On August 6, the Fund sent a letter to the territorial offices of the compulsory health insurance and published the document in the public domain on the organization’s website. The authors described in detail the algorithm on how insurers should identify errors by doctors and clinics.
Each month, the regional funds must select cases in which the patient is admitted to a hospital bed and is diagnosed for the first time. Then, the employees will compare the data with the results of the patient’s medical examination if he or she underwent it “within the year preceding the provision of medical care.”
The analyses will then be verified by specialists in medical and economic examinations and in quality of medical care, said Ilya Balanin, chairman of the Compulsory Medical Insurance Fund, in a letter to regional offices.
In cases where specialist doctors fail to detect a dangerous disease in patients or have made an incorrect diagnosis, insurers will cut off funding to clinics. The attachment to the letter lists 275 diagnoses. We are talking about malignant tumors, neoplasms, diabetes mellitus and its complications, hypertension, gastritis, gastric ulcers, angina, ischemia and other diseases of the cardiovascular system and digestive organs.
Insurance companies must submit progress reports to the territorial fund of compulsory health insurance once a quarter, and summary reports, based on the results of the 6th, 9th and 12th months of the year.
“The quality control of medical care provided within the framework of compulsory health insurance is the responsibility of insurance organizations. Our clinic has not yet received this letter or other instructions on interaction under this document, but the work of our doctors was previously supervised by specialists of the Compulsory Medical Service of the territorial fund of compulsory health insurance,” says. o. Elena Potkina, head of clinic No. 1 in the city of Vologda.
Alexander Kudryakov, the head physician of another clinic No. 3 in Vologda, confirms that representatives of the regional department have not yet explained the reasons for the new fines.
Under the current system in the Russian Federation, funds from compulsory health insurance and the budget are transferred to clinics as reimbursement of the costs of treating patients. The new document gives insurers the opportunity to more actively punish doctors and health workers for their mistakes, especially since Vologda residents often raise the issue of poor-quality clinical examinations on social networks. An attempt to bypass all specialists in one day ends with examinations “for show” and fictitious medical notes in the card and “health” certificate.
According to Sergei Vinogradov, a general practitioner and candidate of economic sciences, medical errors in diagnosis exist and occur all over the world.
The entire burden falls on the front-line therapist, who must correctly guide the patient. The doctor is responsible for the patient and it all depends on how much harm is caused to him. But how to fully link the responsibility of the doctor and the patient, since there are patients who do not undergo additional procedures, despite prescriptions, the doctor wonders. After all, patients are also responsible for their health.
This is confirmed by Riza Kasimov, a freelance chief specialist in medical prevention at the Ministry of Health of the Russian Federation in the North-West Federal District and the Vologda Region Health Department, who speaks not only about supporting and improving primary health care, but also about shaping patients’ responsibility for their health. According to statistics, 24 percent of citizens have never undergone a medical examination during the entire period of its operation. This is a lot, said a representative of the department, convincing residents of the Kaduysky district of the Vologda region, where the rate of clinical examinations is half the regional average.
In order to solve the problem, the Kaduyskaya Central District Hospital has formed mobile teams that go to enterprises and organizations to conduct medical examinations.
Another idea, put forward by representatives of the Russian Union of Industrialists and Entrepreneurs at an event in the Vologda region, is to conduct medical examinations within two days due to the heavy workload of medical personnel. Another problem is the lack of shop doctors and health centres at enterprises, so management of enterprises can revive shop services to create healthy conditions at workplaces, said the vice-president of the union Viktor Cherepov.
Directors of Vologda clinics fear that the introduction of new algorithms for fines will become another round of the eternal struggle between medical institutions and insurance companies. To change the situation when determining the diagnosis, insurers should not limit doctors in the choice of studies. For example, to prescribe an MRI, it is often necessary to go to a consultation, and this delay plays against the patient, said doctor Sergei Vinogradov.
For now, patients in the region are learning to defend their rights and those of their relatives in court. In 2024, the Vologda City Court accepted a widow’s claim demanding compensation for moral damage from all medical institutions in the city where her husband died in 2023. And although the examination did not establish a cause-and-effect relationship between the established defects in the provision of medical care and the death of the spouse, the court satisfied the widow’s claim and recovered from each hospital compensation for moral damage in the amount of 200 thousand rubles.
