the Relevant ministries and agencies had to urgently address the issues of increasing production and procurement of various drugs and medical devices – means of individual protection, special equipment, instrumentation, and test systems.
But for these urgent tasks have not been forgotten and complicated system problems of organization of medical care – planned hospitalization, labeling of drugs and monitoring over the movement of medicines, ensure medicines of preferential categories of the most vulnerable and in pandemic conditions.
the State Duma has adopted the bill “On amendments to certain legislative acts of the Russian Federation on issues of providing citizens with medicines, medical products and specialized nutritional”. The document provides for the creation of a Federal registry of citizens eligible for benefits. Under the bill, to provide a separate preferential categories of citizens will be in the amount of drugs included in the List of vital and essential drugs (EDL), and a list of NLS, which provided Federal benefit recipients will be abolished. To provide necessary medicines to the regional beneficiaries in the framework of the territorial programmes of state guarantees will also be on the List of essential drugs. The list will be able to review at least once a year.
About what the solution is prepared, said in his address to the Federal Assembly the President of the country in January this year: “this year should earn a single serial register of the recipients of the drugs that are provided to the person for free or a big discount at the Federal or regional benefit, so the confusion here was no more”.
About the necessity of this decision, the physicians, patient organizations, experts spoke more than one year. To overestimate its importance is simply impossible – the law finally make a transparent, clear and secure system of provision of medicines of beneficiaries – both Federal and regional.
– as a result, everyone who will be included in the register, will receive a guarantee that he will be provided with the necessary medicines, – explained the “RG” Alexander Petrov, a member of the state Duma Committee on health, who introduced a bill to the deputies. – Today, the beneficiaries that receive medication, you don’t. The funds allocated for these purposes from the Federal budget, are determined by, incomprehensible even to us, the deputies of the state Duma. Is allocated some amount, and we say – enough. But to verify this, nobody can. And when it turns out that this is not enough, we begin to make changes to the budget. And if we know the number of beneficiaries and amount of treatment each of them, we will be able of these tools to calculate with mathematical precision – that never happened before. And procurement of drugs and medical products will be built differently- they can be done for a year, and not “pieces” as they are now, wondering whether the money you will give, or not give… And since it will be the biggest purchase that we will be able to reduce prices, and therefore Federal spending. Moreover, we have now allowed a three-year contract, the state with these producers can negotiate directly, and when they will know what to purchase their drugs will be three consecutive years, they will reduce prices. Centralization of procurement will lead to streamlining, patients will stop running from one region to another in search of a preferential provision of better, they will get all the necessary medicines where they live. The number of complaints should decline.
– the register – step correct because we are talking about billions of rubles, which the Federal government and the regions spend on subsidized medicines – I agree and co-chair of the all-Russian Union of patients Yuri Zhulev. – To increase the efficiency of the system will clear the account. All beneficiaries must be counted, must be clear the need of each – this will lead to cost savings and equal conditions for all privileged groups. Now system entities vary greatly, especially for regional benefit. Not less important decision – the provision exempts for Preckwinkle. Numerous monitoring showed that regional lists are quite different, depending on the economic situation in the regions, which is wrong.
– this idea has always strongly supported – said in an interview with “RG”the Chairman of the coordinating Council of the Interregional public organization “Movement against cancer” Nikolay Dronov.- We need to count and understand how many people need certain medications. People find it difficult to explain why the Federal credit someone receives the necessary drug, but regional – no, although the disease is the same. For a basis we can take the registers of the Pension Fund or recipients of social assistance. Of course, much will depend on how the will is written legal documents. But the fact that the process has moved forward, we should welcome it.
Experts draw attention to the fact that the uniform Federal register of beneficiaries is not only a system of forecasting and accounting of public funds spent, but also means that the mappings are correct and quality treatment.
– the Register is not just a list of people is a form where you can see the progress of patient’s treatment, survival, quality of life, whether he passed the examination or not, when he received the cure, has been identified side effects, etc. – the subject��nods Alexander Petrov. – In addition, now each pack of medicine will have unique markings, and the traffic monitoring system of drugs will show that this packing is used. Furthermore, we can be sure that the expensive medication received, the patient and not the fact that it was blamed on the patient, and then “grey” has sold such facts also emerged, but largely by accident. In digital health, when all will be tracked in electronic form and the patient registry will lead to diseases, will be seen at a glance.
