Together or separately – Company – Kommersant Samara

The Ministry of Health of the Ulyanovsk Region plans to start again optimizing the healthcare system in the region and to merge a number of medical institutions. The deputies of the regional legislature criticized the draft and believe that it requires detailed study. Representatives of the public appealed to the prosecutor’s office of the Ulyanovsk region and the administration of the President of the Russian Federation about this. Officials of the regional government do not comment on the situation. Experts note that many regions are going for consolidation in order to level the shortage of medical staff.

The government of the Ulyanovsk region intends to return to the issue of optimizing healthcare institutions in the region. This, according to the deputies of the regional legislature, Deputy Prime Minister of the regional government Sergei Kuchits at the end of last week told members of the health commission under the Ministry of Health, which includes representatives of all parliamentary factions.

As reported Kommersant-Volga deputies, according to the “modernization project” (that’s what they call it in the Ministry of Health), at the first stage it is planned to merge a number of city medical institutions with large hospitals in Ulyanovsk (for example, all clinics in the microdistrict of aircraft builders – with the Central City Clinical Hospital, also located in the Zavolzhsky district of Ulyanovsk , an ambulance station with a disaster medicine center). At the next stage, it is planned to merge with large Ulyanovsk hospitals 14 district and district hospitals, as well as trauma centers of the regional center (for example, the Mama perinatal center, Mainskaya, Veshkaymskaya, Surskaya and Karsunskaya district hospitals will have to merge into the regional clinical hospital). In total, 15 mergers are planned, in which 42 healthcare institutions will participate.

The deputies spoke critically about the project, noting that they would be ready to consider the project only after it has been worked out with the provision of all arguments, economic calculations and a roadmap. They also noticed that if some mergers can be accepted, then they have questions about the possibility and effectiveness of the management of the former district hospitals, which will be located 150 kilometers away.

There was no official information from the regional Ministry of Health about the planned reform. Meanwhile, information about the planned optimization that got into the media caused a negative public outcry. Ulyanovsk independent lawyer and human rights activist Konstantin Tolkachev on Tuesday sent a letter to the prosecutor’s office of the Ulyanovsk region, the presidential envoy in the Volga Federal District and the presidential administration of the Russian Federation with a request “to intervene and stop attempts by the Ministry of Health and the government of the Ulyanovsk region to optimize healthcare institutions in the region”, noting that such plans make it impossible to implement the national projects “Health” and “Demography” in the region. He also stated the need for “broad public discussion of the project.”

It was not possible to get an explanation from Sergey Kuchits on the new optimization project – on Wednesday he was not available for comment, he did not respond to a request from Kommersant-Volga.

Sergey Sherstnev, chairman of the relevant committee of the legislative assembly, believes that “the purpose of the proposed mergers is purely managerial, to improve the medical services provided,” and the reason is the personnel problem, the lack of specialists: “If there are no narrow specialists in a district or district hospital, then after modernization the head the institution will be able to send them there, and it is easier to do this when it is one legal entity.” Mr. Sherstnev noted that after the submission of the elaborated draft, it will be discussed both by the commission and at the relevant committee. “But before the adoption of the document, it must be discussed as publicly as possible so that citizens and medical workers understand that this will not worsen their situation, but, on the contrary, will improve it,” the deputy told Kommersant-Volga. He also explained that, in his opinion, it is necessary to carry out the reform in stages, “to see what comes out of this on a pilot project.”

Indeed, the personnel problem in regional health care is very acute.

As follows from the report of Sergey Kuchits to the regional Civic Chamber, the shortage of medical personnel (taking into account the part-time coefficient) is 573 people today, the average medical staff is 556 people, and, despite efforts to employ new doctors, “natural personnel growth remains negative”, in In 2022, “the industry has lost more than 400 doctors.”

Alexei Kurinny, deputy chairman of the State Duma Committee on Health Protection (formerly head physician of the Ulyanovsk Center for Specialized Medical Assistance), noted that a number of mergers of medical institutions in Ulyanovsk may be reasonable, but plans for regional hospitals “raise doubts” with him. In his opinion, the merger project is created “out of hopelessness”, and this is due both to economic issues – “an attempt to dilute the debts of a weak regional institution with a strong hospital” and a chronic shortage of personnel. “Legally, it may become easier to redirect narrow specialists, but this is not a solution to the problem, but plugging holes, because the problem of personnel will continue to grow, and it is necessary to solve it by raising the salaries of medical staff. But this is a problem not only at the regional, but also at the federal level,” the deputy said, calling the initiation of the reform on the eve of the elections an ill-conceived step.

Director of the Institute for Health Economics at the Higher School of Economics Larisa Popovich notes that the lack of medical staff is not only a Russian problem, but also a global one, “and it will only grow further.” “There is nothing wrong with a merger as long as help is available. Many regions of Russia are now moving towards enlargement in order to alleviate the shortage of personnel, to provide opportunities for the prompt dispatch of specialists and equipment, to make it easier to resolve issues of compulsory medical insurance. The main thing is that vital points are not closed, and people are explained why all this is being done, ”— noted the expert.

Sergey Titov, Ulyanovsk