Medical care lost its heart rate – Kommersant
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The All-Russian Union of Insurers (ARIA) revealed last year 370,000 violations in the provision of medical care to patients with cardiovascular diseases (CVD). This is a third more than a year earlier, and almost 40 thousand more than in pre-pandemic 2019. Insurers recorded the largest number of complaints in recent years about the quality of cardiological medical care – almost 140 thousand. In addition to purely medical complaints, patients talk about difficulties with making an appointment with a doctor, too long waiting time for an appointment – and the need to pay for medical care, which by law should be free. Cardiologists question the presented statistics, but acknowledge the problems with the timely transfer of patients to a higher organization and their drug provision, although they note that in a number of regions, for example, in Moscow, solutions are found for them.
Last year, the number of violations in the provision of medical care in the cardiology profile increased by more than a third compared to 2021 – up to 370 thousand, Kommersant was told in the All-Russian Union of Insurers. In 2020, insurance companies recorded 260,000 violations, and 324,000 in pre-pandemic 2019. The ARIA explains this temporary improvement in the situation by a decrease in the number of planned hospitalizations during the COVID-19 pandemic. In 2022, the volume of planned medicine recovered: for example, the number of visits to the doctor as part of dispensary observation increased by about 20%. The negative trend, according to insurers, continues this year: in the first quarter, 90,000 violations have already been identified.
Most often, patients went to medical institutions with complaints of coronary heart disease, myocardial infarction in the past, heart rhythm disturbances, hypertension and heart failure, follows from the consolidated data of insurance companies that Kommersant has read. The most frequent violations in the provision of outpatient medical care to cardiological patients were associated with exceeding the waiting time for diagnostic instrumental studies, untimely placement of the patient for dispensary observation, problems of continuity in treatment, and the lack of necessary consultations or consultations. Among the most common violations in the provision of medical care in hospitals, experts name the failure or poor performance of diagnostic and laboratory tests; the absence in the medical documentation of the results of examinations, examinations and consultations, diary entries that allow assessing the dynamics of the state of health; untimely transfer of the patient to a medical organization of a higher level; inappropriate prescribing of drugs.
According to ARIA Vice President Dmitry Kuznetsov, 2022 was a record year for insurers, not only in terms of the number of violations identified as part of ongoing examinations in the cardiology field. Medical insurance organizations also recorded the largest number of complaints about the quality of medical care from patients with cardiovascular diseases in recent years — almost 140,000 such complaints, which is 3.5 times more than in 2021. Among the most common reasons for the dissatisfaction of those insured under compulsory medical insurance in the “cardiology” segment are the provision of poor-quality medical care, difficulties in making an appointment with a doctor, waiting too long for an appointment or examination, as well as the need to pay for medical care, which by law should be provided free of charge, told Kommersant ” in the VSS.
Aleksey Erlikh, a cardiologist at the Chaika clinic, believes that the statistics are provided by “financially interested companies that charge medical institutions fines in case of violation of their own standards of care, but not clinical recommendations.” The two categories, he says, “do not always coincide.” Of all the violations listed by insurers, he singles out non-referral to a higher medical organization. “However, here the situation is not the same in all regions. For example, in Moscow, of course, referring a patient to more equipped medical centers is devoid of logistical and other difficulties,” Mr. Erlich concludes.
It should be noted that cardiovascular diseases remain one of the main causes of high premature mortality in Russians. The federal project “Fight against cardiovascular diseases” should reduce it. In 2021, as part of the project, a federal program of additional drug provision for patients at risk of heart attack and stroke was launched: those who have had heart attacks, strokes, and heart surgeries can receive medicines for two years after the disease. The list of drugs to provide patients with CVD includes more than 30 items, including expensive ticagrelor, rivaroxaban, dabigatran etexilate and apixaban. Over 10 billion rubles are annually directed to them, however, independent purchases have remained high over the past two years, say pharmaceutical market experts interviewed by Kommersant. The real need for them may be 2-3 times higher than the current level of public procurement, confirms Nikolai Bespalov, development director of the analytical agency RNC Pharma. According to his estimates, the share of purchases of cardiovascular drugs in the budget segment last year did not exceed 46% of the total market of these items of 528 million rubles. Purchases and commercial sales were at the same level in 2020 and 2021.
“Unfortunately, the insurance system is built in such a way that the appointment of a specialist is covered by compulsory medical insurance, but the purchase of medicines is not, and this is wrong,” Alexey Erlikh comments on the situation. He cites Moscow as an example, where a regional supplementary drug program for patients at risk of stroke has already saved “so many”. In his opinion, it should be replicated in other regions, “because not all patients can afford to spend 3-4 thousand rubles. per month for medication.
Yuri Zhulev, co-chairman of the All-Russian Union of Patients, notes that most often patients buy medicines from the list on their own due to lack of awareness or if they are treated in a private clinic. There is also the problem of low adherence of patients to treatment, when the drug is taken for six months instead of the prescribed two years. In addition, Mr. Zhulev continues, even the current additional support programs are not available to everyone: “So far, patients with chronic heart failure have not been included in the benefit program. It includes only those who have suffered acute conditions such as a heart attack or stroke.”
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