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Features of health care reform in the Yaroslavl region. 

Anythe reform of the  is associated with the changes. If there is a constructive dialoguethe participants of the process, you can avoid   problems standing in the wayreal reform is so necessary as patients, and  healthcommunity.

Inhalewhether the innovations of the new life in the health care system, previously orientedsolely on the society, and now- forced to live onpragmatic laws  of XX1 century? To this and other questions were answered AlexanderNikolaevich Senin, Deputy Governor of the Yaroslavl region.

1.Whatexpected in 2013 ярославцам  health professionals from health care reform?

Notis for the word «reform» of the banal reduction of  the costs?

Costson health in 2013 in the Yaroslavl region will be increased  compared with the year 2012, almost 2.8 billion rubles.  or by 24%. But someoneapparently want to cast a shadow on the reform, to replace their purpose and  the meaning.The necessity of optimization of structure of the health system to improve itsquality, accessibility and effectiveness, trying to substitute the supposedly necessaryreduction of costs.

 Weunderstand  the current situation with the assessment of population quality organization of medical assistance.  Almost half of the inhabitants of the region is not quitesatisfied with the level of its provision. The leadership of the country  put specific objective: to improve the  the health care system.  Stepswe take to perform this task, of course to a greater extent affect the medical community. This, it must change, that wouldmeet modern requirements. We understand that not all workers,working in  the health sector, will welcome these  change understand that  and there will be dissatisfied. And all that at the present time inhealth is a positive or  the negative, because of thethe fact that the beginning of  the actual changes. The process in General slogans clear -  we need to go to a totally new and modern level. Whatsame in detail?  To our huge unfortunately most Yaroslavl doctors  pre-retirement age. They gave all my lifemedicine and not their fault that these are new times and  all so fastbegan to change. Probably, it is difficult to start  maintain a record ofpatients at the reception, use of modern information and digital technology in the diagnostic process and t.d.? And this needs of the modernstandards.  of This and many other places before man in the white coatspecific problems. By nature man is conservative, not all are able and willing toquickly reorient proportion to the fast changing world. And, asyou know,  many people think, as if from all this work loose, tothe changes were minimal and did not affect the familiar rhythm. Here are many casesit is because of this fact, and there are  complaints, rallies, etc.

-Anythe reforms are aimed at changing the established order, require their victims.It turns out that the  either the person is integrated in the new system conditions, orcome down with «locomotive» and is looking for another niche for the application of professional skills and talents?

-Yes, it is so. Due to the modernization now in hospital are massivethe delivery of the new equipment. The majority of physicians eyes lit up moodhas improved , that on such a remarkable equipment could work.It would seem, a positive factor, but he made  certain problems with the organization of its efficient operation.  the Complexity of the equipment requiresimprovement of professional skills of our  doctors, laboratory technicians, New technologies, sometimesat the root,  change  the concept of the therapeutic process. For example,  morerecently, in order to make the x-ray  laboratory assistant shouldwas  charge the tape in the tape, take a picture, to show the film, afterthis give the doctor. The time spent on production of one study may begreat.  With the advent of  digital technologies  time andfinancial costs to get a picture of steel in times less. Radiation load andthe staff and the patient also decreased. Naturally should increasethe number of x-ray studies carried out on the equipment during one shiftshift, that is, availability to rise  and turn be reduced.However, such a prospect enthusiasm for health workers is not caused - workwant the new equipment, and the load count in old.

Whatto « go with the паравоза», in conditions of the most severe shortage of health workersfor us retention of personnel the first task.  All of whom must belearn, learn new skills  is the maximumassistance and with the legal and financial points of view.

-Can, is  infringement of the in the material plane?

 No.The fact is that, the staff  want to do the same amount of work, whichdone before, to which you are accustomed, and believe that any of  thethe increase in research is an intensification of their work. They do notcounted on that  during the transition to digital technologies.  In the DecreeThe President №597 clearly outlined wage increase of medicalthe personnel and the population in the right to demand  that would be with the increase of wagesBoard has increased the number and quality of work of medical personnel.

 In2013 in hospitals will be supplied with modern diagnostic equipment.This is what will increase the opportunities for  diagnostic  and medical base.

Theaccordingly,the  state counts of  the adequate answerfrom the medical community. Yes, if the doctor  will  receivesalary, for example, the  in two times more, that, means,  and work  to  more intensive. Then come all, i.e. happensynergy processes: the equipment and technologies, they are in a hospital, will  most effectively used, doctors will be moreto work effectively and  receive more  wages  a fee, andpopulation - will be more high-quality medical assistance.

