Ñïèñîê ôîðóìîâ ×àñòíàÿ ìåäèöèíà è ðåôîðìà çäðàâîîõðàíåíèÿ Óêðàèíû ×àñòíàÿ ìåäèöèíà è ðåôîðìà çäðàâîîõðàíåíèÿ Óêðàèíû
Ôîðóì ïîñâÿù¸í âîïðîñàì ðàçâèòèÿ â Óêðàèíå ÷àñòíîé ìåäèöèíñêîé ïðàêòèêè
 
 Îòñëåæèâàåìûå òåìûÎòñëåæèâàåìûå òåìû   FAQFAQ   ÏîèñêÏîèñê   ÏîëüçîâàòåëèÏîëüçîâàòåëè   ÃðóïïûÃðóïïû   ÐåãèñòðàöèÿÐåãèñòðàöèÿ 
 RSSRSS   ÏðîôèëüÏðîôèëü   Âîéòè è ïðîâåðèòü ëè÷íûå ñîîáùåíèÿÂîéòè è ïðîâåðèòü ëè÷íûå ñîîáùåíèÿ   ÂõîäÂõîä 

Ðåçóëüòàòîâ ïîèñêà: 1362
Ñïèñîê ôîðóìîâ ×àñòíàÿ ìåäèöèíà è ðåôîðìà çäðàâîîõðàíåíèÿ Óêðàèíû
Àâòîð Ñîîáùåíèå
  Òåìà: Ìèôû îá ÑÑÑÐ-3: Ñîâåòñêàÿ ìåäèöèíà
AndreyN

Îòâåòîâ: 0
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ÑîîáùåíèåÔîðóì: Íîâîñòè èç-çà ðóáåæà   Äîáàâëåíî: Âñ Ñåí 06, 2015 8:10 pm   Òåìà: Ìèôû îá ÑÑÑÐ-3: Ñîâåòñêàÿ ìåäèöèíà
Ìèôû îá ÑÑÑÐ-3: Ñîâåòñêàÿ ìåäèöèíà
http://www.kasparov.ru/material.php?id=55EC59AD9FDB2
  Òåìà: Äåâ³ç ôîðóìó
AndreyN

Îòâåòîâ: 5
Ïðîñìîòðîâ: 13888

ÑîîáùåíèåÔîðóì: Î ðàáîòå ôîðóìà   Äîáàâëåíî: ×ò Àâã 20, 2015 11:56 am   Òåìà: Äåâ³ç ôîðóìó
Ëàòûíü íà êàæäûé äåíü:

Te accersi favitores mei feras esse — «Òû âòèðàåøü ìíå êàêóþ-òî äè÷ü»

In me est malo animo. Salve, fervidum vinum — «Íàñòðîåíèå ïîä íîëü. Çäðàâñòâóé, êðåïêèé àëêîãîëü»

Quid ibi ucrainis est? — «×å òàì ó õîõëîâ?»

Vita, heus, vel mentulam teneas — «Ýõ, æèçíü, õîòü çà õóé äåðæèñü»

Zenais, futuebam matrem tuam! — «Çèíà, íó ¸á òâîþ ìàòü!»

Sero discursare est — «Ïîçäíÿê ìåòàòüñÿ»

Si inverecundus nimis es, nihil est infectum — «Íåò íè÷åãî íåâîçìîæíîãî, åñëè òû îõóåë äî íóæíîé ñòåïåíè»

Nullus est enim — «Èáî íåõóé»

Ad hanc merdam nimis vetus sum — «ß ñëèøêîì ñòàð äëÿ ýòîãî äåðüìà»

Eia cape, mentula tomatae... — «Âîò òå íàòå, õóé â òîìàòå...»

Chan necessariae non sunt — «Òÿí íå íóæíû»

Fabularum incredendarum hora adfuit — «Íàñòàëî âðåìÿ îõóèòåëüíûõ èñòîðèé»

Solis ego autem non lucet. — «ß ñîëíûøêî, íî òåáå íå ñâåòèò.»

Stercus obrepsit — «Ïèçäåö ïîäêðàëñÿ íåçàìåòíî»

Arienas, homines vendo. Joculor, non arienas — «Ïðîäàþ áàíàíû, ëþäåé. Øó÷ó, íå áàíàíû»

Magnos spiritus sibi sumere abi in plateam tuam — «Èäè âûåáûâàéñÿ â ñâîé äâîð»

In puelle non aenigmae essendus est, sed mihi — «Â äåâóøêå äîëæåí áûòü ÿ, à íå çàãàäêà»

Culum sustulisti, locum amisisti — «Æîïó ïîäíÿë, ìåñòî ïîòåðÿë»

Sic omnia equine futuant! — «Äà åáèñü îíî âñå êîí¸ì!»

Et piscem edere atque supra mentulam subsidere — «È ðûáêó ñúåñòü, è íà õóé ñåñòü»

En animo tardatur — «×¸ò ïðèóíûë»

Omnes cinaedi sunt, sed d'Artagnan sum! — «Âñå ïèäîðàñû, à ÿ Ä'Àðüòàíüÿí!»

Scrofa in vino non curator lacunae — «Ïüÿíàÿ ãàéêà ðåçüáå íå õîçÿéêà»

In nate plane sede — «Ñèäè íà æîïå ðîâíî»

Stilla magonici — «Øëåïîê ìàéîíåçíûé»

Vaporitrahula potuit ergo potuero — «Ïàðîâîçèê ñìîã, è ÿ ñìîãó»

In meam auris noli mingere, canis — «Íå ññû ìíå â óøè, ïåñ»

Ceu vitriculum sobrius — «Òðåçâ, êàê ñòåêëûøêî»

Res capis — «Ñå÷åøü ôèøêó»
  Òåìà: Ìåäèöèíñêàÿ ðåôîðìà. Ïî÷åìó íå ïîëó÷èëîñü è ÷òî äåëàòü?
AndreyN

Îòâåòîâ: 0
Ïðîñìîòðîâ: 3453

ÑîîáùåíèåÔîðóì: Ðåôîðìà â Óêðàèíå   Äîáàâëåíî: ×ò Èþë 30, 2015 9:09 am   Òåìà: Ìåäèöèíñêàÿ ðåôîðìà. Ïî÷åìó íå ïîëó÷èëîñü è ÷òî äåëàòü?
http://medreforma.org.ua/medicinskaya-reforma-pochemu-ne-poluchilos-i-chto-delat-dalshe/

29 èþëÿ 2015

Ê ñîæàëåíèþ, ìû ñòàëè ñâèäåòåëÿìè î÷åðåäíîãî ïðîâàëà î÷åðåäíîé ïîïûòêè ðåôîðìèðîâàòü íàøó ìíîãîñòðàäàëüíóþ ìåäèöèíó. Ñ æàðêèì îáñóæäåíèåì è îñòðîé ïîëåìèêîé â ìàññìåäèà (â ÷àñòíîñòè, â ñòóäèè ó Ñ.Øóñòåðà).

Âðà÷ Ñåìåí Ãëóçìàí – â Èíòåðíåò èçäàíèè « Í» çà 06.07.15 âîîáùå îõàðàêòåðèçîâàë ýòî äîñëîâíî òàê: «…íà øîó øëà áîðüáà íå çà ðåôîðìó. Øëà áîðüáà ïðîòèâ ðåôîðìû, çà äåíüãè...» Äîâîëüíî æåñòêî, íî ÷àñòü èñòèíû â òàêîé îöåíêå èìååòñÿ! È âñå áû íè÷åãî, åñëè áû íà ýòîì øîó áûëè ïîäíÿòû ðåàëüíûå ïðîáëåìû. Àí íåò. Âñ¸ îïÿòü êðóòèòñÿ âîêðóã ïðåñëîâóòîé «ôàðì ìàôèè» è å¸ êðûøåâàòåëÿõ ñ óêàçàíèåì ôàìèëèé. È âñå ïðèñóòñòâóþùèå çàáûëè ÷òî ñðåäñòâà, óõîäÿùèå ïîä îïåêó ýòîé «ôàðììàôèè» ñîñòàâëÿþò âñåãî 10% îò ñðåäñòâ, èäóùèõ â ìåäèöèíñêóþ îòðàñëü. Òîò ëè ýòî ïóòü îáñóæäåíèé?

Åñëè ó÷èòûâàòü î÷åðåäíóþ îòñòàâêó Ìèíèñòðà (19 ÿ çà íîâóþ èñòîðèþ Óêðàèíû), òî ìèíèñòåðñêàÿ ÷åõàðäà è âïðÿìü ïîêàçûâàåò: ïðè âûáîðå î÷åðåäíîãî Ìèíèñòðà ÷òî-òî èäåò íå òàê! Âûñòóïèâøèé íà òîê-øîó ãîñïîäèí (êàæåòñÿ Øåðåìáåé èç Ëèãè çàùèòû ïàöèåíòîâ) â ÿðîñòè ïðèçûâàë îòäàòü ïîä ñóä âñåõ ïðåäûäóùèõ Ìèíèñòðîâ, êàê ÿâíûõ êîððóïöèîíåðîâ. Ìîè 5 êîïååê ïðîòèâ ýòèõ ñëîâ. ß, íàïðèìåð, 20 ëåò çíàþ îäíîãî èç áûâøèõ ìåäèöèíñêèõ Ìèíèñòðîâ (Íèêîëàÿ Ïîëèùóêà) è íå çàìå÷àë çà íèì êîððóïöèîííûõ íàêëîííîñòåé. Òàê ÷òî íå âñå òàê ïðîñòî.

À ïîñëåîòñòàâî÷íûå èíòåðâüþ À.Êâèòàøâèëè âîîáùå çàâîäÿò âñå ïîÿñíåíèÿ â òóïèê. Ïîëó÷àåòñÿ åìó ÍÈÊÒÎ íå ìåøàë (íå ñ÷èòàÿ ïàðû-òðîéêè íàðîäíûõ äåïóòàòîâ), íî è íè÷åãî íå ïîëó÷èëîñü.
Âåðîÿòíî, âûáðàííûé ïóòü ê ìåäèöèíñêèì ðåôîðìàì ñòðàíû èçíà÷àëüíî áûë îøèáî÷íûì. Îí áûë âûáðàí îïÿòü ñ ïðåîáëàäàíèåì àäìèíèñòðàòèâíîãî ðåøåíèÿ ïðîáëåìû! ß ëè÷íî áûë â ñîñòàâå òîé ãðóïïû èííîâàöèîíùèêîâ, êòî åù¸ â 1993 ãîäó ïûòàëñÿ ïîñòðîèòü ýêîíîìè÷åñêóþ ìîäåëü çäðàâîîõðàíåíèÿ äëÿ ñòðàíû, ñ «ïèëîòíûì» ïðîåêòîì íà ìàññèâå âñåãî ã. Êèåâà. Òîãäà íå ïîëó÷èëîñü, ê ñîæàëåíèþ, â ñèëó ðàçíûõ ïðè÷èí, íî ïðîòèâîäåéñòâèå ðàäèêàëüíûì ïðåîáðàçîâàíèÿì â ñòðàíå áûëî ìåíüøèì. Òåïåðü, ïî ïðîøåñòâèè äâóõ äåñÿòèëåòèé, âñå ñòàëî çíà÷èòåëüíî ñëîæíåå. È ïóòü âûõîäà íà íàñòîÿùèå ìåäèöèíñêèå ïðåîáðàçîâàíèÿ òåïåðü òîëüêî íå ñòàíäàðòíûé.
À òåïåðü ãëàâíûé âîïðîñ è èííîâàöèîííûé îòâåò îäíîâðåìåííî!
À ñìîæåò ëè íûíåøíèé Ìèíçäðàâ è åãî ËÞÁÎÉ ðóêîâîäèòåëü (äàæå íå ïî ïàðòèéíîé êâîòå) îñóùåñòâèòü ìåäèöèíñêèå ðåôîðìû íóæíîé ãëóáèíû è â êðàò÷àéøèå ñðîêè, íà ôîíå øèðîêîé ìåäèöèíñêîé êîððóïöèè, èìåþùåé è Êèåâñêóþ «ýëèòíóþ ñîñòàâëÿþùóþ» è å¸ «íèçîâóþ ÷àñòü» â îáû÷íûõ ËÏÓ ïî âñåé ñòðàíå? Íå âàæíî, áóäåò ëè ìèíèñòð íàçíà÷åí Ïðåçèäåíòîì, ÂÐ èëè ïîáåäèò íà îòêðûòîì êîíêóðñå. Äåïóòàò ÂÐ – Î.Áîãîìîëåö ñ÷èòàåò, ÷òî â Óêðàèíå äîëæåí áûòü ñîçäàí Öåíòð ìåäèöèíñêèõ ðåôîðì. Ãîðÿ÷î ïîääåðæèâàþ ýòî ìíåíèå!

Äèàãíîç îäíîçíà÷åí: íå ñìîæåò ëþáîé íîâûé Ìèíèñòð íè÷åãî îñóùåñòâèòü â íûíå ôóíêöèîíèðóþùåé ñòðóêòóðå. Íà ñåãîäíÿ êðàéíå ñëîæíî âåñòè òåêóùóþ ðàáîòó â Ìèíèñòåðñòâå çäðàâîîõðàíåíèÿ è ýòèìè æå ñïåöèàëèñòàìè ãîòîâèòü òåõíîëîãè÷åñêèå ìàòåðèàëû äëÿ ïðåäñòîÿùèõ ãëîáàëüíûõ ïðåîáðàçîâàíèé.

Íåîáõîäèìî íûíåøíèé øòàò Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿ ñòðàíû ðàçäåëèòü íà äâà âåäîìñòâà. Îäíî äîëæíî îñóùåñòâëÿòü òåêóùóþ îïåðàòèâíóþ ðàáîòó è íà ìåñòî åãî ðóêîâîäèòåëÿ ñëåäóåò ïîäîáðàòü õîðîøåãî «áåñïàðòèéíîãî» ðóêîâîäèòåëÿ, ãëóáîêî ïîíèìàþùåãî ïðåäñòîÿùèå íîâàöèè è ñïîñîáíîãî ê ïîýòàïíîìó èõ âíåäðåíèþ, ïî ìåðå ãîòîâíîñòè, â ñâîé Ìèíçäðàâ. À ãîòîâèòü ðåôîðìàòîðñêèå ïðåîáðàçîâàíèÿ äîëæíî «Âðåìåííîå ìèíèñòåðñòâî ìåäèöèíñêèõ ðåôîðì». 3-4 ãîäà ðàáîòû òàêîãî ìèíèñòåðñòâà – ñåãîäíÿ êðàéíå íåîáõîäèìî è àêòóàëüíî. Îòëè÷íûé îïûò åñòü ó Ñëîâåíèè, êîòîðàÿ óñïåøíî ïîøëà ïî òàêîìó ïóòè.

Åù¸ îäíî öèòèðîâàíèå Ñ.Ãëóçìàíà «….èìååòñÿ ðèòîðè÷åñêèé âîïðîñ, êîòîðûé â Óêðàèíå íå ïðèíÿòî ïðîèçíîñèòü âñëóõ: ìîæåò ëè Ìèíèñòåðñòâî Çäðàâîîõðàíåíèÿ ñàìî ñåáÿ ðåôîðìèðîâàòü? Èíûìè ñëîâàìè ñàìî ñåáÿ çà âîëîñû âûòàùèòü èç áîëîòà…» ×òî ÿ äîïîëíèòåëüíî ê ýòèì ñëîâàì ïðåäëàãàþ!. Ñóäÿ ïî ïîñëåäíåìó òîê – øîó (ó Ñàâèêà) ñ ó÷àñòèåì ïðåäïîñëåäíåãî ýêñ-Ìèíèñòðà (Î.Ìóñèÿ) ìíîãîå â ìåäèöèíñêèõ Óêðàèíñêèõ íîâàöèÿõ àâòîìàòè÷åñêè òîðìîçèòñÿ ïî áþðîêðàòè÷åñêèì ïðè÷èíàì, ââèäó îòñóòñòâèÿ äîëæíîãî óðîâíÿ ïîëèòè÷åñêîãî ëîááèðîâàíèÿ ìåäèöèíñêèõ ðåôîðì.

Âñïîìíèòå Õ.Êëèíòîí (å¸ ïëàí ìåäðåôîðì) è óðîâåíü ïîääåðæêè ñî ñòîðîíû å¸ ìóæà Á.Êëèíòîíà, îöåíèòå óðîâåíü íûíåøíåãî âíèìàíèÿ óäåëÿåìîå ìåäèöèíå ËÈ×ÍÎ Á.Îáàìîé, íå çàáûâàéòå ëè÷íóþ ðîëü Ì.Òýò÷åð â ìåäèöèíñêèõ ðåôîðìàõ Âåëèêîáðèòàíèè è ìíîãîå ñòàíåò ïîíÿòíûì. Ìåäèöèíñêèå ðåôîðìû â ñòðàíå íå ìîãóò ñîñòîÿòüñÿ áåç ëè÷íîé (ÿ áû ñêàçàë – åæåäíåâíîé) ïîääåðæêè ïåðâîãî ëèöà â ñòðàíå èëè åãî ÏÅÐÂÎÉ «ëåäè».

 Óêðàèíå – íà ñåãîäíÿ åñòü ïðåêðàñíàÿ ñèòóàöèîííàÿ âîçìîæíîñòü. Ñóïðóãà Ïðåçèäåíòà – Ìàðèíà Ïîðîøåíêî ïî ñâîåé îñíîâíîé ñïåöèàëüíîñòè, âðà÷ — ñ íûíåøíåé «ñòàòóñíîé» ìåäèöèíñêîé íåçàíÿòîñòüþ. Âîçìîæíî, åé ñëåäóåò ó÷ðåäèòü è âîçãëàâèòü «Ôîíä ìåäèöèíñêèõ ðåôîðì», àíàëîãè÷íûé «ôîíäó Ìåëèíäû è Áèëà Ãåéòñà»? ×åì íå ïðèìåð äëÿ ïîäðàæàíèÿ?

Îëèãàðõè â î÷åðåäü áóäóò ñòàíîâèòüñÿ äëÿ âíåñåíèÿ ðåàëüíûõ áëàãîòâîðèòåëüíûõ âçíîñîâ. Èñïîëíèòåëüíûì Äèðåêòîðîì òàêîãî ôîíäà ñòîèò íàçíà÷èòü êðèçèñíîãî òîï-ìåíåäæåðà ÷åðåç ãëàñíûé êîíêóðñ ñ âîçìîæíûì ó÷àñòèåì ñïåöèàëèñòîâ èç-çà ðóáåæà. È òàêîé ôîíä è äîëæåí ñòàòü îñíîâíûì êóðàòîðîì ðàáîòû «Âðåìåííîãî ìèíèñòåðñòâà ìåäèöèíñêèõ ðåôîðì» ñ îôèöèàëüíûì ëîááèñòîì â ëèöå æåíû Ïðåçèäåíòà.

Äîêóìåíòîîáîðîò íåîáõîäèìûõ íîâûõ çàêîíîâ, ïîñòàíîâëåíèé Ïðàâèòåëüñòâà è óêàçîâ Ïðåçèäåíòà çàâåðòèòñÿ â ðàçû áûñòðåé, íà ìåäëèòåëüíîñòü êîòîðîãî òàê ñåòîâàë ýêñ-ìèíèñòð À.Êâèòàøâèëè.
Îñíîâûâàÿñü íà íàøåì ïðåäûäóùåì îïûòå, îïèøåì ïîýòàïíóþ (â íàøåì âèäåíèè) æèçíåííî âàæíóþ ïîñëåäîâàòåëüíîñòü äåéñòâèé «Ìèíèñòåðñòâà ìåäèöèíñêèõ ðåôîðì…».

1. Íîâîìó Ìèíèñòðó è åãî «Êîìàíäå», êàê íè êðóòè, íåîáõîäèìî ïðåäñòàâèòü ñâî¸ âèäåíèå «Îáùåé Ñòðàòåãèè» ìåäèöèíñêèõ ðåôîðì è å¸ IT-ñîïðîâîæäåíèå. Áðàòü âñå ïîäðÿä îò ïðåæíåé ãðóïïû (ïðåæíåãî Ìèíèñòðà) íåëüçÿ, òàì ìíîãî ñòðàòåãè÷åñêèõ îøèáîê.

2. Íà íûíåøíåì âðåìåííîì îòðåçêå äîáèòüñÿ êîíñòèòóöèîííûõ èçìåíåíèé â ñòàòüþ 49 Êîíñòèòóöèè íå ïîëó÷èòñÿ, äà ýòî è íå ñâîåâðåìåííî. Íóæíî ââîäèòü â ïðàêòè÷åñêóþ ðàáîòó çäðàâîîõðàíåíèÿ òàêîå ñìûñëîâîå ïîíÿòèå êàê Ãîñóäàðñòâåííàÿ Ïðîãðàìì Ãîñóäàðñòâåííûõ Ãàðàíòèé (Ã.Ï.Ã.Ã.).
Íàñåëåíèå âñåé ñòðàíû çà ãîä – ïîëòîðà äîëæíî ÷åòêî ïîíÿòü, ÷òî âõîäèò â íåå, à ÷òî íå âõîäèò. Âñå ÷òî âõîäèò â íåå – âñåãäà äëÿ íàñåëåíèÿ áóäåò çà ñ÷åò îáùåñòâà. Âñå ÷òî âíå Ïðîãðàììû ãîñ. ãàðàíòèé — èëè çà ëè÷íûé ñ÷åò îáðàòèâøåãîñÿ, èëè çà ñ÷åò ëè÷íîãî Äîáðîâîëüíîãî ìåäèöèíñêîãî ñòðàõîâàíèÿ. Ìîæåò äëÿ âåñüìà ñîñòîÿòåëüíûõ ãðàæäàí ñòðàíû, ïî óðîâíþ èõ äîõîäîâ, ìîæíî è îãðàíè÷èòü «êîðçèíêó ãîñãàðàíòèé». È òîëüêî òîãäà ñòîèò ÷åðåç ÑÌÈ ãîòîâèòü íàñåëåíèå ñòðàíû (è äåïóòàòîâ ÂÐ) ê èçìåíåíèÿì â Êîíñòèòóöèè.

3. Íàèáîëåå çëîáîäíåâíàÿ ïðîáëåìà, òðåáóþùàÿ ñâîåãî ñïðàâåäëèâîãî è ñðî÷íîãî ðåøåíèÿ! Ïðåæäå âñåãî, íåîáõîäèìî ïðèíÿòü ïîëèòè÷åñêîå è çàêîíîäàòåëüíîå ðåøåíèå î ïîðÿäêå ôîðìèðîâàíèÿ ëè÷íîé çàðïëàòû â îòðàñëè çäðàâîîõðàíåíèÿ. Íóæåí çàêîí ïîä ðàáî÷èì íàçâàíèåì «...Òàðèôû íà îêàçàíèå ìåäèöèíñêîé ïîìîùè â Óêðàèíå…». Îí äîëæåí îðãàíè÷íî âõîäèòü â ïàêåò ìåäèêî-ýêîíîìè÷åñêèõ çàêîíîâ. Íåëüçÿ ïëàòèòü ìåäèêàì, â áîëüøèíñòâå ñëó÷àåâ, çà âðåìÿ, ïðîâåäåííîå â ëå÷åáíîì ó÷ðåæäåíèè. Ïëàòèòü íàäî ïåðñîíàëüíî çà âûïîëíåííóþ è ïðîêîíòðîëèðîâàííóþ ðàáîòó.

