Scrape the corners: how much Russian regions are spending on the fight against coronavirus

Lyudmila Butuzova

Cabbage against the epidemic

Krasnoyarsk Territory , seventh place in Russia in terms of the number of infected. Messages about what is happening now in some of its points are reminiscent of reports from hell.

Residents of the city of Achinsk in the Krasnoyarsk Territory collect food for doctors and patients of a covid hospital on the basis of a local hospital - Achinsk MRH. The corresponding announcement hangs on the website of the city administration and the city council of deputies. Attached to the announcement is a note explaining the charitable campaign: "Despite the fact that the covid hospitals are fully equipped with everything necessary, we are ready to respond to the wishes of the townspeople to provide such assistance when the number of cases has increased significantly".

Meanwhile, patients and their relatives tell in local publics on Vkontakte that the hospital does not even have drip stands, not to mention expensive antibiotics and equipment.

“People get up at three, at five in the morning to put IVs. Because there are only 9 tripods for 35 people in the department. Although tripods are not expensive antibiotics, they can be bought, - Victoria Baturina, a resident of Achinsk, who has just been discharged from a covid hospital, told her fellow countrymen. - At night people really froze. In addition to the fact that the lungs hurt, the temperature, they also froze! Hospital beds are really tin..."

From the hospital, the girl was able to contact the deputy of the Achinsk city council, Lilia Chernyshenko. Chernyshenko bought and brought to the hospital 30 mattresses, 30 pillows and 30 blankets. The chairman of the city council, Sergeн Nikitin, handed over teapots and a microwave oven to the covid patients, bought with the money of deputies and parishioners of the Church of Worship.

“One of the patients really turned to Lilia Vladimirovna”, - Anna Chernyshenko's assistant confirmed to Novye Izvestia. -. Reported that there are no bedding. We decided to respond to the request. Then the patients sent us a video with gratitude. Of course, it's not normal when there are no blankets or mattresses in the hospital. Given that the second wave was planned when the first was not over yet. But why our healthcare was not ready, I don’t know. This question should be asked to those who occupy higher positions.

A plot about the collection of food for doctors and patients for the Achinsk Central Regional Hospital was shown on the regional channel "Yenisey". Well, that's real: people drag food from their personal gardens to the hospital.

How everything started

Vitaly Yakushev, a microbiologist and expert at the Health Independent Monitoring Foundation, says it hurts him to look at the government's efforts to fight the coronavirus. The federal center gave everything to the regions. Therein lies a great slyness: the center knows perfectly well what the state of the local health care system is - it has been brought to the handle by optimization. It is aware of regional budgets, most of which have nowhere to get additional funds, not only for anti-epidemiological measures, but at least to bring hospitals into a divine state. The role of a stern but wise counselor is a weak position for the government:

- The regions need money. Lack of food, medicine, medical technology and equipment - not just the healthcare system faced this, people - more than 100 million people outside the capitals - faced this. What will happen to them after 6-7 months of torment? Money is needed urgently to endure. And not microscopic tranches for a couple of tens of billions, but at least hundreds for the restoration of medicine, and not just for the part of it that fights covid.

Human losses and economic woes will be much greater if the government continues to shift responsibility to the regions. So far, this has only led to local authorities reporting that the situation is under control, but in the past two months there has not been a week or even a day without a scandal in one of the cities. That's when the federal center turns on, "extinguishes the fire" in the emergency mode.

There are no more than two such cases in the entire pandemic. In early November, the emergency doctors of Khakassia posted a video in which their colleague kneeling begs the hospital to accept an elderly war veteran woman for treatment. The Ministry of Defense has promised to send military doctors and a mobile hospital to Khakassia. Of course, such a decision could not have been made without Putin's personal order. Next, doctors from four hospitals in Kurgan asked to send military medics to help them. “A complete collapse, an ambulance service serves up to 700 calls a day, and specialized doctors were transferred to treat patients with coronavirus infection. Help before the people start dying in our streets, ”reads the address to the President. Two days later, military doctors were sent to the region, including infectious disease specialists, anesthesiologists-resuscitators and a doctor for laboratory and PCR diagnostics.

