There were no applicants for the cancer award – Newspaper Kommersant No. 231 (7432) dated 12/13/2022

The government of the Russian Federation has extended the program to encourage doctors for cases of oncology detected at an early stage for a year, but will reduce the bonus budget by almost ten times. If in 2021 more than 500 million rubles were transferred for these purposes. (and twice as much is planned), then in 2023 – only 53.9 million. As follows from the data of the Ministry of Health, the regions do not master the funds. So, in 2021, medical organizations used 194.1 thousand rubles. (0.04% of the funds provided) for identifying 86 cases. According to the report of the Accounts Chamber, in the first quarter of 2022, only 12 thousand rubles, or 0.04%, were spent on payments to doctors for the detection of cancer out of the allocated 30 million.

In 2023, medical professionals will continue to receive special payments for diagnosed cancers in patients. The order was signed by Prime Minister Mikhail Mishustin. According to the document, 53.9 million rubles will be distributed between the territorial funds of compulsory medical insurance of the regions. Most funds will be sent to the Moscow region (2.9 million rubles), Krasnodar Territory (2.7 million rubles) and Moscow (2 million rubles). The smallest amounts were allocated to the Chukotka and Nenets Autonomous Okrugs (4.2 thousand and 6.5 thousand rubles, respectively), the Republic of Altai (8.6 thousand rubles) and the Magadan Region (21 thousand rubles). Doctors receive bonuses for early diagnosis of oncological diseases during medical examinations and professional examinations from 2020. Funds for this purpose are annually received from the budget of the Federal Compulsory Medical Insurance Fund, and then the money is distributed among medical organizations.

Previously, for each case of newly diagnosed cancer (the diagnosis must be confirmed in further studies), the doctor responsible for organizing and conducting the examination and medical examination (with the exception of the head of the medical organization) received 500 rubles; a health worker who referred a patient for examination by an oncologist – 250 rubles; the same number of a health worker who “implemented the timely establishment of dispensary observation of the patient.” However, in December 2022, the Ministry of Health proposed to change the approach: to provide a stimulus payment of 1 thousand rubles. only to a health worker who suspected a disease, appointed a patient a consultation with an oncologist, diagnostic tests, or put him on a dispensary record. The department explained that the division of the amount leads to a low level of disbursement of funds, and given the small amount of premiums, medical organizations do not submit applications to the territorial compulsory medical insurance funds. Thus, according to the Ministry of Health, in 2021, 502.9 million rubles were transferred from the budget of the FFOMS to the budgets of terfunds for cancer alertness – 42.5% of the approved annual amount (1.183 billion rubles). At the same time, medical organizations used 194.1 thousand rubles. (0.04% of the amount of funds provided) for the detection of 86 cases of cancer during medical examinations and professional examinations. For the entire existence of the program (as of October 1, 2022), out of the allocated 66.1 million rubles. slightly more than 1 million rubles were used. (1.6%) for identifying 762 cases of cancer. For comparison: according to the statistical collection of the Ministry of Health of the Russian Federation, in 2020 more than 550 thousand malignant neoplasms were registered in Russia.

It should be noted, according to the report of the Accounts Chamber of the Russian Federation, for the first quarter of 2022, only 12 thousand rubles, or 0.04%, were spent on payments to doctors for the detection of cancer, out of the allocated 30 million.

Neurologist Yan Vlasov, co-chairman of the All-Russian Union of Patients, notes that not all regions fully understand how to receive incentive payments and what criteria to assign them. Where the mechanism was sorted out, cancer alertness increased, he assures: “For example, in Buryatia, payments are quite substantial, doctors receive them, and the result is obvious.” According to Mr. Vlasov, there are also facts of “non-mandatory” implementation of recommendations on cancer alertness by the head physicians: as soon as they understand that the money cannot be directed to the needs of the clinic, motivation decreases. “Doctors work under a colossal workload, many take two positions or more. In such an environment, the physician may simply miss the symptoms. Abroad, doctors are not allowed to take more than 1.2 rates precisely so that doctors can perform their work in a qualified manner,” notes Yan Vlasov.

Hematologist, medical expert of the Tinkov Family Foundation (helps patients with oncohematological diseases) Andrey Abrosimov believes that it is necessary to introduce and expand advanced training programs for oncology awareness of polyclinic doctors as part of continuous medical education. “Doctors do not refer patients for additional examinations, not because they do not want to, but because they do not have all the relevant information about the early symptoms of cancer. This is shown, among other things, by our courses for doctors on cancer alertness, which are held in the regions together with the Peoples’ Friendship University of Russia,” says Mr. Abrosimov. According to him, after completing the courses, doctors show a qualitatively new level of knowledge and involvement in the situation.

Andrey Konoval, co-chair of the Deystviye medical workers’ trade union, points to another possible problem of a “systemic and managerial nature.” He recalls a similar situation that developed after the government began to allocate a budget for the salaries of newly hired doctors through the CHI system in 2019. In the first year, 12.3 billion rubles were allocated for these purposes, but out of the planned 25 thousand medical workers, only 9.8 thousand people actually received their salaries from the allocated funds. In 2020 and 2021, 18.3 billion rubles each were provided for these purposes, but in 2020 only 7 thousand doctors out of the projected 25 thousand received payments, and in the first half of 2021 – 2.8 thousand out of estimated 39.2 thousand. For the nine months of 2022, out of the pledged 17.3 billion rubles. regions spent only 1.33 billion rubles. In 2023, only 7.4 billion rubles will be allocated to the salaries of newly hired doctors. “Just as in the case of the premium for cancer alertness, good budgets were allocated, but in reality the regions simply did not master them,” comments Mr. Konoval.

Natalya Kostarnova