Àíàëèçèðóÿ âûõîäÿùóþ èç Ìèíçäðàâà èíôîðìàöèþ ìîæíî ñäåëàòü âûâîä: ïåðâîíà÷àëüíî èçìåíèòü îïëàòó òðóäà ïðåäëàãàåòñÿ, ñóäÿ ïî ïîñëåäíåé ïðåññå, «íà ïèëîòå» ò.å. â ãîðîäå Êèåâå (Ì.Ðàäóöêèé). Ïëàíèðóþò àäìèíèñòðàòèâíûì ïóòåì ïëàòèòü Êèåâñêèì âðà÷àì îò 8 äî 12 òûñÿ÷ ãðèâåí. Íî ýòî âåäü ÷èñòî êîððóïöèîííûé ïóòü. Âåäü äëÿ îäíîãî âðà÷à è 8 òûñÿ÷ ãðèâåí ñëèøêîì ìíîãî (åñëè îí ëåíèâûé è áåçãðàìîòíûé), à äëÿ äðóãîãî è 12 òûñÿ÷ ãðèâåí ÷ðåçâû÷àéíî ìàëî (óìíîãî, ìíîãî è âûñîêî — êâàëèôèöèðîâàííî ðàáîòàþùåãî).
 ìèíèñòåðñêèõ ìàòåðèàëàõ, äëÿ áóäóùèõ ïðåîáðàçîâàíèé â çäðàâîîõðàíåíèè ïðåäëàãàåòñÿ èñïîëüçîâàíèå «ãèáðèäíîé îïëàòû òðóäà» ìåäèêîâ.

Íî ÷òî òàêîå «ãèáðèäíàÿ îïëàòà òðóäà»? Ïî òåêñòó ïðåäëàãàåìîãî Ìèíçäðàâîì ê îáñóæäåíèþ êîíöåïòóàëüíîãî ìàòåðèàëà ïîä íàçâàíèåì «Ñòðàòåãèÿ», — «ãèáðèäíàÿ ñèñòåìà îïëàòû òðóäà» ìåäèêîâ ïåðâè÷íîãî çâåíà ñîâñåì íå ïîíÿòíà. Òàì ãäå âñå íå÷åòêî, ãäå âñå ïîñòðîåíî íà ïðåìèàëüíûõ ñèñòåìàõ, – âñå ýòî äîâîëüíî ñóáúåêòèâíî è âðÿä ëè îñóùåñòâèìî â íûíåøíèõ ðåàëèÿõ. Íåîáõîäèìà çíà÷èòåëüíî áîëåå ÷åòêàÿ ñèñòåìà îïëàòû òðóäà ìåäðàáîòíèêîâ, ÷åðåç ïåðñîíàëèçàöèþ ëè÷íî çàðàáîòàííûõ ñðåäñòâ â ñòðóêòóðå ìåäèöèíñêîãî òàðèôà êîíêðåòíûì ñîòðóäíèêîì, ÷òî ëåãêî äåëàåòñÿ ñîâðåìåííûìè IT- òåõíîëîãèÿìè. Çàðïëàòà ìåäèêîâ íå äîëæíà çàâèñåòü îò ãëàâíîãî âðà÷à èëè îò âàëîâûõ ïîêàçàòåëåé ËÏÓ. Íå ñòîèò ïîääåðæèâàòü è òèðàæèðîâàòü îäíî èç õóäøèõ ñîâåòñêèõ íàïðàâëåíèé.

Ïëàòèòü íàäî çà êà÷åñòâåííóþ ëè÷íî âûïîëíåííóþ, ïðîêîíòðîëèðîâàííóþ è ïîëíîñòüþ îïëà÷åííóþ ðàáîòó. Òî÷êà. Íèêàêèõ îãðàíè÷åíèé. Ïðåäëîæåíèÿ ïî «îïëàòå â ãðàíèöàõ îïðåäåëåííîé àäìèíèñòðàòîðàìè âèëêè» (ã.Êèåâ), âîçíèêëè îò òîãî ÷òî ó ðàçðàáîò÷èêîâ ïðåäëàãàåìîé ê îáñóæäåíèþ àäìèíèñòðàòèâíîé òåõíîëîãèè, îòñóòñòâóåò ðåàëüíûé èíñòðóìåíòàðèé äëÿ îñóùåñòâëåíèÿ ýêîíîìè÷åñêèõ ïðåîáðàçîâàíèé â ìåäèöèíñêîé îòðàñëè.
À ýòîò èíñòðóìåíòàðèé íàõîäèòñÿ â ñåêòîðå ìåäèöèíñêîé ýêîíîìèêè è íàçûâàåòñÿ – «...ýêîíîìè÷åñêè îáîñíîâàííûå ìåäèöèíñêèå ìíîãîêîìïîíåíòíûå òàðèôû íà âñå âèäû ìåäèöèíñêîé ïîìîùè, îêàçûâàåìûå â ñòðàíå...»! Íî ïîíÿòèå «ýêîíîìè÷åñêè ñîñòîÿòåëüíûå ìåäèöèíñêèå òàðèôû» íà 33 ñòðàíèöàõ ïðåäëàãàåìîé íà ñàéòå «Ñòðàòåãèè» îò À.Êâèòàøâèëè íå âñòðå÷àåòñÿ.

 1993 ãîäó íà ìàññèâå âñåõ ËÏÓ ã.Êèåâà ìû â òå÷åíèè ãîäà ñîáèðàëè è îáðàáàòûâàëè òåõíîëîãè÷åñêèé ìàòåðèàë äëÿ ôîðìèðîâàíèÿ èííîâàöèîííûõ ìíîãîêîìïîíåíòíûõ òàðèôîâ íà ìåäèöèíñêóþ ïîìîùü è ïîíèìàåì êàê ýòî âàæíî äëÿ íàñòîÿùèõ ìåäèöèíñêèõ ðåôîðì.
Òàêàÿ ðàáîòà ñ ïðèâëå÷åíèåì ñîòåí Êèåâñêèõ ìåäðàáîòíèêîâ âûñîêîãî êëàññà, òðåáîâàëà îãðîìíîãî àäìèíèñòðàòèâíîãî ñîïðîâîæäåíèÿ è ñóùåñòâåííûõ ôèíàíñîâûõ çàòðàò. Ìîãó òîëüêî ïðåäñòàâèòü, ñêîëüêî âðåìåíè è ñðåäñòâ ïîòðåáóåòñÿ â íûíåøíèõ óñëîâèÿõ äëÿ òåõíîëîãè÷åñêîãî ïîâòîðåíèÿ ðàáîòû ïî ñáîðó òàêîãî æå ìàññèâíîãî ìàòåðèàëà. Íî áåç òàêîé ïðåäâàðèòåëüíî ïîâòîðåííîé ðàáîòû, ïðåîáðàçîâàíèÿ â ñòðàíå ëó÷øå è íå íà÷èíàòü!

Ïðè ýòîì, åñëè âíèìàòåëüíî èçó÷èòü ðàáîòû Äåïàðòàìåíòà ìåäèöèíñêèõ ðåôîðì â Ìèíçäðàâå, òî òàì ãîäàìè èç îäíîãî íîðìàòèâíîãî äîêóìåíòà â äðóãîé êîïèðóåòñÿ îäíà è òà æå ìàíòðà: «…íåîáõîäèìî ðàçðàáîòàòü åäèíóþ ìåòîäèêó òàðèôîâ íà ìåäèöèíñêóþ ïîìîùü…». Íî (òàðèôíóþ ìåòîäèêó) ïî ñóòè, íåëüçÿ ñäåëàòü â ñòðàíå åäèíîé äëÿ âñåõ ñïåöèàëüíîñòåé è íàïðàâëåíèé. Ñðàâíèòå ÷èñòî èíòåëëåêòóàëüíóþ ðàáîòó âðà÷à íåâðîïàòîëîãà íà ïðèåìå è ðîáîòèçèðîâàííóþ õèðóðãè÷åñêóþ îïåðàöèîííóþ òåõíîëîãèþ, ãäå ðàáîòàåò íåñêîëüêî õèðóðãîâ – ñïåöèàëèñòîâ, ýëåêòðîíùèêîâ è èñïîëüçóåòñÿ ñâåðõäîðîãàÿ àïïàðàòóðà â ìèëëèîíû äîëëàðîâ.

Íàáîð ìàòåìàòè÷åñêèõ ôîðìóë äëÿ ðàñ÷åòà ìåäèöèíñêèõ òàðèôîâ â ýòèõ äâóõ ñëó÷àÿõ áóäåò ñîâåðøåííî ðàçíûé, òåõíîãåííûå è ìàòåìàòè÷åñêèå ïîäõîäû ñóùåñòâåííî ðàçëè÷àþòñÿ. Ïðîñòî äëÿ ôîðìèðîâàíèÿ ìåäèöèíñêèõ îáùåãîñóäàðñòâåííûõ òàðèôîâ íåîáõîäèìî èñïîëüçîâàòü çàêîíû ýêîíîìèêè è îáùåãîñóäàðñòâåííûå êîîðäèíèðóþùèå ïîäõîäû íà ñòàäèè ôîðìèðîâàíèÿ àâòîìàòèçèðîâàííûõ òàðèôíûõ òåõíîëîãèé.
Ïîýòîìó ôàêòè÷åñêèé ïðîâàë ïðåäûäóùåé ïîïûòêè ìåäèöèíñêîãî ðåôîðìèðîâàíèÿ â òàê íàçûâàåìûõ «4-õ ðåãèîíàõ ïèëîòàõ» îáúÿñíÿåòñÿ ïðåæäå âñåãî òåì, ÷òî âñ¸ â ýòèõ ðåãèîíàõ îñóùåñòâëÿëîñü ÷èñòî àäìèíèñòðàòèâíûì ïóòåì. Íèêàêîé ýêîíîìè÷åñêîé ìîòèâàöèè!
Ðÿäîâûå ìàññû ìåäèêîâ íå ïðèíÿëè ýòè âíåýêîíîìè÷åñêèå íîâîââåäåíèÿ, íå ñòàëè ñîþçíèêàìè ðåôîðì â ýòèõ ÷åòûðåõ ðåãèîíàõ ñòðàíû. Äà è áîðîòüñÿ ñ íèçîâîé ìåäèöèíñêîé êîððóïöèåé (êîíâåðòû, ïîäíîøåíèÿ è ò.ä.) áåñïåðñïåêòèâíî ïðè íûíåøíèõ íèùåíñêèõ çàðïëàòàõ ìåäèêîâ. Äàæå åñëè íàçâàòü ýòè êîíâåðòû ãîíîðàðîì.
Ïðè ýòîì â îòðàñëè ñïëîøíàÿ óðàâíèëîâêà ïî îïëàòå òðóäà. Íåîáõîäèìî ñîçäàâàòü ãîñóäàðñòâåííûå âîçìîæíîñòè äëÿ ìåäèêîâ äîñòîéíî çàðàáàòûâàòü â ñâîåé ñòðàíå, ïðè êà÷åñòâåííîé ðàáîòå è ïðè å¸ ïðèëè÷íîì îáú¸ìå. Ýòî áóäåò íàèáîëåå âåñîìûé âêëàä â áîðüáó ñ ìåäèöèíñêîé êîððóïöèåé íà íèçîâîì óðîâíå.

4. Äëÿ áîðüáû ñ «ôàðììàôèåé», äëÿ êîððåêòíîñòè ýêîíîìè÷åñêèõ äàííûõ â óêðàèíñêîé ìåäèöèíå, íåîáõîäèìî íà óðîâíå ñòðàíû îïðåäåëèòüñÿ ñ ìåõàíèçìîì îïðåäåëåíèÿ «ýòàëîííûõ» èëè «ðåôåðåíòíûõ» öåí (êîððåêòèðóåìûõ â on-line ðåæèìå), ïî âñåìó ðååñòðó ôàðìàöåâòè÷åñêèõ ïðåïàðàòîâ, ðàçðåøåííûõ ê ïðèìåíåíèþ íà òåððèòîðèè Óêðàèíû. Îá ýòîì òàê æå ïèñàëà â ñâî¸ âðåìÿ è ïðåäñåäàòåëü ìåä. êîìèòåòà ÂÐ Î.Áîãîìîëåö.

Ýòî íàìíîãî äåéñòâåííåé âñåé âîçíè ñâÿçàííîé ñ òåíäåðíûìè çàêóïêàìè. Ïóñòü âíà÷àëå ìåäèêàìåíòû çàêóïàþò ìåæäóíàðîäíûå ñòðóêòóðû, çàòåì ïîñòåïåííî ñäåëàòü çàêóïêè íà ðûíî÷íûõ óñëîâèÿõ è âêëþ÷èòü â ýòîò ïðîöåññ ãîñóäàðñòâåííî — ÷àñòíîå ïàðòíåðñòâî.
Àíàëîãè÷íûé ïîäõîä íåîáõîäèì è ïî ãðóïïå Ìåäòåõíèêè, ãäå ôèíàíñîâûå ïîòîêè âåñüìà âåëèêè è ñîïîñòàâèìû ñ ôàðìàêîëîãè÷åñêèìè ñðåäñòâàìè. Äëÿ ýêîíîìè÷åñêèõ ðàñ÷åòîâ, ïðåæäå âñåãî äëÿ ôóíêöèîíèðîâàíèÿ àâòîìàòèçèðîâàííûõ ìåäèêî — òàðèôíûõ îáùåãîñóäàðñòâåííûõ òåõíîëîãèé, òðåáóåòñÿ ðåøåíèå è öåëîãî ðÿäà äðóãèõ àíàëîãè÷íûõ âîïðîñîâ, êîòîðûå ìîæíî ñãðóïïèðîâàòü â åäèíûé àíòèêîððóïöèîííûé áëîê «Ñòàíäàðòû ìàòåðèàëüíûõ çàòðàò».

5. Íåîáõîäèìî ïîâûñèòü îáùèé óðîâåíü ìåäèöèíñêîé ýêîíîìèêè îòðàñëè. Íà ñåãîäíÿ êàê â Ìèíçäðàâå, òàê è â ËÏÓ íà ìåñòàõ, ìåäèöèíñêàÿ ýêîíîìèêà ðåàëüíî îòñóòñòâóåò. Èìååò ìåñòî ðàáîòà ñ ôèíàíñàìè è ïðîñòàÿ áóõãàëòåðñêàÿ ðàáîòà. È äàæå ïîìîùü â ýòîì âîïðîñå ìåæäóíàðîäíûõ îðãàíèçàöèé (èç òîãî, ñ ÷åì ÿ çíàêîì) íå ïðîèçâîäèò áîëüøîãî âïå÷àòëåíèÿ. Îáû÷íîå ìåëêîòåìüå äëÿ îñâîåíèÿ «ãðàíòîâûõ ñðåäñòâ».

Ïîðà ïåðåñòàòü ãîâîðèòü îá ýêîíîìè÷åñêîé äåÿòåëüíîñòè â ËÏÓ, à íàäî ñòðîèòü ïåðâè÷íóþ ýêîíîìèêó îòäåëüíîãî çàáîëåâàíèÿ, îòäåëüíîãî Ïðîòîêîëà âåäåíèÿ áîëüíîãî.

Ïðè íàëè÷èè ãðàìîòíûõ ýêîíîìè÷åñêè ñîñòîÿòåëüíûõ òàðèôîâ, íåîáõîäèìî íà ïåðâûõ ïîðàõ ïðèñòóïèòü ê òåõíîëîãèÿì âûïèñêè ïåðñîíàëüíûõ ñ÷åòîâ çà îêàçàííóþ ìåäèöèíñêóþ ïîìîùü. Ñôîðìèðîâàííûå ìàññèâû òàêèõ áàç äàííûõ ïîçâîëÿò ôîðìèðîâàòü Ïðîòîêîëû ëå÷åíèÿ ïî îäíîãðóïïíûì çàáîëåâàíèÿì.
À ýêñ-ìèíèñòð À.Êâèòàøâèëè â ñâî¸ì âûñòóïëåíèè â ÂÐ íåäàâíî ïðåæäåâðåìåííî ãîâîðèë î «…Ïðîòîêîëàõ ëå÷åíèÿ áîëüíûõ…», íå èìåÿ â ñòðàíå ïðåäâàðèòåëüíûõ òåõíîëîãè÷åñêèõ IT-ìàòåðèàëîâ äëÿ èõ ôîðìèðîâàíèÿ. Òåëåãà âïåðåäè ëîøàäè! Âåäü åñëè «Ïðîòîêîëû ëå÷åíèÿ áîëüíûõ», áåç ñáîðà èíôîðìàöèîííûõ áàç äàííûõ, ôîðìèðîâàòü «ïî íàóêå», òî íèêàêèõ ñðåäñòâ ñòðàíû íà íèõ íå õâàòèò, è ê òîìó æå â íèõ íå áóäóò çàêëàäûâàòüñÿ ñðåäñòâà íà ñîïóòñòâóþùóþ ïàòîëîãèþ.
Íà ñåãîäíÿ ìîäíî ãîâîðèòü î ò.í. òåõíîëîãèÿõ «ãëîáàëüíîãî áþäæåòà» ïðè ôèíàíñèðîâàíèè ìåäèöèíû. Íî âåäü äîñòîâåðíûå äàííûå äëÿ ðàñ÷åòà «ãëîáàëüíîãî áþäæåòà» â êîíêðåòíîé ñòðàíå íåëüçÿ ïîëó÷èòü áåç ñáîðà è ïðåäâàðèòåëüíîé îáðàáîòêè ñïåöèàëüíûõ äàííûõ, ÷åãî â ñòðàíå òàêæå ïîêà íåò. Ýòî íà ñåãîäíÿ âîîáùå íå àêòóàëüíî è ñòàíåò âîçìîæíûì â Óêðàèíå òîëüêî ÷åðåç íåñêîëüêî ëåò.

6. Ïàêåò çàêîíîâ, ïîäàííûõ â Âåðõîâíóþ Ðàäó è ìíîãîêðàòíî àíîíñèðîâàííûé À.Êâèòàøâèëè, íå ïðîøåë îáùåñòâåííîãî îáñóæäåíèÿ, ÷òî âíîñèò îïðåäåëåííûé äèññîíàíñ â îáñóæäåíèå íåîáõîäèìîãî äâèæåíèÿ â ìåäèöèíñêèõ ïðåîáðàçîâàíèÿõ. Íî, ñëóøàÿ íåäàâíåå âûñòóïëåíèå Ìèíèñòðà À.Êâèòàøâèëè â ÂÐ, ÿ áûë ïðàêòè÷åñêè âîçìóùåí åãî ñëîâàìè î íåîáõîäèìîñòè è âîçìîæíîñòè ïðèâëåêàòü ñðåäñòâà «äîíîðîâ». Íåóæåëè ñòðàíå ìàëî êîððóïöèîííûõ ñêàíäàëîâ ñâÿçàííûõ ñ ïðèíóæäåíèåì áîëüíûõ â ËÏÓ ê âçíîñàì â ðàçíûå ôîíäû è íåïðîçðà÷íîñòüþ â ðàñõîäîâàíèè ñðåäñòâ òàêèõ ôîíäîâ. Ýòî âñå äëÿ ëè÷íîãî îáîãàùåíèÿ êîðïóñà ãëàâíûõ âðà÷åé è èõ îêðóæåíèÿ è íè â êîåé ìåðå íå èäåò íà ïîëüçó çäðàâîîõðàíåíèþ. Î÷åíü íå õîòåëîñü áû ÷òîá íîâûå ðåôîðìàòîðû øëè ïî ýòîìó ïóòè.

7. Âòîðîé ïóòü â áîðüáå ñ ìåäèöèíñêîé êîððóïöèåé ñëåäóåò íà÷èíàòü ñ íàäåëåíèÿ íå òîëüêî ËÏÓ, íî è âðà÷åé áîëüøîé ôèíàíñîâîé íåçàâèñèìîñòüþ. È íà÷èíàòü ñëåäóåò ñ ïåðâè÷íîãî çâåíà, ò.å. èçìåíèòü ðîëü è ìåñòî âðà÷à ïåðâè÷íîãî êîíòàêòà.

 Ãðóçèè âñå ïðèâàòèçèðîâàëè è âðîäå òàì âñå íåïëîõî. Íå âåðþ, ÷òî ïðåäñòîÿùàÿ ïðèâàòèçàöèÿ â Óêðàèíå ïåðâè÷íîãî ìåäèöèíñêîãî çâåíà áóäåò óñïåøíîé. Â.Êóðïèòà – îäèí èç ýêñïåðòîâ ðàçðàáîò÷èêîâ «Ñòðàòåãèè» Ìèíçäðàâà, â ýòîì óáåæäåí, ïðàâäà áåç îáúÿñíåíèé è ðàñ÷åòîâ. ß ñàì çà ïðèâàòèçàöèþ, íî íå íà ýòîì ýòàïå ðåñòðóêòóðèçàöèè îòðàñëè. Äà è ìèðîâûå òåíäåíöèè ñåé÷àñ îòäàþò ïðåäïî÷òåíèå ãðóïïîâîé âðà÷åáíîé ïðàêòèêå, ò.å. ìèíè — ïîëèêëèíèêàì (áåç ïðèâàòèçàöèè) ïðè äîáðîâîëüíîì îáúåäèíåíèè åäèíîìûøëåííèêîâ.

Ïîëåçíî èçó÷åíèå òàêîãî îïûòà â Øâåöèè. Áîëåå ïðàâèëüíûì íàì âèäèòñÿ ïóòü âûâåäåíèÿ (ïðåæäå âñåãî âðà÷åé îáùåé ïðàêòèêè) èç ïîä÷èíåíèÿ íûíåøíèõ ïîëèêëèíèê (èëè Öåíòðîâ ïåðâè÷íîé âðà÷åáíîé ïðàêòèêè, ãäå îíè ôóíêöèîíèðóþò) è íàäåëåíèÿ èõ þðèäè÷åñêèìè ïðàâàìè, ÷òî ñåé÷àñ ãîòîâèòñÿ, è äîñòîéíî âñÿ÷åñêîé ïîääåðæêè. Íî äàëåå, ñòîèò ïåðåéòè íà ïîäóøåâîå ïîëî-âîçðàñòíîå ôèíàíñèðîâàíèå ñ ÷àñòè÷íûì ôîíäîäåðæàíèåì çà ïðèêðåïëåííûõ ëèö ê äàííîìó âðà÷ó ïåðâè÷íîãî êîíòàêòà.

Íàäî ñîçäàâàòü êîíêóðåíòíîå ïîëå ìåæäó âðà÷àìè ïåðâè÷íîãî êîíòàêòà, îñîáåííî â ãîðîäàõ è áîëüøèõ ïîñåëêàõ. Ðàñ÷åò ïîëîâîçðàñòíûõ íîðìàòèâîâ ôèíàíñîâûõ âçíîñîâ (íàëîãîâ îò ïðåäïðèÿòèé è îáùåñòâà) è ïîñëåäóþùèõ ïîëîâîçðàñòíûõ íîðìàòèâîâ ôèíàíñèðîâàíèÿ (äëÿ ÑÌÊ) äîâîëüíî ñëîæåí, òðåáóåò âûïîëíåíèÿ ïîñëåäîâàòåëüíîé öåïî÷êè ðàáîò (ýòî ïîðÿäêà 3000 çàäà÷, ÷òî ôèíàíñîâî òðóäíîâàòî äëÿ îäíîãî ðåãèîíà, íî âïîëíå âûïîëíèìî äëÿ ñòðàíû).  «Ñòðàòåãèè» î òàêîé íåîáõîäèìîñòè ïðåäâàðèòåëüíîãî âûïîëíåíèÿ ãîñóäàðñòâåííûõ ðàáîò òàêîãî îáú¸ìà íå ñêàçàíî íè ñëîâà.

