Doctors quit, riot, record video messages. We are used to it. Not that they have mastered, but resigned themselves to the bitter knowledge - there is no money in our medicine. So doctors tell us in plain text: "Well, no!" And then they give a bunch of referrals for unnecessary tests.
Over the past few years, I have very often dealt with our state medicine and have realized a simple truth: that there is no money in medicine, people write who have not come across it.
There is money there! Huge, just some fantastic money, but they are all thrown into a bottomless hole.
Don't believe there is such a locomotive with trailers? Now I will prove it to you.
See example one. The country is getting poorer, there is no money, but in our clinical, district, inter-district hospitals and other hospitals there is a wild rule: the patient will not be accepted if he goes to the clinic on duty himself, through the emergency room. In some regions, you can still directly get into traumatology, gynecology or an ENT specialist: just come to the emergency room yourself and be received in the order of the general queue. If you try very hard, sometimes a person "from the street" can get an appointment with bleeding. What should the rest of us do?
There are comfortable ambulances at the disposal of other Russians in Russia. There are hospitals that openly say: we don't take from the street. This means that the patient must be brought in an ambulance, even if he walks, is in full mind, or can get to the hospital by taxi.
Do you know why? I don't know completely either, but I believe that the matter is in the account of the insurance company: the more the ambulance takes to the hospital, the higher the payments. So the poor fellows are rolling back and forth around the city … And these are not isolated cases - this is how the system works.
There are other options as well. A specific example: in the antenatal clinic, an urgent ultrasound scan was prescribed and an appeal to a surgeon. The consultation is located exactly 800 meters from the emergency hospital with a gynecological department. But a woman cannot go there with her own feet. According to the official protocol for providing medical care, the doctor must offer the patient an ambulance call. She can write a refusal and go to the emergency department herself. If, of course, she had previously checked that she would be accepted from the street.
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But a woman has a choice only at first glance. In fact, by signing a waiver of medical care, she actually relieves the attending physician from any responsibility, even if you have to run for emergency help because of his mistake. It is undesirable to sign such refusals, so the woman is waiting for an ambulance for several hours. He sits on a bench near the wardrobe and cannot go anywhere. The ambulance also knows that the call is not urgent, so they are not in a hurry.
There is already another problem - not financial. Who came up with such a point in medical care? In our country, everyone is very much afraid of maternal mortality, because the state puts these reports under the nose of those who want to recognize themselves as developed. For the death of a pregnant woman or a woman in childbirth, doctors are reprimanded so that they collect a bunch of papers for each sneeze and send it to the ambulance out of sight. I came with pain in the lower back - an ambulance. The tone of the uterus is also "fast". The main thing is to get rid of a potential problem from the hands: the fewer pregnant women are registered, the better the doctor's statistics.
This tone is generally already like folklore. Nowhere in countries with developed medicine is it treated, everyone knows that from a certain time the uterus begins to contract in training. Does a pregnant woman have a stony stomach for a long time? Yes, this is normal, and only here a poor woman is put on CTG - cardiotocography of the fetus, that is, the measurement of its heartbeat. They immediately look at her on the armchair, this is generally almost every visit to the consultation. Doesn't want to be in the chair - refusal. Doesn't want to go to the hospital - refusal. But then let them prepare that no one is responsible for her.
And how much money flies into this pipe, the FFOMS will not tell us.
Or let's take another problem. In Russia, there are a number of doctors who are required to conduct manual or instrumental examination of a patient every time he has complaints. Even if the patient comes within five days with the same problem, the doctor must, fixing the same reason for the appeal, conduct an examination.
Especially unlucky for gynecologists, urologists, vascular surgeons. It comes to ridiculousness: the urologist prescribed an MRI to the patient, he went, the study showed the absence of pathologies in the prostate gland, but found varicose veins. And the urologist is obliged to offer the patient a rectal examination, because there is a complaint.
A significant part of the time, such specialists are busy with printing and processing refusals for inspection. Because if, nevertheless, something happens to the patient, the one who actually harmed him can turn the matter around so that the doctor is to blame for not touching him once again. In St. Petersburg, specialists have already got printers in their offices - refusals are being printed.