Not all regions decided to admit the situation is awful and disturb the Kremlin. The Vologda authorities' fear of being fined before the center turned out to be stronger than common sense. One of the visitors to a covid mono-hospital in the regional center photographed patients lying on mattresses in the corridor. The Ministry of Health of the region gave the most exotic explanation for what happened: the patients themselves lay down on the floor “in protest”, and the media allegedly “replicated” the photo along with the statement that there were not enough places in the hospital. “Patients who expressed dissatisfaction were given wards”, - the health department said. However, the next morning, the editors of the local newspaper City of Vo received new photographs showing that patients were still lying in the corridors. After that, the head physician of the mono-hospital, Pavel Sheprinsky, expressed a different version. According to him, the administration of the clinic sometimes decides to place the patient not in the ward, but in the corridor - closer to the post of the nurse on duty. The doctor's explanation was posted by the official account of the Vologda Oblast government on the VKontakte social network.

At that time, only two hospitals in Vologda had the status of "covid". Now there are five of them. Can you imagine how many extra mattresses were needed?

Spread in a thin layer

In November, the Vologda Region received 43 million rubles for patients with covid, another 15 million rubles will go from the federal center to equip the laboratories of mono-hospitals in Vologda, Cherepovets, Veliky Ustyug. Lucky not only in this area. The decision to provide federal funds to provide free medicines to people who are being treated for coronavirus infection at home was made by Russian President Vladimir Putin on October 28 at a meeting with members of the Cabinet. “We will additionally allocate 10 billion rubles to the regions for this, and another billion rubles to support regional laboratories”, - said Prime Minister Mikhail Mishustin.

Some of the results of that meeting were covered online by the telegram channel Conscience of the Governorate:

“Now all the governors have shrunk and are waiting. Based on the results of the meeting, conclusions will be drawn by region, who is coping and who is not. But none of them knows how the money will be distributed: will they give more to the best or to those who are doing really badly?"

Then Tatyana Golikova began to report on the disbursement of funds. According to her, there are regions in the country, and there are many of them (40, as it turned out later) that cannot cope with the effective development of federal tranches.

“The arguments of those regions where funds for the fight against coronavirus have not been spent are unfounded!”, - Tatiana Golikova said.

Contrary to the popular belief that the center is sitting on an endless bank and does not want to share with the provinces, money was allocated to the regions on behalf of the president, which was given back in April. Not trillions, of course, but "the regions of Russia received 300 billion rubles", - said the head of the Ministry of Health of the Russian Federation Mikhail Murashko at a meeting of the State Duma Committee on Health Protection.

The analytical agency ACRA, accredited with the Central Bank of the Russian Federation, counted much more spending by the federal center - 700 billion rubles for seven months of 2020. Of this amount, 247 billion rubles. went to the Federal Medical Insurance Fund, and 225 billion rubles to the regions and helped them to “close” the increased health care costs. Own expenditures of regional budgets in this area have almost doubled in 2020. The maximum is in the Saratov region (3.2 times), in Sevastopol (3.1 times) and in Dagestan (3 times). In absolute terms, the regions with the largest budgets showed the maximum growth, such as Moscow (plus RUB 190 billion) and the Moscow Region (RUB 37 billion). By types of expenditures, the largest increase occurred in the previously inconspicuous budgetary subsection “Sanitary and Epidemiological Wellbeing” - its volume increased immediately 26 times, to 17.5 billion rubles.

Where did the money go? According to Mikhail Murashko, they were spent on re-profiling the bed fund, stimulating payments to medical workers, centralized deliveries of ambulances.

This is exactly what people do not see.

Take the doctor

People on social media wonder where their taxes go if there is no medicine, equipment, or hospitals. There is no transport either.