8. Èç òåêñòà ïðåäëàãàåìîé ê îáñóæäåíèþ «Ñòðàòåãèè» íå ïîíÿòíî — áóäåò ëè â ïðàêòè÷åñêîå çäðàâîîõðàíåíèå ââåäåíî òàêîå îáùåýêîíîìè÷åñêîå ïîíÿòèå, êàê ïðèáûëü. ß, ïðàâäà, ïðåäïî÷èòàþ äëÿ îòðàñëè áîëåå «öèâèëèçîâàííîå» îïðåäåëåíèå – ðåíòàáåëüíîñòü. Âåäü íèêòî â ìèðå ýêîíîìèêè, ÍÈÊÎÃÄÀ íå ðàññêàçûâàë, êàê ìîæíî ðàçâèâàòüñÿ áîëüíèöå íå èìåÿ ðåíòàáåëüíûõ ñðåäñòâ (ò.å. ñðåäñòâ ñâåðõ çàòðàò). Çàáûòû àçû ýêîíîìèêè!

Ïðåäëàãàåìàÿ «Ñòðàòåãèÿ» íå äàåò îòâåò è íà ýòî óïóùåíèå, òåì áîëåå ÷òî îíî äîëæíî áûòü îáÿçàòåëüíî çàêðåïëåíî çàêîíîäàòåëüíûì ïóò¸ì! Áåç ðåøåíèÿ ýòîãî ÷èñòî ýêîíîìè÷åñêîãî âîïðîñà, ËÏÓ òàê è áóäóò íàñòàèâàòü íà «áëàãîòâîðèòåëüíûõ âçíîñàõ â ôîíä ñâîåãî ËÏÓ».

9. Âñòðåòèë â «Ñòðàòåãèè» Ìèíçäðàâà ìûñëü î ïðåäñòîÿùåì ôèíàíñèðîâàíèè îòäåëüíûõ íàöèîíàëüíûõ ËÏÓ. Ïðåäñòàâëÿþ, êàêàÿ «ïîäêîâåðíàÿ» áîðüáà ðàçâåðíåòñÿ çà ïîïàäàíèå â òàêîé ñïèñîê íåïðèêàñàåìûõ. Ýòî îòäåëüíûé è äîâîëüíî áîëüøîé ïëàñò òèïè÷íîé ìåäèöèíñêîé êîððóïöèè, êîòîðûé êîãäà-òî íàéäåò ñâî¸ ðåøåíèå â ðàìêàõ ñïåöèàëüíîãî çàêîíà «Î ìåäèöèíñêîé êîððóïöèè», ÷òî-òî àíàëîãè÷íîå äåéñòâóþùåìó çàêîíó Ñòàðêà â ÑØÀ.

Êàêîé æå ïðàâèëüíûé ïóòü ðåøåíèÿ ïî ôèíàíñèðîâàíèþ Íàöèîíàëüíûõ ìåäèöèíñêèõ öåíòðîâ ñòðàíû ñòîèò ïðèíÿòü â ðàìêàõ íûíåøíåé «Ñòðàòåãèè»? Îòâåò âåñüìà ïðîñòîé. Íóæíû ýêîíîìè÷åñêè îáîñíîâàííûå ìåäèöèíñêèå òàðèôû íà âñå óíèêàëüíûå (åñëè îíè óíèêàëüíûå) òåõíîëîãèè. Ýòî è êîìïåíñàöèÿ ïîâûøåííûõ ðèñêîâ, è îïëàòà çà èííîâàöèè è ò.ä. È ê òîìó æå â òàêèõ îáùåãîñóäàðñòâåííûõ Öåíòðàõ è íàêëàäíûå ðàñõîäû îáîñíîâàííî âåëèêè, ÷òî è äîëæíî ïîçâîëÿòü èì íîðìàëüíî ôóíêöèîíèðîâàòü. Íî âñå óíèêàëüíûå ìåäèöèíñêèå öåíòðû äîëæíû íàõîäèòüñÿ è ðàáîòàòü â îáùåêîíêóðåíòíîì ïîëå ñòðàíû. Íå âñå îíè, íûíåøíèå Íàöèîíàëüíûå ìåäèöèíñêèå Öåíòðû, ñìîãóò ñîõðàíèòüñÿ! Íî, ìåäèöèíñêàÿ ðåôîðìà ïî ñâîåé ñóùíîñòè è ïðåäïîëàãàåò îòñåêàòü âñå íåæèçíåñïîñîáíîå. À ñàìè ýòè íåóñïåøíûå Öåíòðû ïðîñòî ýâîëþöèîííî ïåðåéäóò â ðàçðÿä îáû÷íûõ ëå÷åáíûõ ó÷ðåæäåíèé, è áóäóò âíîñèòü ñâîé âêëàä â îáùåå äåëî.

10. Î âåäîìñòâåííîé ìåäèöèíå, êîòîðàÿ çàáèðàåò 25% âñåõ ìåäèöèíñêèõ ñðåäñòâ. Êàæåòñÿ, íà ñåãîäíÿ â Óêðàèíå îíà ñîñòîèò èç 14 ðàçëè÷íûõ ñòðóêòóð è âñå ñî ñâîèìè áþäæåòàìè.
Íàãðóçêà íà ìåäïåðñîíàë è ñðåäíåâçâåøåííàÿ òÿæåñòü áîëüíûõ â ýòèõ áîëüíèöàõ çíà÷èòåëüíî íèæå, ÷åì â îñíîâíîé ìåäèöèíñêîé ñåòè. Âåðîÿòíî, ñòðàíå ñòîèò ñîõðàíÿòü è ðàçâèâàòü îòäåëüíî òîëüêî âåäîìñòâåííóþ ìåäèöèíó ñèëîâûõ âåäîìñòâ, ò.å. âîåííî — ïîëåâóþ è ìîðñêóþ õèðóðãèþ. Âñÿ îñòàëüíàÿ ñåòü âåäîìñòâåííûõ ËÏÓ äîëæíà áûòü çàêîíîäàòåëüíî óïðàçäíåíà è âõîäèòü â åäèíóþ ãîñóäàðñòâåííóþ ñèñòåìó çäðàâîîõðàíåíèÿ.

11. Î ÷àñòíî-ãîñóäàðñòâåííîì ïàðòíåðñòâå. Çàêîíîäàòåëüíîå çàêðåïëåíèå ïåðâè÷íîé àðåíäû ñðàçó íà 50 ëåò, êàê ïðåäëàãàåòñÿ â ìàòåðèàëàõ Ìèíçäðàâà, ïðè íûíåøíèõ íåñôîðìèðîâàííûõ è íåîïðåäåëåííûõ ôèíàíñîâûõ îòíîøåíèÿõ, âðÿä ëè îïðàâäàííûé øàã.
Íóæåí ïðîäóìàííûé çàêîí î ÷àñòíî-ãîñóäàðñòâåííîì ïàðòíåðñòâå. È ãîñóäàðñòâó ïîîùðÿòü íóæíî ñîçäàíèå ñîáñòâåííûõ ÷àñòíûõ ËÏÓ, à íå àðåíäó íà 50 ëåò â äåéñòâóþùèõ áîëüíèöàõ. Çà÷àñòóþ ãëàâíûå âðà÷è ñàìè è áóäóò àðåíäîâàòü ó ñåáÿ çà êîïåéêè ïîìåùåíèÿ, äîðîãîñòîÿùåå îáîðóäîâàíèå, ïåðåêëàäûâàÿ áðåìÿ íàêëàäíûõ òåêóùèõ ðàñõîäîâ íà îñíîâíîå ËÏÓ, ò.å. íà îáùåñòâî.

 ãîñóäàðñòâåííûõ è ÷àñòíûõ ËÏÓ äîëæíû áûòü ðàâíîêîíêóðåíòíûå óñëîâèÿ è òàðèôû íà îêàçàííóþ ðàáîòó. À âîò âûñòàâëÿåìûå ñ÷åòà â ÷àñòíîì ËÏÓ ìîãóò áûòü âûøå (ó íèõ ìîæåò áûòü âûøå óðîâåíü ðåíòàáåëüíîñòè), íî ýòó äîïëàòó â èíäèâèäóàëüíîì ñ÷åòå îñóùåñòâëÿåò èëè ñàì ïàöèåíò èëè äîáðîâîëüíàÿ ñòðàõîâàÿ êîìïàíèÿ, ãäå îí çàñòðàõîâàí. Íàëîãîâûå ñëóæáû ñòðàíû, îáëàäàÿ èíôîðìàöèåé î ðåàëüíûõ òàðèôíûõ çàòðàòàõ ïðè ìåäèöèíñêîé ïîìîùè â ÷àñòíîì ËÏÓ, â ýòîì ñëó÷àå – îïèðàÿñü íà «ðåôåðåíòíûå öåíû», áóäóò ðàçáèðàòüñÿ ñ òàêîé ïîâûøåííîé ðåíòàáåëüíîñòüþ ÷åðåç íàëîãîâûå ìåõàíèçìû, îãðàíè÷èâàÿ ñòðåìëåíèå ÷àñòíûõ ËÏÓ ê íåîïðàâäàííîìó ðîñòó ðàñõîäîâ íàñåëåíèÿ ïðè ïîëó÷åíèè ìåäèöèíñêîé ïîìîùè.

Êàê îáåñïå÷èòü ñðàâíèòåëüíóþ ýôôåêòèâíîñòü è ðåçóëüòàòèâíîñòü ðàáîòû îòäåëüíûõ ËÏÓ, åñëè â ñòðàíå íå áóäåò îñóùåñòâëåí ïåðñîíèôèöèðîâàííûé ó÷åò âñåé îêàçàííîé ìåäèöèíñêîé ïîìîùè? ×óâñòâóåòñÿ â «Ñòðàòåãèè» âëèÿíèå ðàáîò Ì.Ïîðòåðà (èç Ãàðâàðäà), íî çàáûò åãî ïîñòóëàò î íåïðåëîæíîì âûïîëíåíèè çàêîíîâ ýêîíîìèêè. À îíè äëÿ ñòðàíû ñåé÷àñ ëåæàò â ïëîñêîñòè ãðàìîòíûõ ìåäèöèíñêèõ òàðèôîâ íà îêàçàííóþ ìåäèöèíñêóþ ïîìîùü.

12. Íè ñëîâà â «Ñòðàòåãèè» íåò î ñòðàõîâàíèè ïðîôåññèîíàëüíîé îòâåòñòâåííîñòè ìåäèêîâ! Ìîæåò ýòî ïîêà è õîðîøî, ÷òî íå çíàþò, êàê ïîñòóïèòü ñ ýòîé ïðîáëåìîé. Íî âåäü åñëè áóäåò èíòåíñèôèêàöèè ðàáîòû â çäðàâîîõðàíåíèè, òî âïîëíå âåðîÿòíî, ÷òî è ïðåòåíçèè ê ìåäèêàì óâåëè÷àòñÿ. È èì íàäî èìåòü ñðåäñòâà äëÿ ñòðàõîâàíèÿ ñâîåé ëè÷íîé îòâåòñòâåííîñòè.

Èìåÿ ïðèëè÷íûé îïûò â ôîðìèðîâàíèè àâòîìàòèçèðîâàííûõ ìåäèöèíñêèõ òàðèôîâ, íàì âèäèòñÿ, ÷òî ñðåäñòâà äëÿ ïðîôåññèîíàëüíîé ñòðàõîâêè ìåäðàáîòíèêîâ äîëæíû áûòü çàëîæåíû â êàæäûé ìåäèöèíñêèé òàðèô (ñóììàðíî ïî ñòðàíå íà ýòî ïîòðåáóåòñÿ âåñüìà ñóùåñòâåííûå ôèíàíñîâûå çàòðàòû). Ýòî îãðîìíûé ïëàñò ðàáîò äëÿ îáùåñòâåííûõ ìåäèöèíñêèõ ïðîôåññèîíàëüíûõ îðãàíèçàöèé è ñòðàõîâùèêîâ.

Âåëè÷èíà òàêèõ ñòðàõîâûõ êîìïåíñàöèé â êîíêðåòíîì ìåäèöèíñêîì òàðèôå äîëæíà áóäåò çàâèñåòü îò âåëè÷èíû ðèñêà îñëîæíåíèé ïðè âûïîëíåíèè êîíêðåòíîé îïåðàöèè, ïðîöåäóðû ñ âûñîêèì ðèñêîì è ò.ä. Ò.å. ÷åì áîëüøå îïåðèðóåøü, ïðîèçâîäèøü ìíîãî ñëîæíûõ èññëåäîâàíèé, òåì íà òâîèõ ëè÷íûõ ñ÷åòàõ ñóììà ôèíàíñîâûõ îò÷èñëåíèé äëÿ ëè÷íûõ ñòðàõîâûõ âîçìîæíîñòåé óâåëè÷èâàåòñÿ. Íåëüçÿ çà ãîñóäàðñòâåííûé ñ÷åò ñòðàõîâàòü ïåðñîíàëüíóþ îòâåòñòâåííîñòü íà îäèíàêîâóþ ñóììó, êàðäèîõèðóðãà äåëàþùåãî îäíó îïåðàöèþ â ìåñÿö è êàðäèîõèðóðãà äåëàþùåãî 25 òàêèõ æå îïåðàöèé â ìåñÿö.
À ÷åðåç ñòðàõîâóþ äîëþ â îïåðàöèîííîì òàðèôå (â çàâèñèìîñòè îò ñëîæíîñòè îïåðàöèè) ýòî ëåãêî ðåøàåìûé âîïðîñ ñ ïðèìåíåíèåì IT–òåõíîëîãèé. Ê òîìó æå ñàì çàêîí î ïðîôåññèîíàëüíîé îòâåòñòâåííîñòè ìåäèêîâ äîëæåí ïðèíèìàòüñÿ «ïàêåòîì» îäíîâðåìåííî ñ ïðèíÿòèåì çàêîíà î ïðàâàõ è îáÿçàííîñòÿõ ïàöèåíòà.

13.×ðåçìåðíàÿ ñïåöèàëèçàöèÿ áîëüíèö è äèñïàíñåðîâ òàêæå òðåáóåò ñâîåãî ïåðåîñìûñëåíèÿ è íàõîæäåíèÿ ñâîåãî ìåñòà â ïðåäëàãàåìîé «Ñòðàòåãèè». Íî ýòî íåñêîëüêî îòñðî÷åííûå ðåøåíèÿ, òàê êàê ïîêà íå ñíÿò çàêîíîäàòåëüíûé ìîðàòîðèé îò 2014 ãîäà, çàïðåùàþùèé ñîêðàùàòü äåéñòâóþùóþ ñåòü ËÏÓ.

2200 áîëüíèö è 400 000 êîåê â ñòðàíå – âîîáùå áîëüíàÿ òåìà! Âñåãî ñëèøêîì ìíîãî, íî â áîëüíèöàõ ÷àñòî òîëüêî ãîëûå ñòåíû è ê ñàìîé êîéêå, íåìíîãî ÷åãî èìååòñÿ! Íî åñëè ïðîâåñòè èíâåíòàðèçàöèþ ðàáîòû è ïîéòè ïî ïðàâèëüíîìó ïóòè äèôôåðåíöèàöèè ËÏÓ ïî ñòåïåíè èíòåíñèâíîñòè ëå÷åíèÿ, òî ëåãêî, íå çàêðûâàÿ ËÏÓ, ðåøàòü âîïðîñû ôîðìèðîâàíèÿ ñîöèàëüíûõ áîëüíèö ñ äâîéíûì ïîä÷èíåíèåì, õîñïèñîâ, ðåàáèëèòàöèîííûõ öåíòðîâ è ò.ä. Äà è 400 000 êîåê ñòðàíå íå íàäî ïðè íåèçáåæíîé èíòåíñèôèêàöèè ëå÷åíèÿ (åñëè áóäåò çàèíòåðåñîâàííîñòü ìåäèêîâ). Ïóñòü ýêîíîìè÷åñêèå ñòèìóëû çà 4-5 ëåò ðàáîòû îòðàñëè ïðèâåäóò ýòî íåîáîñíîâàííîå ÷èñëî ê ðàçóìíûì ïîòðåáíîñòÿì. Íå ñòîèò ôèíàíñèðîâàòü ËÏÓ ïî ÷èñëó êîåê, ñòîèò îïëà÷èâàòü òîëüêî âûïîëíåííóþ ðàáîòó è æåñòî÷àéøèì îáðàçîì îòñåêàòü (íå îïëà÷èâàòü) èçáûòî÷íóþ ðàáîòó (êàê â ÑØÀ).

Ñ óâàæåíèåì, Ñåðãåé Ïåòðîâ.
  Òåìà: Áîðèñ Òîäóðîâ: Àìîñîâ òðåìÿ ñëîâàìè ïðåäîïðåäåëèë ìîþ ñóäüáó
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ÑîîáùåíèåÔîðóì: Ïðåññà Óêðàèíû î ðîäíîé ìåäèöèíå   Äîáàâëåíî: Ïí Èþí 22, 2015 12:02 pm   Òåìà: Áîðèñ Òîäóðîâ: Àìîñîâ òðåìÿ ñëîâàìè ïðåäîïðåäåëèë ìîþ ñóäüáó
Áîðèñ Òîäóðîâ: Àìîñîâ òðåìÿ ñëîâàìè ïðåäîïðåäåëèë ìîþ ñóäüáó

http://www.ukrinform.ua/rus/news/boris_todurov_amosov_tremya_slovami_predopredelil_moyu_sudbu_1757082
  Òåìà: Åêñïåðò: ç Óêðà¿íè ùîð³÷íî åì³ãðóº 7 òèñÿ÷ ìåäèê³â
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ÑîîáùåíèåÔîðóì: Ðåôîðìà â Óêðàèíå   Äîáàâëåíî: Âñ ßíâ 25, 2015 12:05 pm   Òåìà: Åêñïåðò: ç Óêðà¿íè ùîð³÷íî åì³ãðóº 7 òèñÿ÷ ìåäèê³â
http://www.unn.com.ua/uk/exclusive/1428513-ekspert-z-ukrayini-schorichno-viyizdit-7-tisyach-medikiv

Íà äóìêó Ëàðèñà Êàíàðîâñüêî¿, ïåðøèìè êðîêàìè ìåäè÷íî¿ ðåôîðìè ó ñòîëèö³ ìຠñòàòè âèð³øåííÿ êàäðîâî¿ ïðîáëåìè, çàïðîâàäæåííÿ ñèñòåìè ñîöçàõèñòó ë³êàð³â ³ âèðîáëåííÿ ïðîçîðèõ ìåõàí³çì³â ô³íàíñóâàííÿ ãàëóç³
ÊȯÂ. 20 ñ³÷íÿ. ÓÍÍ. Ç Óêðà¿íè ùîð³÷íî âè¿çäèòü äî 7 òèñÿ÷ ìåäè÷íèõ ïðàö³âíèê³â. ×åðåç öå òà íåáàæàííÿ ïðàöþâàòè ó ìåäè÷í³é ñôåð³ ò³ëüêè ó ñòîëèö³ áðàêóþ 3,5 òèñÿ÷ ë³êàð³â. Ïðî öå ó êîìåíòàð³ ÓÍÍ ïîâ³äîìèëà ãîëîâà Ðàäè Êè¿âñüêî¿ ì³ñüêî¿ ïðîôñï³ëêè ïðàö³âíèê³â îõîðîíè çäîðîâ’ÿ Ëàðèñà Êàíàðîâñüêà.

"Ó Êèºâ³ ò³ëüêè ïî Äåïàðòàìåíòó îõîðîíè çäîðîâ’ÿ (ÊÌÄÀ – Ðåä.) ó íàñ íå âèñòà÷ຠ3,5 òèñ. ë³êàð³â ³ áëèçüêî 8 òèñ. ìåäñåñòåð. Öå äàí³ çà ìèíóëèé ð³ê. Çîêðåìà íå âèñòà÷ຠ500 ä³ëüíè÷íèõ ë³êàð³â, 100 ôòèç³àòð³â, 100 ïàòàëîãîàíàòîì³â, 248 ëàáîðàíò³â ³ ò.ä.", - çàçíà÷èëà âîíà.

Ùî ñòîñóºòüñÿ ïîä³áíî¿ ñòàòèñòèêè ó âñåóêðà¿íñüêîìó ìàñøòàá³, òî ñòàíîì íà 2008 ð³ê êðà¿í³ íå âèñòà÷àëî 50 òèñ ë³êàð³â ³ 80 òèñ ìåäñåñòåð. Âò³ì, Ë.Êàíàðîâñüêà çàçíà÷èëà, ùî öÿ ïðîáëåìà àêòóàëüíà ïðàêòè÷íî ó ö³ëîìó ñâ³ò³, âêëþ÷àþ÷è ³ äîáðå ðîçâèíåí³ êðà¿íè.

"Ó ãðóäí³ 2013 ðîêó ÂÎÎÇ ïðîâåëà ïîçà÷åðãîâó ñåñ³þ, ïðèñâÿ÷åíó ìåäè÷íèì êàäðàì. Áóëî çàÿâëåíî, ùî ó ñâ³ò³ íå âèñòà÷ຠ7 ìëí ìåäïðàö³âíèê³â. Ðîçïîä³ëåííÿ òàêå: 100 òèñ - â ÑØÀ, 120 òèñ – â Êàíàä³, 45 òèñ – â Àíã볿. Òàêîæ áóëî ñêàçàíî ïðî ïðîãíîç íà ïåðñïåêòèâó: öÿ öèôðà ïîäâî¿òüñÿ äî 2020 ðîêó. ×îìó? Áî ñüîãîäí³ ìîëîäü, ÿê ³ ó íàñ, íå õî÷å éòè ó ìåäèöèíó. ª ñ³ì îñíîâíèõ ïðè÷èí öüîìó. Çîêðåìà òðåáà âñå æèòòÿ â÷èòèñÿ. ª ôàêòîð ðîçá³éíèõ íàïàä³â õâîðèõ ³ ðîäè÷³â. Òàêîæ º ðèçèê ³íô³êóâàííÿ - îò ó íàñ óïðîäîâæ ðîêó ó Êèºâ³ 25 ìåäïðàö³âíèê³â çàðàæàþòüñÿ òóáåðêóëüîçîì, à êîæåí øîñòèé õ³ðóðã, çà äàíèìè àêàäåì³êà Âîäÿíîãî, º íîñ³ºì àíòèãåííîãî ãåïàòèòó. Öå âñå ïðîôåñ³éí³ ðèçèêè", - ðîçïîâ³ëà åêñïåðò.

Ùå îäíèì ïåðøî÷åðãîâèì êðîêîì ó ðåàë³çàö³¿ ìåäè÷íî¿ ðåôîðìè ó ñòîëèö³, íà äóìêó Ë.Êàíàðîâñüêî¿, ìຠáóòè çàáåçïå÷åííÿ ñîö³àëüíîãî çàõèñòó ë³êàð³â.

