Medicine took a step forward , and patients stayed there where they were

Exclusive interview with Prof. AALebedev.

draft law "On the basics of health care in the Russian Federation", which was harshly criticized by the medical community, can be adopted this summer - before the parliamentary recess.That is a national health care system, told told the doctor of medical sciences, professor of the department of management, health economics and health insurance improvements faculty physicians of the Russian State Medical University, Alexander Lebedev.

- Alexander, what is the difference between health and proper medicine?

- Is the health care system - a form of government in the field of health policy, and there is medicine - a tool that the government uses to achieve their needs and requirements to ensure the health care of the population.

- And the state has such a need?

- The state can not be such a need, because he needs a healthy young people to join the ranks of the armed forces, those who produce the national income - the workers and the workers o

f the agricultural complex, who produces the intellectual wealth of the country.With increasing life expectancy, there is a need in the state and in the strengthening of health of the elderly, as the growth rates of their illness directly violates the health indicators of economic efficiency on the axis of the relationship doctor-patient.Therefore, the state has a direct need for healthy and able-bodied citizens who create the wealth of their work and the well-being of the nation.Sick people will never be able to make a great nation, powerful and stable.The state, which only declares that cares about the health of its citizens, but nothing in this case does not, to change health indicators - morbidity and mortality - is doomed to systematic extinction.

- count that the realization of the national project "Health" will help solve the problem of healthy lifestyle, public health and health care modernization, hardly worth it.According to President Medvedev, it is necessary "to either increase scale project" Health "in the tens of times, or focus on the economic development of this task, turning healthcare into one of the priority economic sectors."You as the organizer of public health which see ways and means to make cost-effective health care industry?

- Cost-effective for the state sector only one that does not ask for money.I want to emphasize once again that health and medicine - different categories.

Health as a form of public policy aimed at preserving and strengthening the health of the nation, can not be effective without government support.The state initially, creating a health care system that dooms itself to the inevitable spending on maintenance of the system itself.Health Tool is medicine - the science of human health and disease.It can be both first aid and that decides not to long-term objectives, but only short-term - the elimination of injury, acute cases and the like, as well as preventive, precautionary, preventive.There already it faces other problems: it does not wait for when a particular disease will lead the person to a temporary or permanent disability, and taking active steps to ensure that the occurrence of most diseases were unlikely, rare and random event, then there really would be consistent with the concept ofinsurance risks (events).Today in our country, despite the fact that we declare the development of the health insurance system, these characteristics - it is unlikely rare events and accident insurance - broken by all the canons.The population continues to hurt, is steadily growing number of chronically ill and disabled, health care which is paid by insurers - the commercial insurance organizations whose primary purpose is not to solve problems to enhance people's health, and profit.Because of this, today we are dealing with systemic manifestations of ill health as a single person, and the nation as a whole.

- How to convey to the human value of disease prevention, health worth?Perhaps it is necessary to introduce compulsory medical examinations?

- The need to see a doctor only when it is necessary to take sick leave or health trouble has happened, said the low level of medical culture of the population as a whole, is just not interested in leading healthy lifestyles.And even if it were interested in this, how to do this most healthy?For this state mechanisms should be established.

- Like what?

- for example, the state says: "Dear citizens of the taxpayers!We free you from the tax burden, and you of what earned you please - buy health insurance, some portion set aside for pension insurance, not to be in old age in poor condition and be able to use medical care in full "and so on.I believe that you need to build a culture of responsibility and the population for the purchase of social package that today is not the prerogative of the state policy.For the population of social package becomes the employer, it is - a huge drawback of the current social policy, the population is irresponsible, uncultured in ensuring their own social package.A person receiving a salary and paying taxes, can do with their "earned" as you like - for a walk, to spend on food or repayment of the loan, but in a state of ill-health it is not based on your budget and not on their acquired policies, and on state aid.

- But article 41 of the Constitution, and so ensures high quality, timely and free medical care for every citizen in the institutions of the state of the municipal health system ...

- Yes, it is - the basis of law, which can not be undone, a kind of Bible, but there areand regulations - "tales evangelists deputies", and between the first and the second - the abyss!Because the regulations are written every "evangelist" (or a group of the Companions), taking into account their own understanding of a situation in which it is located in a specific time period.Although article 41 of the Constitution, we have a law "On Circulation of Medicines", the mandatory health insurance and so on.And these laws are beginning to substitute for meaningful and semantic structure of the articles of the Constitution - in the name of the law refers to the Basic Law, and the content of the leaves no stone unturned.

last example - an attempt to push through new about the basics of health law wording that the medical services provided by the state and municipal budget medical institutions can be both free and paid.Such an attempt to divide the medical care to the paid and free - a direct violation of Article 41 of the Constitution.From my perspective, the medical services should be divided into free and paid at the place of their provision: if the state-municipal fiscal health facility - if you please, treat us for free, we also pay taxes to the state treasury and insurance premiums.If I went to a private clinic, which has no state accreditation for the right to participate in the program of state guarantees, in which case I either alone pay for medical services personal funds, or if there is an insurance policy of voluntary medical insurance cost of these paid services shall be compensated by the insurance company.At the same time, the state (power) attempts by the money of the population solve the problem of underfunding of the state of the municipal network of health care institutions across the segment of paid medical services by introducing a bill on the principles of health article, which law governs the payment and free medical services.

- That is, after the adoption of this law and its entry into force population will face the need to pay money out of pocket in the public institutions, which are funded from our taxes, for medical services?

