ОБЩЕРОССИЙСКАЯ ОБЩЕСТВЕННАЯ ОРГАНИЗАЦИЯ ИНВАЛИДОВ-БОЛЬНЫХ РАССЕЯННЫМ СКЛЕРОЗОМ

RIGHT OF CHOICE: ‘LAW OF SERFDOM’ TO ABOLISH IN HEALTHCARE?

Rossiiskaya gazeta, #4581, 6 Feb 2008

http://www.rg.ru

Irina Nevinnaya

 

(FEDERAL NEWS) Although the patient’s right to choose a physician is recorded in the Health Insurance Act, practically, the enforcing of the law faces enormous challenges both explicitly and implicitly.

‘The patient should choose it himself, who treats him and where’, First Vice Prime Minister Dmitri Medvedev stated at a meeting of the presidium for implementing the National Projects. In the opinion of the chief monitor for the National Projects, it is the competition among clinics, which will be ensured by free application of insurance policies, and this will make it possible to promote healthcare services. The patient-pays-principle must redistribute financial resources among more or less successful medical treatment facilities, as well as more or less efficient physicians within a single clinic.

True, we have to think it over how to specifically launch this new mechanism, which requires a heavy (if not profound) restructuring of the compulsory medical insurance system.

To be honest, the patient’s right to choose a physician and the free application of insurance policies are formally at work; these are law-guaranteed. On the other hand, one can employ this right in practice very seldom.

According to Alexander Saversky, President of the League for Protection of Patients’ Rights, in 2006, there were over 100 thousand complaints received about healthcare professionals refusing to render assistance to patients, even though they had policies of the compulsory medical insurance, but which were registered with other medical facilities. Never ever was there a single case of a discontent patient who managed to convince the chief physician to change his (the patient’s) doctor. ‘Though, I say it again, the medical insurance law provides for this kind of change’.

The idea to make physician, mainly to interest him/her financially to, compete to treat a patient is not new at all. This principle had to serve as a basis for the birth-giving certificate: Each mum-to-be, each maternity patient brings net income to the clinic for women, which supervises her, and to the maternity home, where she delivers. In this connection, the Federal Service on Surveillance in Healthcare and Social Development acknowledges that maternity patients with positive background really tend to increase in number.

However, there are quite many obstacles, too. Thus, it is only big cities that can boast there are several maternity homes, which can compete with each other. To speak of the clinic for women, a walking distance factor counts in choosing an agency; a woman may want to have a highly-experienced professional supervise her but the professional can, if ever, have his/her practice in another part of the town.

In fact, the principle when territories are assigned to doctors in rendering medical assistance is a great hindrance in building competitive environment. ‘Sure, from the patient’s point of view, it is good that he can choose, for instance, a primary care physician’, Natalia Kravchenko, professor of the Healthcare Management Department at the Sechenov Medical Academy, comments. ‘But one needs to be fully aware of what difficulties may accompany this, too. Take organizational difficulties – as a doctor has more patients in the surgery than he is able to receive, and, financial ones – the more workload should be respectively paid. But what about rendering assistance in the home? Well, if we don’t follow the principle of settling a certain sub-district on a doctor, then, it has to be made clear, how he/she must work on call if this is the case’.

One has to keep in mind, as well, the factor of the subjectivity of patients’ evaluation. Patients pay more attention to the physician’s service quality, that is, how polite or attentive he/she is. However, the evaluation of the medical service effectiveness, that is necessary examinations or correct management of treatment in place, can be performed by professionals with certain expertise but never by ordinary patients.

‘This is why, - Alexander Saversky goes on, - we should develop clear standards and criteria to define the performance quality of a physician in particular and medical treatment facility on the whole. If we introduce such compulsory evaluation and, besides, make this statistics open, communities will have objective information that will enable them to make unbiased choices’.

Currently, the Ministry of Health and Social Development is working on a draft of the conception of the Russian healthcare development. Its goals have been stated and made clear-cut well enough: It is necessary that both physician and medical facility orient themselves on the eventual result, which is the patient getting well; and, their wages should reflect the efficiency of the eventual result. Given this, how to get this result with the least costs remains to be developed.

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