"Ó íàñ çîâñ³ì â³äñóòí³é ñîö³àëüíèé çàõèñò. Ó Êèºâ³ ìè çàéìàºìî 29 ì³ñöå ïî çàðïëàò³. Íàì äåðæàâà 23 ðîêè õðîí³÷íî êðóòèòü ô³ëüì "Ïðèõîäüòå äî íàñ çàâòðà". Îá³öÿþòü ³ êâàðòèðè, ³ ãóðòîæèòêè. Ìè æ ÷åðåç öå çàëó÷èòè ìîëîäü íå ìîæåìî", - çàçíà÷èëà åêñïåðò.

Âîíà òàêîæ íàãîëîñèëà íà ïðîáëåì³ â³äñóòíîñò³ íîðìàëüíèõ óìîâ ïðàö³ ³ òåõí³÷íîãî çàáåçïå÷åííÿ. ×åðåç óñ³ ö³ ïðîáëåìè, çà ¿¿ ñëîâàìè, ÷èìàëî õîðîøèõ ìåäèê³â âè¿æäæຠïðàöþâàòè çà êîðäîí.

"Ìè îòðèìóâàëè äî 2013 ðîêó ³íôîðìàö³þ â³ä ÌÇÑ, ùî 7 òèñ ìåäïðàö³âíèê³â ùîðîêó âè¿æäæàþòü çà êîðäîí. Ó íàñ ïðàöþþòü ê³ëüêà áþðî òàê çâàíî¿ ìåäè÷íî¿ ì³ãðàö³¿. ¯ì çäàþòü äîêóìåíòè, îïëà÷óþòü ¿õ ïîñëóãè, âèáèðàþòü êðà¿íó, ÿêó ïðîïîíóþòü, ìîæóòü åêñòðåíî íàâ÷èòè ìîâ³ íà áàçîâîìó ð³âí³. ² äîïîìàãàþòü ó ìåäè÷í³é ì³ãðàö³¿. Âæå áàãàòî íàøèõ ë³êàð³â òàê âè¿õàëî çîêðåìà äî ²çðà¿ëþ òà ͳìå÷÷èíè", - ðîçïîâ³ëà ãîëîâà Ðàäè Êè¿âñüêî¿ ì³ñüêî¿ ïðîôñï³ëêè ïðàö³âíèê³â îõîðîíè çäîðîâ’ÿ.

Îêð³ì òîãî, åêñïåðò ï³äêðåñëèëà, ùî ó õîä³ çàïðîâàäæåííÿ ìåäè÷íî¿ ðåôîðìè íåîáõ³äíî âèðîáèòè ÷³òêó ³ ïðîçîðó ñèñòåìó ô³íàíñóâàííÿ ìåäè÷íî¿ ãàëóç³.

"Ìè ïëàòèìî 15% ïîäàòêó êîæåí îñîáèñòî (íà îõîðîíó çäîðîâ’ÿ - ðåä.) ³ ùå 38% ç ôîíäó çàðîá³òíî¿ ïëàòè. Âñüîãî ïîíàä 50% ïëàòèìî äåðæàâ³; ó öèõ ïîäàòêàõ ³ º äåðæàâíà áåçêîøòîâíà ìåäè÷íà äîïîìîãà. Äå ö³ ãðîø³? Ìåíå ïîñò³éíî äîïèòóþòü ÷ëåíè ïðîôñï³ëêè, äå ö³ ãðîø³", - ðåçþìóâàëà âîíà.
Íàãàäàºìî, ó Êèºâ³ ðîçïî÷àâñÿ ï³ëîòíèé ïðîåêò ïðîâåäåííÿ ðåôîðì ó ãàëóç³ ìåäèöèíè.

Ìåð ñòîëèö³ ³òàë³é Êëè÷êî îçâó÷èâ 10 êðîê³â, ÿê³ íåîáõ³äíî çàïðîâàäèòè äëÿ ðåôîðìóâàííÿ ñòîëè÷íî¿ ìåäèöèíè.
  Òåìà: The New Competition: What’s the Goal? Rereading of M. Porter
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ÑîîáùåíèåÔîðóì: Ðåôîðìà çà ðóáåæîì   Äîáàâëåíî: Âò Äåê 23, 2014 12:43 pm   Òåìà: The New Competition: What’s the Goal? Rereading of M. Porter
The New Competition: What’s the Goal? Rereading of Michael Porter

In any field of human endeavour, the major motivators are adversarial, with an unwillingness to be lagging, and the activity of medical providers is no exception. For what actually do the medical providers compete and patients and how will this change in the future? It is convenient to consider the example of USA as competition in medicine, which has a medical market in its purest form.

I must say that the U.S. health care system has distinctive features that allow it to be described as a kind of anachronism that miraculously survived to this day. Despite the highest medical technology, including technology of business governance and the best in the world scientific basis, the ideology of U.S. health care itself, in my opinion, is almost an exact copy of the system that was brought to America by early European colonists. Historians, if they wish, can recreate the average look of ideology of health care as it was in Europe in the middle of seventeenth and the beginning of eighteenth century, but adjusted to national identities. The only upgrade which the system has undergone during this time between patient and physician now appears as an intermediary: insurance company.

What are these distinguishing features? First, medicine remained relatively closed, a clannish profession, a type of medieval guild. Neither the state nor citizens until very recently were allowed into the ‘guild kitchen’, which adopted the technological and marketing solutions. The medical community there still stands apart from the rest of social institutions, largely retaining its medieval ‘liberties’.

Second is the method of payment for medical services. The doctor gets education in a closed ‘clannish’ system for his money and then tries to justify the invested funds, providing services to citizens through business intermediaries, which are insurers and assisting companies. From the point of view of the doctor, his service is economically and fundamentally no different from repairing a TV or car in instalments. The social role of the state in such an ideology only recently attempted to wholly or partially participate in medical payments of citizens, and health care workers all in history made out a bill for their services, for both individual citizens and the state that paid for them. At the stage of the doctor’s education or the stage of certification or the stage of practice and continuing education, the state does not claim its social interest in the results of the medical community as a whole, preferring to find out detours through educational programmes for potential and current patients and encouraging or fining certain types of businesses, including pharmaceutical, tobacco, alcohol, food companies, etc.

The third feature of the United States is that it continuously receives massive population from all the world, with the majority of the population having no experience of co-financing social insurance projects, or even if such experience is present, it is not compatible with different groups of immigrants. A large proportion of the foreign population leads to the fact that the United States still cannot create a complete system of health insurance for the entire population. For the state with such a structure of population, the risks of health insurance are too big and it is logical to put him into private hands, which by definition can afford to risk much more by artificially restricting the market and limiting itself to the most solvent parts of the population. This unique and permanent social ‘instable routine’ does not allow the U.S. health system become European, designated for ‘stationary’ population that is able to articulate their social goals and generate a social ‘umbrella’ of sufficient size to cover the majority of citizens. Such a health care system by their ideology is still a ‘temporary’ system that spontaneously arose in the era of the first settlers that are prone to constant changes of residence and is characterised by sharp social, material, and cultural inequalities.

There comes the understanding that this HCS, despite medical advances, as a separate service of a specific physician for a specific patient, starts to break down during the transition to fundamentally new technologies. The U.S. population has begun to notice that the price of such health care is prohibitive, and the accessibility of modern effective treatment is reduced. Medieval way of financing health care has become like a brake, in the sense that even the most advanced technology cannot show its effectiveness for society fully because of their low availability. The public opinion will begin to shift, aimed at greater social responsibility of medicine, at the fact that the population has begun to influence the clannish medical community, not so much in order to control ‘what?’ doctors make, but for the fact that people could make physicians also implement ‘why?’ and ‘what for?’ which in the immediate interests of doctors are not yet included. The book Redefining Healthcare by M. Porter and E. Teisberg is one of the attempts to indicate to the American (and not only!) society some oddities in the health care system that are becoming more visible to the professionals.

In this book in Chapter 8, ‘Health Care Policy and Value-Based Competition. Implications for Government’, the authors write:

The fundamental flaw in U.S. health care policy is its lack of focus on patient value. (p. 323)

If there is any overarching perspective that has guided public policy, it is government’s version of zero-sum competition: drive down the cost of government programs by policing costs, forcing down prices, and shifting costs to the private sector. (p. 324)

In all of these disparate views, however, there is agreement on one thing: the current system is not working. A fresh approach is clearly needed to address a health care system that is consuming a larger and larger share of public, corporate, and individual resources with questionable results. (p. 326)

Thus, the main words uttered are ‘the current system is not working’! I think that it should be clear that a system that does not work could not survive a couple of hundred years, resisting any attempts to reform it. The point is that the system works, but for itself! There is no mechanism that would allow the system to produce the result, which it is expected. If it is more precise, nowadays the American society can begin to understand what exactly is expected from the system. I think that this is what the authors of this book are trying to convey to the reader.

First of all, it would be nice to understand exactly who competes with whom and for what resources? Porter says that medical providers compete for patients’ money, and it’s totally logical in a market economy, no more and no waiting. The means of competition are relevant in offering services that are the most appropriate to customers’ expectations at a reasonable price. Porter says that this competition is counterproductive, because it offers a process, not outcome for the patient. It seems to me that the root of the problem is that the patient and medical provider traditionally understands by the proposed product that there are two different things:

• Medical services provider speaking about treatment refers to the chain of process steps, reaching the best possible results for some time and known money.

• The patient under treatment refers to the elimination of his medical and social problems to restore his ability to work within a certain time and fit in the available amount for him.
The only factors for which patient and medical provider can come together are the sum and time. If these conditions are met, the transaction is considered concluded. But the results of all medical procedures in general are probabilistic in nature, and the parties understand them differently. For medical providers, the result is a faithfully executed process chain, for the patient, there is restored workability or more years of life, and the first does not necessarily guarantee the second. All the many proposals of Porter in this chapter were reduced in order to force the medical provider to understand the results just as the current patient understands. But there is a huge problem: The patient obtains the explanation about the possible outcome from exactly the medical provider, i.e. someone who is financially interested in his misinformation to ensure maximum sales! Therefore, most of the conclusions of Porter in Chapter 8 focuses on how to organise the information field, which would be correct, impartial, and timely information for the patient about the best possible outcome for his medical condition.
I think that in reality the problem is even more complicated. There is competition among medical providers for patients’ money – that’s not all. In fact, all actors compete: medical providers, patients, medical insurers, and governments.

• Providers, as already mentioned, compete for money of patients and for now all the available potential patients, not just the population of this state. Limitation of this type of competition serves the cost of moving the patient from the residence to the provider of medical services. We should expect that as the solution of traffic problems and reduce the cost of moving people on the planet; the available pool of patients will increase and competition of this type will increase.

• Providers of medical services compete with each other also for the public funding they receive because of government’s involvement in paying for medical services for some categories of patients and some socially important disease entities. The purpose of this competition may also get all sorts of preferences: tax, advertising and information, technological, political, personnel, and others, which allow access to new medical technologies and new pools of patients.

• In the countries that have HCS, which cannot evenly cover the entire territory of accessible medical service providers, patients compete for the possibility of getting even formal medical care. The advantages of such competition are awareness of patients about the availability of the medical provider, ability to quickly move around the country, and material prosperity, since under such conditions the prices will be unreasonably high.

• Patients compete for saving the maximum amount but achieve the desired result (not necessarily the provider from the current state). Under the ‘desired result’, they can assume quite different things, depending on the patient’s understanding of his medical state and possibilities of modern medicine. In this competitive field, patients are divided into multiple pools with different requirements for the final results, depending on many factors: age, education, profession, awareness of its pathology, financial features (both personal finance and financial capabilities of their insurance company), etc. But subconsciously, all patients are well aware of finite resources of any health care system, and that fact encourages competition between them.

• Insurers compete, firstly, with each other for money of potential patients, and secondly, they compete with providers of medical services, by absorbing the money not only of current but also of future patients ‘on the distant approaches’ to hospitals and, thus, reduce the pool of customers who could pay providers directly for services. The fact that there is competition among medical services providers and the insurers for the finite resources of the patient, in my opinion, is insufficiently reflected in the literature.

• Insurers compete for the number of healthy population that is sufficiently solvent to pay for modern insurance services. The means to attract the customers to the insurer is the price and complete coverage of potential medical and social needs of patients. Limiters for such a competition are the laws of various states while the physical presence of the patient for the contract and the insurance payment is not necessary, and if it were not for these limitations, health insurers would have long operated on the internationalised pools of clients of enormous size; moreover, the contemporary banking services have already allowed that.

• Recently, insurers have begun to compete also for the opportunity to save on a denial of service to already sick clients or customers who often get sick. This type of competition arose after the state began to try and force insurers to work also with customers that are unfavourable. In fact, this is just turned out in the previous paragraph, but it should be recalled that it is an important motivator of behaviour of insurers in the market. To combat this phenomenon, Porter offers to ‘create pools of patients at risk’ and distribute them equally among insurers, thus making the market fairer in relation to insurers. However, to implement this idea, all insurers should be unified and equal in terms of prices and ranges of services provided, otherwise the situation will be unfair to customers. For now can only dreamed of this.

• The state competes with other states for the number and quality of current and future patients, for they are the taxpayers, working hands, and parents of future generations of citizens. Resource is the quality of life as well as duration of life that is offered to potential immigrants and their descendants. I want to emphasise that the state is the only player in the market that competes not for money patients, but for the patients themselves. Namely, the current and future patients are the basic value for it. Let’s remember this fact.

That is to say, all of these types of competition in health care are aimed at making one or another way to attract and utilise the maximum amount of money of current or future patients. But funds that even the rich elderly citizens that often get sick of a given state can spend on their health and social needs are fairly limited. To broaden the base for competition and, thus, increase their income, market actors began to apply specific techniques:

• Customisation of health services, with medicines, serums, and medical devices (including implantable) developed specifically for a particular patient or a small group of patients. Price of the service while dramatically increasing, but the added value created for the customer is rather doubtful. But in the future, with the application of nanotechnologies, the customisation of medical services will become an integral and necessary part of making medical decisions and all medical activities.

• Compulsory insurance of the population dramatically increases the amount of funds available for consumption by competitors at the moment, but the problem is that the list of advanced technologies in medicine is clearly expanding faster than the list of medical conditions and methods of treatment that is covered by insurance. Thus, the probability that in certain circumstances and/or combination of diseases the patient will have to pay also for the newest treatment (that is not covered by insurance) is growing, which is the aim of competitors.

• There is active fundraising of patients from abroad, both as individual payers for medical services (now we call it medical tourism) and also as customers of transnational medical and social insurers and their alliances. State boundaries at this level of competition do not exist at all, and thus competition in the market of health and social services is no longer locked in their national quarters.

• International markets of semi-medical goods and services, including medical assistance, are developing. Special value to competitors represents technologies for lifelong support of a patient, while he cannot switch to another medical service provider for reasons of medical or technical nature.

• The use of telemedicine is a means to provide medical service to local or foreign patients without his physical presence, giving a sharp increase in the pool of potential patients which significantly save on travel costs. The market of telemedicine services currently shows one of the most impressive growth curves and promises to be a giant planetary market, as it is almost not influenced by local laws.

• Using the high availability of medical information to the end customer in the world today, health care providers purposefully create the fashion for certain medical technologies, causing inexplicable spikes of demand for scientists and developers and then cyclical disappointment in them though. Such information campaigns are a powerful way to create planetary demand for medical technologies’ effectiveness which has yet to be proven and collect money patients before the publication of the late results of the given medical technology.

As mentioned in the previous sections, the only source of funds, consumption of which is the aim of the players on the medical services market and related markets, is the current and future patient which is now the whole world’s population, while the citizens of more developed countries have more than the less developed ones. The population of economically developed countries is mere titbit simply because the average labour productivity in them is substantially higher, and respectively, the average per capita income is higher. That is, I want to say that for the money, for example, an American or Swedish pensioner now will indirectly fight simultaneously all medical providers in the world, as well as all providers of health and social insurance. The only player in the market, which will be interested not in the consumption of current and future patient’s money, but in improving its quality with a reasonable increase in its quantity, will be the state. NGOs of patients, even global ones, will fight only for ‘honest business’, but no more for matters in general beyond their competence and interests. To expect from them requirements to better organise the HCS or to introduce advanced medical techniques to increase the number of people is as naive as to expect from the mall visitors the claims that the store has requested for additional buyers. The patient is a natural marketer; he knows exactly the fact that if other things being equal, the prices are as low as possible when there are fewer buyers; that’s why the population is always sharply opposed to increasing its size at a rate at which this becomes evident.

Launched globalisation will lead to a more and larger percentage of patients being ‘shared’. By analogy with physics, which recognises that all objects in the universe (even the ones that we can not detect) attract each other proportional to their masses and inversely proportional to the square of the distance between them, now we can say that the entire population of the Earth (and even part of it living far beyond civilisation) is indirectly included in the pool of holders of the planetary health system that has formed before our eyes and which tries to regulate the same planetary market of health and insurance services. As an analogy of the mass here, it is the financial ability of the client, but as an analogy of distance, it is the degree of his accessibility for the system. It remains to find out what will be analogous of inertia in such representations. I propose to announce the degree of loyalty a patient has for outdated medical technologies the analogy of inertia, while such a loyalty is a function of his age and degree of financial ability, i.e., to be approximately the same relationship as the inertia and mass in physics. The accessibility, I suggest, is the physical accessibility of the patient (without this it is hard to provide medical and social services) and the accessibility of patient’s funds to use by the system.

As soon as competitors in the market of health and social services will go global, their competition will get new features, and, in particular, one can easily predict the following:

• Competitors will be interested to involve in the system more and more new customers; in the first place, the most affluent customers will be involved, regardless of their place of residence or citizenship. Thus, actors in this market will be indirectly interested in the fact that rich people will as much as numerous, and, in general, it is good.

• Competitors will seek to ensure that client’s funds are in the form most convenient for consumption of the system, for which they will lobby for changes at the state level. Such changes may lead to a decrease in the degree of client control over the expenditure of his own funds and a view in which they are, and, in general, it is bad.

• The process of establishing global medical and social markets will likely try and undergo all the stages double quickly, which passed large-scale machine production in the early twentieth century, with transnational mega-corporations, attempts to monopolise markets, lockouts in the form of mass rejection of support of large groups of patients, strikes by patients in the form of a mass refusal to pay the bills, and other charms of a little-regulated market. Any sudden movements at such a critical market for the population as the health care market is very bad, but for certain groups, it is even catastrophic. The only player at the outset who can lead a new emerging market in the civilised appearance will again be the state.

• Advertising on this new market will have features; as opposed to other goods and services, medical service can be tested by the client usually only once. Because the clients usually in such conditions cannot go to a competitor, competition tightens, respectively, and the pressure of advertising on its target audience will increase. The state here will need to intervene to protect the interests of clients in the early stages of market.
It is already seen that a difficult time is expected for the market of health and social services. In fact, it has already begun. Those countries that had begun to use new technologies not just of medicine but integrated chains of various medical and social technologies into one meaningful whole have abruptly pulled ahead in terms of providing additional value to their patients. What is the main additional value?

If you recall the birth of technologies of mass production of goods in the early Middle Ages, the main way to distinguish a quality product from an amateur forgery was the presence of trademark, which confirmed the qualifications of the master and his membership of the guild. Counterfeiting of trademark attracted severe punishment. Thus, the client no longer had to spend time for checking the quality of goods, but it was enough to see the trademark of a standard form. With the complexity of products, the ability of the client to personally evaluate the quality of goods fell, because for this, they needed to have sophisticated skills or create a special situation. How can you check the quality of the gun if you do not shoot out of it a few times? But what if you do not know how or cannot shoot? How can we determine the quality of a fabric, if we not wear it for many years? There is no other way to assess the quality of technologically sophisticated goods as entrusting it with its testing specialist. Thus, the responsibility for quality is automatically transferred from the individual master to the management of the relevant organisation that performs the quality control. What confirms the presence of trademark? It confirms that this master (or the whole team) produces consistently high-quality product. That master was able to get rid of the probabilistic results of the application technology of making this product, and its defects are minimal.

As described in the previous section, a university medical diploma at one time served as the trademark that allowed an even completely illiterate patient to easily distinguish a genuine doctor from the quack doctors, but it’s still not a guarantee of quality service. The current state of the market of health and social services and, in particular, modern management techniques as well as quality control of services pretty much allow the probabilistic nature of medical services results to be overcome, while the patient obtains a new added value of enormous size – stable (option: guaranteed) quality of chain of medical services which ends with the best possible outcome. It means quality control in the form of new medical brands come to the fore in the battle for the customer. But the clients due to their incompetence are deprived of the slightest opportunity to personally evaluate the very complex multi-component medical services and look for ‘trademark’. What namely does he look for now?

I think that a trademark now and in the foreseeable future will be performing the health systems of countries that were able to organise a continuous quality control of medical services in their territories. It is remarkable that this country does not necessarily have to be developed in the technological and purely medical sense. As always, when you go to a newly created market, competitors are on the same starting position, and past achievements hardly play a role. When Henry Ford applied the new principle of assembling cars, there was no technical innovation in this, but he was able to give the customer totally new quality and quantity of goods, which ultimately changed the whole country.

Thus, the name of the country turns into a trademark that guarantees the quality of medical and social services on the given territories. How long will it last? Probably not for long, because this technology is the so-called ‘open source code’, i.e. completely open to imitation. Dissemination of good management decisions in health care among states with political systems that will not prevent such borrowing will be held by historical standards immediately, and then only two brands will remain: a ‘system with quality control’ and ‘system without quality control’. It is logical to expect that the new system will gain instant victory; that is, there will be no appreciable period of the struggle because the old system has no chance to keep the position, but it will not disappear completely, like the cottage industry didn’t disappeared with the advent of robotic production lines. A man just likes to do something with their hands, showing his individual skills.

In the new system, the competition will take place already in the form of grinding of managerial techniques, in the struggle for a percent of successful results by reducing unproductive expenditures, for ‘best design of medical services’, that is, already semi-medical values, as well as in duration and ubiquity of ‘warranty’ of achieved results. Solitary handicraft medical providers remain to meet the needs of rare eccentrics who appreciate individual high art of the given physician at risk to get complications.
Next, in Chapter 5 in Implications for Individual Physicians, M. Porter and E. Teisberg wrote (p. 201):

• ‘Medical practice must be designed around value for patients, not convenience for physicians.’ Apparently, the author here implies that the owners of medical institutions (federal government, state governments, local communities, religious structures, and private owners) need some organisational efforts to oppose the doctors (and medics at all) who are trying to get the greatest return and are creating businesses just for this. It is the peculiarity of the United States that all doctors (with rare exceptions) and much of the nurses are self-employed private entrepreneurs, the whole meaning of the activity of which consists of obtaining the highest possible income in the current legislation. For the implementation of this conclusion, the author would have them all as employees that would just change their system of incentives but at the same time, if I’m not mistaken, come into conflict with the letter and spirit of the U.S. Constitution, which provides freedom of entrepreneurial activity for all citizens.

I see only one way to realise the author’s conclusion: deliberately pushing the patient and the doctor together in the same competitive field, namely, that the patient is able to demand and receive from the doctor the most value for his money – he must be a co-owner of medical structures and have a strong direct business mechanism to impact its functioning. The structure of the U.S. health care should be corporatised by patients, and one of the shareholders should be the state (governments at all levels), which also pursues its own, different from the patients, tasks of top-level management.