- That's right, and I believe that to do so in any case it is impossible!Financing health care in the framework of existing sectoral rules and regulations, as is happening now, will never be able to cover the needs, requirements and population needs in health care, there is need this amount of money, which the state is unable to identify, and that accounts for the officials to come up with ways to findadditional resources through the adoption of specific laws.

- And how do your work on the bill?

- Formation of the legislative framework on health care - very painful and difficult process.For example, a set of laws on health care in some countries of the Old World, for example the UK, Germany, France, has a century ago.For example, the Code Napoleon the first time spelled out the elements of social insurance in France, including health insurance elements.Bismarckian model laid the foundation for a system of socio-professional insurance modern Germany.We have in this respect the history of their own.We were living in '73 in a state where there was no concept of private property, and the Russian Federation - a young country, only some twenty years ...

- In your remarks, to be healthy should be not only a right but also an obligation.How to achieve this?

- Any person who comes into this world, if he has no genetic diseases, is practically healthy.A further task of parents, pediatricians, general practitioners, school doctors and teachers - to preserve the health of the baby, so it does not become infirm first, and then - the chronically ailing, then - disabled.Bet only on medicine, the doctor only in the preservation of the health of the child may be, but it is inefficient, because not everything depends on doctors.According to Academician Yuri Pavlovich Lisitsyn, health accounts for no more than 20% of the volume of activity in this matter.The other 80 - a cross-cutting task.It is therefore necessary from childhood to instill in people the responsibility for their own health.This is what today are not in our country.In the Soviet Union something like it - was a state policy: the builders of communism had to be healthy people, both physically and mentally ... you know ... patients do not take into astronauts.

in the country from which we came, there were the security services, the army - five million people, has been the BAM, Magnitogorsk, the Sayano-Shushenskaya HPP, the public agricultural sector.And despite the fact that the state was not simple, but specific, health issues can be resolved much better and wiser than they are solved now.Therefore, from 1926 to 1972 in the Soviet Union through the state healthcare policy life expectancy figure rose to 26 years, which allowed for the 1980s to catch up with leading European countries on this indicator.Today, we are lagging behind in life expectancy by these countries for men - 15-16 years, women - 13-14 years.This is a very bad trend, she says that we die, it will die the next generation.If the succession goes to them, who will live out in the country?If the native population is dying, then it is replaced with migrants, and those are not the migrants of the former Soviet bloc, which we see today.This is a new sub-culture, the formation of a new national structure, dominance over other religions, indigenous, development of traditional lands and other non-traditional nationalities.This suggests that what happens assimilation of the indigenous people who will lose their historical roots in the process.

- But this is not a health issue ...

- I must say that the flowering of preventive medicine - it is between the Ministry Yevgeny Ivanovich Chazova who tried in the country to establish a system of general clinical examination, however, he did not realize that it was impossible to organizebased on the available funding.The figures, which today produces statistics, it is not adequate to the situation: health care costs are growing at an exponential rate, and the efficiency of the health care sector is growing in arithmetic, so there is a backlog.According to reports from 2004-2005, when the financing of health care was at the level of 495 billion rubles, and the records of 2010, when financing has grown more than three times - up to 1.5 trillion rubles, health outcomes are no different - at three times reared budget.

- But it says that the money for health care are not being developed in order to create health.If a facility in the allocated money will buy new computers, the population of this does not become healthier.

- Absolutely.Funds spent on the solution of health problems.All this - the result of the policy, which has built the state itself.national project money is spent on technical re-equipment of hospitals rather than primary care, ie the clinic - a stronghold of Preventive Medicine.But most importantly, in my opinion, is this: today it is necessary to adopt a law on medical practice, which would be spelled out that the medical practice is the form in which it can and should be implemented, under what conditions and what are the principles.Within the framework of this law it is very important to explain to the medical community that the privatization of medicine should not begin with the privatization of hospitals and to implement procedures particularization medical specialty.This procedure assumes that the reorientation of the current policy of socialization (nationalization) of medical practice on its policy of isolation from the monopoly of the state on the basis of individual and unique criteria for evaluating the activity of the doctor as a subject of rights.Qualified doctors should be given public law for medical practice.The very same medical practice can be implemented in two forms: state-municipal and private.It depends to some form of practice will gravitate one or another doctor.Within the framework of the law on medical practice, it is necessary to introduce one more important point: the practice of medicine has the right to deal with only one doctor, which the state grants a license.But the doctor, claiming the right to the possession of a state license is required to pass the selection in a corporate environment.Corporate environment, in turn, should be submitted to the regional, inter-regional or national professional medical organization, acting in relation to their members surety.Development of the corporate guarantee of the Institute will form a completely new matrix Health Organization, based on the doctor's professional self-regulation and self-government.Upon successful completion of the relevant verification test physician professional medical organization, of which he is a must as a guarantor, to apply to the territorial health authority with a request for a license to this doctor.If there is no good reason to refuse to grant licenses to the territory of the health authority is obliged to give her medical attention.But medical organization (institution) regardless of ownership must undergo the procedure of state accreditation for permission to use the fixed assets and premises for the organization and provision of medical and preventive public services such as the program of state guarantees, as well as for other programs, non-governmentalfunding source.

- Then it turns out that even a doctor, not a medical institution has the right to open a channel of funding?

- Yes, of course.It is the doctor who has a license to perform certain types of activities will be the very mechanism by which the state accredited medical organizations (institutions) will gain the right to obtain financial resources.

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