On the verge of change
After a certain succession of events that are destructive for the Russian Armed Forces, which have already received the nominal name “Reform of Serdyukov – Makarov”, it is perhaps the most difficult to come to life with military medicine, where alone orders and orders did not quickly restore the lost specialists and the well-established before that work of medical institutions and medical schools. And yet the situation is slowly but getting better.
RESTORATION OF THE LOST
While reforming military medicine, it was not only military personnel who suffered. Veterans of military service turned out to be undeservedly forgotten, many of whom, after the closure of a number of garrison hospitals, were forced to attach themselves to civilian medical institutions - hospitals and polyclinics. However, according to the Ministry of Health, no money was allocated for this, so the veterans were in limbo. In addition, civilian polyclinics did not always have the set of medical equipment and services that existed in military institutions.
Moreover, these problems sometimes affected the entire population of individual settlements in remote regions, where there was no medicine at all (beyond the Urals, in the Far East) and where exactly the military physicians were engaged in the treatment, prevention of citizens and even childbirth. The new leadership of the Ministry of Defense went the other way. The main military medical administration developed the best recommendations and proposals for the restoration of the broken. What did you manage to do in 2013 year?
Speaking at the international business congress “Security and Protection of the Personality, Society and the State”, the head of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation, over the past year, many changes have been made to the management system for medical support of the Russian Armed Forces. In particular, military-medical institutions of central subordination, medical services of military districts, types and types of troops (the medical services of types and types of troops were restored during 2013 year), institutions of higher professional education, sanatorium complexes, as well as research organizations of the medical service of the RF Armed Forces. The Institute of Military Medicine, which today is part of the Military Medical Academy (St. Petersburg), is being restored.
A three-tier system of medical care in the domestic armed forces has been built. The first level - medical units of the military unit. The second level - medical institutions of the military districts (for the year 2013 occurred their downsizing). The third level - medical institutions of central subordination, which previously included the Main Military Clinical Hospital named after Academician N.N. Burdenko, P.V. Medical Medical and Scientific Center Mandryki, Third Central Military Clinical Hospital, Medical Academy, Medical Center of the Ministry of Defense of the Russian Federation.
It is particularly noted, unfortunately, the fact that the organizational decisions that were previously made to change the organizational and legal forms of military medical institutions did not yield the desired result.
“Therefore, the Minister of Defense supported our initiative to restore three military medical institutions of central subordination in the budgetary status,” said Alexander Fisun. - And today the work on the transformation into budgetary institutions of the 3 Central Military Clinical Hospital named after A.A. Vishnevsky, Military Medical Academy, 9 medical diagnostic center of the Ministry of Defense of the Russian Federation.
What is expected of this in the leadership of the Main Military Medical Directorate? First of all, improving the quality of medical care and the number of patients treated. In those years when the organizational and legal form was, as they say, a bureaucratic one, there was a sharp decline both in the number of patients, and in the economic gain received, in terms of the amount of money earned. Preliminary calculations showed that if the management starts to work in the new organizational structure and becomes a budget organization, by the end of 2014, it will reach the figures of about 2010, and by the end of 2015, - on the indicators of 2011.
If the medical institutions of the Main Military Medical Department had worked in the budget system for the past two years, these figures could have been even better. And this, in turn, would have a positive impact on the growth of employees' wages, and on improving the material base of institutions. In the Military Medical Academy, for example, over the past two years (2012 – 2013) there have been almost no incentive payments. But by the end of 2014, the incentive payments to academy employees, as announced, had reached 19 thousand rubles, and the salaries of the academy employees would exceed the average in St. Petersburg.
About the same calculations are for other medical institutions. With the proper organization of funding, the adequate preparation of state tasks and their implementation in the Main Military Medical Administration, the situation is expected to be rectified by the end of 2014. Now there is an analysis of the activities of medical institutions, which can become budgetary in military districts.
It was also possible to change the ideology itself and return to the military medicine specialties and specialists who were cut, in particular military psychiatrists, neurologists, therapists, and a number of others. And if it is possible to redistribute the states, change the organizational structure, then the officer posts of doctors, nurses, and emergency medical services will also be introduced.