- The doctor mustmeet  patterns of health worker, whose conceptnow is dictated by the upgrade? And not hiding any of the pretentious word «reform»the reduction of social services to the company, not simulated whether the process of modernization?

-There are many examples of that, if you want to understand the big issue,it should be spread on a little. The health care system is not an exception.For example, the problem of accessibility. It is in the most part from excessiveзаорганизованности process. Ask yourself a question, and often does a visit to the clinicends with a full-fledged examination,  the result? Lets take on thethe steps well see-come  the patient to a clinic, stood in a queue, got талончиа to the doctor again came to the clinic, got  todoctor, doctor,  just wrote out a direction for testing!!!, thenthe patient went to the queue for the ticket for testing and t.Dr.. Receivethe ultimate care of the patient  is being pulled at a time. But the  doctorevery such visit sees this as a full-fledged polyclinic reception, and expectsrelevant payment.  And the patient there is no  no resulthe has received. Therefore, and begin to demand from the organizers of the health simplifythe diagnostic process, and the doctor strict compliance with the standards of diagnosticsand treatment.

Letsconsider a different standard  a situation - the patient with chronicdisease, such as diabetes. In order to  the  receivefree medication he needs every month for tests. Tell me, whyas his monthly stand in the clinic  for some явочкой in the laboratoryfor testing?  Who invented it? The patient should immediately go to thethe laboratory, and there thanks to the information system should be information aboutthe amount necessary for his research. I hope in the nearest time, thisthe problem we decide and съекономим a lot of strength and health of our patients. And with doctorswe clear $ time to really treatment work.

- do  in thereform defend the  the interests of the region to the Federal structures?What is the logic of  the reform process?

-In my opinion, health now in such a situation, that, so to say,неправильностей a lot. For example, earlier thought, that the need for greaterthe clinic.  And now  in some areas, there are hugepolyclinics.  They are almost empty, but utilities and other costsrequire. What with them  do? Before time dictated  their requestssociety. Today everything has changed, it is time other calls. In one of thedistricts of the region has a hospital on 15 thousand sq. m., and the area is small. In the housing2 thousand sq. M. there are only two  round-the-clock beds and twooutpatient units. Communal expenses on the maintenance of suchthe housing are more than a million rubles a year!  When   startedmeets  situation, the first question which I asked the leadership of thehospital: «People, and you are not lazy to wash the square and walk on them?». As a result ofdiscussion the decision was made,  the body  from the treatment processhospital  it is necessary to withdraw. The hospital will be able to  accommodate, located init  affiliated companies, in the main building. Съекономленые the means to sendat the improvement of  the therapeutic process, and  free housing to transfer tothe bodies of social security.  And this is a very important moment.

Sometimes surgical beds perform social  functions, they are filled with peoplethe elderly, who simply have nowhere to put it. I not for the fact that the bedclose, but for the fact that it is properly called. The need to increasethe number of social beds.  If the «social», the berth should be in a boarding school, and not in the hospital.

Reformin the health sector should go in parallel with the changes in the social sphere .For example, the regional psychiatric  the hospital has a half thousand bedsround-the-clock stay. In addition, about 300 people on indications may betranslated in psycho-neurological boarding school. But we dont have in the area of freeplaces in these institutions ! Turn on placing in it is of the order of 150people. If we build a boarding school, it will solve several problems at once: in a hospitalreleased expensive therapeutic beds and patients in need of treatment receive it.Patients also need  only in a specialized  care will bebe in the boarding school. It is more comfortable and convenient. All  thisremap the  financial resources and flows of patients. Plan to theto solve the problem in the next three years and to build boarding schools  in thearea. This is what will create the additional jobs there. However, the position ofresidents may not always be favorable. In 2013 want to open the similarthe boarding school in the Myshkin district.

Whatsame goes for the regional interests, we interpret the reform in accordance with thethe needs of the region. Understand the responsibility and believe that the  eachsurgical berth should function  in accordance with itsstatus, and not for receiving remuneration, to  have not been created imitation  health care reform.

-What medical institutionsit is planned to  to give concessions?

-The region has no plans to transfer the  any  medical institutionsin the concession. Recently the privatization program, the government of the region excluded sanatorium «Sosnovy Bor» and «Regional pharmacy» because theseobjects give a guarantee of performance of social obligations in the region. And  weclearly need to understand how to fulfill it. The sanatorium will be repurposed most part under the rehabilitation of children with disorders of the locomotor systemof the machine.

 Through«Облфармацию» is the main stream of providing drugpatients of the region. All  in the region is consumed medicinesorder in  1 billion. RUB.  We are for competition, for decentralization, butthere are things over which the government may not loosen their control. It is,for example,  provision of funds on free prescriptions,expensive and rare preparations, where shortages of drugs,poses a threat to health.

