Health care reforms. The prospect is self-medication. On the use of ambulances for other purposes

Today in the village Shimsk, Novgorod region, a protest rally was held in connection with the "optimization" local medicine. Both Shim residents and doctors took part in it. The fact is that the administration of the region made a tough decision to close the only hospital in the Shimsky district, leaving local residents only a day hospital with a few beds with extremely scarce funding.

“We risk getting another Syamozero!” In Karelia, they rebel against the wholesale optimization of educational institutions

Five Karelian technical schools will immediately cease to exist from January 1 next year. By order of the republican government, they will join other educational institutions. The same fate touched several kindergartens, schools, centers additional education for children, hospitals and maternity hospitals. Head of Karelia Artur Parfenchikov calls optimization a "logical measure", arguing that unification leads to progress, and not to degradation at all, as citizens fear, the correspondent reports. On the eve.RU.

Russian doctors will take part in a rally against corruption and healthcare optimization

A rally was held in Karelian Pitkyaranta demanding to preserve the cultural center and the maternity ward

In the city of Pitkyaranta in Karelia, a mass rally was held demanding not to close the house of culture and the maternity ward in the district hospital, as well as to hold the canceled enrollment for the first year of the Pitkyaranta branch of the Sortavala College.

Sacrifice Due to the optimization of medicine, a resident of the Urals lost three babies who did not have time to be born

Olga Ladygina, a resident of the village of Russian Potam, Achitsky district Sverdlovsk region, two wonderful sons. But she and her husband always wanted more children. And it is likely that today a young mother could already receive a well-deserved award from the hands of the governor - "Maternal Valor", if it were not for the optimization of health care in the region. There is no more ambulance station in my native village, which means that there is almost no chance to survive if the birth is difficult.

Be healthy: the number of beds in Russian hospitals rolled back 85 years

In terms of the number of hospitals, today's Russia is already lagging behind the RSFSR of 1932, and at the current rate of reduction in medical infrastructure, in 5-6 years Russia can reach the level Russian Empire 1913. Today at 17000 settlements The country does not even have paramedical stations.

Doctor visits down by 105 million in two years

For 10 months of 2017, mortality among rural population amounted to 12.5 cases per 1000 inhabitants, which is 3% higher than the planned figure, and exceeds the birth rate by 114 thousand people. The auditor said Accounts Chamber Alexander Filipenko, speaking at the "Government Hour" in the State Duma with the participation of Minister of Health Veronika Skvortsova.

Time cures

Optimization Russian healthcare in general, and Moscow in particular, is in full swing. Quality improvement medical care in general, and emergency medical care in particular, has reached unprecedented heightsSince the beginning of November 2017, it has become customary to see how ambulances line up in unison at the emergency departments of some Moscow hospitals to transfer the patient to the hospital doctors. True, everything is not as romantic as it seems from the windows of the ministries.

V.A. Zhogov

I cannot look without shudder at what our reformers are doing and what they have already done with health care now, today. Why did the population begin to look at doctors with hatred?

I remember how on February 12, 2004, speaking to trusted representatives, V.V. Putin, answering a question about his vision further development Russian healthcare, said that he would like medical institutions to receive money not for the mere fact of their existence in nature, in a city or in a village, but for the quality and quantity of services provided. In this, V.V. Putin saw a solution to health problems.

Everything seemed to be correct.

However, this correctness turned out to be deeply erroneous. Planned tasks were immediately organized both for medical institutions and for each doctor.

And as soon as doctors began to be paid for the quality and quantity of the services provided, that is, as soon as medicine was transferred to piecework wages, it immediately turned from a chronically ill person into a falling into hell.

Yes Yes Yes.

Firstly, now doctors tend to serve patients who require minimal attention, minimal time, but always with good results. Therefore, there were cases of refusal to serve seriously ill patients, patients with an unclear diagnosis, with a dubious prognosis or requiring long-term treatment.

Secondly, this led to the appearance of additions to completed medical services, which distorts the indicators of morbidity, morbidity of the population. There were patients with false diagnoses, not shown to them by the laboratory, instrumental examinations, surgical interventions etc., etc., and all this for the sake of indicators.

