The Ministry of health wants to change the order of rendering of medical aid. A criterion of its quality should become clinical practice guidelines, said the amendments to the law “On fundamentals of citizens ‘health”, published on the website disclosure of legal information.
Now the minimum amount of medical assistance guaranteed standards of medical care, on the basis of calculated tariffs of the Federal mandatory medical insurance Fund, the founder of the all-Russian Union of patients Yuri Zhulev. “We propose to replace the standards for “clinical guidelines” that entails some kind of variation. It is unclear on what to focus, to understand what kind of treatment are guaranteed to the patient,” — says the expert.
Recommendations should be from a document of the Ministry of health, is a list of actions the health worker and their sequence based on proven clinical experience and necessary for the diagnosis and treatment of each disease. Development of recommendations the Department will impose on a medical professional non-profit organization. Ready documents must approve the scientific Council of the Ministry of health, after which they will be accepted at specialized congresses and conferences and posted on the Agency’s website.
Optional for execution
Medical standards developed and approved by the Ministry of health, therefore, they were binding, says Zhulev. Clinical guidelines will have force of the order, the compulsion of their performance under the big question, he concluded. The document, developed by the public Association of doctors for themselves and not recorded in the proper order, with current industry regulation would apply only on a voluntary basis, agrees the President of the League of defenders of patients Alexander Saversky.
The debate about mandatory clinical guidelines is underway at the government level, said a source close to the Cabinet. Meetings on this subject are regularly held with Deputy Prime Minister Olga Golodets. For the mandatory recommendations of the very acts Golodets and the Federal Antimonopoly service, the Ministry of health for a long time held the opposite opinion, said the source, but recently the position of the Agency changed.
“For us it is very important that they [the recommendations] acquired binding nature in the territory of the whole country”, — said Skvortsova, speaking at the VII all-Russian Congress of patients, “the state and the citizens in building a patient-centred health care in Russia”. In a press-service of the Ministry of health did not respond to a request .
The Ministry of health has failed to ensure full implementation and standards of care, specifies the Director of the Centre for research in Economics and management in public health of the Moscow school of management SKOLKOVO Yuri Krestinsky. To recommendations is still respected, the Agency should establish a system to monitor the activities of physicians and hospitals, the expert believes. The Minister of health Veronika Skvortsova said that such a system will be electronic cards of patients, which the Agency will enter everywhere until 2025 in the framework of national projects on public health.
As will be developed recommendations of what should be their structure and how they will be approved is unknown, the draft says nothing. But now ready 1.2 thousand recommendations, said Skvortsova. They relate to diseases that generate 90% of mortality in Russia.
Some of recommendations were made in the mid 1990-ies, said the Chairman of the Moscow city scientific society of physicians Pavel Vorobiev. “You can not seriously relate to these documents. And not only because of their relevance twenty years ago, but because of the content. Among them are, for example, recommendations for gynecological care for men”.
The development of recommendations can not be trusted non-profit organizations, I’m sure sparrows. According to him, such organizations can easily become dependent on pharmaceutical companies. Recommendations should do specific institutions on public money and solely in the interests of patients and the government, he said.
Finance in the old way
Medical standards from the legislation wouldn’t go promised Skvortsova, because they need to budget for treatment. In the explanatory note to the published draft stated that now the standards will be developed based on clinical guidelines. But in the bill rules for the development of standards is not spelled out, indicates the head of the pharmaceutical areas of the law firm Vegas Lex Maria Borzova. In the current legislation, standards and recommendations are not directly related.
Earlier the Ministry has prepared standards for yourself and for several years has developed around a thousand of them, and then work was stopped. At the same time of diseases according to International classification of diseases, more than ten thousand, says Deputy Director of the pharmaceutical company STADA CIS Ivan Glushkov. According to him, now that the standards will be based on recommendations made by profoundest, this work starts again and will go faster.
If doctors will be obliged to treat patients according to the new guidelines, and the money for the same treatment the government will allocate under the old standards, it may ruin the whole health system, said Glushkov.