• ‘The business of physicians is addressing medical conditions, not performing a specialty. Physicians must understand what different businesses they are in.’ Here, authors are trying to force the current physicians to become specialists in one or two diseases, but this situation the medical community is still considered a sign of low professionalism or even degradation. It’s not so much a market problem as the problem of physicians’ psychology. Centuries-old medical tradition involves a large element of universalism in this profession; a couple of hundred years ago, the concept of medical specialisation did not exist, yet the entire medical world was divided into surgeons and therapists. Now, M. Porter offers the next step in the specialisation of medical staff and its division into competing enclaves with various professional and business interests, which would automatically lead to the disappearance of the physician’s profession, as we know it currently. The word ‘doctor’ will remain, but it will mean absolutely different. This has already happened in the past with the profession ‘engineer’. Remember the universal engineer Cyrus Smith from the novel Mysterious Island by Jules Verne? And so these universal engineers are long gone, and in terms of contemporaries of Jules Verne, current engineers are not engineers; they are just professionals to develop extremely narrow classes of devices and structures. Market for design has matured and forced engineers to split into narrow specialties. Unlike doctors, engineers were not a clan with centuries-old professional traditions, and so, for them this division was painless. Specialisation of the medical staff in the patient’s medical conditions is a very painful step for most doctors, but it’s inevitable, and the authors are probably right. Customers with their money will force doctors to take the next step in their specialisation, not for this, but for the next generation of doctors. Just keep in mind that this specialisation is not the last; there is specialisation in the age of the patients, in their professional ‘profile’, on race and genotype, the geography of residence, type of environment and climate, and their combinations.

• ‘Patient value comes from expertise, experience, and volume in particular medical conditions. Physicians must choose those medical conditions in which they will participate and achieve true excellence, rather than try to do a little of everything.’ I think the authors here are offering to split the proposal on market sectors before the splitting of demand happens. One can imagine a situation where a man in the late nineteenth century, wanting to buy a car, asks: ‘Do you want sports car, SUV, or family coupe?’ The client does not understand the question and says that he just wants to drive. In another situation, a customer comes into the store, just knowing that he needs a coffee mill. But at the entrance, he meets the manager who has a psychologist diploma. He stares into the customer’s eyes and says that he, as a professional, believes that he needs a meat grinder. And the customer humbly agrees to pay for the meat grinder. Does this not remind you of our health care facilities? Before starting to compete for clients at the level of medical conditions, a doctor must undertake the set of measures, sometimes on the verge of detective investigation, in defining this medical condition. In such a situation, the narrow specialist is unproductive, especially if you have to differentiate a dozen fundamentally different medical conditions. Even now, in the presence of medical specialists universal in its field, the complex differential diagnosis often turns into a long process with nonzero probability of failure. How can the diagnostic process be built in the world where the doctors are divided and compete at the level of medical conditions, i.e. separate disease entities or its narrow groups? All of these specialists may take time in the diagnostic process as a sequential bypass, which is critical for timely assistance. Apparently, the diagnostics, as a form of medical practice, will have to be separated and excluded from the general field of competition, otherwise collusion between the narrow specialists and group that diagnoses medical conditions may happen. Do you remember the aforementioned manager that offered the meat grinder? Can anyone believe that he offered it unselfishly?

Another problem is the problem of full coverage of medical conditions. The fact is that they are clearly not equivalent in terms of complexity, time required for diagnosis, and treatment. In addition, they are very different in the effectiveness of therapeutic measures and the percentage of successful outcomes. What happens if the doctors in some area or the country will en masse specialise in the direction of the easiest medical conditions in terms of business? Who will do the treatment of labour-intensive and rare medical conditions? Who in such circumstances would impose on doctors the treatment of conditions that are unfavourable to them? Now such a covering happens because of the universality of physicians within their specialty; that is, after treating some unfavourable patient, the doctor immediately goes to the next favourable patient and makes up for lost profits. The imposition of such patients happens at the moment of splitting of the general medical field into narrow specialisations. If the doctors will determine the areas in which they are most effective on their own, it is almost guaranteed that all the areas that are uncomfortable for the treatment of medical conditions would be left out. Even if a doctor tries to specialise in such medical conditions, he will inevitably lose in the competition for the customer, because after developing the individual patients with this pathology in his area, he will be forced to become a nomad in search of casual patients. ‘Shipping’ patients to the narrow-specialised doctors will be several times more expensive than conventional wholesale delivery of goods to remote residence places – this is a feature of the market of health and social services, where not the goods are transported but namely the customers themselves.

• ‘Health care value is maximised by an integrated team, not individuals acting and thinking as free agents. Physicians must know what team or teams they are part of, and ensure that these are functioning as teams.’ It seems to me that this phrase of the authors slightly exaggerates the situation. Certainly, service that is provided by a team will generally be fuller and better than the same provided by the single specialist. The question is: How it will affect the price of such services? Whether the entire cost of such integrated medical services will be approved by the patient as a thing he really needed and as exactly what he expected? The value of medical services for the patient is a complex set of factors such as quality of service, its price, the time needed for providing the service, his psychological comfort, waiting time, confidentiality, and much and much more. Do we not get the situation where by improving the quality of care we reduce other components of its value? I think that it will be better to stick to the principle of reasonable sufficiency.

Another problem is that narrow specialists belonging to different teams specialising in different medical conditions can and likely will compete with each other for the client because of the fact that they remain free agents in the market. The most valuable professionals become a bone of contention between the teams, which will lead to the fact that every team wants to have its own exclusive narrow specialist. The market of medical education will respond as it is accepted in the market: will start overproduction of narrow specialists compared with today; that is, if the number of doctors will be more, then their income will decrease. Thus, the application of such a principle can make the doctors oppose such changes.

• ‘Physicians rarely have full control over the value delivered to patients, but are part of care cycles. They need to know what care cycles they are involved in, and how to integrate care with both upstream and downstream entities to ensure good patient results.’ The authors here, in my opinion, want to entrust the doctors with the role of system integrators who develop and maintain the ‘interface’ for a smooth and predictable interaction between professionals that make up the team and in between teams. I believe that the narrow specialist cannot be a system integrator in this case, as he will try to do administrative functions not intended for him, and even at the level at which he found himself. The more narrow specialist is the physician, the less he will be fit for the role of system integrator. This is a specific task of higher level management.

• ‘Physicians have no right to provide care without demonstrating good results. Results should be made available to patients, other providers, and health plans as soon as measurement is reliable.’ Requiring is absolutely reasonable, but we will need to precisely define the words ‘good results’; other health care workers may be subjected to targeted harassment, which is a type of competition under the banner of increasing value to the patient. First of all, we should understand they have to measure the results achieved by a physician or as a team relative to what or whom. Can we now compare the results of the example of Turkish and American cardio surgeons? Would it not be that after this Turkey would immediately close all cardiac clinics and stop all attempts to establish this type of specialised care? Is it fair to Turkish patients? Is it an acceptable comparison of the results of a specialised private cardiac clinic somewhere in New York City with the results of a small university clinic of the same profile somewhere in the outback USA? And how do we assess the value of such care for the health of the patients from the provinces, if it turns out that for this added value, they have to travel across the country to New York City and get it in a private clinic for a much higher price?

• ‘Physician referrals should be based on excellent patient results, together with the ability of referred providers to share information and integrate care across the entities involved in the care cycle.’ Translating this requirement of the authors in ordinary language, we can say that the doctor should do analytical work to determine the degree of openness of the work of their colleagues (by what criteria?), the accuracy of this information (by what means and powers?), to build a registry of achievements (only now – on a global scale), knowing which care cycles his colleagues of other specialties are involved in and what is the degree of integration of his colleagues in these care cycles. Does it not seem to you that this activity, to say the least, is unusual for a doctor? From my perspective, this work is the power of a group of specialists, analysts, marketers, and system integrators, organised into a kind of national office with the prospect of transformation into a global organisation for the control of the quality of care. To require this from private practitioners, it means to try and discourage him from professional development, time for which does not remain.

• ‘Electronic records and the ability to exchange and share information are indispensable to excellent medical practice. Physicians will limit effectiveness unless they wholeheartedly embrace IT.’ The question about the form of reports he sends to the doctors in regulatory agencies and to his colleagues is only a matter of speedy decision-making in the health care field. Exchange of information happens anyway and management decisions will be made anyway, but in today’s world, it is critical, namely, the speed of the decision-making process. Avoiding the use of the fastest ways to share information is just as amazing as the attempts to control the country through the mails, which are carried in postal stagecoaches on the condition that you have a valid airmail and phone. The fact that many doctors do not use the electronic methods of information exchange is the result of the fact that in a professional environment there is no public demand for results in fast information integration of this environment because these results are not needed by doctors, so they do not increase their income and social status. This question is not for a doctor; it is a question to a state which does not expect (as opposed to patients) a significant improvement in the quality of medical services by introducing more rapid ways of information exchange.

• ‘Physicians must seek out partnerships and relationships with excellent providers in their areas of practice in order to access knowledge and improve the integration of patient care.’ I believe this point is the most controversial. The main competitor of the modern doctor is his colleague, coinciding with specialisation and servicing the same pool of patients. Can you imagine the car corporation, which, referring to marketing research to improve the quality and after sales service of manufactured vehicles, suddenly began to build integration with other car corporations which were in the same market segment? And most importantly, will it open its technological developments for the greater integration for counterparts? Such processes in the business are called as mergers and acquisitions, and such things happen, as a rule, not voluntarily. In fact, the authors proposed to begin the process of creating corporations or medical cartels, which would virtually monopolise the local market of medical services for selected medical conditions. Firstly, such a practice is forbidden by antitrust law in many countries, and secondly, the first thing that happens after such a monopoly is the rapid rise in prices for treatment of above-mentioned medical conditions. The customer and his insurance company, as I indicated above, are practically deprived of the opportunity to try a particular medical service from different providers (as is observed in the production of ordinary goods and services); thus, they immediately become dependent on the producer of medical services closest to them, from which the customer will not be able to escape (as opposed to an insurance company that can change the provider). Thus, the only victims of such a market of medical conditions that is super-monopolised and artificially divided into small sectors will be patients.

Summing up, I agree with the basic provisions of M. Porter and E. Teisberg, where the general directions of changes in the future health care are shown correctly, in particular, the fact that the market of health and social services will be mature and divided into sectors within each medical specialty. The division will be based on medical conditions which are the most suitable for organisations of full cycle business processes with quality control to deal with the probabilistic nature of the medical service results. Following the segmentation of demand, segmentation of proposal will be logical; that is, the professional field of doctors and nurses in the next generation will begin to specialise in the treatment of medical conditions, a list of which will dictate the market. Next to this, the market of medical education will start to be segmented, which will produce much more narrow specialists than even today, but they will call them ‘physicians’ like before.

At the same time, the complex processes of extrusion of private insurers out of health care businesses and increasing the shifting of social insurance functions to the state and its subdivisions will take place. The state will more clearly show their social interest in the quality of health services and their cost and start with those medical conditions that are the first to come to the form of individual market segments with reliable quality control. After a while, the state will start to standardise the form in which current and future patients keep their funds in order to enable the health system to use them immediately, without lengthy procedures and delays. It is unlikely that this will be a special mega-community foundation; most likely it will be a new form of money, something like a virtual cash equivalent. Health insurance as a form of business in developed countries pretty quickly wanes, and this kind of competition will disappear in the near future. Market actors of health care and social services will more realistically envision the essence of the processes and predict the consequences of their activities in the medium and long term.

Patients for more effective control of the business chains and the quality of treatment will stimulate the processes of corporatisation of medical institutions and with the participation of the state force medical staff to implement a quality control system even for those medical conditions that are not quite suitable for this purpose in terms of medical business, achieving the highest coverage of the market and overcoming the resistance of conservative physicians with compensations and benefits. Patient in these circumstances will consider an attempt to treat him without quality control as an attempt to premeditated murder. States acting as the brands of health care systems will directly and openly compete with each other for complete coverage of medical conditions in the new quality control system, and the competition can lead to a kind of expansion; that is, more medically developed countries will provide assistance to people with certain medical conditions also not on its territory. In fact, this process has already begun. Providers of medical services will start to compete not so for the money of patients but more so for the mere fact of its existence in the system of quality control. Rare medical conditions and physicians who treat them will not fall into the new system; thus, they will be marginalised in the public consciousness of the next generation of patients, because they will look like artisans.

Managing the medical and social processes as a type of business with strict quality control and predictable results will be a very profitable service, as demanded by individual medical providers and entire states. We can predict an explosion of interest in new methods of quality control in medicine and marketing of health and social care services that are currently in the budding stage. At some stage, such management services will appear far more expensive than the actual treatment of medical conditions. Patients in the system in which the highest possible quality is guaranteed will compete for the opportunity to save their virtual money in choosing the right provider, which will offer the most comprehensive medical services for longer life of the customer and high quality of his life. At a certain stage of development of such a market, a new kind of competition for the new critical indicator will arise – extra years of life for patients and their more numerous progeny.
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Äóæå ñïîä³âàºìîñü, ùî åêñåïðòè çìîæóòü çàáåçïå÷èòè åôåêòèâíå âïðîâàäæåííÿ ðåôîðìè â Óêðà¿í³. гøåííÿ ïîòð³áí³ äîñèòü øâèäê³.
http://www.kmu.gov.ua/control/publish/article?art_id=247499681
  Òåìà: Ìåäèöèíñêàÿ ôóòóðîëîãèÿ - Ìåäèöèíñêàÿ èñòîðèÿ ÷åëîâå÷åñòâà
AndreyN

Îòâåòîâ: 72
Ïðîñìîòðîâ: 100691

ÑîîáùåíèåÔîðóì: Êíèãè   Äîáàâëåíî: Ñá Ñåí 28, 2013 7:57 pm   Òåìà: Ìåäèöèíñêàÿ ôóòóðîëîãèÿ - Ìåäèöèíñêàÿ èñòîðèÿ ÷åëîâå÷åñòâà
Øâåéöàðñêèõ áåäíÿêîâ íà ñòàðîñòè ëåò ïðåäëàãàþò "ññûëàòü" â Ìàðîêêî
MIGnews.com.ua
http://mignews.com.ua/ru/articles/146114.html

Äåïóòàò Íàðîäíîé ïàðòèè Øâåéöàðèè Èâ Íèäåããåð ðåøèë âîïëîòèòü â æèçíü ìå÷òó êàæäîãî ïåíñèîíåðà - íà ñêëîíå ëåò ãðåòüñÿ íà ñîëíûøêå íà áåðåãó ìîðÿ. Îí ïðåäëîæèë ñîçäàòü íåáîëüøîé øâåéöàðñêèé àíêëàâ â Ìàðîêêî, êóäà áóäóò ïåðååçæàòü ìàëîèìóùèå ïåíñèîíåðû. Îí äàæå âûáðàë ìåñòî äëÿ øâåéöàðñêîé êîììóíû – ðÿäîì ñ ãîðîäîì Òàí-Òàí, â 330 êì þæíåå Àãàäèðà, êàê ðàç íàïðîòèâ Êàíàðñêèõ îñòðîâîâ.

Èäåÿ Èâà Íèäåããåðà, êîòîðóþ îí ñîáèðàåòñÿ âûíåñòè íà ðåôåðåíäóì, çàêëþ÷àåòñÿ â òîì, ÷òîáû ïðåäëîæèòü íàèìåíåå îáåñïå÷åííûì øâåéöàðñêèì ïåíñèîíåðàì, ïîëó÷àþùèì ñîöèàëüíóþ ïîìîùü, ïåðååõàòü â Ìàðîêêî, ãäå ïðîæèâàíèå è ìåäèöèíñêîå îáñëóæèâàíèå îáõîäÿòñÿ ãîðàçäî äåøåâëå. Òàêèì ñïîñîáîì ïîëèòèê íàäååòñÿ ðåøèòü ñðàçó íåñêîëüêî ïðîáëåì – îò êðèçèñà íà ðûíêå íåäâèæèìîñòè äî ðàñòóùèõ ðàñõîäîâ ìóíèöèïàëèòåòîâ íà îêàçàíèå ñîöèàëüíîé ïîìîùè.

Ïîñëå "âûñûëêè" ïåíñèîíåðîâ íå ëèøàò ãîñïîääåðæêè, òàê êàê æèòåëè "øâåéöàðñêîé äåðåâíè" â Ìàðîêêî áóäóò ïî-ïðåæíåìó ñ÷èòàòüñÿ ãðàæäàíàìè Øâåéöàðèè. Íî òàê êàê ñòîèìîñòü ìåäèöèíñêîãî îáñëóæèâàíèÿ, êàê è æèëüÿ, â Ìàðîêêî íåñðàâíåííî íèæå, òî èç ãîñáþäæåòà Øâåéöàðèè ñîöèàëüíûå âûïëàòû áóäóò ãîðàçäî íèæå, ÷òî ãîñóäàðñòâó î÷åíü âûãîäíî.

Ïðîåêò æåíåâñêîãî ïîëèòèêà ïîçâîëèò ñîçäàòü â Ìàðîêêî äîïîëíèòåëüíûå ðàáî÷èå ìåñòà, ïîýòîìó äåïóòàò ðàññ÷èòûâàåò ïîëó÷èòü ïîääåðæêó ìàðîêêàíñêèõ âëàñòåé è ëè÷íî êîðîëÿ Ìóõàììåäà VI. Èâ Íèäåããåð óæå äâàæäû åçäèë â Ìàðîêêî è ãîâîðèò, ÷òî ìåñòíûå âëàñòè áëàãîñêëîííî ïðèíÿëè åãî ïðåäëîæåíèå.

Îòìåòèì, ÷òî Ìàðîêêî - îäíî èç èçëþáëåííûõ ìåñò îòäûõà øâåéöàðöåâ. Ê ñëîâó, îòåö íûíåøíåãî êîðîëÿ Ìàðîêêî, Õàñàí II, áóäó÷è îäíèì èç ñàìûõ áîãàòûõ ëþäåé ïëàíåòû, èìåë äåñÿòêè äâîðöîâ è ðåçèäåíöèé ïî âñåìó ìèðó, â òîì ÷èñëå è â Øâåéöàðèè.

Äåïóòàò Íèäåããåð óâåðåí, ÷òî ïåíñèîíåðû áóäóò äîâîëüíû. "Åñëè êîìó-íèáóäü â âîçðàñòå îò 65 äî 80 ëåò ïðåäëîæàò âûáîð ìåæäó äâóõêîìíàòíîé êâàðòèðîé â Ïàêè (íå ñàìûé áëàãîïîëó÷íûé ðàéîí Æåíåâû) è íåáîëüøèì äîìèêîì íà áåðåãó ìîðÿ â îêðóæåíèè âíèìàòåëüíûõ ïîìîùíèêîâ, ýòîò ÷åëîâåê âûáåðåò âòîðîé âàðèàíò", - ñ÷èòàåò äåïóòàò, îòìå÷àÿ, ÷òî åãî ïðîåêò îðèåíòèðîâàí â ïåðâóþ î÷åðåäü íà ìàëîîáåñïå÷åííûõ ïåíñèîíåðîâ.

Èäåÿ îòïðàâëÿòü ïåíñèîíåðîâ â áëàãîóñòðîåííûå öåíòðû çà ãðàíèöåé íå íîâà. Äåñÿòêè òûñÿ÷ íåìåöêèõ ñòàðèêîâ æèâóò â Âåíãðèè è Ñëîâàêèè, ãäå ìåäèöèíñêîå îáñëóæèâàíèå äåøåâëå, ÷åì â Ãåðìàíèè. Íî, ñîãëàñíî èññëåäîâàíèþ ñòðàõîâîé êîìïàíèè Swiss Life, òîëüêî 9% øâåéöàðñêèõ ïåíñèîíåðîâ õîòåëè áû ïåðååõàòü æèòü çà ãðàíèöó. Îñòàëüíûå õîòåëè áû æèòü íà ðîäèíå: 66% ìå÷òàþò î æèçíè â äåðåâíå, 25% - ãîòîâû îñòàòüñÿ â ãîðîäå.

Ïðåäëîæåíèå äåïóòàòà ïîêà âûçâàëî íåãàòèâíûå ðåàêöèè, òàê êàê íåïîíÿòíî, íàñêîëüêî äîáðîâîëüíûì áóäåò òàêîé ïåðååçä ìàëîîáåñïå÷åííûõ ïåíñèîíåðîâ â Ìàðîêêî.
  Òåìà: ÝÊÑÒÐÅÍÍÀß ÏÎÌÎÙÜ: ÐÅÔÎÐÌÀ ÈËÈ ÒÅÐÐÎÐ ÄËß ÌÅÄÈÊÎÂ
AndreyN

Îòâåòîâ: 0
Ïðîñìîòðîâ: 3551

ÑîîáùåíèåÔîðóì: Ïðåññà Óêðàèíû î ðîäíîé ìåäèöèíå   Äîáàâëåíî: Ïí Ñåí 16, 2013 9:19 am   Òåìà: ÝÊÑÒÐÅÍÍÀß ÏÎÌÎÙÜ: ÐÅÔÎÐÌÀ ÈËÈ ÒÅÐÐÎÐ ÄËß ÌÅÄÈÊÎÂ
ÝÊÑÒÐÅÍÍÀß ÏÎÌÎÙÜ: ÐÅÔÎÐÌÀ ÈËÈ ÒÅÐÐÎÐ ÄËß ÌÅÄÈÊÎÂ
http://innocentsukr.blogspot.com/2013/09/blog-post_7272.html

Ôèíàíñîâûå íàêàçàíèÿ ñîòðóäíèêîâ ñêîðîé â Êèåâå, óâîëüíåíèÿ ìåäèêîâ â Õàðüêîâå, íåäàâíèå ïðîòåñòû ñêîðîïîìîùíèêîâ â Ñóìàõ è Îäåññå, à òàêæå íåäîâîëüñòâà â äðóãèõ ãîðîäàõ Óêðàèíû, çàñòàâëÿþò çàäóìàòüñÿ, êàê æå íà ñàìîì äåëå ïðîèñõîäèòü ðåôîðìèðîâàíèå ñëóæáû ñêîðîé ïîìîùè è êàêîé öåíîé ïðèõîäèòüñÿ ðàñïëà÷èâàòüñÿ ìåäèêàì çà ñàìîäóðñòâî ÷èíîâíèêîâ íà ìåñòàõ.

Òàê, ñîâåðøåííî íåîäíîçíà÷íàÿ ñèòóàöèÿ ñëîæèëàñü â ãîðîäå Õàðüêîâå, ãäå â îáëàñòíîì öåíòðå ýêñòðåííîé ìåäèöèíñêîé ïîìîùè, íà ñåãîäíÿøíèé äåíü, óâîëèëîñü óæå 80 ÷åëîâåê ñîòðóäíèêîâ. Èç ñîîáùåíèÿ ñîòðóäíèêà Õàðüêîâñêîé ñêîðîé ïîìîùè, àêòèâíîãî ïðîôñîþçíîãî äåÿòåëÿ Âèòàëèÿ Áåëîóñà, ñòàëî èçâåñòíî, ÷òî óñëîâèÿ ðàáîòû óõóäøàþòñÿ äî íåâîçìîæíîñòè, áðèãàä êàòàñòðîôè÷åñêè íå õâàòàåò, ìåäèêîâ ïðîñòî-íàïðîñòî ýêñïëóàòèðóþò êàê õîòÿò, áîëüøîé íàïëûâ âûçîâîâ, à àâòîòðàíñïîðò è îáîðóäîâàíèå îñòàâëÿåò æåëàòü ëó÷øåãî.