A slogan appeared: the main thing is to pay - and we will invent the disease!

Insurance medicine!

Its introduction during the Gorbachev perestroika was conceived as a way additional increase wages for health workers, as if an addition to the budget item "salary" at the expense of enterprises, institutions where sick people work.

And what happened?

First, a very numerous, very expensive, far from harmless and completely unnecessary intermediary in health care has appeared. - Secondly, it is she, insurance medicine, having introduced so-called subsidies at the beginning of its activity, transferring them to each medical institution, voluntarily or unwittingly led to a quarrel in the division of these subsidies between departments within the hospital. And as a result of the quarrel - the disintegration of the once whole district, city hospitals into separate small and smallest but independent institutions with their own budget, chief doctors, their deputies, and accounting. As a result, instead of a single district hospital, such medical institutions as a hospital, a polyclinic, a children's hospital, a maternity hospital, an ambulance, etc. appeared. And what they could not share (food unit, garage, stoker) was made self-supporting enterprises.

Thirdly, by introducing the so-called insurance policy, it divided the entire population of the country into those who have this policy and enjoy (?) the right to receive “free” medical care and those who do not have this policy and therefore are obliged to pay for medical services.

Fourthly, it completely replaced the local authorities with its activities, taking on the functions of financing medical institutions for salaries, purchasing medicines, equipment, monitoring and inspecting the work of medical institutions, widely using fines, underfunding, etc. as punishment. .

Of course, in Soviet times, there were many shortcomings and flaws in the work of health authorities, but even then it was the best on the planet, although it required some reorganization.

Today's transformations in medicine are replacing the struggle for human health with the struggle for profit from treatment.

Recently added to doctors general practice(district therapists) a certain salary supplement. It would seem that this is good. And is it really so?

Firstly, these doctors were immediately tied (enslaved) with money to this position for many times. But they are ordinary doctors and most often not very successful in medicine. They need constant deep practice, which is not and never will be on the site.

Secondly, the local doctor in his daily work a consultation is constantly needed by a number of working doctors: a surgeon, a neuropathologist, a cardiologist, an ENT, etc. but they are deprived by the state (Remember Zurabov's speech that the district doctor will freely replace both the oculist, measuring his eye pressure, and the surgeon, having made the necessary dressing) But this is a serious conflict in the medical team.

Not! An increase in salaries for district physicians does not bring medical care closer to the population and not only does not improve, but, on the contrary, reduces the quality of this medical care.

What needs to be done to bring healthcare out of this state of emergency?

Of course, he needs, first of all, competent leadership, but not by academicians, but by medical workers who know practical healthcare and not in the capital, not in large cities, but in the remote periphery, where it is difficult for a patient to see a doctor, and it is difficult for a doctor visit the patient at home.

This is first.

Secondly, the treatment of a patient is a single inseparable process, consisting of diagnosis, treatment, rehabilitation, and should be carried out in a single medical institution, therefore, scattered into parts, district, city hospitals should be reunited.

Thirdly, the obligatory health insurance, as an expensive and not harmless intermediary, should be abolished.

Fourthly, when carrying out the reorganization of healthcare, it is necessary to decide on the following issues:

a) what positions in medicine are leading, main;

b) which medical and diagnostic institutions are closest to the population, bear the greatest burden of providing medical care;

c) what principles should underlie the organization of the work of health authorities.

I am sure that no one will object to the fact that the leading, main positions in medicine are an ordinary ordinary doctor and his head of the department in whatever medical institution they work.

It is on their knowledge, skills, competence, desire, finally, that the level of quality and timeliness of medical care for each patient depend.

Not chief physician, not his deputies play in this matter leading role.

In our health care, a whole series of orders, instructions, methodological letters regulates what, where, when, to whom, how to act in certain cases, what is allowed and what is prohibited from medical treatment - diagnostic measures in precinct, district, city, regional, etc. hospitals.

The doctor at certain intervals is required to pass qualification barriers:

certification, protect licenses in order to receive this or that salary.

And who is it for the good?