But back to pregnant women - this is a Klondike for hospitals. The gold mine. Whatever they are assigned! Especially if they end up in the hospital. During pregnancy, I was several times in maternity hospitals and antenatal departments. All of them had a minimum of procedures, and in one hospital of regional significance, in two weeks I was so driven by examinations that at the end I began to fall asleep on the go.
I underwent ultrasound of the pelvic organs, ultrasound of the liver, kidneys, pancreas, thyroid, sugar test, dermatologist, dentist, physiotherapist, ENT, endocrinologist. In fact, it is very difficult, in the hospital you cannot sleep and relax, often impose dietary restrictions, often because of the examination or procedure, the pregnant woman skips breakfast or lunch.
A pregnant woman has a stomach ache due to adhesions, and in the morning she is driven hungry to do an ultrasound of the thyroid gland, where she sits in line for an hour and a half and is ready to faint from hunger. I spoke with the head of one department of pathology of pregnant women: she honestly admitted that they had a list from the hospital management - to provide the maximum number of services in order to shake off the insurance money as much as possible.
By the way, this is not all the tests that have fallen to me - during that hospitalization I ended up donating three liters of urine. And this is not a figure of speech - three liters! In words. A three-day diuresis is called. The hospital does not know how else to pump out the insurance money for a specific pregnant woman - let him prescribe her a three-day diuresis. For three days in a row, the poor woman writes down in a column all the liquid that she drinks, including fruits, and pees in the jar.
The entire toilet in the ward is filled with banks, everyone is collecting urine. And do not care that I am lying with a diagnosis of complete placenta previa, a neighbor has Rh-conflict, another neighbor has diabetes, and the other two got to the department because of their age - they were fifty. All were assigned the same examinations and procedures. And no one was allowed to go home ahead of time.
It was then that I first learned that you could be held hostage by health insurance. It turned out that if a woman is in the antenatal department for less than 14 days, then the hospital does not receive any compensation. Therefore, they keep everyone.
The same situation is with gynecology, gastroenterology. The woman got to the diagnostic curettage of the uterine cavity - that's all, you can go home the next day. In Britain, there, the princess gave birth in the morning, and in the evening she was already at home. But then Britain - our woman is released on the third day, and the extract is given after eleven more. All this time she "lies" in the department. And it is not clear at what stage the malice was manifested. Either our state is stupid and does not understand how important beds are, or in hospitals they centrally give orders not to write out any longer, so that the insurance money “drips”. The turnover is frantic: in a month, 10 patients can change on one bed, who, according to the documents, spent 140 days in the hospital in total. And this does not bother anyone!
It's the same with vascular surgery. Laser removal of veins. In private clinics, patients drop in for surgery after work and go home a couple of hours later. You unofficially lie in state for at least three days, and officially - two weeks. They write out the first number, and you come for an extract on the eleventh.
But it is not only in hospitals that there are opportunities to significantly increase funding from the FFOMS. Polyclinics, for example, have standards for examining and identifying health problems, on the implementation of which their budget depends. And these norms do not always correspond to common sense. Well, in our clinic, two metro stations from Nevsky Prospekt, there are no crowds of obese people who gorge themselves on fried potatoes! For a long time, people are switching to proper nutrition, in every fifth courtyard there is a sports ground, in every shopping center there is a sports club. And the polyclinic's plans to detect high sugar and cholesterol are burning. I came to get tested for hospitalization to remove the same veins - in addition to being given a referral to donate cholesterol, even if you passed it two months ago after a medical examination.
Not everything is going smoothly with the clinical examination itself. I once decided to go through it in December and was amazed to learn that … it had already passed. The polyclinic completed the paperwork, entered some indicators for me and sent information … Where, where? To the insurance! We thought that I wouldn’t come, but this is lost profit!
In Russian health care, out of the blue, a fountain of money just beats, and everything immediately goes with a whistle into the abyss. And for the recovery of seriously ill citizens, they collect by SMS separately.
Author: Anastasia Mironova