Now under the supervision of the military medical service is almost 7 million people. 14% of them are military personnel, 75% are members of their families and veterans of the Armed Forces, 11% are civilian personnel. But the reality is that not all persons who have the right to medical care are attached to military medical institutions. So that they would not be without help, in 2013, 299 contracts were concluded with organizations of the municipal health care system, and the Ministry of Defense of the Russian Federation financed these agreements in full. Now the Main Military Medical Directorate has no debts for medical aid that has not been given.
As for the state of health of military personnel, it remains approximately the same as in recent years. Although in comparison with 2011 – 2012 over the years there has been a slight decline in the number of people with chronic diseases. To a certain extent, this, of course, was influenced by recent organizational measures, as well as the principled position of the command of a number of military units and formations. Thus, persons who do not comply with the standards for physical training and do not undergo professional psycho-physiological selection are subject to dismissal from the ranks of the Russian Armed Forces.
- We believe that behind this figure there are also certain efforts of the military medical service, - Alexander Fisun expressed his opinion. - This is a clinical examination, and after-hospital treatment, and sanatorium-resort provision.
WHY THE HEALTH CARE IS EMPTYED
But with the health of conscripts, the situation is somewhat different. The most frequent problems of conscripts are diseases of the respiratory system, as, incidentally, contract soldiers. In second place are diseases of the skin and subcutaneous tissue (conscripts) and of the musculoskeletal system (contract soldiers). Further, in descending order are diseases of the digestive system, cardiovascular, nervous systems.
In 2013, a deferment due to illness received 216 thousand people (29%). Of these, 13% are mental disorders, which often manifest themselves in single-parent families, where drunkenness and drug addiction are frequent. 18% accounts for bone diseases - the result of detraining of children who were not involved in physical education and sports at school. 10% - diseases of the digestive system (chronic hepatitis associated with the effects of drug addiction, improper or inadequate nutrition, life in single-parent families). In general, this is a reflection of the situation that has developed in society.
Despite all the problems with financing, high-tech medical care is increasingly being provided in military medical institutions. Today it turns out to be more than 13,5 thousand people annually worth more than 1 billion rubles. (although in recent years military medicine has not received a single ruble from the Ministry of Health or quotas). 19% of them are conscript and contract servicemen. Such assistance is also provided to pensioners who have general medical medical policies for compulsory medical insurance.
Based on the provision of high-tech care to patients lies at the Hospital named after N.N. Burdenko (more than 50%), Military Medical Academy, Central Hospital named after A.A. Vishnevsky, P.V. Medical Center Mandryka. The main military medical administration is ready to continue building up such work, especially since the leadership of the Ministry of Defense has allocated more than 1 billion rubles this year. for these purposes. Although, we repeat, the issue with financing has not been solved for many years, and now it’s not so easy to catch up. In the 2012 year, for example, not a single penny was allocated at all.
In 2013, we managed to complete the formation or come up with an initiative to create regulatory acts that are directly related to medical care. These are changes in government resolutions on dental prosthetics, provision of military personnel and military retirees with medicines, as well as the adoption of the Provision on military-medical expertise, the development of the Provision on the All-Russian Disaster Medicine Service, the draft decree "On the approval of the rules for the payment of medical assistance to citizens who are Abroad". In general, today, medical assistance is 42 thousand soldiers and almost 500 thousand military retirees.
Modular designs allow you to deploy in the areas of hostilities mobile hospitals, equipped with the most modern equipment
In the last 2 – 3, a lot of complaints were brought to the sanatorium-resort supply for military personnel, their families and military service veterans. It turned out to be far from what was desired and even from what was just a few years ago. This situation was the result of the most destructive Serdyukov – Makarov reforms. But, despite the organizational measures, the Main Military Medical Directorate managed to maintain a number of sanatoriums in almost perfect condition. In particular, "Marfinsky", "Arkhangelsk", "Volga", "Paratunka" and "Sochi".
