“They refused to detail the account”: a resident of Komi is trying to get a justification for the cost of assistance provided under the compulsory medical insurance

The resident of the village of Usogorsk, Republic of Komi, 33-year-old Anna P. has systemic lupus erythematosus. This is a chronic autoimmune disease in which antibodies to one's own DNA appear in the body, which leads to damage to the connective tissue and blood vessels, as well as the involvement of internal organs in the pathological process.

Medical history

In June 2017, Anna began to worry about leg pain. In the Udora central district hospital, the surgeon diagnosed her with a shin injury, but the medications prescribed by him did not help. A year later, the girl was hospitalized with acute deep vein thrombophlebitis of the right thigh. A vascular ultrasound confirmed thrombosis, and doctors recommended Anna to consult a gynecologist.

In the fall of 2018, Anna was admitted to the hospital of the hematology unit of the Komi Republican Oncology Dispensary, where doctors tried to transfuse her, change her therapy, but her health condition did not improve.

“I was discharged from the oncology dispensary. But the leg continued to swell, I started a rash - small blood spots throughout my body, merging into huge spots, ”Anna recalls. “And they again took me to the Udora central district hospital again.” There were no examinations there for ten days of hospitalization, and the surgeon advised me to consult a dermatologist. ”

According to the girl, despite the deterioration, the doctors were in no hurry to send her from the district hospital to Syktyvkar. Then her mother demanded discharge and referral to the State Institution of the Republic of Kazakhstan “Clinical Cardiology Dispensary”, where Anna conducted all the necessary examinations and selected another treatment, after which she felt better.

“My attending physician contacted the Medical Research Center. Almazova, whence a week later an invitation came for hospitalization in the rheumatology department. They dealt with me very quickly, having diagnosed "systemic lupus erythematosus." In general, I believe that I was still very lucky, and the diagnosis was made quite quickly, since many have been visiting doctors for several years, taking tests, but they still live without a diagnosis and therapy, ”the girl says.

166.9 thousand in 10 days of the hospital

In May this year, Anna received a certificate on the cost of the medical care provided to her through the Gosuslug portal for the treatment of her disease - from 2017 to 2020. Most of the accounts do not exceed 4 thousand rubles. But seven items on the list differ in significant amounts from 19.2 thousand rubles to 166.9 thousand rubles.

Among the medical institutions that issued such invoices: GU “Komi Republican Oncology Dispensary”, GU RK “Clinical Cardiology Dispensary” and GBUZ RK “Udora Central Regional Hospital”.

“What surprised me most was the amount of 166.9 thousand rubles for 10 days of the hospital in the therapeutic department of Udora Hospital,” says Anna. - These days, blood was taken several times from me, but they do not do expensive complex tests in our village. I did not have an ultrasound scan and CT scan, because we don’t have a CT scan at all. A couple of times I was consulted by a surgeon, they injected Clexane, this is an inexpensive medicine, antibiotics were dripped. We bought some of the drugs ourselves, because they weren’t. ”

Moreover, as follows from the certificate, a month of treatment in the cardiology department of the State Institution of the Republic of Kazakhstan “Clinical Cardiology Dispensary” in the city of Syktyvkar cost the state 64.6 thousand rubles. The total bill for the medical services provided by the State Institution “Komi Republican Oncology Dispensary”, in which Anna was twice treated and spent more than a month, amounted to 83.4 thousand rubles.

“It turns out that ten days of a hospital without complicated procedures and part of the medication at their own expense in a regional hospital cost 2.5 times more than a month and several days in a specialized cardiocenter, where I was examined along and across, underwent blood transfusion and plasmapheresis (procedure mechanical blood filtration - RT). I was curious how such a check is possible at all and what they could include in it, ”the girl wonders.

Closed Information

Anna called the Ministry of Health, the Federal Compulsory Medical Insurance Fund (MHIF), an insurance company, to find out what services were pledged in the amount of 166.9 thousand rubles, but she was told that this was classified information.

“Nowhere could they explain anything to me. They said that the details of the accounts are not provided, that this is classified information. I tried to explain to them that there could not be such a difference in the amounts, that perhaps this is a mistake. And they ask me: how do you know, you are not a specialist, ”Anna resents.

RT sent a request to the Ministry of Health of the Russian Federation. They said that the request was submitted to the MHIF, but there was no response from the department.

In a conversation with RT, the President of the Doctors Defense League, Semyon Halperin, noted that the law does not contain a clause on informing the patient about the costs of the medical assistance rendered to him through the compulsory medical insurance system.

“In essence, this is accounting documentation,” the expert explains, “and patients have no way to receive such reports, which makes the compulsory medical insurance system opaque. Due to lack of cost information there may be tampering. This is a real issue worth discussing. ”

The expert recalled that after online access to medical records was opened, a large number of posts were revealed.

“In the case of high costs for inpatient care, it is difficult to say which services could be so expensive. Suppose that the cost of treating patients with coronavirus infection reached 200 thousand rubles, while the cost of treatment in most cases was not very large - most often, patients simply went to hospital and received symptomatic therapy. This explained the interest of many medical institutions in hospitalizing patients, ”Halperin said.

According to the president of the Patient Protection League, Alexander Saversky, the problem of the non-transparency of the compulsory health insurance system is that doctors are paid salaries not for labor, but for the number and volume of services rendered, which are not difficult to attribute.

“The worse the patient’s state of health, the more the clinic will receive money for him,” the expert comments. - Therefore, for example, it is better to call ordinary appendicitis peritonitis in order to fulfill the plan and master the budget. According to the MHIF reports, in 2015, again, there were about 30% of vaccination campaigns and medical examinations. And this is only what is revealed. ”

The expert is sure that this situation can be changed if you return to the Soviet health care system, one of the organizers of which was Nikolai Semashko.

“You can pay doctors a salary in one right way - for his work. Plus stimulate for patient satisfaction and the dynamics of mortality reduction. Now this issue is very relevant in connection with the pandemic, ”says Saversky.

Earlier, the speaker of the Council of the Federation of the Russian Federation, Valentina Matvienko, repeatedly noted the inefficiency of the current medical insurance system. In 2018, at a meeting of the Scientific and Expert Council under the chairman of the Federation Council, she called insurance organizations that receive money from the Compulsory Medical Insurance Fund (MHIF) “gaskets for pumping citizens' money”, which are not fully controlled, and therefore suggested make the insurance system voluntary.

In April of this year, Matvienko reiterated the need for reform of the compulsory medical insurance system on the Russia 24 television channel, stating that against the background of the situation with coronavirus, she showed herself to be “very formal”.