“The transport is more than a strange story”, - said Igor Boldenko, co-chairman of the Russian Public Center for Combating Counterfeiting, a member of the Alliance of Doctors trade union. - In the first wave, they did not represent the full severity of the epidemic and believed that one ambulance for three districts would be more than enough, the doctor would walk to the patient on foot, and not finish it, after all, people used to get along somehow. Now the situation is different. In some regions, there are up to 900 calls a day - both to hospitalization and to home, where now it is supposed to treat patients of mild and moderate severity. Volunteers have to carry the precinct policemen on calls - the action "Take the Doctor" is now taking place throughout Siberia.

There are cases when officials give their cars. Local authorities are negotiating with enterprises to replace ambulances. There are not enough 2,700 ambulances across the country, ”reports Minister Murashko. What's next? The cost of the cars is 1.5 million rubles each, a total of 4 billion is needed. Not a word about centralized purchases this time, the budget for the ambulances, apparently, was spent at the beginning of the epidemic, and the government does not know how to get out. If you open the page of Public procurement for tenders, you can see that in 2021 the state will spend 4.3 billion from the budget for the transportation of “top officials”. This money would be enough to buy 2,866 ambulances for the regions and FULLY cover the deficit, which is said in the Ministry of Health of the Russian Federation. Having saved on the transportation of officials of ministries, departments and deputies of different levels, it would be possible to painlessly pay "covid" doctors, which they completely do not receive or pull out with a fight when they themselves become infected at work.

“In St. Petersburg, nine workers of the city ambulance station have filed a lawsuit against the city authorities for refusing to provide payments to health workers who have fallen ill with COVID-19”, - says Boldenko. - Officials believe that the infection of doctors is not associated with their help to sick citizens. Can you imagine how much the risks increase and how much the salaries of doctors will decrease with the transfer of patients to home treatment?

From December 2020, ambulance workers and polyclinics in Russia can lose up to half of federal co-payments for work with COVID-19 patients. This is due to the new payment procedure, which was approved by the government on October 30. If earlier additional money was paid simply for the fact of working with patients with COVID-19, as well as with patients from risk groups, now only the number of hours spent with the infected will be taken into account. Regional authorities are anxiously awaiting the first winter month - a decrease in payments may lead to an outflow of doctors from the emergency room and polyclinics.

- It is always like this with us: first they will do it, then they will think about it, - says Boldenko. - Doctors will leave, but we will increase the service of patients at home. How? The latest solemn promises, such as online treatment and free drugs for those who are not admitted to hospitals, are in the air. The very principle of distribution of the last government tranche of 11 billion rubles is not clear. We got 80 regions. Someone was given 15-20 million for the intended purpose, some 50-60 million. How did they count the home sick? From the total number of residents? The number of missing beds in hospitals? Or only those who were able to achieve an official diagnosis of COVID-19, and not SARS and pharyngitis with bronchitis? After all, there is no diagnostics, and hardly anyone now has an idea of how many test systems need to be produced in order to provide the whole country with them. But even if they do, in order to use all this, special laboratories, reagents, specialists who know how to work with it and so on are needed... You won't get off with one billion...

Everyone understands this very well, so the money is spent, first of all, on organizing measures to prevent contacts of infected people with healthy ones - that is, on the compulsory retention of citizens at home. If you monitor social networks, there are thousands of testimonies how the expectation of a free one turns into a prolongation of the disease, and how much people spend to recover without the help of the state.

Indeed, sadness... Marina A. from Belgorod: “I went to polyclinic № 2 without waiting for a doctor to come home. There was a list of prescribed drugs for 4500 rubles. From the free one - a disposable cloth for a mug. THERE ARE NO TESTS IN POLYCLINICS! I requested a coronavirus test at the hospital. They refused: you are not ours, you are home. No medicine was given for the same reason. I myself cannot buy - there is no money. I have a mortgage, now we are trying to save on food and clothes, we had to refuse treatment, the temperature has not changed to this day. They cannot be allowed to work because of the decisions of the governor. They can be fined... I will repeat my main question: where does the money go to support people in the fight against coronavirus?"