But today the Department of sanatorium and resort support has been disbanded. Instead, a separate Directorate of medical and psychological rehabilitation and sanatorium-resort treatment was created in the Main Military Medical Directorate. The military sanatoriums "Yalta", "Svetlogorsk" and eight sanatorium-resort complexes located abroad are closed to it. There were no subordinate sanatoriums in the military district, although this is probably wrong. After all, sanatoriums always also functioned as hospitals for the wounded when deploying a hospital base in wartime, rehabilitation centers, and bases for medical and psychological rehabilitation. Paradox, but to the commander today flotilla in Kamchatka to get places for medical and psychological rehabilitation of subordinates in Paratunka, it is necessary to coordinate this with Moscow. And these are also the consequences of the “Serdyukov – Makarov reforms”.
“We see positive moments that have appeared in military medicine in recent years, but we also know about negative ones,” Fisun notes. - Among the positive ones is the optimization of the management system.
Now changed the order of receipt of vouchers. For this you need to register on the website of the Ministry of Defense. There is a reconstruction of sanatorium-resort complexes, the introduction of modern forms of service. But excessive centralization has its flaws. Thus, the system of interaction between the district medical service and a particular sanatorium was disrupted. There is no proper control over the correct referral of the patient to the sanatorium-resort treatment. Sometimes people go to sanatoria who have direct contraindications to being in its climatic zone.
Today, the work of the system of medical and psychological rehabilitation of servicemen has been disrupted; there is practically none. Planning and organization of sanatorium services takes place in the absence of an understanding of the true need and algorithm of the applicable standards for such services. Their quality has been reduced, to which there is a huge number of complaints. Grew up the cost of permits. Reduced medical staff.
All this led to the fact that if in 2008, 215 thousand people were treated in medical institutions of the Ministry of Defense, then in 2012 year - already 143 thousand, and the proportion of military personnel among them was completely reduced more than 10 times. Specialists of the Main Military Medical Department conducted a comparative analysis of the cost of the voucher and the size of the monetary allowance of the serviceman. The results were disappointing. If in 2008, the share of the cost of purchasing a voucher in the military’s wallet was 29%, today with an increase in their value and the cancellation of benefits - 52%. Of course, it is expensive. If the soldier goes with his wife and children, then triple. Against this background, the proposals of various travel agencies to spend holidays in Turkey, Egypt and Thailand look much more attractive. Therefore, they are more in demand by our servicemen than military sanatoriums. Unless, of course, they have the right to go abroad.
How to correct the situation?
The Minister of Defense supported the initiative of the Main Military Medical Department to freeze the cost of vouchers until 2016. In addition, those services that are paid for by the Defense Ministry of the Russian Federation will be excluded from their prices. As a result, the share of the cost of the ticket in the 2016 year will remain the same as it was in the 2008 year. In addition, the cost of child vouchers has been reduced since 2013. The Minister of Defense supported the initiative of the leadership of the Main Military Medical Directorate, so that Suvorov, Nakhimov, Cadets without parents could rest in children's health camps and rest homes for free. This applies to cadets of military higher educational institutions.
Centers for sanatorium-and-spa provision in the districts will be created, a terminal system will be restored where you can hand in documents for vouchers. Communication directly with such a center, according to the head of the Main Military Medical Directorate, will be more productive than with a polyclinic. But he acknowledged that "terminals where you can turn and get a ticket, today is extremely insufficient." And there is something to work on.
The development of a new concept for the development of medical and sanatorium-resort support for servicemen and military service veterans is now being completed. It must be approved by the Minister of Defense and provides for issues of medical support for participants and disabled people of the Great Patriotic War, as well as participants in military operations in the military medical institutions of the Ministry of Defense of the Russian Federation.
“In the near future, we must attach to us more than 300 thousands of front-line soldiers with whom we will provide medical assistance as part of the implementation of state guarantees, and in some cases high-tech medical care,” explained Alexander Fisun.
