I agree with all of the above, but I think the key problem with the so-called. "Medical organizations of primary health care": Polyclinics, Dispensaries, FAP outpatient clinics. Unfortunately, for the most part, these institutions have degraded to the level of factories for hospital prescribing and, in fact, serve as a powerful barrier between the patient and real medical care.
The second most important problem is seen by middle and junior medical personnel - there are few of them, they are as demotivated as possible (doctors justifiably complain about the salary, what then are nurses and orderlies?) and are often incompetent.
I work in the intensive care unit in Moscow. Not in the city, but in the planned center of the federal level. We have become accustomed to the fact that there are no necessary medicines, or very few of them. We are accustomed to postponing for a rainy day, working day after day, violating all regulations and norms. The checks, which are the main thing to fine. There were cases when checks interfered with treatment. And I generally keep quiet about poorly working equipment.
New inadequate standards are being introduced. And the treatment of patients comes down to collecting papers. And then to the description of their condition, while maintaining all the necessary time intervals. Otherwise, bobo.
They pay when how. That is average, then a little. Almost everyone works at 2 jobs.
In urban areas, the situation is worse - in intensive care, 18 beds can accommodate 25-30 patients. And the quality of service therefore falls.
Most of all I love it when the management says that everything is fine with us, that everyone is happy and happy. That the salary was raised !!! (in fact, the salary is being raised. I have 17 thousand. That is, an increase of 20% is plus 3.4 thousand. It doesn't sound so nice anymore)
But the main problem is insurance payments. Here is a patient for 30 days. And they don't pay for it. But she's being treated. A certain amount of money is shown for each insured event. And be so kind as not to cross the line.
Everything described is only in a single resuscitation unit. I'm afraid to imagine what's going on in the clinic.
In addition to the "insufficient funding" and "insufficient personnel", which has already set the teeth on edge, I would single out many more problems:
The second example, when again money is allocated, a huge hospital or a center is being built, and then it is idle because there are no patients.
Disunity of medical institutions. Even in small towns, each medical facility as a separate state lives by its own way. How many small-town orders, paperwork exist. There are very few valid physician associations that are really active. We still have a "St. Petersburg school", "Moscow school", "but in our department it is." This leads to the following problem:
There are no uniform standards. In some hospitals they rely on the WHO, somewhere on the "Association of American Cardiologists", and in the hinterland on the textbook of the early XX century. Hence the unfounded research and treatment regimens.
Medical staff inertia. There are few initiative people who want to learn more, change, adapt to circumstances. Most doctors have learned once in some double year and they still treat for 50 years in a row. Enthusiasm is mainly found only among young people, but it also goes away. And I would separately highlight the superstition of all our medicine. That is, when we seem to have put evidence-based medicine on the edge of the corner, all the same, we bloom and smell any "maybe", incomprehensible treatment regimens, homeopathy, anti-vaccination wave, dietary supplements, "traditional medicine", and the list is endless. p>
The rehabilitation period should be highlighted separately. Yes, there are professionals who have no equal; do extremely rare and complex operations. But after all, everything can easily come to naught if the rehabilitation is illiterate. And here she is completely in a deplorable state. Partly because nursing is in the same dire state.
Old laws and orders. All this USSR in my head. Of course, there seem to be reforms, but besides them there is so much "junk" in the legal field that fetters every step.
Mutual guarantee. A doctor in Russia is not legally protected in any way. He a priori "owes" everyone. Although there are individuals who are certainly guilty of criminal negligence. But it so happened that they cover their own. And everyone.
Underdevelopment of outpatient care and prevention. Here you can wholef write a canvas about how important prevention is; that 80% of patients can be treated on an outpatient basis; how all this is beneficial in the long run. Nevertheless, the current "availability" of the polyclinic speaks for itself.
I just sketched it offhand. If you sit and think, you can write as much more.
Of course, one size fits all. We have wonderful doctors, centers, departments. But they are like flashes in a dark field.
The biggest problem is the problem of the transition from Soviet medicine to Western medicine.
People already think differently, but the system works in the old way.
For example, there is no clear understanding " his "patient, when the doctor is responsible for the one who heals. Instead, there is "collective responsibility", which reduces the level of interest of the doctor (they will cover their own anyway).
In addition, there are many different Soviet prejudices both in the organization of health care and in the behavior of the doctor.
This will change sooner or later, because doctors live in the same society, but the transition for the medical community is quite painful.
The problem of our healthcare is the system of organizing this healthcare. Endless queues for you to be assigned to a different queue.
The next reform is the reorganization and closure of hospitals, I will only say about Moscow, because I do not know what is in other cities. After visiting one of these closed hospitals, which later became abandoned, I wrote a post in LiveJournal about healthcare reform livejournal.com
I will add that there are a lot of closed hospitals today, some of them are still standing empty.
This is not to mention the insane bureaucracy, low salaries and motivation of talented doctors, low-quality and expensive medicines.
There is an awful lot in Russian public health care.
I'll just tell you a story.
Our employee got sick. It is not so important what, I will only say that the diagnosis is very difficult and potentially fatal. But not very obvious.
At first she was persuaded for a long time that it was okay and would pass by itself. Then, after doing several tests, they prescribed heating and electropharesis treatment, which was absolutely impossible to do. As a result, her condition deteriorated sharply.
This whole epic in Russia took - attention - two and a half months, of which most of the time she just waited for her turn. That is, make an appointment with a doctor, he will take in two weeks, oh you could not come then wait another two weeks, and yes, you can take free tests one day a week for two hours in the morning, and wait for the results for another five days, and so more.
So we strained and made her go to a paid clinic. Not to Israel or Germany - to India, it’s cheaper there.
In two days there they did all the tests and finally made the correct diagnosis. Another day - surgery.
There is still a week or two of therapy ahead - and that's it, home.
This is roughly what is awful: insanely overloaded medical institutions, low salaries and often low qualifications of doctors, the actual destruction of the middle medical level. The relatively high level of surgery is negated by the extremely low quality of diagnostics, rehabilitation and service.
Advanced medical technologies are available only in large cities, and mass medicine is gradually collapsing, which is called optimization in the language of officials.