Èìååòñÿ èíôîðìàöèÿ, ÷òî óâîëèâøèåñÿ ñîòðóäíèêè ÷àùå âñåãî ïèøóò çàÿâëåíèÿ «ïî ñîáñòâåííîìó æåëàíèþ», à êòî ïûòàëñÿ íàïèñàòü â çàÿâëåíèÿõ îá íåñîîòâåòñòâóþùèõ óñëîâèÿõ òðóäà, òî òå ëþäè â äàëüíåéøåì èìåëè ïðîáëåìû ñ äîêóìåíòàì è òðóäîóñòðîéñòâîì íà äðóãîå ìåñòî ðàáîòû.

Òàêæå Âèòàëèé ñîîáùèë, « -íåãàòèâíûõ ôàêòîâ äîñòàòî÷íî ìíîãî, âñå îíû èçëîæåíû â ñîîòâåòñòâóþùèõ çàÿâëåíèÿõ è îòïðàâëåíû â ïðîêóðàòóðó è Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Óêðàèíû. Ïîêà ðåàêöèÿ íóëåâàÿ…»

Íå ìåíåå ïå÷àëüíóþ èíôîðìàöèþ ñîîáùèë âðà÷ Êèåâñêîé ñòàíöèè ñêîðîé ïîìîùè, Ïðåäñåäàòåëü Íåçàâèñèìîãî ïðîôñîþçà ðàáîòíèêîâ ýêñòðåííîé (ñêîðîé) ìåäèöèíñêîé ïîìîùè Ìàêñèì Èîíîâ. «-Ìíå ïîñ÷àñòëèâèëîñü ïîáûâàòü íà îäíîì èç ñîâåùàíèé, ãäå ãëàâíûé âðà÷ ñ ïðîíçèòåëüíîé íàñòîé÷èâîñòüþ çàÿâèë, ÷òî «- ìû íèêîãî íå äåðæèì è óäåðæèâàòü íå ñîáèðàåìñÿ, êîìó óãîäíî ìîãóò èäòè ðàáîòàòü êàññèðàìè â ìàãàçèí «Ñèëüïî»…». Ïðè ýòîì îí îçâó÷èë çàðàáîòíóþ ïëàòó âðà÷åé è ôåëüäøåðîâ, êîòîðóþ íè ÿ, íè ìîè êîëëåãè íèêîãäà íå ïîëó÷àëè. Âîçìîæíî íàì ãîñóäàðñòâî è äàåò çàðïëàòó ñâûøå 4 òûñÿ÷ ãðèâåí, íî íàêàçàíèÿ è îò÷èñëåíèÿ èç íàøåé «êðîâíîé» íàäáàâêè çà èíòåíñèâíûé òðóä ðåãóëÿðíî ñíèìàþòñÿ.  èòîãå íà ðóêè äîõîäèò – ïðîæèòî÷íûé ìèíèìóì».

Íàäáàâêè ñíèìàëèñü è áóäóò ñíèìàòüñÿ.  ýòîì ãëàâíûé âðà÷ ñòîëè÷íîé ñêîðîé îñòàâèë âñåõ áåç ñîìíåíèÿ. Ìíîãî ðàçðåêëàìèðîâàííàÿ è îçâó÷åííàÿ åù¸ âíà÷àëå 2013 ãîäà ñåíñàöèÿ ïðî óâåëè÷åíèå çàðàáîòíîé ïëàòû ñîòðóäíèêàì ñèñòåìû ýêñòðåííîé ìåäèöèíñêîé ïîìîùè ïî÷òè íà ïîëîâèíó, îêàçàëàñü íàäáàâêîé â 40%, êîòîðóþ òàêæå áóäóò îòíèìàòü.

«-Êàê çàÿâèëîñü, óæå ðàçðàáîòàíû ôîðìóëû ïî êîòîðûì 20% èç 40% áóäóò âûñ÷èòûâàòüñÿ ñ èñïîëüçîâàíèåì òåðìèíà «èíäèâèäóàëüíûå ïîêàçàòåëè â ðàáîòå», êîòîðûé íå ïðîïèñàí íè â Çàêîíå «Îá ýêñòðåííîé ìåäèöèíñêîé ïîìîùè», íè â ïîñòàíîâëåíèè Êàáèíåòà Ìèíèñòðîâ, à ïðèäóìàíà íàøåé àäìèíèñòðàöèåé. Ïî ñóòè, ýòî îêàæåòñÿ î÷åðåäíîé ñèñòåìîé ïðèäèðîê ê ðàáîòíèêàì».

«-Ñòðåìëåíèÿ àäìèíèñòðàöèè ïîíÿòíû. Îíè âèäÿò âðà÷åé ñêîðîé ïîìîùè, òîðãóþùèõ «íà áàçàðå ðûáîé» (öèòàòà). Ïîýòîìó íà ñåãîäíÿøíèé äåíü, íà ñòîëè÷íîé ñêîðîé íàñòîëüêî æåñòêèé ïðåññèíã ñîòðóäíèêîâ, îñîáåííî âðà÷åé, ÷òî ÿ áû ñêîðåå íàçâàë ýòî áîëåå ðåàëüíûì ñëîâîì – òåððîð! Õî÷ó çàìåòèòü, ÷òî åù¸ áîëåå ãîäà íàçàä ÿ ãîâîðèë íà ìíîãèõ ïðåññ-êîíôåðåíöèÿõ, ÷òî èäåò íåãëàñíîå èñòðåáëåíèå âðà÷åé ñî ñêîðîé ïîìîùè. Âîò è áóäåò âèäíî, ÷òî â áëèæàéøåå âðåìÿ, îò âðà÷åé íà ñêîðîé áóäóò èçáàâëÿòüñÿ âñåìè âîçìîæíûìè ñïîñîáàìè».

«-Òàê, íàñ íàêàçûâàþò çà äîåçäû íà ïðîñòóäû è ïåðåâîçêè íå â 10 ìèíóò, à çà 12 ïî ôàêòó, â òî âðåìÿ êàê ñåðäå÷íûå ïðèñòóïû è ñóäîðîãè ó äåòåé ïðè òåìïåðàòóðàõ ïðîñòàèâàþò è æäóò áëèæàéøóþ îñâîáîäèâøóþñÿ ÂÐÀ×ÅÁÍÓÞ áðèãàäó. Áîëåå òîãî, ïîïóëÿðíûì ñòàíîâèòñÿ íàêàçàíèÿ çà ñïàñåíèå ëþäåé è îêàçàíèå ïîìîùè ëþäÿì â ýêñòðàîðäèíàðíûõ ñèòóàöèÿõ».

Ê ïðèìåðó, ñ ìåíÿ ñíÿëè 50% íàäáàâêè, çà òî, ÷òî ÿ îêàçûâàë ïîìîùü òÿæåëîìó ðåáåíêó â ïðèåìíîì îòäåëåíèè áîëüíèöû, à ïî ìíåíèþ àäìèíèñòðàöèè ÿ äîëæåí áûë áðîñèòü ðåáåíêà íà ãëàçàõ ó ðîäèòåëåé è ñâîèõ êîëëåã, ðàçâåðíóòüñÿ è óåõàòü. Âîò òàêîé ïîäõîä ê îêàçàíèþ ïîìîùè. Ïðè÷åì ïðèêàç íà ìîå íàêàçàíèå áûë ïîäïèñàí çàäíèì ÷èñëîì, äîæäàâøèñü ïîêà ÿ óéäó â îòïóñê. Çàòî «ïðîêàïûâàòü» ÷èíîâíèêîâ è îñóùåñòâëÿòü ïåðåâîçêè ïî äîãîâîðåííîñòÿì ñ íà÷àëüñòâîì ìû äîëæíû ïî 2 è áîëåå ÷àñà…

Äðóãîé ïðèìåð, áîëåå ñêàíäàëüíûé, êîòîðûé ðàçáèðàëñÿ íà óðîâíå êîëëåãèè ãëàâíîãî óïðàâëåíèÿ çäðàâîîõðàíåíèÿ ãîðîäà Êèåâà, ýòî îêàçàíèå ïîìîùè ãðàæäàíêå Ðîññè, èç-çà êðîâîòå÷åíèÿ ó êîòîðîé ïðèøëîñü ïîñàäèòü ñàìîëåò â àýðîïîðòó «Áîðèñïîëü». Çà ñïàñåíèå æèçíè êîòîðîé, âðà÷à Í. ïîäñòàíöèè ¹9 íàêàçàëè âûãîâîðîì, à ýòî ñíÿòèå âñåõ íàäáàâîê è ïðåìèé íà öåëûé ãîä.  ðåçóëüòàòå ÷åãî âðà÷ ïîïàë â áîëüíèöó ñ íàðóøåíèåì ðèòìà ñåðäöà.  äàííûé ìîìåíò îôîðìëÿåò èíâàëèäíîñòü. «Æåëòûé» è ïðîäàæíûé ïðîôñîþç äîêòîðà ïîääåðæàòü îòêàçàëñÿ, òàê êàê ïðèêàç íà âûãîâîð åìó áûë ïîäãîòîâëåí çàðàíåå, è äàæå êîëëåãèÿ ÃÓÎÇ Êèåâà íà ýòî íå ïîâëèÿëà, òàê êàê – «ìàôèÿ áåññìåðòíà»…

Ïî ýòèì äâóì ñëó÷àÿì ãîòîâÿòñÿ ðàçáèðàòåëüñòâà â ñóäå, ïîòîìó ÷òî íåïîíÿòíî, ìû äîëæíû îêàçûâàòü ïîìîùü ëþäÿì èëè çàíèìàòüñÿ ïðèïèñêàìè â 10 ìèíóò. À ñêîëüêî òàêèõ ïðèìåðîâ, ïî êîòîðûì ìåäèêè ïðîñòî íèêóäà íå îáðàùàþòñÿ è ïðîñòî ñìèðÿþòñÿ ñ òåì, ÷òî ñèñòåìà àäìèíèñòðàöèè âñå ðàâíî çàäàâèò!?

Âðà÷ Ìàêñèì Èîíîâ äîáàâèë, «-ïîäíÿòü íåêîòîðûå íàáîëåâøèé âîïðîñû ìû ïðîáîâàëè íà íåçàâèñèìîé ïðîôñîþçíîé êîíôåðåíöèè, î ÷åì áûëî îãîâîðåíî ñ ãëàâíûì âðà÷îì ñòîëè÷íîé ñêîðîé, íî âìåøàëèñü «æåëòûå» ïðîôñîþçû, êîòîðûå çàÿâèëè, ÷òî ó íàøèõ ñîòðóäíèêîâ íèêàêèõ ïðîáëåì íåò, áîëåå òîãî, áûëî çàâÿëåíî, ÷òî ó áîëüøèíñòâà ðàáîòà íà ñêîðîé ýòî âñåãî ëèøü ïîäðàáîòêà è âñåì âñ¸ ðàâíî íà îòñóòñòâèå èëè ïðèñóòñòâèå ïðîöåíòíûõ ñòèìóëèðóþùèõ íàäáàâîê. Ìîë, ëþäè è òàê ðàáîòàþò íà 2-3-õ ðàáîòàõ. Âîò òàêàÿ ôàðèñåéñêàÿ ïîçèöèÿ ïî çàùèòå íàøèõ ìåäèêîâ».

«- À êîíôåðåíöèþ ìû âñå ðàâíî ïðîâåäåì, õî÷åò ýòîãî êòî-òî èëè íåò».

« -Õî÷ó îòìåòèòü, ÷òî íåäàâíî ïðèíèìàë ó÷àñòèå â çàñåäàíèè îáùåñòâåííîãî ñîâåòà ïðè Ìèíèñòåðñòâå çäðàâîîõðàíåíèÿ Óêðàèíû, ãäå âûñòóïàë îäèí èç çàì.ìèíèñòðîâ, êîòîðûé íà êðèòèêó â ñòîðîíó ðåôîðìû îòâåòèë: «ìû çíàåì î ïðîáåëàõ â ðåôîðìå, îíè ïðîèñõîäÿò èç-çà äåÿòåëüíîñòè ãëàâíûõ âðà÷åé è àäìèíèñòðàöèè íà ìåñòàõ….»

(ñ) Àðèé Ïàõàðü
  Òåìà: Â Óêðàèíå èñ÷åçíóò áóìàæíûå ìåäèöèíñêèå êàðòî÷êè
AndreyN

Îòâåòîâ: 1
Ïðîñìîòðîâ: 3440

ÑîîáùåíèåÔîðóì: Íîâîñòè èç ÌèíÇäðàâà   Äîáàâëåíî: Ñð Ñåí 11, 2013 5:08 pm   Òåìà:  Óêðàèíå èñ÷åçíóò áóìàæíûå ìåäèöèíñêèå êàðòî÷êè
 Óêðàèíå èñ÷åçíóò áóìàæíûå ìåäèöèíñêèå êàðòî÷êè
MIGnews.com.ua
http://mignews.com.ua/ru/articles/145094.html

Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Óêðàèíû âíåäðÿåò Âñåóêðàèíñêèé ýëåêòðîííûé ðååñòð ïàöèåíòîâ (ÝÐÏ), ïîñëå ÷åãî áóìàæíûå ìåäèöèíñêèå êàðòû â áëèæàéøåå âðåìÿ ñòàíóò èñòîðèåé. Îá ýòîì çàÿâèë çàìåñòèòåëü ìèíèñòðà çäðàâîîõðàíåíèÿ Ðîìàí Áîãà÷åâ.

"Ñ ïåðåõîäîì íà ýëåêòðîííóþ ñèñòåìó ñáîðà è õðàíåíèÿ èíôîðìàöèè îòîéäóò â ïðîøëîå è ïðîáëåìû, ñâÿçàííûå ñ áóìàæíûì ìåäèöèíñêèì êàðòàì. Ñåé÷àñ êàðòî÷êè õðàíÿòñÿ ïî ìåñòó æèòåëüñòâà ïàöèåíòà è ñ ýòèì ñâÿçàíû äîëãîâðåìåííûå áþðîêðàòè÷åñêèå ïðîöåäóðû. Òàêæå âîçíèêàþò òðóäíîñòè â ïðîöåññå ñáîðà àíàìíåçà, íàïðèìåð, êîãäà ïàöèåíò ïîïàäàåò â ó÷ðåæäåíèå çäðàâîîõðàíåíèÿ â íåîòëîæíîì ñîñòîÿíèè áåç ìåäèöèíñêîé êàðòî÷êè. Ïîðîé èç-çà ÷åëîâå÷åñêîãî ôàêòîðà áûâàþò ñëó÷àè ïîòåðè ìåäèöèíñêîé èíôîðìàöèè. Öåíòðàëèçîâàííûé ÝÐÏ ïîçâîëèò ðåøèòü ýòè âîïðîñû, ÷òî, áåçóñëîâíî, ïîâûñèò äîñòóïíîñòü ìåäèöèíñêîé ïîìîùè", - çàÿâèë Áîãà÷åâ.

Ïåðñîíàëüíûå äàííûå ïàöèåíòîâ áóäóò ðàçìåùàòüñÿ íà ñåðâåðíîì îáîðóäîâàíèè Ìèíçäðàâà Óêðàèíû, ÷òî ïîçâîëèò öåíòðàëèçîâàííî îáåñïå÷èâàòü êîíòðîëü çà èõ ñîõðàííîñòüþ. Òàêîå ðåøåíèå áûëî ïðèíÿòî íà îñíîâå àíàëèçà ðàáîòû ÝÐÏ â "òåñòîâîì" ðåæèìå â ïèëîòíûõ ðåãèîíàõ - Âèííèöêîé, Äíåïðîïåòðîâñêîé, Äîíåöêîé îáëàñòÿõ è ãîðîäå Êèåâå.

"Âíåäðåíèå ýëåêòðîííîãî ðååñòðà ïàöèåíòîâ àâòîìàòè÷åñêè ìîäåðíèçèðóåò ñëóæáó ìåäèöèíñêîé ñòàòèñòèêè, áëàãîäàðÿ êîòîðîé áóäåò âåñòèñü ó÷åò îáúåìîâ è ìîíèòîðèíã êà÷åñòâà ôàêòè÷åñêè ïðåäîñòàâëÿåìûõ íàñåëåíèþ ìåäèöèíñêèõ óñëóã. À ýòî îäíî èç óñëîâèé êîìôîðòíîãî ïåðåõîäà ê ñòðàõîâîé ìåäèöèíå", - îòìåòèë çàììèíèñòðà, ïåðåäàåò Èíòåðôàêñ-Óêðàèíà.

Âìåñòå ñ òåì, â ïðåññ-ñëóæáå ìèíèñòåðñòâà îòìåòèëè, ÷òî âíåäðåíèå ýëåêòðîííîãî ðååñòðà ïàöèåíòîâ - ëèøü îäèí èç ýòàïîâ èíôîðìàòèçàöèè çäðàâîîõðàíåíèÿ, êîòîðûé îñóùåñòâëÿåòñÿ ñ ïîìîùüþ ïðèâëå÷åíèÿ èíâåñòèöèé. "Ãëàâíûì èíâåñòîðîì ýòîì íàïðàâëåíèè ÿâëÿþòñÿ Âñåìèðíûé áàíê, êîòîðûé íå òîëüêî ôèíàíñîâî, íî è èäåîëîãè÷åñêè ïîääåðæèâàåò Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Óêðàèíû â íîâûõ ïðåîáðàçîâàíèÿõ", - îòìåòèëè â ïðåññ-ñëóæáå Ìèíçäðàâà.

Êàê ñîîáùàë MIGnews.com.ua, ðàíåå ìèíèñòð çäðàâîîõðàíåíèÿ Ðàèñà Áîãàòûðåâà çàÿâèëà, ÷òî â ñòðàíå ðàáîòàåò áîëüøå áîëüíèö, ÷åì ýòî íåîáõîäèìî íàñåëåíèþ: "Íàñ÷èòûâàåòñÿ 4,7 ëå÷åáíîãî çàâåäåíèÿ è 80 êîéêî-ìåñò íà 100 òûñ. ÷åëîâåê, õîòÿ â ñòðàíàõ Åâðîñîþçà ýòè ïîêàçàòåëè ñîñòàâëÿþò 2,6 è 65 ñîîòâåòñòâåííî". "Äàííûõ î çàêðûòèè áîëüíèö ó íàñ íåò, èíôîðìàöèÿ òàêîãî ðîäà íåîáúåêòèâíà. Ðå÷ü èäåò î ðåîðãàíèçàöèè ìåäó÷ðåæäåíèé äëÿ ôîðìèðîâàíèÿ ýôôåêòèâíîãî ìàðøðóòà ïàöèåíòà", – ñîîáùèëà ìèíèñòð.
  Òåìà: Êàêèå çàðïëàòû ó âðà÷åé â Ðîññèè, ... è â îñòàëüíîì ìèðå?
AndreyN

Îòâåòîâ: 1
Ïðîñìîòðîâ: 4498

ÑîîáùåíèåÔîðóì: Íîâîñòè èç-çà ðóáåæà   Äîáàâëåíî: Ñð Ñåí 04, 2013 10:43 am   Òåìà: Êàêèå çàðïëàòû ó âðà÷åé â Ðîññèè, ... è â îñòàëüíîì ìèðå?
Êàêèå çàðïëàòû ó âðà÷åé â Ðîññèè, ... è â îñòàëüíîì ìèðå?
4 ñåíòÿáðÿ, 17:40
http://vladmedicina.livejournal.com/86530.html

Ïî îïðåäåëåíèþ, âðà÷ - îäíà èç ñàìûõ óâàæàåìûõ ïðîôåññèé â ëþáîì îáùåñòâå. Óâàæàåìàÿ, íî íå âñåãäà è âåçäå àäåêâàòíî îïëà÷èâàåìàÿ, à çíà÷èò, îöåíèâàåìàÿ ãîñóäàðñòâîì. Êàê æèâåòñÿ ïðàêòèêóþùèì âðà÷àì íà ïðîñòîðàõ ÑÍà è äîëæíû ëè îíè çàâèäîâàòü çàðóáåæíûì êîëëåãàì - òåìà î÷åðåäíîãî àíàëèçà ýêñïåðòîâ àêàäåìèè Ôîðåêñ è áèðæåâîé òîðãîâëè Masterforex-V.

Çàðïëàòû âðà÷åé â ÑÍÃ

Ðîññèÿ è Ìîñêâà.  Ðîññèè ðàáîòàåò áîëåå 600 òûñÿ÷ âðà÷åé - ýòî îäèí èç ñàìûõ âûñîêèõ ïîêàçàòåëåé â ïåðåñ÷åòå íà äóøó íàñåëåíèÿ (â ÑØÀ ñ íàñåëåíèåì áîëåå ÷åì â 2 ðàçà áîëüøèì, ÷åì â Ðîññèè, ïðàêòèêóþò îêîëî 800 òûñÿ÷ âðà÷åé).  èòîãå íà îäíîãî äîêòîðà ïðèõîäèòñÿ:

â Ðîññèè 199 ïàöèåíòîâ;
âî Ôðàíöèè - 294 ÷åë.;
â Áåëüãèè - 238 ÷åë.;
â Áåëàðóñè - 1246 ÷åë.

Êàê îáùåñòâî îöåíèâàåò ðàáîòó ðîññèéñêèõ âðà÷åé? Ýêñïåðòû îöåíèâàëè òîëüêî îôèöèàëüíóþ çàïëàòó, áåç «êîíâåðòîâ» è «áëàãîäàðíîñòåé ïàöèåíòîâ», íàäáàâîê çà ó÷åííóþ ñòåïåíü è ò.ä.. Âîò íåñêîëüêî ôàêòîâ:

ñðåäíÿÿ çàðïëàòà ìåäèêîâ - 26 òûñÿ÷ ðóá., îêîëî $ 800. Ïðè ýòîì - ýòî ñðåäíÿÿ çàðïëàòà ìåäèêîâ, ó÷èòûâàþùàÿ çàîáëà÷íûå çàðïëàòû âðà÷åé-îðãàíèçàòîðîâ è ÷èíîâíèêîâ, íå èìåþùèõ ê ëå÷åíèþ íåïîñðåäñòâåííîãî îòíîøåíèÿ. Ìèíèìàëüíàÿ çàðïëàòà ðîññèéñêèõ ïðàêòèêóþùèõ âðà÷åé çíà÷èòåëüíî ìåíüøå. Ïî äàííûì Ðîññòàòà ìèíèìàëüíàÿ çàðïëàòà â Ðîññèè íûíå ñîñòàâëÿåò 13,2 òûñ. ðóá. (ïðîòèâ ñðåäíåé çàðïëàòû ïî ñòðàíå 18,3 òûñ. ðóá., à â Ìîñêâå - 35,6 òûñ. ðóá.), ò.å. ìåíüøå «ñðåäíåé òåìïåðàòóðû ïî áîëüíèöå» áîëåå ÷åì íà 25%.
ïðîôåññèÿ âðà÷à â ïîñëåäíèå ãîäû íå ïîêèäàåò ÒÎÏ-10 ñàìûõ íèçêîîïëà÷èâàåìûõ ïðîôåññèé â ñòðàíå
íåñìîòðÿ íà åæåãîäíûé âûïóñê ìåäèöèíñêèìè óíèâåðñèòåòàìè äåñÿòêîâ òûñÿ÷ âðà÷åé, â ñòðàíå îùóùàåòñÿ áîëüøàÿ íåõâàòêà âðà÷åé - ïîðÿäêà 30%. Âðà÷è ìàññîâî óõîäÿò â äðóãèå ñôåðû äåÿòåëüíîñòè èëè ïåðåêâàëèôèöèðóþòñÿ â ôàðìàöåâòîâ.
÷àñòíàÿ ìåäèöèíà, ãäå çàðïëàòû âðà÷åé ìîãóò áûòü íà ïîðÿäîê âûøå, ÷åì â ãîñóäàðñòâåííûõ êëèíèêàõ, ìàëî ðàñïðîñòðàíåíà â Ðîññèè è îáñëóæèâàåò óçêóþ ïðîñëîéêó íàñåëåíèÿ.