 Withthe other hand, there are a number of low-power institutions, which we  closing. Toexample, before the system was  health municipal andregional,  was duplication. It turned out that there are two identicalobject  of different subordination. Now for us it is not necessary, we укрупняем, combine,but  it  nothing in the concession not to transmit dont plan to .

 -Atthese processes occur  personnel matters. How are they solved?

" Inever heard of  not a single example, when would we offered to someonego  on the street. We have  the system of certification and qualification the system of retraining from one post to another. If closesobstetrics bed and the nurse goes to another Department, then it needsпереучиться. If someone is the principal positions, that is, the output is the transition to private medicine.

-Closingmaternity hospitals. Subject was painful resonance?

-the Themeacquired a completely incredible dimensions, inflated artificially. You need to understand,the state  raises the requirements to the quality of provision of medical aid, introducesnew orders and  standards. Requirements  serious - to besure in safe childbirth should work intensive care, neonatology, etc.,i.e., the system of obstetric aid should be at a high level.

the Process ofreduction began not yesterday, but since 2004, approximately, in the year of 26 beds. Objectivepicture, for example, in the Myshkin district of  the  2012 was 38 genera.This means that the bed «worked» 1 once a month. Some leave to give birth inthe city, i.e. there, where the conditions are better.  Birth certificate allows you to makethis choice. The argument of  the reduction in Finance is often used to dischargeof the situation. The order of the Ministry of health says that  childbirth safe to take there,where it is done systematically, not less than 500 births  in the year. I.e.,  strengtheninga specialist team works  well-and clearly like clockwork.

for example, in the Borisoglebsk district hospital is located  in a woodenbuilding  Some had said so do not agree with the closure of the hospital: «Weconducted repairs, brought up to the level of standards, the  we have shower and toilet, noteach hospital can boast of it.» And about a pit remained silent. Absurdity. Any requirements of fire safety  wooden building notwithstands. To get out  from the last century. The world around changes.

Stategives the  great importance of the demographic situation. Each lostbaby  its a big disaster. The perinatal center  it is equipped with allnecessary to create all conditions for the  new mothers. Informationtechnologies allow us to do something that was not previously: combine all information ina single network, keep track of online  a situation with a history of women,are there any factors that increase the degree of risk, etc.. depending  from situation of  the woman falls into that or another category, it accompanieson an individual schedule. The situation is worked out to the last detail. I would not liketo nonspecialists speculated this theme.

 Evensomeone brought the argument that, say, our steps are directed against the President - hedefined the task of improving the demographic situation, and we, allegedly, put it to thefulfillment under threat. But the President is calling  to innovations, to new,modern,  and not to how to keep the old wooden barracks.

-Whatcriteria must meet heads of medical establishments, as controlled by their actions?

-The quality of managerial personnel, is  the big problem of the modern health care.For the last time there was a change of some  leaders. Not correctmanagement decisions hospital Director seen quite clearly: ifof 100 rubles allocated on his therapeutic work 95 RUB.  spent onwages, the means, to ensure the  the therapeutic process hospitalthere are only 5 rubles. Here in  some hospitals and are requested to bring witha  their medications.  I.e.,  hospital becomes a mechanism forensure the salaries of doctors, and not for the treatment of people. Chief doctor of suchinstitutions should  leave his work.

-Whatthe output?

 -Nowit is fashionable to discuss the effective contract with the head. If we want to improveDirectors responsibility for the actions that need to move to a system ofan effective contract. Probably, it is not very like healthcommunity. After all, if used to work differently,  it difficult to enter thethe frame. But this must be done.

the Powers of the leaders will be limited.  With time, verticalto build and  rotation among managers of health care institutions will beoccur more frequently.

-Howwill be appointment to the posts?

 -Before, the chief physician was more therapeutic than economic tasks:public utilities payments, procurement of medicines, repairs  etc.was engaged in the Department. Now hospitals in these matters shall be independent. Thisit means that the institution began to be assigned more responsibilities:interaction with insurance companies, legal and economic questions, etc. Sometimes, the healing process of the chief doctor occupies only 30% of workingtime. Increased role of the second, the economic part. On the agenda the question: whoshould be the principal, who provides the functionality or medical part, in anycases enter the division of responsibilities? For example, in one of the district hospitalsintroduced the position of Director. I think that in this case it is irrational step.Because the separation of the functions reasonably under certain volumes. To the extentincrease of the work will be  separate  the therapeutic and commercialfunction. But this process, in my view, must be synchronized with the norms ofthe current legislation, and not every doctor may connect the twohypostasis.

