Experts discussed how to erase the differences between private and public medicine

What should Russian medicine be like in modern realities? What do patients and doctors mean by the concept of “quality of medical care”? Experts spoke about this and much more during the round table “Public and private medicine: guarantee of quality and safety in modern conditions” held in Moscow.

As the co-chairman of the All-Russian Patients’ Union, head of the Council of Public Organizations for the Protection of Patients’ Rights in Roszdravnadzor, Professor Yan Vlasov, said, today in Moscow the number of public and private medical organizations is approximately equal. At the same time, one can quite often observe a negative attitude of patients towards “private traders”: they say they make money from us. “Patients view public and private healthcare challenges differently. For the first, it is important to treat quickly and cheaply. The task of private providers: the patient must come more often and receive more expensive treatment. Some even advise under-treating the patient so that he has a reason to come back again. However, today there is an imposition of additional services in government agencies. To protect themselves from the investigative committee, doctors have to prescribe to patients everything that is in the clinical recommendations. Many doctors are afraid to work in this system: today, any patient complaint can end in a criminal case. But the doctor and the patient are in the same boat: if the doctor drowns, the patient will drown too. Therefore, we need to decriminalize the actions of a doctor.”

In addition, the expert notes that a person’s satisfaction is related not only to the help he received, but also to the way it was “packaged.” For example, residents of remote regions want to give birth in Moscow and are willing to pay a lot of money for it just because the ward has its own toilet, its own staff and white walls. Vlasov notes that today the doctor has ceased to be a healer of human souls, and the profession has ceased to be a ministry: “At the same time, health is presented as a commodity. And health has no price. We need to bring this concept back to educational institutions. It doesn’t matter whether medicine is private or public, it must serve the patient.”

Deputy General Director of the Federal State Budgetary Institution National Institute of Quality Oleg Shvabsky does not agree that medicine is an art. In his opinion, medicine is hard, routine work, and the only way to avoid harm is to comply with the standards. “Treatment should not be longer or shorter, but equally, according to standards. Then the difference between private and public medicine will be leveled.”

Academician of the Russian Academy of Sciences, head of the department of therapy, general medical practice and nuclear medicine of the Russian National Research Medical University Grigory Roytberg notes that the quality of medical care in countries with a high standard of living is in second place among the reasons that motivate a person to live in a particular country: “The user should not care who owns the clinic building or tomograph; Medicine is either good or different. We often confuse patient satisfaction and quality of medical care. The first may be high – doctors can speak beautifully. And they can be rude and unfriendly, but they are doctors from God. But the world has come up with systems for certification and professional assessment of the quality of medical care, systems for assessing clinics, for example, voluntary certification JCI. And it is also very important that in the current conditions we do not lose international connections in cases where this is possible – we cannot live in a confined space. Otherwise, it will turn out like Zhvanetsky’s – if we don’t see other shoes, ours are the best.”

But what conditions need to be created in the country to improve the quality of medical care? The rector of the Higher School of Healthcare Organization and Management Guzel Ulumbekova spoke about this. She noted that the quality and safety of medical care is largely determined by the knowledge of doctors, but there are problems with this. We live in an era of large amounts of information – the amount of data, according to expert estimates, doubles every year. And if earlier doctors received knowledge from textbooks, today they have access to computer databases. Artificial intelligence is widely used in medicine, which allows the use of electronic chart data. “However, there remains a problem with updating the knowledge of doctors,” says Professor Ulumbekova, “annually, examinations of the quality of care in the compulsory medical insurance system reveal 25% of defects in its provision, and the investigative committee has even created a medical examination department – more than 170 cases against doctors are brought to court every year . At the same time, the wages of professors and university teachers, including medical ones, are 2.5 times lower than in Soviet times in comparable money.

In Russia, the training time for doctors is shorter than in developed countries, and our doctors begin working with patients even before their internship. Most medical organizations today do not have libraries, and only 20% of doctors read medical literature.”

In Russia, incentive payments have now been introduced for doctors (for the number of patients, etc.). However, international studies have shown that such a system does not work. As is the punishment system. For doctors to work effectively, they cannot be driven, they need to create good conditions and a favorable environment in the team.

And in Russia, the number of identified complications is 28 lower than in America. Not because there are fewer of them – they are simply afraid to identify them. Clinics offer incentive surcharges for reducing the mortality rate of the working-age population by 10% per year, while in fact it has increased by 7% in recent years.

According to experts, today it is necessary to make serious investments in improving the level of knowledge of doctors. For example, according to UK statistics, every dollar invested produces from 2 to 9 dollars of effect.

However, experts remind that not everything depends on doctors. As RAS processor Natalya Kondratova says, a person can have a successful operation with a highly qualified doctor, but if after the operation the nurse does not wash her hands and a purulent complication arises, this is a problem for the entire system.