Running into slavery: what will patients lose after changing the law on Compulsory Health Insurance

Irina Mishina

After the adoption of the law in the first reading, disputes began. The Accounts Chamber of Russia and Roszdravnadzor did not accept the initiative of the State Duma. The parliamentarians were also reminded that the failure to provide medical care is contrary to the Criminal Code: an article is provided for in the Criminal Code of the Russian Federation. The Legal Department of the State Duma in its conclusion also noted that the new amendments violate the right of Russians to affordable medical care.

What are the amendments that have been prepared for us?

The deputies decided to remove from part 5 of Article 15 of the Federal Law "On Compulsory Health Insurance" the clause stating that a medical organization has no right to refuse to provide medical services to insured persons. In the new version of the law there is no longer a provision stating that Russian medical organizations have no right to "refuse to provide medical assistance to insured persons".

Let us recall: according to Federal Law FZ-323, the insured person has the right to medical care. In Art. 7 FZ-323 refers to the availability of medical care. The deputies decided to remove this item from the law. This was expected. Earlier, the first deputy chairman of the State Duma Committee on Economic Policy Sergei Kalashnikov made a proposal to liquidate the Mandatory Medical Insurance Fund. The politician suggested that Russians switch to "personal social insurance." "What should be done? It is necessary to introduce normal personal social insurance, which will be compulsory and for which each person will pay himself. Moreover, the line of these insured events must be expanded ... A person must insure himself, if he wants, against unemployment, against loss of temporary disability, against some kind of disease, and so on. But he must do this on his own, ” said Sergei Kalashnikov. According to some deputies, Russians can conclude agreements with medical institutions for the provision of partially paid services, which were previously guaranteed by the compulsory medical insurance policy.

The question arises: what about the taxes that working Russians regularly contribute to the CHI fund? Maybe if amendments to the law on compulsory medical insurance are adopted, this tax will no longer have to be paid?

We decided to ask the experts what we should prepare for. “In the new version of the law, there is no longer a provision that Russian medical organizations have no right to refuse to provide medical assistance to insured persons. Wanted - took for treatment, did not want - refused. On the one hand, this violates the patient's constitutional right to affordable medical care. On the other hand, it brings doctors under the criminal article “Failure to provide assistance to a patient”, - said Alexey Starchenko, a member of the Public Council for the Protection of Patients' Rights at Roszdravnadzor.

Prior to the advent of new amendments, a medical organization should have been responsible for refusing to provide medical care to a patient. New legislative changes nullify this rule. Lawyers of the Legal Department of the State Duma also warn about this legal incident in their conclusion to the draft amendments to the law on compulsory medical insurance.

We decided to find out about the essence of the proposed amendments from the primary source - in the State Duma Committee on Health Protection. “This law applies only to federal medical institutions and in no way can negatively affect the possibility of receiving medical care by patients. Only the procedure for financing the most important medical institutions is changing - university clinics, research medical centers, etc. The Federal Health Insurance Fund will directly, bypassing insurance companies, pay for their medical services, which will allow more funds to be directed specifically to medical institutions and to ensure greater availability of medical care for our citizens. All this is for the benefit of patients with the most serious pathology, who enter the centers according to quotas distributed by the Ministry of Health of the Russian Federation. Nobody can refuse a patient if there is a quota, either now or in the future", - Tatiana Tsybizova, a member of the State Duma Health Protection Committee, said to Novye Izvestia.

It turns out that the amendments introduced by the State Duma relate exclusively to the provision of expensive high-tech medical care?

In fact, the proposed changes are much deeper and more serious. "The system is changing. Regional funds for compulsory medical insurance are excluded from the system of financing high-tech medical care - complex operations, diagnostic manipulations, financing will go directly to federal medical centers. But how patients will be able to get to these federal medical centers and how they will select patients is still a big question today, ”comments Alexander Saversky, head of the League for the Protection of Patients' Rights.

"NI" asked the Ministry of Health of the Russian Federation about the system of distribution of patients to federal medical centers (if amendments to the law were adopted). However, at the time of publication of the material, no response had been received from the Ministry of Health.

“Now they say that there will supposedly be some kind of a database of federal patients. The question arises: who will compile this base and on what basis? Who will issue the referral? Or will it not be needed, the doctor's discharge from the district clinic will be enough? And will everyone be admitted on these extracts? If so, how, then, can you help everyone in need of help? All these questions, as far as I know, have not been finalized today. There is a possibility that federal medical centers will not cope with the flow of patients and will sooner or later begin to offer paid services. Such a system has already been taking shape recently", - Alexander Saversky, head of the League for the Protection of Patients' Rights, told Novye Izvestia.

That is, the situation is not completely ruled out when the planned volume of medical care in a regional hospital or in a federal center specializing in expensive high-tech medical care will at some point be exhausted. In this case, the medical organization will have a legally guaranteed right to refuse a patient. For example, the Helmholtz National Medical Research Center for Eye Diseases has been running out of places for Muscovites for several months now (the Moscow budget has run out of funds to pay for high-tech care for those who suffer from eye diseases). What to do in this case for patients who were operated on at the N.N. Helmholtz, were treated there for years by a certain doctor? Start all over again at another ophthalmological center? And then, when the volumes of planned assistance are over there, should we look for a third medical center? Now doctors offer to continue treatment for a fee. So the new system is already working.

“Today, the need of Russians for medical care does not meet the standards for its financing established by the health authorities in the regions. With the adoption of the new amendments, patients will face unpunished refusals en masse”, - warns Alexey Starchenko.

But no extra expenses!

There is one more point that can infringe upon the rights of patients. Today, people insured under compulsory medical insurance can seek medical help from any medical organization for help, regardless of where this medical facility is located. But the amendments introduced to clause 4 of part 1 of Article 16 of FZ-326 indicate that the choice of a federal clinic by a patient is limited by the procedure established by the authorized federal executive body. The lawyers of the legal department of the State Duma also paid attention to this in their conclusion to the draft amendments to the law on compulsory health insurance.

As a result of all the planned changes and amendments, it seems that the patient will simply be driven into a rigid framework according to the principle: we treat ourselves where it is available, wishes are inappropriate. “We deprive the patient of the right to choose a medical organization, to protect their rights, we focus exclusively on the capabilities of the system that are now available. In the absence of an independent examination of the quality of the assistance provided, all this will sooner or later turn the patient into a "serf" who will be provided with the assistance that is available at a given time in this particular region, and not the one that he needs", - said a member of the Public Council on the protection of patients' rights at Roszdravnadzor Alexey Starchenko.

The law will come into force after it is passed in the third reading. So far he has passed only the first. This means that public opinion still has a chance to influence legislators.