Ïî äàííûì ÐÁÊ.Ðåéòèíãà, íà ñïåöèàëèçèðîâàííûõ HR-ñàéòàõ áîëüøå âñåãî âàêàíñèé ñòîìàòîëîãà (ñðåäíåå ïðåäëîæåíèå ïî çàðïëàòå - $ 1,5-1,8 òûñ.), òåðàïåâòà ($ 0,8-1,1 òûñ.), ïñèõîòåðàïåâòà ($ 1,0-1,3 òûñ.), ïåäèàòðà ($ 1,0-1,3 òûñ.), ïðè ýòîì ñðåäíÿÿ ïðåäëàãàåìàÿ çàðïëàòà âûâîäèëàñü áåç äåëåíèÿ íà ãîñóäàðñòâåííûå è ÷àñòíûå ìåäó÷ðåæäåíèÿ. Ïî ìíåíèþ ãåíåðàëüíîãî äèðåêòîðà ðåêðóòèíãîâîé êîìïàíèè HeadHunter Ì. Æóêîâà, ñèòóàöèÿ ñ äîõîäàìè ðîññèéñêèõ è àìåðèêàíñêèõ âðà÷åé â 95% ñëó÷àåâ «äèàìåòðàëüíî ïðîòèâîïîëîæíàÿ».

Ïðè òàêîì ïîäõîäå, ïî ìíåíèþ íàøåãî ýêñïåðòà ðóêîâîäèòåëÿ çåìëÿ÷åñòâà ÑØÀ è Êàíàäû Ðàñóëà Æåëàëîâà (êàíä. ìåäèöèíñêèõ íàóê) ñòðàíå óãðîæàåò êîëëàïñ ãîñóäàðñòâåííîé ìåäèöèíñêîé ïîìîùè óæå â áëèæàéøåå âðåìÿ.

Íåóäèâèòåëüíî, ÷òî ïðîäîëæèòåëüíîñòü æèçíè â Ðîññèè íà 20 ëåò íèæå, ÷åì â ðàçâèòûõ ñòðàíàõ.

Óêðàèíà. Ïîëîæåíèå óêðàèíñêèõ âðà÷åé â ãîñóäàðñòâåííîé ñèñòåìå çäðàâîîõðàíåíèÿ õóæå, ÷åì ó èõ ðîññèéñêèõ è áåëîðóññêèõ êîëëåã. Ïî äàííûì Ãîñêîìñòàòà, ñðåäíÿÿ çàðïëàòà óêðàèíñêèõ âðà÷åé - $ 294. Ïîñëåäíåå ïîâûøåíèå îêëàäîâ áþäæåòíèêîâ äàëî ïðèáàâêó ê çàðïëàòå òåðàïåâòà âûñøåé êàòåãîðèè 125 ãðí. ($ 15).

Êàê æå óäàåòñÿ âûæèòü óêðàèíñêîìó âðà÷ó, åñëè: (õóæå òîëüêî äîëæíîñòè ìåäñåñòåð, ïðîäàâöîâ, ñåêðåòàðåé è äâîðíèêîâ). ×òîáû ïîëó÷àòü áîëüøå, âðà÷è âûíóæäåíû ðàáîòàòü íà 1,5 - 2 ñòàâêè, ïî ñîâìåñòèòåëüñòâó è ò.ï. Èç-çà ïîâûøåííûõ íàãðóçîê ó ðîññèéñêèõ âðà÷åé íå îñòàåòñÿ âðåìåíè íè äëÿ ïîâûøåíèÿ êâàëèôèêàöèè, íè äëÿ ñàìîîáðàçîâàíèÿ.

íà çäðàâîîõðàíåíèå â Óêðàèíå íèêîãäà íå òðàòèëîñü áîëåå 3% ãîñáþäæåòà (ñòîëüêî æå çàëîæåíî íà 2011 ãîä).
ãîëàÿ ñòàâêà ó÷àñòêîâîãî òåðàïåâòà - äî 1 òûñ. ãðí. ($ 125). Íàäáàâêè çà âðåäíûå óñëîâèÿ, êàòåãîðèþ, íàó÷íóþ ñòåïåíü, ïðåïîäàâàòåëüñêóþ äåÿòåëüíîñòü, áåçóñëîâíî, óâåëè÷èâàþò çàðïëàòó. Òàê, àíåñòåçèîëîã âûñøåé êàòåãîðèè, èìåþùèé ñòåïåíü êàíäèäàòà ìåäèöèíñêèõ íàóê è ðàáîòàþùèé äîöåíòîì êàôåäðû óíèâåðñèòåòà, ìîæåò ïîëó÷àòü $ 375 - 440.
îïûòíûé âðà÷ ñêîðîé ïîìîùè è êàðäèîõèðóðã Èíñòèòóòà èì. Í. Àìîñîâà â Êèåâå ïîëó÷àþò ïî $ 250 - 340 (íà óðîâíå îõðàííèêà ñóïåðìàðêåòà èëè øâåéöàðà ïðåñòèæíîãî îòåëÿ).
ðåàëüíàÿ çàðïëàòà ïðàêòèêóþùèõ âðà÷åé íà òðåòü ìåíüøå îôèöèàëüíûõ äàííûõ -- $ 199.
äåôèöèò âðà÷åé â Óêðàèíå - 46 òûñ. ñïåöèàëèñòîâ. Åæåãîäíî ãîñóäàðñòâåííîå çäðàâîîõðàíåíèå íåäîñ÷èòûâàåòñÿ 6 òûñ. âðà÷åé, êîòîðûå ìåíÿþò ïðîôåññèþ èëè ýìèãðèðóþò. 40% ðàáîòàþùåãî ìåäèöèíñêîãî ïåðñîíàëà - ïåíñèîíåðû.

Ââåäåíèå áåçâèçîâîãî ðåæèìà ñ Åâðîñîþçîì âûçîâåò ìàññîâûé îòòîê ìåäèöèíñêîãî ïåðñîíàëà èç ñòðàíû è êàòàñòðîôó ãîñóäàðñòâåííîé ñèñòåìû çäðàâîîõðàíåíèÿ.

Áåëàðóñü. Óêðàèíñêèå âðà÷è çàâèäóþò ñâîèì ñåâåðíûì êîëëåãàì - ó íèõ ñðåäíÿÿ çàðïëàòà ìåäèêîâ áîëåå $ 300. Íî ñàìè áåëîðóññêèå âðà÷è íåäîâîëüíû ñâîèì ïîëîæåíèåì è êèâàþò íà áîëåå áëàãîïîëó÷íûõ ñîñåäåé - Ðîññèþ ($800), Ëèòâó (? 700 - 800), Ïîëüøó ($ 1,5 òûñ.).

Áåëîðóññêèå âðà÷è â ñâîåì áîëüøèíñòâå ñ÷èòàþò, ÷òî èõ òðóä íåäîîöåíåí ãîñóäàðñòâîì:

ñòîèìîñòü ÷àñà ðàáîòû áåëîðóññêîãî âðà÷à îöåíèâàåòñÿ â $ 2-3 - ýòî ìåíüøå, ÷åì â ïðîìûøëåííîñòè, ñòðîèòåëüñòâå è äðóãèõ îòðàñëÿõ;
ïî óðîâíþ çàðïëàòû ðàáîòíèêè çäðàâîîõðàíåíèÿ íàõîäÿòñÿ íà ÷åòâåðòîì ìåñòå ñíèçó, îïåðåæàÿ ëèøü ðàáîòíèêîâ îáðàçîâàíèÿ, ñåëüñêîãî õîçÿéñòâà è ñîöèàëüíîãî îáåñïå÷åíèÿ.
â 2009 ã. çàðïëàòà â çäðàâîîõðàíåíèè ñîñòàâëÿëà ëèøü 68,2% îò çàðïëàòû â ïðîìûøëåííîñòè (ïðè÷åì â 2005 ã. ýòîò ïîêàçàòåëü ñîñòàâëÿë 82%).
äåôèöèò êàäðîâ - â ñòðàíå íåõâàòêà îêîëî 4 òûñ. âðà÷åé è 5 òûñ. ìëàäøåãî ìåäïåðñîíàëà. Åæåãîäíî çäðàâîîõðàíåíèå òåðÿåò íå ìåíåå 800 ñïåöèàëèñòîâ.

Áåëàðóñü íå ìîæåò â áëèæàéøåå âðåìÿ ðàññ÷èòûâàòü íà áåçâèçîâûé ðåæèì ñ ÅÑ, íî ìåñòíûå âðà÷è ïðè ïåðâîé æå âîçìîæíîñòè óåçæàþò çà ãðàíèöó. Íàèáîëåå ïîïóëÿðíûå ó áåëîðóññêèõ âðà÷åé ñòðàíû - Ïîëüøà, Ôèíëÿíäèÿ, Øâåöèÿ.

Êàêàÿ çàðïëàòà ó âðà÷åé â ÑØÀ è ÅÑ?

ÑØÀ.  Àìåðèêå, âðà÷è - íàñòîÿùèå êîðîëè.  ðåéòèíãå «Ôîðáñ» â ÒÎÏ-10 ñàìûõ âûñîêîîïëà÷èâàåìûõ ïðîôåññèé ïåðâûå äåâÿòü ìåñò çàíèìàþò âðà÷è.  íå ìåíåå àâòîðèòåòíîì ðåéòèíãå ñàéòà PayScale â äåñÿòêå ñàìûõ äîõîäíûõ ñïåöèàëüíîñòåé âðà÷è îêêóïèðîâàëè âîñåìü ìåñò. È â òîì, è â äðóãîì ðåéòèíãå ñàìûå âûñîêîîïëà÷èâàåìûå ïðîôåññèè â ÑØÀ - õèðóðã è àíåñòåçèîëîã, çàðàáàòûâàþùèå $ 16 - 17 òûñ. â ìåñÿö:

• ñàìûå íèçêîîïëà÷èâàåìûå âðà÷åáíûå ñïåöèàëüíîñòè â ÑØÀ - ñåìåéíûå âðà÷è ($ 14,5 òûñ. â ìåñÿö), ïåäèàòðû ($ 15 òûñ.), òåðàïåâòû ($ 15,9 òûñ.);
• âûñîêîêëàññíûå âðà÷è çàðàáàòûâàþò ãîðàçäî áîëüøå: õèðóðãè-îðòîïåäû äî $ 43 òûñ. â ìåñÿö, óðîëîãè - äî $ 33 òûñ.

×òî æå èìåþò âðà÷è ÑØÀ ïîìèìî çàðïëàòû?

ñîöèàëüíûå ëüãîòû;
ëüãîòû ïðè îïëàòå ìåäèöèíñêîé ñòðàõîâêè;
îïëàòà ãîñòèííèö, êîíôåðåíöèé, êîìàíäèðîâîê è ïð.;
ãîíîðàðû çà ïóáëèêàöèè íàó÷íûõ ñòàòåé, ó÷àñòèå â êîíôåðåíöèÿõ;

Êàæäûé ÷åòâåðòûé àìåðèêàíñêèé âðà÷ ïîëó÷èë îáðàçîâàíèå çà ïðåäåëàìè ÑØÀ. Âîïðåêè ìèôàì î òîì, ÷òî äèïëîìû ìåäóíèâåðñèòåòîâ ñòðàí ÑÍà íå êîòèðóþòñÿ â Àìåðèêå, àìåðèêàíñêîå çàêîíîäàòåëüñòâî ïðèçíàåò äèïëîìû âñåõ ñòðàí, âõîäÿùèõ âî Âñåìèðíóþ îðãàíèçàöèþ çäðàâîîõðàíåíèÿ, íåîáõîäèìî ëèøü ïðîéòè òåñòèðîâàíèå, ïîäòâåðæäàþùåå êâàëèôèêàöèþ âðà÷à è çíàíèå àíãëèéñêîãî ÿçûêà.

Åâðîñîþç.  ñòðàíàõ Åâðîñîþçà ïðîôåññèÿ âðà÷à - óâàæàåìàÿ è òàê æå âûñîêî îïëà÷èâàåìàÿ.  Âåëèêîáðèòàíèè, íàïðèìåð, ó÷àñòêîâûå âðà÷è ïîëó÷àåò áîëüøå, ÷åì ïðåìüåð-ìèíèñòð. Ïðàâäà, íåîáõîäèìî ñäåëàòü ñíîñêó íà òî, ÷òî óðîâåíü çàðïëàò âðà÷åé âíóòðè Åâðîñîþçà ñèëüíî ðàçëè÷àåòñÿ - ìåæäó «ñòàðûìè» ÷ëåíàìè ñîîáùåñòâà è íåäàâíî âñòóïèâøèìè â íåãî (ñòðàíû Âîñòî÷íîé Åâðîïû, Áàëêàí).

Ïðèâåäåì ñðàâíèòåëüíûå äàííûå ðåàëüíûõ ìèíèìàëüíûõ çàðïëàò âðà÷åé â ðàçíûõ ñòðàíàõ ìèðà:

Ãäå äëÿ âðà÷åé ñîçäàíû íàèáîëåå áëàãîïðèÿòíûå óñëîâèÿ ðàáîòû?

Âðà÷è òîæå ëþäè, ïîýòîìó èùóò, ãäå ëó÷øå:

âðà÷è ñ ïîñòñîâåòñêîãî ïðîñòðàíñòâà âûåçæàþò ê ñîñåäÿì ïî Âîñòî÷íîé Åâðîïå - â Ïîëüøó, ×åõèþ, Ñëîâàêèþ - è äàëüøå: â ÑØÀ, Àâñòðàëèþ, Àôðèêó. Òîëüêî â Åâðîïå è ÑØÀ ðàáîòàåò áîëåå 20 òûñ. âðà÷åé èç áûâøåãî ÑÑÑÐ:
÷åøñêèå âðà÷è íåäîâîëüíû óðåçàíèåì èõ çàðïëàò, ìàññîâî âûåçæàþò â Ãåðìàíèþ, Ôðàíöèþ, ÑØÀ è ñòðàíû Àçèè. Çà ïîñëåäíèå ìåñÿöû èç ñòðàíû óåõàëî 3,5 òûñ. âðà÷åé;
60% èíîñòðàííûõ âðà÷åé, ðàáîòàþùèõ âî Ôðàíöèè, - ðóìûíû, â òî âðåìÿ êàê â ñàìîé Ðóìûíèè ÿâíàÿ íåõâàòêà ñïåöèàëèñòîâ: â ñòðàíå ïî÷òè 50%-íûé äåôèöèò àíåñòåçèîëîãîâ. Ñ 2007 ã. èç Ðóìûíèè, ïî îôèöèàëüíûì äàííûì, óåõàëî áîëåå 8,5 òûñ. ìåäèöèíñêèõ ðàáîòíèêîâ. Ðóìûíèÿ çàíèìàåò 1-å ìåñòî â Åâðîñîþçå ïî ýìèãðàöèè âðà÷åé, ñëåäîì çà íåé ñëåäóþò Áîëãàðèÿ, Âåíãðèÿ, Ïîëüøà;
ðàáîòà âðà÷à â Åâðîñîþçå ïðèâëåêàòåëüíà äëÿ ñïåöèàëèñòîâ èç ÑÍà íå òîëüêî âûñîêèìè çàðïëàòàìè, íî è âîçìîæíîñòüþ ïîëó÷èòü åâðîïåéñêîå ãðàæäàíñòâî, à òàêæå ïåðñïåêòèâîé êàðüåðíîãî ðîñòà.
Ëèâèÿ - íå Åâðîïà, íî òîæå çàçûâàåò êâàëèôèöèðîâàííûõ âðà÷åé, ïðåäëàãàÿ óêðàèíñêèì âðà÷àì îò $ 1 òûñ. â îáû÷íûõ êëèíèêàõ äî $ 2 òûñ. â ó÷åáíûõ öåíòðàõ.
âñåãî æå äåôèöèò âðà÷åé â Åâðîïå - ïîðÿäêà 150 òûñ. ÷åë., à âî âñåì ìèðå - áîëåå 2 ìëí. ÷åë. Âîçíèêàåò çàêîíîìåðíûé âîïðîñ: êàêîå áóäóùåå ó çäðàâîîõðàíåíèÿ Ðîññèè, Óêðàèíû è äð. ñòðàí ÑÍà ïðè íûíåøíåé ñèòóàöèè, êîãäà â ìèðå äåôèöèò êâàëèôèöèðîâàííûõ ìåäèöèíñêèõ âàêàíñèé, à îòå÷åñòâåííûå ìåäèêè ïîëó÷àþò "êîïåéêè"?

Ðåäêîëëåãèÿ æóðíàëà "Áèðæåâîé ëèäåð" è ýêñïåðòû àêàäåìèè áèðæåâîé òîðãîâëè Masterforex-V ïðîâîäÿò îïðîñ:

Äîëæíî ëè ãîñóäàðñòâî ñóùåñòâåííî ïîäíÿòü çàðïëàòû ïðàêòèêóþùèì âðà÷àì â áëèæàéøåå âðåìÿ?

äà, íóæíî ðåçêî ïîäíèìàòü çàðïëàòó âðà÷åé, à íå ÷èíîâíèêîâ, äåïóòàòîâ;
åñëè äåíåã ó ãîñóäàðñòâà íåò, íóæíî äåëàòü ìåäèöèíó ïëàòíîé îôèöèàëüíî, èíà÷å îäíè âðà÷è áóäóò ïðîäîëæàòü áðàòü äåíüãè ñî ñâîèõ ïàöèåíòîâ, äðóãèå - óåçæàòü çà ðóáåæ;
óæå ïîçäíî ÷òî-òî ìåíÿòü.

Èñòî÷íèê: http://vladmedicina.ru/
  Òåìà: Íàì çàêóïèëè ìàøèíû, â êîòîðûõ çàïðåùåíî ïåðåâîçèòü ëþäåé
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ÑîîáùåíèåÔîðóì: Ðåôîðìà çà ðóáåæîì   Äîáàâëåíî: Ïò Àâã 30, 2013 10:58 am   Òåìà: Íàì çàêóïèëè ìàøèíû, â êîòîðûõ çàïðåùåíî ïåðåâîçèòü ëþäåé
«Íàì çàêóïèëè ìàøèíû, â êîòîðûõ çàïðåùåíî ïåðåâîçèòü ëþäåé»
http://www.novayagazeta.ru/society/59729.html

 ïèñüìå Ïóòèíó êàì÷àòñêèå ìåäèêè ðàññêàçàëè, ÷òî îñòàëîñü îò çäðàâîîõðàíåíèÿ êðàÿ ïîñëå 13 ëåò ñòàáèëèçàöèè
30.08.2013

 êîíöå àâãóñòà òèõèé îìóò êàì÷àòñêîãî çäðàâîîõðàíåíèÿ âçáàëàìóòèëè ìåäèêè ñòàíöèè ñêîðîé ïîìîùè. Ëþäÿì â áåëûõ õàëàòàõ íàäîåëî ðàáîòàòü â ñêîòñêèõ óñëîâèÿõ è îíè ðåøèëè ðàññêàçàòü îá ýòîì… Ïóòèíó. Ïèñüìî ïðåçèäåíòó ïîäïèñàëè âðà÷è, ôåëüäøåðû, ìåäñåñòðû, âîäèòåëè — âñåãî áîëüøå 70 ÷åëîâåê. Îíè ñîîáùèëè íàöèîíàëüíîìó ëèäåðó, â êàêîì ñîñòîÿíèè îêàçàëîñü çäðàâîîõðàíåíèå ïîñëå 13 ëåò ñòàáèëüíîñòè è ìîäåðíèçàöèè.

 êðàåâîì öåíòðå ïîëóîñòðîâà, êàê âûÿñíèëîñü, íå îñòàëîñü íè îäíîé ñïåöìàøèíû ñêîðîé ïîìîùè, íè îäíîé óêîìïëåêòîâàííîé ìåäèöèíñêîé áðèãàäû!  ãîðîäå ñ íàñåëåíèåì ïîä 200 òûñÿ÷ ÷åëîâåê âðà÷è ðàáîòàþò íà äîïîòîïíîì îáîðóäîâàíèè è ïåðåâîçÿò ïàöèåíòîâ â ãðóçîâèêàõ. Íà ñòàíöèè êàòàñòðîôè÷åñêè íå õâàòàåò ìåäèêîâ, çàòî øòàò ïîä çàâÿçêó çàáèò áóõãàëòåðàìè, ýêîíîìèñòàìè, þðèñòàìè, ïðîãðàììèñòàìè è ïðî÷èìè ÷ðåçâû÷àéíî íóæíûìè â çäðàâîîõðàíåíèè ëþäüìè.

Âîò íåñêîëüêî öèòàò èç ïèñüìà Ïóòèíó.

«Íà ñòàíöèè ñêîðîé ïîìîùè ÷èñëÿòñÿ îêîëî 20 áóõãàëòåðîâ è ýêîíîìèñòîâ, êîòîðûå îáñ÷èòûâàþò 5-7 âûåçäíûõ âðà÷åé. Äëÿ ñðàâíåíèÿ, â ñîâåòñêîå âðåìÿ, êîãäà íå áûëî êîìïüþòåðîâ, à âûåçäíûõ âðà÷åé áûëî 20, îäèí áóõãàëòåð-ðàñ÷åò÷èê îáñëóæèâàë 3 ìåäèöèíñêèõ ó÷ðåæäåíèÿ (ñêîðóþ ïîìîùü, äåòñêóþ áîëüíèöó, äåòñêóþ ïîëèêëèíèêó). È íè÷åãî — ñïðàâëÿëñÿ».

«Íà ñòàíöèè íåò íè îäíîé óêîìïëåêòîâàííîé áðèãàäû ñêîðîé ìåäèöèíñêîé ïîìîùè — íè âðà÷åáíîé, íè ôåëüäøåðñêîé. Íåêîòîðûå áðèãàäû, êîòîðûå îáÿçàíû îêàçûâàòü ïîëíîìàñøòàáíóþ ìåäèöèíñêóþ ïîìîùü, ñîñòîÿò èç îäíîãî ÷åëîâåêà. Îí ôèçè÷åñêè íå â ñîñòîÿíèè äàæå ïðèíåñòè íà âûçîâ íåîáõîäèìûé êîìïëåêò îáîðóäîâàíèÿ. À îáðàòíî íàäî íåñòè åùå è ïàöèåíòà, îêàçûâàÿ åìó ïðè ýòîì ðåàíèìàöèîííóþ ïîìîùü. Ñ òàêîé ðàáîòîé íå ìîãóò ñïðàâèòüñÿ è äâà ÷åëîâåêà — ïî íîðìàòèâó èõ äîëæíî áûòü 4-5».