Tatiana Kuzina, Tomsk: “I felt the onset of the covid, called a doctor, the dispatcher promised that they would come in three or four days. What to do now? - "Wait." And if…? - "Wait". I did the test for a fee - 3500 rubles. Positive. I spent on drink the second course of antibiotics for 30 thousand. New test -. 4200. CT scan in a private clinic - 14,000, therapist's appointment there - 7500. Business on covid is clearly going uphill. I feel almost healthy and very angry. Do not fool yourself that someone - the Department of Health, the Ministry of Health - will bear the costs of treating coronavirus patients at home. We were simply locked up in apartments, from where, if you want to recover, there is only one way - to paid medicine and to pharmaceutical speculators".

How much does it cost to heal the "crown" at your own expense

How much does it actually cost in Russia to treat one patient with COVID-19 under the compulsory health insurance policy of compulsory health insurance? How comparable are these figures with the cost of medical care for other diseases?

“The cost of treating a patient with COVID-19 under compulsory medical insurance is determined by the regional tariff for paying for any infectious disease and may depend only on the severity of the disease”, - Professor Sergey Borisov, vice president of resuscitation specialists of Russia, told NI. –Let's take a look at Moscow as an example. The tariff for paying for medical care for patients with pneumonia does not depend on what kind of infectious agent it is caused by. That is, the amount will be the same in the treatment of coronavirus pneumonia, and another viral, and caused by pneumococcal bacteria or mycoplasma. This is 205 thousand rubles. In Krasnodar, 173 thousand, in Bryansk - 126, in Tyumen - 216, in Kemerovo - 233, Rostov - 149, in the Khanty-Mansi Autonomous Okrug - 255 thousand rubles. I also know for sure that they don't pay extra for resuscitation anywhere, oxygen, tomography are also not included in the compulsory medical insurance tariffs. Accordingly, all this is extremely insufficient, and patients in essence can only count on a bed, bypassing doctors and some medical manipulations.

During the epidemic, the government turned its attention to private clinics, which were much better equipped. But very soon it became clear that the compulsory medical insurance payments did not cover their costs of treating the infected. Of the four non-state hospitals that treated covid patients in the spring, only two remain to date, the number of commercial covid beds that worked under compulsory medical insurance in Moscow has decreased from 800 to 280. Commercial hospitals have not taken root in large provincial cities: if you have a tomograph on credit for 37 million rubles, then you will never beat them off, receiving pennies from the state for the patient. Here's the harsh truth: it is more profitable for private traders to diagnose coronavirus than to treat it at compulsory medical insurance rates.

Another truth is that the bed capacity in hospitals for patients with coronavirus is more than 90% full in Russia. People need to go somewhere... Muscovite Nikolay P. published a post that collected more than a thousand responses. And here's why: "Eyes on the forehead crawl from the exposed price tag, but my mother, who was tormented for a month in the district hospital, was put on her feet in a private clinic in a week." Judging by the responses, people are jealous that there is no clinic in their backwoods where you can get a miraculous deliverance. One important conclusion of the author of the post is missing on my ears: “Mom's clinic belongs to a famous billionaire, the owner of a medical network. And she got there under the compulsory medical insurance. According to the standard, the cost of 1 covid patient for 14 days is 200,000 rubles. This clinic has 260 beds. The arithmetic is very simple. A person survives on the water and on light droppers - their merit, dies - "we did everything we could! But COVID-19 is not yet 100% cured". That is, they behave like any creepy hospital. You pay, they immediately transform into a clinic of the 21st century.

Let's think about it tomorrow... Now it's just the order of prices in the two most famous clinics of the Moscow Region, as the patients treated there presented them to Novy Izvestia.

In April, two weeks of hospitalization in Otradnoye Krasnogorsk district (the hospital of the company "MEDSI", owned by AFK "Sistema" billionaire Vladimir Yevtushenkov) cost the patient, depending on the class of the ward, 175-420 thousand rubles, with an advance payment of 400 thousand rubles. ...The number of beds for coronavirus patients was then more than 300 . Now two weeks there are 400-500 thousand rubles, an advance for a single room - 500 thousand. The number of beds reserved for covid is 160-170 , another 30-40 are allocated for intensive care.

