Difficult childbirth just got a little easier – Picture of the Day – Kommersant

The number of violations identified by insurers in terms of pregnancy and obstetrics under compulsory medical insurance has decreased by a third over the past year. The All-Russian Union of Insurers explains the “favorable trend” by “strengthening expert control”. At the same time, the number of complaints from women to insurance medical organizations, on the contrary, continues to grow. Pregnant women most often complain about the quality of medical care, report on the collection of money and point to problems with the provision of medicines. The All-Russian Union of Patients believes that significant improvements in the system could not have occurred and the situation is “far from favorable”.

The frequency of violations committed by medical institutions as part of the provision of medical care for compulsory medical insurance in the profile “Obstetrics and Gynecology” in terms of pregnancy and childbirth has decreased by a third over the past year, Kommersant was told in the All-Russian Union of Insurers (ARC). According to the results of the examinations of insurance organizations, in 2020 more than 400 thousand violations were detected, in 2021 their number was about 290 thousand. In the first half of 2022, insurers revealed a little more than 100 thousand such facts. It should be noted that the VSS is based on data from registers of insurance medical organizations: the number of insured persons who received medical assistance in terms of pregnancy and obstetrics was 7.275 million in 2020; in 2021 – 7.869 million; and for the six months of 2022 – 4.519 million rubles.

The favorable trend in the VSS is explained by the strengthening of expert control and the work of insurance representatives to accompany and inform patients about the possibilities of free medicine, “which ultimately helps to minimize the risk of errors in the diagnostic and treatment process.”

At the same time, Dmitry Kuznetsov, vice-president of the ARIA, said that the tendency for patients to neglect prophylactic examinations and various kinds of screenings, even when they are free of charge under compulsory medical insurance, still persists.

According to Mr. Kuznetsov, when carrying out expert measures, insurers found that violations are most often associated with failure to comply with the procedure for providing medical care and clinical recommendations for female infertility. Other common violations include: untimely or improper implementation of the necessary diagnostic and therapeutic measures for the patient; the lack of medical documentation of the results of examinations, examinations, consultations of specialists, diary entries that allow assessing the dynamics of the state of health and assessing the quality of medical care; unreasonable prescription of drugs, as well as distortion of information provided in medical records, for example, additions, corrections, “inserts” and even a complete re-registration of the medical history.

If the number of violations identified by insurers falls, then the number of complaints received by insurance medical organizations for the management of pregnancy and obstetrics from patients, on the contrary, is growing. There were 546 in 2019, 668 in 2020, 781 in 2021, and 413 in six months of 2022.

Most often, according to the ARIA, women complain about the quality of medical care during childbirth, during pregnancy, the collection of funds, the organization of the work of the medical institution, and problems with drug provision.

Commenting on the statistics of the VSS, co-chairman of the All-Russian Union of Patients, neurologist Yan Vlasov notes that the situation in terms of pregnancy management and obstetrics is “not so clear”. “Most women go to private clinics for observation. A large number of mistakes that maternity hospitals and obstetric institutions made in the past are affecting. Infant mortality is on the rise, although not by much. These and many other factors indicate that significant improvements in the system could not have occurred and the situation is far from favorable,” says Mr. Vlasov.

It should be noted, according to Rosstat, the infant mortality rate in Russia in 2021 was 4.6 (per 1,000 live births), and in 2018 it was 5.1. Among the regions, the leader was the Chukotka Autonomous Okrug with a coefficient of 15.4. The report notes that the value of this indicator more than others depends on the state of medicine. Iceland has the lowest infant mortality rate in Europe at 1.6. Russia occupies 49th place in the world ranking of countries, neighboring Chile, Bahrain, Macedonia, Qatar, Sri Lanka and Malta.

Yan Vlasov adds that, according to representatives of the patient community, the issue of updating clinical guidelines for pregnancy management is long overdue, as old methods and technologies are used. As a result, Mr. Vlasov continues, the number of patients with cerebral palsy is increasing, in particular. In addition, the problem of nosocomial infections is acute. “In the West, new medical institutions appear much more often, obstetric structures and maternity hospitals are the first to start working in them. Our maternity hospitals have been operating for centuries,” says Yan Vlasov. “The number of nosocomial infections that accumulate during this time poses a threat to mother and child.”

Natalia Kostarnova