Regulatory frameworks are harmful and medical workers. and the population (and even this entire regulatory procedure, before it had time to appear, turned into an ordinary dirty feeding trough).

If a doctor in a medical institution is limited in his activities by certain limits of the ban, then he is deprived of the opportunity to grow and improve as a specialist in this institution, which in no way improves the level and quality of medical care to the population and in no way contributes to the retention of medical personnel in the field. By law, a doctor who has graduated from higher educational institution and having received a diploma, legally acquires the right to a full-fledged, and not regulated, medical activity.

Our government is finally beginning to understand that the bulk of the population in our country lives in villages, towns, district centers, and small peripheral towns. Therefore, it is in these regions that rural precinct, district, city hospitals are closest to the population. in the departments of which patients receive medical care.

Get the patient for consultation and treatment in the regional and republican centers extremely difficult, difficult, and for many simply impossible. Here, the material possibilities of patients, and road transport problems in the outback, and the inability of relatives and friends to organize extra care for the sick while he is in the regional or republican hospital.

Yes, and life itself, practice shows that not regional, not republican, not metropolitan medical institutions make weather in medicine.

No matter how they are strengthened with personnel, finances, expensive devices, laboratories, they will never be able to solve main task health care - to maintain and improve the level of health of everyone individual person and the population of the country as a whole.

Now, for the umpteenth time, the government is organizing centers to provide high-tech medical care to the population, placing them in large administrative centers. But we already had similar examples not so long ago, when Minister of Health E. Chazov, having received 19 billion rubles from the government, opened large diagnostic centers to improve the quality of disease diagnosis. These centers were also located in large administrative cities. Unfortunately, the work of these centers did not affect the state of medicine in the country.

High-tech medical care is, of course, necessary for the population.

But after all, today in every regional, regional, republican center there are medical institutes, academies with 2 - 3 or more faculties, where each of them has a whole series of functioning clinics of various profiles and all these clinics are staffed with highly qualified personnel and equipped with the latest equipment.

Isn't that enough, at least today, when in the nearest villages, settlements, not to mention the distant outback, medical care in best case appears to be at the level of the 50s of the last century?.

What are the principles of healthcare?

In my opinion there are three of them: Availability, quality, responsibility.

Accessible medical care can be only when it is as close as possible to the population and would be free. During the Soviet era, there was a slogan in the country:

HUMAN HEALTH IS THE PROPERTY OF THE STATE!

Today we live under the motto: HUMAN HEALTH IS THE PROBLEM OF THE MAN ITSELF!

It is currently very difficult, if not impossible, to improve the quality of medical care for the population in general and for every sick person in particular.

I'll try to explain why.

Without a doubt, the quality of medical care depends on the knowledge, skills, competence, desire, and finally, the medical staff. But this is not enough.

The fact is that the time has long come to deal with such an issue as the role of the clinic and the hospital in the diagnosis, treatment, rehabilitation of patients.

Until now, the leading, the main role was given to the polyclinic (ambulatory). So. It was in the days of the USSR, in the era of socialism, it also remains in the era of a market economy, after the collapse of the USSR.

Yes, indeed, outpatient care for a patient is much cheaper for the state than his treatment in a hospital.

However, it has long been recognized that the examination of patients in the clinic is incomplete, it does not accurate diagnosis, the treatment is mostly symptomatic, blocking the symptoms of the disease: pain, cough, body temperature and is carried out until improvement general condition sick, not until he is well.

Polyclinic examination and treatment for really sick people is painful, and sometimes unbearable for the elderly. (Queues to see a doctor, to a laboratory, to any diagnostic room, for procedures, and all this in cities and towns where road transport problems have not been resolved, etc.)

It is not for nothing that people say: in order to be treated on an outpatient basis, one must have iron health.

That is why many patients can not stand even complete examination, nor full treatment in outpatient settings.

It is the polyclinic that is the main culprit of the growing morbidity of the population, the main creator of chronic disease processes.

It will not be superfluous to emphasize here that chronic sluggish current inflammatory process in any organ or tissue human body is an ONCOLOGICAL PROCESS in which a cancerous tumor can develop.

That is why it is long overdue that all primary patients be examined and treated in a hospital.