In a hospital in the village of Lapino, Odintsovo District (a network of clinics "Mother and Child" of the multimillionaire Mark Kurtser), the advance payment for hospitalization increased from 400 to 600 thousand rubles. The day of treatment, which cost 40 thousand in the spring, now reaches 75 thousand, depending on the class of the ward. Accordingly, the cost of a two-week treatment has also changed - now it will cost from 350 thousand to 1 million rubles. For resuscitation you will have to pay extra 3.4-4.8 thousand per hour. The number of beds in Lapino dropped from 170 to 120. They no longer accept compulsory medical insurance here.

BUSINESS PROJECT IN THE REGIONS

Covid as a business project is being tested in the regions. For example, in Novosibirsk, on the basis of the Siberian Regional Medical Center of the Federal Medical and Biological Agency of the Russian Federation (SOMC FMBA), a covid hospital was opened in November. At the same time, it was reported that the medical facility would accept patients free of charge. It was very handy - the Novosibirsk region is breaking all records in morbidity, there are not enough beds, local media reported that patients of the infectious diseases department of the Kuibyshev Central District Hospital are placed on stairwells. Less than a week later, the hospital under the federal agency began to provide paid services. So, to get there for money, it is necessary that the patient has a high fever, loss of smell and shortness of breath, and most importantly, than pay.

A day of stay for a mild form of a Kovidnik will cost from 17 thousand rubles. This amount does not include resuscitation, coronavirus tests and CT scans. With moderate severity, the same services - 25 thousand rubles per day. The hospital is ready to provide a bed for patients with a severe form of coronavirus for 32 thousand rubles a day. Computed tomography without contrast costs 7.6 thousand rubles, daily observation of an intensive care patient in the department of anesthesiology and intensive care will cost 9.3 thousand rubles, - the dispatcher told the NI correspondent who called the Novosibirsk hospital on the machine.

Interestingly, since January of this year, the head of the FMBA is Veronika Skvortsova, who previously held the post of Minister of Health of Russia. In November, she was awarded the order "for her great contribution to the development of health care, organization of work to prevent and prevent the spread of coronavirus infection."

In regions where there are no stellar medical managers and few solvent patients, socially oriented entrepreneurs take on covid projects. One of them, Vladimir Otmashkin, is financing the conversion of the Posuda Center trade building in Barnaul into a hospital for 500-600 beds. But, unfortunately, the question remains unanswered, how, when and for what money will the medical equipment be purchased? On what terms will the government take this premises for rent? The hospital costs millions of dollars. There is catastrophically no money in the region, you cannot even collect from the sick for a simple boarding house in the former "Dishes".

In the Oryol Region, re-profiling for covid hospitals is carried out at no cost at all, in the genre of a raider operation: they squeezed out the department - they hung up a sign with a new name. Now this is happening in the Semashko emergency hospital - - the surgical department has been liquidated - the basis and the profile of its existence, beds with viral patients. “In general, we are doing everything necessary to make the Semashko hospital a full-fledged covid hospital”, - head of the Department of Health Zalogin said at an online briefing. Where the inconspicuous surgical patient is treated, Zalogin described vaguely - to whom where.

The analytical agency AKRA, as we remember, counted a bunch of spending by the federal center on health care during the fight against the pandemic in the country. At the same time, it is noted that a significant part of the new expenses were made by the entities at their own expense - in the face of falling incomes and increasing debt. However, the conclusion is pessimistic - it is unlikely that in the coming years the regions will be able to maintain spending on healthcare at this level. Therefore, after the end of the pandemic, "it will be necessary to analyze the costs incurred and the possibility of using the material and technical base created to fight the coronavirus in the future." There is no doubt that the regions will cope with the analysis, plus everything will go - from mattresses donated by the population to strengthen the material base of ruined hospitals, to surgical operations in viral departments, which were done out of savings so as not to spend twice on patients.