-Sometimespolicy chief doctor  causes reasonable discontent among the staff.What is done in such cases?Becausea nervous situation can and in patients effect?

-Change in the structure of the hospital, the reduction of some rates for doctors, the creation ofother  - it is the prerogative of the head physician. And of course, always causing a stormthe emotions. They all want to advise how to do better, and only one of  the mainthe doctor has the burden of responsibility. The responsibility for the formation of the staff,its performance is also his concern.

 Arisinglabour disputes are decided jointly with the  the trade unions.

 Forthe last half a year Director of the Department of health  Вундервальд S.L.,the Director of the Fund Pushkov M.A. and I,  double  met withпрофактивом area.  And I think we have a very constructivethe dialog.

Wecontrol of the chief physician of the methods and mechanisms, which providesthe current legislation. If the team begin problems of the systemthe nature of that prevent the working process, the  take note of and work withthem,  используясь administrative resources.

the That theCan you say about the specialization of hospitals? On treatment in Moscow?

-What innovations  here?

" Neversingle hospital does not have the full range of medical services. Hospitalshould be large, multi-faceted, but should be and hospitalshighly specialized. The regional health care system should beconstructed so that the  not less than 95% of the population cured  in the region, andbased on this you need to buy the equipment, technologies, organizethe healing process. For  the treatment of rare diseases is the Federalmedical institutions of narrow profile.  

Wefor the strengthening of scientific relations of our hospitals with the Federal clinics. Asexample say that the Yaroslavl Oncology hospital entered into a  theto receive the  consultation  on histology drugs withprofile of the Institute of Oncology  them. Herzen, Regional clinical hospital with a  Institute of Hematology and so on. of course, that the doctor  should be able to get adviceon the more complex cases, when it is the doubt.

-Atthe elimination of the medical institutions is taken into account whether the opinion of the people?

for example,  closed  in Yaroslavl  hospital №4. In fact, it merges into another hospital. For the patients, nothing changes forpersonnel changes. Then there are conflicts and difficulties. It is obvious - the patientprofitable: he came in large medical institution, possessing gooddiagnostic base, which wasnt there before.

I believe that modern diagnostic technologies, such as computer томмография, nuclear magnetic resonance angiography,laboratory analyzers, should work round the clock.  the Challenge of todaysthe day - to arrange this work in at least two shifts. It is obvious to all thatambulances should work around the clock, and  heres polyclinic in twochange not at all. If  to calculate how much it is worth empty classrooms after14-00 in polyclinics and  how many of equipment, which does not use theyou can very surprised at these figures. In addition, the receipt of medical assistancealso stretches to the patients.

-Whatis happening today in the system?

Firstof all, we feel a shortage of personnel, about 150 doctors. The order for the specialists for the medical University made, but the  the process of joining specialists it takes years.

Wewill  shut down  institutions with the projected capacity of less than 100 beds,do enlargement, to raise the quality of  assistance. Whatfor closing and re-profiling of those or other branches, some of the buildings,we consider the extra  in the system, will hand over to the state Treasury. For example, the  inpic. Норском was the TB sanatorium, who was  squarein  1,8 ha. Building on the Bank of the Volga river, there is a boiler house.  Therapeutic processthere was halted three years ago, because the building does not correspond to thesanitary norms. We pay rate of the personnel, guards, истопников,utility services. From 1 January 2013 the office is closed, people are warnedon  this property complex will be sold. In Скобыкино is  the childrens sanatorium on 2 hectares. No child is not there, guard the object you need, pay for communal expenses, too,  and so on. Thisonce the object.  All it was worth a lot of money, and we need to understand how many of the medical institutions is indeed one of the therapeutic process.Another example. Division of  the medical institution is located on the territory of thethe factory. The plant raised the rent in three times. Why  the money, whichare intended for the organization of treatment,  should be given for rent? Andif tomorrow will still rise  rent?" The facility is«Polyana» for the money. Who should lead the conversation with the leadership of the plant on thisthe theme? The local authorities. By the way, immediately found a «friend», who said,what we want to close this Department. And we dont want to. But you need to decide the questionwith a private company-Director of the factory.

 Problemsthe regional health care on the background of the reform of the many. The the company still does not  estimated for themselves  positive aspects of the reform.May everything is still ahead? The situation is ambiguous, it is possible that it lacks thepublic participation, to the good intentions of the reformers do not have gone astray,the more the process is for our with you, the taxpayers expense.

Victoria Sotskova

the Yaroslavl regional newspaper"Health" №1-2 from 11.01.2013г

 

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