Only such a tactic will make it possible to drastically reduce errors in diagnosis and bring the patient to recovery. The polyclinic (outpatient clinic) should deal with the rehabilitation of patients, medical examination of the population.

And more about quality.

We will never raise it if we do not pull rural, regional, city hospitals out of decay.

Only they are able to bear responsibility for the health of each person, for the health of the country's population as a whole.

For regional, regional, metropolitan medical institutions it is possible to consolidate only the functions of organizational and methodological centers and nothing more. There should be no diktat here.

And yet, doctors, physicians treat, repair the MAIN PRODUCTION FORCE OF SOCIETY - HUMAN, STAFF, and therefore their remuneration should be an order of magnitude higher than that of any official.

Finally the last one. The management, financial and supervisory functions should be returned to the health authorities of the local authorities.

V.A. Zhogov

I cannot look without shudder at what our reformers are doing and what they have already done with health care now, today. Why did the population begin to look at doctors with hatred?

I remember how on February 12, 2004, speaking to trusted representatives, V.V. Putin, answering a question about his vision for the further development of Russian healthcare, said that he would like medical institutions to receive money not for the mere fact of their existence in nature, in a city or in the countryside, but for the quality and quantity of services provided. In this V.V. Putin saw a solution to health problems.

Everything seemed to be correct.

However, this correctness turned out to be deeply erroneous. Planned tasks were immediately organized both for medical institutions and for each doctor.

And as soon as doctors began to pay for the quality and quantity of services provided, that is, as soon as medicine was transferred to piecework wages , so immediately she turned from a chronically ill person into a falling into tartarara.

Yes Yes Yes.

Firstly, doctors now tend to serve patients who require minimal attention, minimal time, but always with good results. Therefore, there were cases of refusal to serve seriously ill patients, patients with an unclear diagnosis, with a dubious prognosis or requiring long-term treatment.

Secondly, this led to the appearance of postscripts to the performed medical services, which distorts indicators of morbidity, morbidity of the population. Patients appeared with false diagnoses, laboratory and instrumental examinations that were not shown to them, surgical interventions, etc., etc., and all this for the sake of indicators.

The slogan appeared: the main thing is to pay - and we will invent the disease!

Insurance medicine!

Its introduction at the time of Gorbachev's perestroika was conceived as a way to additionally increase the wages of medical workers, as if an addition to the budget item "salary" at the expense of enterprises and institutions where sick people work.

And what happened?

First, a very numerous, very expensive, far from harmless and completely unnecessary intermediary in health care has appeared. - Secondly, it is she, insurance medicine, having introduced so-called subsidies at the beginning of its activity, transferring them to each medical institution, voluntarily or unwittingly led to a quarrel in the division of these subsidies between departments within the hospital.

And as a result of the quarrel - the collapse of once-solid district, city hospitals into separate small and smallest but independent institutions with its own budget, chief physicians, their deputies, accounting. As a result, instead of a single district hospital, such medical institutions as a hospital, a polyclinic, a children's hospital, a maternity hospital, an ambulance, etc. appeared. And what they could not share (food unit, garage, stoker) was made self-supporting enterprises.

Thirdly, by introducing the so-called insurance policy , she divided the entire population of the country into those who have this policy and enjoy (?) the right to receive “free” medical care and those who do not have this policy and therefore are obliged to pay for medical services.

Fourthly, it completely replaced the local authorities with its activities, taking on the functions of financing medical institutions for salaries, purchasing medicines, equipment, monitoring and inspecting the work of medical institutions, widely using fines, underfunding, etc. as punishment. .

Of course, in Soviet times, there were many shortcomings and flaws in the work of health authorities, but even then it was the best on the planet, although it required some reorganization.

Today's transformations in medicine are replacing the struggle for human health with struggle to profit from treatment .

Recently, general practitioners (district therapists) have been given a certain salary bonus. It would seem that this is good. And is it really so?

Firstly, these doctors were immediately tied (enslaved) with money to this position for many times. But they are ordinary doctors and most often not very successful in medicine. They need constant deep practice, which is not and never will be on the site.