«Äîñòàâèòü áîëüíîãî äî ñòàöèîíàðà æèâûì — î÷åíü áîëüøàÿ ïðîáëåìà.  êàì÷àòñêîé ñòîëèöå íåò íè îäíîé ìàøèíû ñêîðîé ìåäèöèíñêîé ïîìîùè. Áîëüíûõ ñ ïåðåëîìàìè ïîçâîíî÷íèêà, ÷åðåïíî-ìîçãîâûìè òðàâìàìè, èíôàðêòàìè è èíñóëüòàìè ïðèõîäèòñÿ ïåðåâîçèòü ïî êàì÷àòñêîìó áåçäîðîæüþ, ïî ñóòè, â ãðóçîâûõ ôóðãîíàõ.  òåõíè÷åñêîé äîêóìåíòàöèè ê ÓÀÇàì, êîòîðûå ïîñòàâèëè íà ñòàíöèþ äâà ãîäà íàçàä, ÷åðíûì ïî áåëîìó íàïèñàíî, ÷òî ïåðåâîçêà ëþäåé â ñàëîíàõ òàêèõ àâòîìîáèëåé — çàïðåùåíà.  äîêóìåíòàõ ðå÷ü èäåò î çäîðîâûõ ëþäÿõ, à ÷òî óæ ãîâîðèòü î áîëüíûõ?»

Ïî ñëîâàì îäíîãî èç àâòîðîâ ïèñüìà, ïðåäñåäàòåëÿ ïðîôêîìà ñòàíöèè ñêîðîé ïîìîùè Èâàíà Ñòàñþêà, ñèòóàöèÿ â ãîðîäñêîé ñëóæáå «03» — íå óíèêàëüíà.  êàì÷àòñêèõ ïîëèêëèíèêàõ è áîëüíèöàõ äåëà îáñòîÿò íè÷óòü íå ëó÷øå. Ïðîñòî ãîâîðèòü îá ýòîì íå ïðèíÿòî.

Èíîãäà, âïðî÷åì, èíôîðìàöèÿ ïðîñà÷èâàåòñÿ â ÑÌÈ. Ýòèì ëåòîì èíôîðìàãåíòñòâî «Êàì 24» ñîîáùèëî, ÷òî â Åëèçîâñêîì ðàéîíå Êàì÷àòêè, ãäå ïðîæèâàþò 64 òûñÿ÷è ÷åëîâåê, ðàáîòàåò òîëüêî îäèí äåòñêèé ñòîìàòîëîã. ×òîáû çàïèñàòü ðåáåíêà íà ïðèåì ê ýòîìó ÷óäî-ñïåöèàëèñòó, ïàïàì è ìàìàì ïðèõîäèòñÿ íî÷åâàòü ó ðåãèñòðàòóðû.

«ß ïðèøëà â 5 ÷àñîâ óòðà è áûëà óæå øåñòàÿ â î÷åðåäè. ×åëîâåê, êîòîðîìó äîñòàëñÿ åäèíñòâåííûé òàëîí, ïðèåõàë â ïîëîâèíå ÷åòâåðòîãî», — ðàññêàçàëà æèòåëüíèöà Åëèçîâà Þëèÿ Ìàðêñ.

Ïðîáëåìà óñóãóáëÿåòñÿ òåì, ÷òî ìàëûøàì íå ïîìîãàþò è â ïëàòíûõ êëèíèêàõ. Ó «êîììåð÷åñêèõ» âðà÷åé íåò ëèöåíçèé íà ëå÷åíèå äåòåé. Ïîýòîìó ÷òîáû èçáàâèòü ðåáåíêà îò êàðèåñà, ðîäèòåëÿì íóæíî ëèáî íî÷åâàòü ó áþäæåòíîé ïîëèêëèíèêè, ëèáî ïîêóïàòü áèëåò íà ñàìîëåò è ëåòåòü êóäà-íèáóäü çà ïðåäåëû Êàì÷àòêè.

Âçðîñëûì áîëüíûì ïîïàñòü íà ïðèåì òîæå íåëåãêî. Ïîðîþ ïîõîäû çà òàëîíàìè çàêàí÷èâàþòñÿ äëÿ íèõ äðàìàòè÷åñêè. Âðà÷è ñêîðîé ïîìîùè ðàññêàçûâàþò îá ýòîì ìíîãî èíòåðåñíûõ èñòîðèé. Ìåñÿöà òðè íàçàä, íàïðèìåð, îíè ñïàñàëè ìóæ÷èíó (áûâøåãî ñîòðóäíèêà ÔÑÁ), êîòîðîãî â î÷åðåäè çà òàëîíîì ñèëüíî ïîáèëè. Ïîòåðïåâøåãî ïðèøëîñü ãîñïèòàëèçèðîâàòü â ïðåäûíôàðêòíîì ñîñòîÿíèè...

Âñå ýòî áåçîáðàçèå ïðîèñõîäèò íà ôîíå áëàãîñòíûõ ñîîáùåíèé â òåëåâèçèîííûõ íîâîñòÿõ î òîì, êàê êàì÷àòñêîå çäðàâîîõðàíåíèå êîëîñèòñÿ è ìîäåðíèçèðóåòñÿ. Ìåäèêè, âïðî÷åì, ïîëàãàþò, ÷òî ãëàâíûì è ñàìûì î÷åâèäíûì ðåçóëüòàòîì ìîäåðíèçàöèè ñòàëî óâåëè÷åíèå ïîãîëîâüÿ ýôôåêòèâíûõ ìåäèöèíñêèõ ìåíåäæåðîâ. Îíè âûòåñíÿþò èç áîëüíèö âðà÷åé, êàê íà äèêîì ïîëå ñîðíÿê âûòåñíÿåò ïøåíèöó. Çàðïëàòû àäìèíèñòðàòîðîâ ÿâëÿþòñÿ êîììåð÷åñêîé òàéíîé. Íà òîé æå ñêîðîé ïîìîùè íèêòî íå çíàåò, ñêîëüêî ïîëó÷àþò ãëàââðà÷ Áàéêàëîâ è åãî ïðèáëèæåííûå. Ñîòðóäíèêàì ñòàíöèè îñòàåòñÿ òîëüêî äîãàäûâàòüñÿ, î êàêèõ öèôðàõ èäåò ðå÷ü — ñ ïÿòüþ èëè ñ øåñòüþ íóëÿìè. Îáû÷íûå âðà÷è æèâóò çíà÷èòåëüíî ñêðîìíåå, ÷åì ãëàâíûå.

Âîò åùå öèòàòû èç ïèñüìà ìåäèêîâ ïðåçèäåíòó:

«Ñàíèòàðû, âîäèòåëè ìåäñëóæáû, ñëåñàðè, êëàäîâùèêè, äèñïåò÷åðû ãàðàæà, òåõíèêè, ìîéùèêè, òîëüêî ÷òî ïðèíÿòûå âîäèòåëè îïåðàòèâíîé ñëóæáû, óáîðùèêè ïîëó÷àþò çàðïëàòó, íåñîâìåñòèìóþ ñ íîðìîé æèçíè è çàêîíà. Âðà÷è è ôåëüäøåðû ñâîäÿò êîíöû ñ êîíöàìè òîëüêî ïðè óñëîâèè âûðàáîòêè äâóõ ñòàâîê. Ýôôåêòèâíûå êîíòðàêòû íà÷àëüíèêè çàêëþ÷àþò òîëüêî ñàìè ñ ñîáîé».

«Äî 2011 ãîäà íàøà ñòàíöèÿ ðàñïîëàãàëàñü õîòü è íå â íîâîì, íî â êàïèòàëüíîì è â îòíîñèòåëüíî êîìôîðòíîì çäàíèè. Íî ïîòîì «äëÿ óëó÷øåíèÿ óñëîâèé ðàáîòû» íàñ ïåðåñåëèëè â íàñêîðî ïîñòðîåííîå ìîäóëüíîå ñòðîåíèå.  íàðîäå íîâîå çäàíèå «ñêîðîé» ïðîçâàëè áóäêîé è îâîùåõðàíèëèùåì (ìîæåò, ïîýòîìó è àâòîìîáèëè çàêóïèëè äëÿ ïåðåâîçêè îâîùåé, à íå ëþäåé)… Êàê âûÿñíèëè êàì÷àòñêèå æóðíàëèñòû, ñòàðîå êàïèòàëüíîå çäàíèå ñêîðîé ïîìîùè âûêóïèë êàêîé-òî êîììåðñàíò çà 26 ìèëëèîíîâ ðóáëåé. Îí æå è ïîñòðîèë íàì «áóäêó», çà êîòîðóþ ìýðèÿ Ïåòðîïàâëîâñêà çàïëàòèëà 76 ìèëëèîíîâ…»

Ïî ñëîâàì Èâàíà Ñòàñþêà, î òîì, ÷òî ïðîèñõîäèò íà ñòàíöèè, äà è âîîáùå â ðåãèîíàëüíîì çäðàâîîõðàíåíèè, ïðåêðàñíî èçâåñòíî è ìåñòíûì, è ôåäåðàëüíûì ÷èíîâíèêàì. Ïðåæäå ÷åì íàïèñàòü Ïóòèíó, âðà÷è îáðàùàëèñü ê êàì÷àòñêèì âèöå-ãóáåðíàòîðàì Ïîòèåâñêîìó è Êàðïåíêî, ê ôåäåðàëüíîìó ìèíèñòðó Ñêâîðöîâîé. Íè÷åãî ïîñëå ýòèõ îáðàùåíèé íå èçìåíèëîñü. Íà íèõ, ïîõîæå, äàæå âíèìàíèÿ íå îáðàòèëè. Ïî áóìàãàì-òî ó íàñ âñå õîðîøî, «â çäðàâîîõðàíåíèè îòìå÷àþòñÿ ïîçèòèâíûå òåíäåíöèè». Õîòÿ â ïðèâàòíûõ ðàçãîâîðàõ êàì÷àòñêèå íà÷àëüíèêè ïðèçíàþòñÿ, ÷òî íà ñàìîì äåëå â ìåäèöèíå âñå î÷åíü ïëîõî, ïîýòîìó ñàìè îíè ïðåäïî÷èòàþò ëå÷èòüñÿ ãäå-íèáóäü çà ïðåäåëàìè ïîëóîñòðîâà — â Ìîñêâå, Þæíîé Êîðåå, Èçðàèëå, íà õóäîé êîíåö — â Êèòàå. Åùå îíè óâåðÿþò, ÷òî äåíüãè íà ìîäåðíèçàöèþ ïîñòóïàþò íåìàëûå. Íî íà ÷òî òðàòÿòñÿ ýòè èíâåñòèöèè? Íà ïîêóïêó ãðóçîâûõ «óàçèêîâ» âìåñòî ñïåöìàøèí, íà ñòðîèòåëüñòâî «áóäîê» âìåñòî áîëüíèö è íà ñîäåðæàíèå ýôôåêòèâíûõ ìåíåäæåðîâ âìåñòî âðà÷åé.

«Äà ýòî íå òîëüêî â ìåäèöèíå, âåçäå òàê, — ãîðüêî çàìå÷àåò Èâàí Ñòàñþê. — Ó íàñ âñÿ ñòðàíà ñåãîäíÿ — ïåòðîïàâëîâñêàÿ ñòàíöèÿ ñêîðîé ïîìîùè…»
  Òåìà: Ë³êàð – ðàá ñèñòåìè ³ çàðó÷íèê ðåôîðì
AndreyN

Îòâåòîâ: 1
Ïðîñìîòðîâ: 3774

ÑîîáùåíèåÔîðóì: Ðåôîðìà â Óêðàèíå   Äîáàâëåíî: Ïò Àâã 23, 2013 11:46 am   Òåìà: ˳êàð – ðàá ñèñòåìè ³ çàðó÷íèê ðåôîðì
http://www.svidomo.org/defend_article/18628
  Òåìà: Ìåäèöèíñêàÿ ðåôîðìà ïîçâîëèò äîâîäèòü äî áàíêðîòñòâà è çàêðû
AndreyN

Îòâåòîâ: 0
Ïðîñìîòðîâ: 2696

ÑîîáùåíèåÔîðóì: Ðåôîðìà â Óêðàèíå   Äîáàâëåíî: Âñ Àâã 18, 2013 3:02 pm   Òåìà: Ìåäèöèíñêàÿ ðåôîðìà ïîçâîëèò äîâîäèòü äî áàíêðîòñòâà è çàêðû
ÑÌÈ: Ìåäèöèíñêàÿ ðåôîðìà ïîçâîëèò äîâîäèòü äî áàíêðîòñòâà è çàêðûâàòü êèåâñêèå ïîëèêëèíèêè
Ñåãîäíÿ, 12:47 Êîððåñïîíäåíò.net

Ìàñøòàáíàÿ ðåôîðìà ñèñòåìû çäðàâîîõðàíåíèÿ â Êèåâå, êîòîðóþ èíèöèèðîâàëè ñòîëè÷íûå âëàñòè, ïîçâîëèò äîâîäèòü äî áàíêðîòñòâà è çàêðûâàòü ãîðîäñêèå ïîëèêëèíèêè.

 ðàìêàõ ðåôîðìû ñ 1 ÿíâàðÿ 2014 ãîäà ïîëèêëèíèêà ñòàíåò êîììóíàëüíûì ïðåäïðèÿòèåì. À, ïî çàêîíó, ÊÏ ìîæíî äîâåñòè äî áàíêðîòñòâà è çàêðûòü, ïèøåò ZN.UA.

Ïî äàííûì èçäàíèÿ, ñ íà÷àëà òåêóùåãî ãîäà â Ñâÿòîøèíñêîì ðàéîíå äîëãè ïîëèêëèíèê ïî êîììóíàëêå ïåðåâàëèëè çà 800 òûñÿ÷ ãðèâåí, à ðåêîðäñìåíîì ÿâëÿåòñÿ Äåñíÿíñêèé ðàéîí, çàäîëæàâøèé áîëåå 2 ìëí 200 òûñÿ÷ ãðèâåí.

Êðîìå òîãî, îòìå÷àåò èçäàíèå, â õîäå ðåôîðìèðîâàíèÿ â Êèåâå èç 102 äåéñòâóþùèõ ó÷ðåæäåíèé ïåðâè÷íîé ìåäïîìîùè îñòàíåòñÿ ëèøü 42. À îãðîìíûå äîëãè ìîãóò ïðèâåñòè ê òîìó, ÷òî êèåâëÿíå â ëþáîé ìîìåíò ìîãóò âîîáùå îêàçàòüñÿ áåç "ñêîðîé ïîìîùè".

 ðåçóëüòàòå ðåôîðìû, ìóíèöèïàëüíûå ìåäó÷ðåæäåíèÿ äîëæíû áóäóò ñàìîñòîÿòåëüíî çàáîòèòüñÿ î ðåøåíèè ôèíàíñîâûõ âîïðîñîâ, êîòîðûå ñåé÷àñ äîëæåí ðåøàòü ãîðîäñêîé áþäæåò. Âåðîÿòíåå âñåãî, ó÷ðåæäåíèÿì ïðèäåòñÿ âíåäðÿòü ïëàòíûå óñëóãè, óâåëè÷èâàòü ðàçìåð áëàãîòâîðèòåëüíûõ âçíîñîâ è ïðèâëåêàòü ñîñòîÿòåëüíûõ êëèåíòîâ.

 ìèíóâøåì ãîäó â ïëàíû Êèåâñîâåòà âõîäèëî âûäåëåíèå äîïîëíèòåëüíûõ 43,6 ìëí ãðèâåí íà ìåäèöèíó.

http://korrespondent.net/tech/health/1593570-smi-medicinskaya-reforma-pozvolit-dovodit-do-bankrotstva-i-zakryvat-kievskie-polikliniki
  Òåìà: Ìåäèöèíñêàÿ ôóòóðîëîãèÿ - Ìåäèöèíñêàÿ èñòîðèÿ ÷åëîâå÷åñòâà
AndreyN

Îòâåòîâ: 72
Ïðîñìîòðîâ: 100691

ÑîîáùåíèåÔîðóì: Êíèãè   Äîáàâëåíî: Ïí Àâã 12, 2013 7:36 pm   Òåìà: Ìåäèöèíñêàÿ ôóòóðîëîãèÿ - Ìåäèöèíñêàÿ èñòîðèÿ ÷åëîâå÷åñòâà
Êàêèå æåíùèíû â ðàçíîå âðåìÿ ñ÷èòàëèñü êðàñèâûìè

10 ìåñòî: Èäåàëîì êðàñîòû Äðåâíåãî Åãèïòà áûëà ñòðîéíàÿ è ãðàöèîçíàÿ æåíùèíà ñ ïîëíûìè ãóáàìè è îãðîìíûìè ìèíäàëåâèäíûìè ãëàçàìè. ×òîáû ðàñøèðèòü çðà÷êè è ïðèäàòü áëåñê ãëàçàì, êàïàëè â íèõ ñîê èç ðàñòåíèÿ «ñîííàÿ îäóðü». Ñàìûì êðàñèâûì öâåòîì ãëàç ñ÷èòàëñÿ çåë¸íûé. Íî ýòî ðåäêèé öâåò. Ïðåäïðèèì÷èâûå åãèïòÿíêè îáâîäèëè ãëàçà çåë¸íîé êðàñêîé èç óãëåêèñëîé ìåäè. Äëÿ çàâåðøåíèÿ îáðàçà êðàñèëè â ç¸ëåíûé íîãòè íà ðóêàõ è ñòóïíè íîã.

9 ìåñòî: Æåíùèíû ìàéà îêðàøèâàëè òåëî êðàñíîé ìàçüþ, â êîòîðóþ äîáàâëÿëè î÷åíü ëèïêóþ è ïàõó÷óþ ñìîëó. Ïîñëå òàêîé ïðîöåäóðû îíè ñòàíîâèëèñü íàðÿäíûìè è íàäóøåííûìè. Íà ëèöî òàêæå íàíîñèëèñü ðàçëè÷íûå êðàñêè.

8 ìåñòî: Èäåàë êðàñîòû â Äðåâíåì Êèòàå – ìàëåíüêàÿ, õðóïêàÿ æåíùèíà ñ êðîøå÷íûìè íîãàìè. Íè îäèí ïðèëè÷íûé êèòàåö íå âçÿë áû â æ¸íû äåâóøêó ñ áîëüøèì ðàçìåðîì íîãè. ×òîáû íîæêà îñòàâàëàñü ìàëåíüêîé, äåâî÷êàì òóãî áèíòîâàëè ñòîïó, è îíà ïåðåñòàâàëà ðàñòè. Êñòàòè, ãëàâíûì äîñòîèíñòâîì ìóæ÷èíû â Êèòàå ñ÷èòàëèñü äëèííûå âîëîñû, êîòîðûå çàïëåòàëè â ïðè÷óäëèâûå êîñû.

7 ìåñòî:  Äðåâíåé Ãðåöèè ñóùåñòâîâàë êóëüò òðåíèðîâàííîãî òåëà. Ýòàëîíîì êðàñèâîãî òåëà ó ãðåêîâ ñòàëà ñêóëüïòóðà Àôðîäèòû: ðîñò – 164 ñì, îêðóæíîñòü ãðóäè – 86 ñì, òàëèè – 69 ñì, áåä¸ð 93 ñì. Ïî êàíîíàì ãðå÷åñêîé êðàñîòû ïðåêðàñíîå ëèöî ñî÷åòàëî ïðÿìîé íîñ è áîëüøèå ãëàçà.

6 ìåñòî:  Äðåâíåì Ðèìå ãîñïîäñòâîâàë êóëüò ñâåòëîé êîæè è áåëîêóðûõ âîëîñ. Èìåííî ðèìëÿíêè ïåðâûìè îâëàäåëè ñåêðåòîì îáåñöâå÷èâàíèÿ âîëîñ. Èõ ïðîòèðàëè ãóáêîé, ñìî÷åííîé ìàñëîì èç êîçüåãî ìîëîêà è çîëîé áóêîâîãî äåðåâà, à çàòåì îáåñöâå÷èâàëè íà ñîëíöå.

5 ìåñòî:  Ñðåäíèå Âåêà çåìíàÿ êðàñîòà ñ÷èòàëàñü ãðåõîâíîé, à íàñëàæäåíèå åé – íåäîçâîëåííûì. Áëîíäèðîâàíèå âîëîñ ïðîâîçãëàñèëè íå÷åñòèâûì çàíÿòèåì. Ôèãóðó ïðÿòàëè ïîä ñëîåì òÿæåëûõ òêàíåé, à âîëîñû — ïîä ÷åï÷èêîì. Òåïåðü Èäåàëîì ñðåäíåâåêîâîé æåíùèíû áûë ïðåñâÿòàÿ äåâà Ìàðèÿ – óäëèíåííûé îâàë ëèöà, îãðîìíûå ãëàçà è ìàëåíüêèé ðîò.

4 ìåñòî:  íà÷àëå XIII âåêà íà÷àëñÿ êóëüò ïîêëîíåíèÿ «ïðåêðàñíîé äàìå». Æåíùèíó òåïåðü ñðàâíèâàþò ñ ðîçîé – îíà íåæíà, õðóïêà è èçÿùíà. Êñòàòè, ïî ýòîé ïðè÷èíå â ìîäå – ìàëåíüêàÿ ãðóäü.

3 ìåñòî:  ýïîõó Âîçðîæäåíèÿ êðàñèâûìè ñ÷èòàëèñü áëåäíûé öâåò ëèöà, ñòðîéíàÿ «ëåáåäèíàÿ øåÿ» è âûñîêèé ÷èñòûé ëîá. Äëÿ óäëèíåíèÿ îâàëà ëèöà äàìû âûáðèâàëè âîëîñû ñïåðåäè è âûùèïûâàëè áðîâè, à äëÿ òîãî, ÷òîáû øåÿ êàçàëîñü êàê ìîæíî áîëåå äëèííîé, áðèëè çàòûëêè.

2 ìåñòî:  ýïîõó Ðîêîêî ãëàâíûé àêöåíò – íà ïðè÷¸ñêó, ýòî — âðåìÿ ÷óäåñ ïàðèêìàõåðñêîãî èñêóññòâà. Äîðîãîñòîÿùåå óäîâîëüñòâèå ïûòàëèñü ñîõðàíèòü êàê ìîæíî äîëüøå: íåäåëÿìè íå ïðè÷¸ñûâàëèñü è íå ìûëè ãîëîâó. Êîðîëåâà Èñïàíèè Èçàáåëëà Êàñòèëüñêàÿ êàê-òî ïðèçíàëàñü, ÷òî çà âñþ æèçíü ìûëàñü âñåãî äâà ðàçà – ïðè ðîæäåíèè è â äåíü ñâàäüáû.

1 ìåñòî: XX âåê. Æèçíü èçìåíèëàñü. Ñåé÷àñ áîëüøå âñåãî öåíÿòñÿ óì, ýíåðãèÿ è óìåíèå çàðàáàòûâàòü äåíüãè, à ãëàâíûì äîñòîÿíèåì æåíùèíû ñ÷èòàåòñÿ ñâîáîäà. Âïðî÷åì, èñòîðèêè ìîäû ñõîäÿòñÿ íà òîì, ÷òî â áóäóùåì ìîæíî áóäåò îïðåäåëèòü ÕÕ âåê êàê âåê êîðîòêèõ æåíñêèõ ïðè÷åñîê è êóëüòà äèñòðîôèè.
 
Ñòðàíèöà 1 èç 91 Íà ñòðàíèöó 1, 2, 3 ... 89, 90, 91  Ñëåä.
×àñîâîé ïîÿñ: GMT + 2
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