to understand what insurance companies are and why they are needed, that they can be contacted for free help. In addition, this year, from under the insurers, as they say, they knocked out a stool, transferring the federal clinics under the control of the MHIF. But the MHIF isn't involved in protecting patients' rights, and it shouldn't be – its job is to distribute money. A small proportion of patients are in federal medical centers, but these are usually the most severe and complex cases. Where should they complain about actual violations & mdash; & nbsp; is not clear. & # 39; & # 39;
Where should patients in federal medical centers go?
However, today, patients increasingly find themselves in a situation where persistent appeals to various bodies are not yielding any results. The author of AIF recently managed to get acquainted with the story of one of these patients. The patient had to undergo a planned ophthalmic operation at a regional branch of one of the federal clinics and has already purchased tickets for the route. However, on the eve of the operation, he was informed that the operation was impossible due to lack of funding and was offered to pay for the expensive operation out of his own funds. The desperate patient turned to the insurance company, but the federal clinics are out of the oversight of the insurers, and they just don't have the power to influence this situation. Appeals to the prosecution, the health ministry and other state institutions have yet to resolve the issue.
This year, federal clinics are really experiencing a funding shortfall due to delays in paying for medical care, or the annual volumes allocated to mandatory medical insurance have ended. The media have repeatedly reported the increase in cases of denial of planned operations and other medical care at federal medical centers. Ironically, an acute shortage of funding for federal medical centers has occurred as a result of the implementation of legislative innovations that were announced last year as a tool to increase and stabilize the funding of federal medical centers: in 2021, the MHIF became the payer for medical care. for federal medical centers instead of insurers. The MHIF has also removed the function of protecting the rights of policyholders from insurers. Who should the patient turn to in such cases if the leadership of the Federal Medical Center does not meet halfway? The protection of the rights of the patient in this case, according to the law, is provided by the same state body (MHIF), which does not give money to the medical center, which becomes the reason for the refusal of medical care? It turns out, “ knocked out a stool '' under the patient?
According to vice-president of the All-Russian Union of Insurers Dmitry Kuznetsov, medical insurance agencies continue to review appeals for refusal to issue referrals, violation of hospital conditions at federal medical centers. Some of these issues are resolved at the level of oral communication with the call center. However, complaints about raising money for the provision of medical care or dissatisfaction with the quality of medical care (and there are almost half of those calls) insurers are forced to redirect to the MHIF , explains Dmitry Kuznetsov.
In this case, the prosecution is also most likely powerless: & nbsp; Due to covid, expected hospital stays in many areas have been increased, and the lack of funds issue cannot be addressed by a prosecutor's check. And calls to the MHIF, as survey data shows, often go unanswered.
“ The number of difficult questions, including those related to denial of medical care due to exceeding clinic volumes, is really growing, & mdash; & nbsp; says Dmitry Kuznetsov. & mdash; & nbsp; However, the vast majority of citizen complaints are resolved much faster, including directly by contacting the insurance company's call center. In terms of recourse, examinations of the quality of medical care are carried out. Almost 80% of the issues identified during the review & mdash; this is the non-compliance by health workers with standards and clinical guidelines, 16.8% & mdash; & nbsp; violations of the conditions for the provision of medical care, including its expectations. At the same time, from January to July 2021, health insurance organizations received 8 & nbsp; 691 requests for medical care dispensed in federal clinics, of which 2,539 & mdash; & nbsp; refusal to issue referrals, hospitalizations, violation of hospital conditions and the right to choose federal medical organizations & raquo ;. & nbsp;