Secondly, the local doctor in his daily work constantly needs advice from a number of working doctors: a surgeon, a neuropathologist, a cardiologist, an ENT, etc. but they are deprived by the state (Remember Zurabov's speech that the district doctor will freely replace both the oculist, measuring his eye pressure, and the surgeon, having made the necessary dressing) But this is a serious conflict in the medical team.

Not! An increase in salaries for district physicians does not bring medical care closer to the population and not only does not improve, but, on the contrary, reduces the quality of this medical care.

What needs to be done to bring healthcare out of this state of emergency?

Of course, he needs, first of all, competent leadership, but not by academicians, but by medical workers who know practical healthcare and not in the capital, not in large cities, but in the remote periphery, where it is difficult for a patient to see a doctor, and it is difficult for a doctor visit the patient at home.

This is first.

Secondly, the treatment of a patient is a single inseparable process, consisting of diagnosis, treatment, rehabilitation, and should be carried out in a single medical institution, therefore, scattered into parts, district, city hospitals should be reunited.

Thirdly, compulsory health insurance, as an expensive and harmful intermediary, should be abolished.

Fourthly, when carrying out the reorganization of healthcare, it is necessary to decide on the following issues:

a) what positions in medicine are leading, main;

b) which medical and diagnostic institutions are closest to the population, bear the greatest burden of providing medical care;

c) what principles should underlie the organization of the work of health authorities.

I am sure that no one will object to the fact that the leading, main positions in medicine are an ordinary ordinary doctor and his head of the department in whatever medical institution they work.

Exactly finally, the level of quality and timeliness of medical care for each patient depend on their knowledge, skills, competence, desire.

Not the chief doctor, not his deputies play the main role in this matter.

In our health care, a whole series of orders, instructions, methodological letters regulates what, where, when, to whom, how to act in certain cases, what is allowed and what is prohibited from treatment and diagnostic measures in the district, district, city, regional and etc.

hospitals.

The doctor at certain intervals is required to pass qualification barriers:

certification, protect licenses in order to receive this or that salary.

And who is it for the good?

Regulatory frameworks are harmful to healthcare workers as well. and the population (and even this entire regulatory procedure, before it had time to appear, turned into an ordinary dirty feeding trough).

If a doctor in a medical institution is limited in his activities by certain limits of the ban, then he is deprived of the opportunity to grow and improve as a specialist in this institution, which in no way improves the level and quality of medical care to the population and in no way contributes to the retention of medical personnel in the field. According to the law, a doctor who graduated from a higher educational institution and received a diploma legally acquires the right to a full-fledged, and not regulated, medical practice.

Our government is finally beginning to understand that the bulk of the population in our country lives in villages, towns, district centers, and small peripheral towns. Therefore, it is in these regions that rural precinct, district, city hospitals are closest to the population. in the departments of which patients receive medical care.

It is extremely difficult, difficult, and for many it is simply impossible for a patient to get out for consultation and treatment in the regional and republican centers. Here, the material possibilities of the patients, and road transport problems in the outback, and the inability of relatives and friends to organize additional care for the patient while he is in the regional or republican hospital play a role.

Yes, and life itself, practice shows that it is not regional, not republican, not metropolitan medical institutions that make a difference in medicine.

No matter how they are strengthened with personnel, finances, expensive devices, laboratories, they will never be able to solve the main task of healthcare - to maintain and improve the level of health of each individual and the country's population as a whole.

Now, for the umpteenth time, the government is organizing centers to provide high-tech medical care to the population, placing them in large administrative centers. But we already had similar examples not so long ago, when Minister of Health E. Chazov, having received 19 billion rubles from the government, opened large diagnostic centers in order to qualitatively improve the diagnosis of diseases. These centers were also located in large administrative cities.

Unfortunately, the work of these centers did not affect the state of medicine in the country.

High-tech medical care is, of course, necessary for the population.

But today in every regional, regional, republican center there are medical institutes, academies with 2-3 or more faculties, where each of them has a whole series of functioning clinics of various profiles and all these clinics are staffed with highly qualified personnel and equipped with the latest equipment.

