This wording best explains recent events: the strengthening of the Doctors’ Union, the "Italian" strikes, the mass layoffs of medical workers who live on a salary for one and at the same time work- without breaks- for two, if not three employees.
In order to rise to a pay of 160 rubles per hour for a diligent newcomer in a fast food restaurant, 2-3 months is enough; nurses and doctors in public medicine get to this for decades. A schoolboy or student determines for himself the time to go to work and the number of hours of work, but the "lower ranks" in a medical institution do not ask - they work for "themselves and the other guy commanding "from above". And this often happens in a deteriorated foundation that has not been renovated since the last century.
The destruction of the main foundations of clinics and district hospitals, the personnel shortages and the low pay for the lower rank medical staff- is a legacy of the 90s. All these years, nothing has changed fundamentally, but the federal officials of the Ministry of Health of the Russian Federation have always been surprised by the flow of professionals into commercial medicine, the transformation of doctors into medical representatives, and generally the departure of 10-12 thousand specialists from medicine every year.
The fish "is rotting" slowly. Less than 10 years after the "optimization operation", the president's press secretary admitted that the Russian health care system is "incapable of self-renewal and self-maintenance of the necessary level of its activity"*.
"The system was not well organized". Well, well, well! The Federal Service for Surveillance in Healthcare (Roszdravnadzor) has annually conducted investigations and reported numerous violations of citizens' rights to the availability and quality of medical care, in thousands of cases of non-provision of medical care. But the government and the Minister of Health in particular were in no hurry to react and draw conclusions!
The lower ranks and the patients are silent and defenseless hostages of the existing corruption system. The collapse in the system of public medicine in regions, the decline of the reputation and status of the doctor is strongly encouraged and supported by the unprofessionalism and indifferent connivance of the Government of the Russian Federation and the Ministry of Health of the Russian Federation in particular:
- Instead of a full–fledged doctor's pay, controlled at the federal level- there is a "bare" salary. Federal officials must be incredibly astonished by the news that their colleagues in the regions all these years, for some reason, reject the transferred funds in their budget and reduce regional allowances for doctors as much as possible. For some reason, the chief physicians of hospitals do not share the bonus pool fairly among all their colleagues, but they transfer it massively to increase their own salaries and material support for their deputies. But ,of course, no information is received "at the top" about the frequent cases of non-payment of overtime work and the appeal to the labor inspectorate.
How do you like the second part of the ministerial game? The president instructed to assign additional payments to primary care physicians, so that the average salary of a doctor exceeds the average level for the region. Instead, the chief doctors, having received an informal order from the ministries to "quickly sort it out", realized that it is easier to put medical workers on an administrative staff pay and report that there is no medical staff with a low salary in the institution. Let the doctor "work" as a cleaner or a security guard – it is not a big deal.
As a result, the medical staff actually "takes the highway" - in a number of regions, patients and their relatives are "hinted" that the doctors and nurses need to feed their family and it would be good to "pay extra" so that the operation is done efficiently, and then the patient receives fair postoperative care, etc.
Annual errors in hospital procurement planning, “slow” response to requests, and unwillingness to receive fines for late bids in regional ministries lead to a constant shortage of medicines and medical devices there. As a result, the patient or his relatives are forced to buy the drugs.
Such a "little thing" as the inability of regional ministries to agree in situations where it is closer and faster to bring a patient to the hospital of a neighboring region. As if the regions are separate principalities of medieval Russia, and computerization as a tool for managing and for payment netting between entities of the Russian Federation is absolutely unknown.
And finally, "the icing on the cake" - the adoption of the Compulsory Medical Insurance (November 29, 2010 federal law N 326) and "optimization", but in fact - the gradual destruction of the health care system. The money goes to the medical institution "after the patient" (this seems to stimulate competition between clinics and hospitals). This system works for countries with compact settlements. In Russia, with sparsely populated territories and large rural and small town problems, this leads to underfunding and the inevitable degradation of medicine. The decision to keep only those medical care stations where a "sufficient" number of attendance is received- is simply brilliant; in a situation where the number of rural settlements of less than 100 people in Russia is almost 120 thousand out of 150, and the constant strong outflow of population from urban-type settlements and small cities leads to their reduction and disappearance**.
Experts of the Centre for Economic and Political Reforms (CEPR) believe that we have "successfully" approached the number of medical institutions during the Russian Empire in 1913 and have already passed the threshold when the number of institutions became less than in 1932. In general, as a result of "optimization", the number of hospitals in Russia decreased from 10.7 to 5.4 thousand, the number of clinics from 21 to 18.6 thousand institutions. At the same time, of course, the population did not stop getting sick, and the load on the remaining institutions increased by an average of 20%***
- Low salaries, working in inappropriate conditions led to a shortage of personnel. Primary health-care lacks about 30 thousand doctors and 130 thousand secondary health workers. The situation when; after coming to work at night, doctors are forced to continue working for the departing staff members without rest, perform operations without the time for sleep and recovery; has become almost a norm in a number of regions. It is not surprising that graduates of medical schools and colleges, having had practicals in public institutions, do not want to work in a situation of poverty, abnormal schedule and complete dependence on the chief physician.
So far, the Minister of Health, Veronika Skvortsova, has officially stated that the number of doctors working in primary health-care has increased by as many as 4,000 in 4 years. That is, she hinted about her readiness to restore the number of doctors in public institutions in 30 years. Despite the fact that, every year in Russia more than 40 thousand young doctors and about 90 thousand auxiliary personnel are still graduating. The problem can be solved in just 1-2 years.
Over the past 15 years, the Russian Government has been required to do only three things:
To knock corruption instruments off the hands of the chief physicians and staff of the ministries. The doctor's pay should be determined only at the federal level, and the distribution of the bonus pool should be "transparent" , etc.;
To adjust the issue of transferring medicines and medical devices to hospitals, taking into account poor planning and the need for stockpiling;
Modernizing, but not destroying, hospitals and clinics.
It is obvious that all these years the prime minister and his deputies have been doing everything but managing, by allowing unchecked executives in the regions to make their scheme work and destroy infrastructure. And here is the result- a mass discontent and an attempt to reach the president of the Russian Federation, followed by a reaction- getting the government to resign.
We must pay tribute to the president's flair – just a little bit and Medvedev's "art" could have led to a social explosion. So, "at the bottom" everyone is pleased and are happily "blowing off steam" on social networks, government officials are transferred to other positions that are not inferior in salary and corruption opportunities, and are about to start "creating" - that is, multiplying documents on the working table and officially report the successes. So the "wolves" are still intact, but whether the "sheep" will be fed- is a big question.