However, experts point out new problems that may arise when creating such a system.
– the Main problem of preferential medicinal provision was that the Federal and regional incentives were introduced at different times and under different statuses, recalled, “RG” Director of the Institute of health Economics, national research UNIVERSITY “Higher school of Economics” Larisa Popovich. – If the programs provide Federal beneficiaries (of ELS) and high-cost nosologies” (WNV) registers leads the Pension Fund, and he managed to establish a system of accounting, then the regional benefit of them formed the regions themselves – and each was as wanted. But most importantly, as a result of the separation of authorities responsible for registers, they are not compatible among themselves. In addition, these types of different benefits and amounts of the obligations: Federal benefits restricted to a list of OLS, which does not always coincide with the list of essential drugs, and regional for a number of diseases in General is not limited.
the overflow of patients who have monetized their Federal benefit (in other words, he took her money), in the regional segment leads to the fact that a huge amount of money simply goes from the Federal budget, and regions bear the additional financial burden, because these people require medicines, within the framework of regional programmes and thus receive benefits on two grounds. To prohibit use of this opportunity is impossible, as it will worsen their situation, which is prohibited by the Constitution. Moreover, the reason for this situation is legally permitted, the option of withdrawal from the Federal benefits system, which completely broke the entire insurance design. As a result, those who are not satisfied with the limitations of the programme of ONLS, she leaves with the money, but the system remains the so-called “bad risks”, that is, those patients who require the most significant expenditures.
you cannot just increase the ratio of funds to beneficiary, because it turns out that the more you give money to the program of ONLS, the more of it leaked from monetizirovat benefits. According to various estimates, the volume of the intersection of patients of privileged categories that have overlapping rights to LEGOyou in the two systems (Federal and regional), can reach 25 percent. And it’s not an exact estimate because there is no single personal accounting for all benefits. In addition, the registers of beneficiaries maintained by different operators. If you can get everyone in a single register, it can streamline the whole system. I’m not sure that it will be easy to do, but it’s at least a good step in the right direction.
– This question has long been debated, and there have been many proposals on how to account for benefits, which registers needs to be – says Alexander Petrov. – We tried to do it, not having the law, but was engaged in various associations, clinical centers. And we need to it was the state the Federal register, which allows you to manage the process. Perhaps this will partly relieve the problem of monetization of benefits, but the monetization we will not cancel. We see this problem, but it needs to be addressed very carefully. And for complete solution you need to move to a system of prescription drug insurance to all insured citizens. And then we have the problem of double financing will certainly eliminate.
all-Russian Union of patients worry and other issues related to the creation of the Federal register.
– the wording of government resolution No. 890, which introduced regional incentives, extremely outdated, – says Yury Zhulev. – And as in names of diseases (there are specified the same, which no longer exist in the current international classification of diseases – ICD-10) and groups of diseases. Union patients are not just faced with the fact that patients eligible for subsidised medicines, do not receive them because of an outdated wording of the resolution. And Minzrav Russia is forced to comment in their letters, both regions should interpret such a phrase of the decision from the current position and to include in their lists the drugs that are the gold standard in the treatment of certain diseases, but the 890-m resolution were not mentioned. However, the letters MOH does not have the force of law, it is only recommendations. In this regard, a cause for concern, as the reduction to a common denominator will affect regional benefit. We are interested in the fact that these interpretations were uniform and corresponds to modern approaches to treatment. And we see that the set of documents to the bill, our concerns are reflected – it is mentioned that should be taken into account the international classification of diseases. I want to emphasize that the decision of the government is the main guarantee for regional exempts, any discussion around it is cause social unrest, but we are for clarification of his positions, and bringing them to modern realities.
In General, experts are unanimous: the decision on creation of the uniform Federal register of citizens entitled to the provision of drugs��and medical goods and therapeutic food – a big and important step in improving the system of drug provision of the population. If approved by the senators and signed by the President of the country, the new law will enter into force on 1 January 2021.