Is this not enough, at least today, when in the nearest villages, settlements, not to mention the distant outback, medical care is at best at the level of the 50s of the last century?

What are the principles of healthcare?

In my opinion there are three of them: Availability, quality, responsibility.

Affordable medical care can only be provided when it is as close as possible to to the public and would be free . During the Soviet era, there was a slogan in the country:

HUMAN HEALTH IS THE PROPERTY OF THE STATE!

Today we live under the motto: HUMAN HEALTH IS THE PROBLEM OF THE MAN ITSELF!

It is currently very difficult, if not impossible, to improve the quality of medical care for the population in general and for every sick person in particular.

I'll try to explain why.

Without a doubt, the quality of medical care depends on the knowledge, skills, competence, desire, and finally, the medical staff. But this is not enough.

The fact is that the time has long come to deal with such an issue as the role of the clinic and the hospital in the diagnosis, treatment, rehabilitation of patients.

Until now, the leading, the main role was given to the polyclinic (ambulatory). So. It was in the days of the USSR, in the era of socialism, it also remains in the era of a market economy, after the collapse of the USSR.

Yes, indeed, outpatient care for a patient is much cheaper for the state than his treatment in a hospital.

However, it has long been recognized that the examination of patients in the clinic is incomplete, gives an inaccurate diagnosis, while treatment is mostly symptomatic, blocking the symptoms of the disease: pain, cough, body temperature, and is carried out until the general condition of the patient improves, and not until his recovery. .

Polyclinic examination and treatment for really sick people is painful, and sometimes unbearable for the elderly. (Queues to see a doctor, to a laboratory, to any diagnostic room, for procedures, and all this in cities and towns where road transport problems have not been resolved, etc.)

Not for nothing do people say: to be treated on an outpatient basis, you must have iron health.

That is why many patients do not withstand either a complete examination or a full-fledged treatment in an outpatient setting.

It is the polyclinic that is the main culprit of the growing morbidity of the population, the main creator of chronic disease processes.

Here it would not be superfluous to emphasize that a chronic sluggish current inflammatory process in any organ or tissue of the human body is an ONCOLOGICAL PROCESS in which a cancerous tumor can develop.

That is why it is long overdue that all primary patients to be examined and treated in a hospital setting .

Only such a tactic will make it possible to drastically reduce errors in diagnosis and bring the patient to recovery. The polyclinic (outpatient clinic) should deal with the rehabilitation of patients, medical examination of the population.

And more about quality.

We will never raise it if we do not pull rural, regional, city hospitals out of decay.

Only they are able to bear responsibility for the health of each person, for the health of the country's population as a whole.

Only the functions of organizational and methodological centers can be assigned to regional, regional, metropolitan medical institutions, and nothing more. There should be no diktat here.

And yet, doctors, physicians treat, repair the MAIN PRODUCTION FORCE OF SOCIETY - HUMAN, STAFF, and therefore their remuneration should be an order of magnitude higher than that of any official.

Finally the last one. The management, financial and supervisory functions should be returned to the health authorities of the local authorities.

RF Constitution, Article 41
1. Everyone has the right to health care and medical care. Medical care in state and municipal health care institutions is provided to citizens free of charge at the expense of the relevant budget, insurance premiums, and other revenues.
2. In Russian Federation funded federal programs protection and promotion of public health, measures are being taken to develop the state, municipal, private systems health care, activities that promote human health, development physical education and sports, ecological and sanitary-epidemiological well-being.
3. Concealment by officials of facts and circumstances that pose a threat to the life and health of people entails liability in accordance with federal law.

If the declared goals and actions to achieve them contradict each other, then what is happening can hardly be called a reform. The described situation fully refers to the situation with the “reform” of health care in Russia, which has been going on for the past few years (the current stage began in 2014, everything continues in 2016). Sometimes people like to use the word “optimization” to describe what is happening, which also contains a noticeable element of craftiness - in the classical view, optimization involves modifying the system to improve its efficiency. AT this case, we are talking only about reducing the costs of maintaining the system of providing free medical care to the population, the limiting case of “optimization” according to the criterion of minimizing costs - complete failure from free medical care for the majority of the population. In fact, what is happening is reminiscent of this particular case, the authorities “reduce the financial burden on the budget”, they do not have sick people, but “the burden on the budget”, they themselves, if they can, are treated abroad. And I am not against treatment abroad, the crafty behavior of the authorities surprises me. And by the way, if the disease is not treatable in Russia, then in theory the possibility of treatment abroad for ordinary citizens at the expense of the state is declared (more precisely, several years ago it was precisely declared that current position did not follow up).