PROSPECTS
From 2014, a number of military sanatoriums, which will become budgetary, should be confined to the management of medical and psychological rehabilitation. The district is the Center for Medical and Psychological Rehabilitation, which acquires the status of an independent public institution, and sanatoriums of district subordination will be included in it as branches. All holiday homes will be closed only on the district.
In 2012, by decision of Serdyukov, the work of 25 children's health camps was stopped. Today, this type of activity is partly implemented on the basis of the Central Military Children's Sanatorium, as well as sanatorium-resort complexes "Moscow Region", "Anapsky", "Privolzhsky" and "Far Eastern". In the future, the system will be changed, and children's recreation organized on the basis of seven children's health camps, which will be subordinate to the medical service of the districts. Some of the health camps planned for closure will be retained, the functions of others will be transferred to existing holiday homes. Their material and technical base will also change, additional tutor positions will appear.
Much work is being done on the construction and reconstruction of facilities in the 13 military sanatoriums of the Russian Ministry of Defense: "Ocean", "Gold Coast", "Aurora", "Sochi" and others. But especially many veterans are actively interested in the fate of the previously prestigious sanatorium named after J. Fabricius, who was visited by the Minister of Defense on May 10. Adopted the concept of its recovery. After the Winter Olympics, restoration work will begin there. It is planned that in the 2013 year the sanatorium will open as an independent budget institution.
Recent events in the country have shown: military medicine is needed and copes with its tasks. For example, during the flood in the Far East, special-purpose medical units (MOSN) deployed there even earlier than some engineering structures of the Ministry of Defense and other departments. During the flood period alone, more than 23 were vaccinated. Thousands of people received medical assistance from almost 2500 applicants. The military doctors also strengthened the All-Russian Center for Emergency Medicine, where they showed themselves from the best side.
New means of evacuating the wounded are being developed. After visiting the “Integrated Safety-2013” exhibition, the Minister of Defense set the task of developing a universal vehicle that could operate on land, in the air and at sea. Kazan Helicopter Plant has prepared a draft of such a tool. It will be equipped with special monitoring systems and other emergency services. In April, 2015 is scheduled to be tested. New automated tools are also being created to search for and evacuate the wounded, as well as to stop bleeding.
Of course, without trained personnel, these large-scale tasks cannot be solved. For many years, there was no recruitment to the Military Medical Academy, located in St. Petersburg. And last year more than 600 people were accepted into it. 41 of them - on postgraduate forms of education. Since the beginning of 2013, more than 80 medical officers have been returned to the service from the reserve. A few dozen personal files are under consideration. Only until the end of 2013, the 100 medical officers of the reserve service were back in line. Of these, more than 20 are paramedics who were previously dismissed from organizational events. Pharmacy officers, dental officers, who have spent a lot of money on training the state, will also return.
Priorities were also identified in the construction and reconstruction of military medical institutions. So far, hospitals in Vladikavkaz, Ryazan, Tver, Perm, Orenburg and Penza are in a difficult situation. It is planned that by the year 2018 they will be completely reconstructed. In the same Military Medical Academy is under reconstruction 12 objects. Each of them receives a monthly report to the Minister of Defense. Funds for this are allocated. If in the 2011, not a single penny was allocated, in the 2012 year - 15 million rubles, and in the 2013 year - already 163 million. Not less money seems to be allocated on the basis of the 2014 year.
Until 2017, special pneumo-frame structures will be purchased for medical mouths, four medical aviation detachments, seven medical special forces. By July 2014, one pneumo-cage will appear for a medical company, a separate aviation medical unit - for a preliminary assessment of their effectiveness.
In October 2013, the Minister of Defense decided to return historical names of a number of military medical institutions. It is impossible to cross out what has been done by predecessors over the years. Historical names are being returned or have already been returned to the Kronstadt military hospital, the 25th Central Military Clinical Hospital of the Missile Forces, the 7th Central Clinical Hospital in Sokolniki, the 32nd Naval Hospital, 1029 Airborne Forces Hospital (Tula), and a number of others. Thus, historical justice will be restored and the memory of entire generations of military doctors who have invested in their creation and many years of work, and their talent, and the fire of the soul.
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