As an introductory material to the topic, a text from the Vedomosti newspaper is offered, which describes in detail what is happening in practice with healthcare in Moscow. It must be understood that quality (availability and quality of various medical procedures) medical care in Moscow is on average higher than in other regions, while over the past few years the situation has been greatly worsened here (in some areas, bringing it to catastrophic). The income of doctors and health workers in Moscow is also significantly higher. The situation even in the Moscow region (a few kilometers from the Moscow Ring Road) is noticeably worse.

The second text from the Vedomosti newspaper is a quote from an interview with Alexander Auzan, Dean of the Faculty of Economics at Moscow State University, which states that the very concept of healthcare “reform” is vicious, the problem is not in implementation.

“Cognitive dissonance begins in Russia”

Dean of the Faculty of Economics of Moscow State University Alexander Auzan on overcoming the inertia of development and why we have to look 25 years ahead (quote about ongoing reforms)

- But people probably need to offer something now? About “in 20 years the complete victory of communism will come” - we have already gone through this.
- If people want to move in a certain direction, you are right that you cannot tell them: wait 10 years and in 10 years something will happen. We need, as they say, closely hanging fruits. I will tell you where, in my opinion, such results should be sought: we need to get out of the impasses in which we now have education, healthcare and the pension system. Because this is the shell in which a person lives, and he sees that the reforms are leading somewhere in the wrong direction. Yes, they built a building, brought in equipment - but in fact it is getting worse and worse. It seems to me that we moved in the wrong model in healthcare, education and the pension system. Let's take health care - the insurance model is very expensive, in it the super-rich America lives with difficulty, spending 2.5 times more per unit of good than England or Germany with good health care, or Israel, or Cuba. Let's see: it turns out that there are many models of good health care, but for people this is important. Do you know why else it matters? It’s somehow not customary to say out loud that we are an aging nation, our human potential lives in an increasingly fragile shell, and, no matter how hard we try with demographic growth, to be honest, nothing really works out. And it won't work. Everyone except the Americans - this is the only historical exception - are moving to a plateau: the demographic growth is ending, the nation is aging. This means healthcare is becoming more important and more sensitive. We are a fairly educated, aging country that needs finely tuned healthcare. And he is not. The same goes for education. We are no longer the most reading country, as Zhvanetsky said about the USSR - in this sense, human capital is also beginning to collapse. Because education is now largely working in the wrong direction, in which it should, but again according to the old Soviet joke: the struggle of the system with the natural talent of a person. The system is starting to win. In education, we have made a market-service model, in which we evaluate, as in a continuously operating supermarket, the quantity and quality of services provided per unit of time. Listen, in general, education is a long-term investment, and the result is a person, not reporting. After all, we have huge transaction costs in education and healthcare, because teachers and doctors not only treat and teach, but write and write. As soon as you cannot formulate a realistic goal, you have great amount reporting. And since it still doesn’t work, let’s add some indicators. We have fallen into a downward selection. We need to change the model. I think that for people, the transition to setting realistic goals [in these areas] is a tangible thing that can be achieved, well, not in a year or two, but in five years, the turnaround can already begin to be felt.

We are talking about the systemic degradation of medicine (health care) in Russia

Problems in healthcare are systemic, doctors are increasingly saying that our medicine is turning into a fake. Polyclinics can accept patients, send them for research, prophylactic medical examinations and prophylaxis, but the diagnoses often do not correspond to reality. Laboratory tests done incorrectly, and the prescribed treatment is very different from the methods used in most developed countries. Details at the link (text Lenta.ru 11/03/2016)

Published on 19.5.2016, version 1.3 of 07.11.2016
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