“We are on the threshold of a broad campaign for a change in the policy of the state in health care”
What happens if physicians declare a mass strike? Interview with Union leader
Last weekend, doctors in Russia celebrated their professional holiday. Healthcare in Russia remains a challenge. This is evidenced by the recent “Italian strike” doctors ambulance station in the Penza region. It brought together over a hundred people. Following the strike declared by the doctors in the Novgorod region. About Lee threatened new protests of the medics, can suffer from them to patients who is to blame for the current situation and how to reform the health care system, in an interview Znak.com says the co-chair of the interregional Union of health workers “Action” Andrey Konoval.
“The medical business is interested to make patients sick a lot and often”
— How would you define today a policy of the Ministry of health?
— The Ministry of health has consistently, for many years, despite sharp criticism from many experts, advocates the preservation of Russia’s insurance (and in fact — a pseudo-insurance) health model. It is primarily on the preservation of parasitic spacers between the health insurance Fund and public health facilities as private insurance companies. These structures do not attract the money of citizens, but somehow dispose of the money invested in regional programs of compulsory medical insurance, the state and the health insurance Fund. While real control over the quality of the treatment process, from our point of view, the insurers do not exercise. But removed a kind of rent as payment for their “services” and fines to hospitals mainly for the errors and deficiencies in registration of medical documentation. There is a double harm — on the one hand, doctors are distracted by meaningless largely paper work, on the other — the already planted on a hungry financial ration medical facilities lose so missing them money.
The only thing from my point of view, the cause of preservation of this system is a continuation of the course on the commercialization of healthcare in the interests of the private medical business. It is not only insurers, but also private investors, including foreign ones.
First, the MMI system also allows access of private traders to state money. The Minister of health Veronika Skvortsova said that sees its task in building a national health system in which public and private organizations will have equal access to state money.
Secondly, the existing medical insurance system are slowly but surely killing the public health sector, and the elimination of a competitor is always beneficial. If in state institutions the queue if necessary check have to wait several months, and for speed you offer them to do on a paid basis, then, of course, patients have to go to the private trader. Objectively private health sector is concerned, the patients suffered a lot and often and earning profits. At the same time, the national health system has the opposite goal is a healthy, very few sick people. Here, the main importance is the prevention system that we have now virtually destroyed.
So, in short, I would say that the policy of the Ministry of health is in violation of article 41 of the Constitution, according to which medical aid in state and municipal health care institutions to citizens free of charge. In the Russian conditions it is necessary to go to the budget health-care model is successfully working in many countries of Western Europe.
— It’s quite a global conclusion. What can you say about the current work of the Department in the framework of the existing model?
— First, it should be noted that the functions of the Ministry of health cut. In reality, it has serious levers of control in the regions to ensure normal funding of the health system and compliance with all necessary regulations and standards. That is, there is no hierarchy strict control of the Ministry of health. The same charges CHI are calculated at the regional level. As a result, this often leads to underinvestment on the part of regional authorities for the system, even in comparison with those standards that are approved at the Federal level. Hence the huge funding gap in medicine between different regions.
The Ministry of health and the Federal center down fitting on the optimization of the structure of medical institutions for the performance of “may decrees” of the President. In the end it just resulted in disaster for the Junior staff of the health system.
Over the past few years, the reductions affected about 300 thousand workers — almost half of nurses in the country.
It’s nurses and Junior nurses, which for the most part transferred to the status of the cleaners, not to raise wages “may decrees”. It leads to gross violations of the Labor code and orders of rendering of medical aid, the confusion in the responsibilities to depressed employees and turnover.
Rationing of medical workers is almost destroyed. Today almost the norm that the doctor serves 2-3 area instead of two. Sometimes the situation is even worse. A vivid example — the children’s out-patient Department № 2 in city Lyubertsy Moscow region, where 12 thousand people the pediatric population for several years served only 4-5 pediatricians. It is at the rate of 800 children at 1 site.
We have ambulance can make up to 20 calls per shift, this is a completely wild strain on the staff. The acceptable standard is 11-13 call for the resuscitation team to seven. Because of such intensity that people can’t even organize themselves technological breaks, to eat, to go to the toilet. This is now in the regions, everywhere is the creation of a single dispatch service. That is, employees can send in another end region. And the result may not be a lot of challenges, but all the time people spend in cars, almost not stopping at the substation. All of this leads to fatigue and stress, and in some cases death.
Recently at work died a young man, an anesthesiologist who worked in a hospital in the Altai region. They say that there doctors work on schedule “two days on duty, one day off”. While the normal schedule, allowing for full recovery of the employee is over three hours. Local authorities said that, according to the audit, the working hours comply with the legislation. It may, of course, the regime and comply with the legislation. But if this people because of lack of staff and low salaries take half to two or even more bets, so the formal mode of work time is not broken, but de facto people have just canceled the normal duration of the working week. Level positions in the health care rolls, not to mention the overtime within a work shift. Most labor standards and orders of rendering of medical aid, including staff requirements, carries a health Advisory in nature and ignored.
“Sabotage of the health care system created by the officials and deputies”
— What is the current situation with wages in the public medicine? According to the recently published data of Rosstat, hourly wage health and social workers has increased over the year by 23% to 259,8 rubles, the average — by 25%, to 40 thousand rubles.
— With regard to average monthly salaries, which are calculated in the methodology of Rosstat, it’s meaningless figures, because this statistic reflects the average wages in calculation on an individual, but not on a single bet. This includes a paycheck with all the overtime, when people work part-time in excess of working time or expanding the service area of the main working. In the end, these numbers in reality are hiding the double and triple processing. As for you mentioned the hourly wage, I have great doubts of the truthfulness of these numbers. With such pay per hour monthly salary really should be about 40 thousand rubles for one bet, but even the majority of doctors in the regions it does not reach this level, not to mention the younger and average medical staff.
Recently the audit chamber reported that “may decrees” of the President to increase the salaries of middle and Junior medical staff are not performed in 50 of the 85 regions of Russia. Why that is the situation? Sabotage on the ground or the President gives unrealistic promises?
— First, the “may decrees” was not originally financed. Didn’t realize how many really need money to implement them. I think that initially the “may decrees” was conceived at the political level as one of the meaningful directions in the development strategy of the country, there is even recorded that the task is “the preservation of personnel potential of the budget sectors.” But those agencies that were responsible for the specific study of their implementation, did not dare to present objective data and suggested as indicators of artificially invented indicators: 200% of the average salary in the region — the average salary of doctors by 2018, and 100% in the region salary and nursing staff. As a result, we received reinforcement of personnel of the disaster, because employers and government officials were interested in reducing the number of providers from imposing additional work load on the remaining in order to report the high average salary per individual, not per bet.
No accident in the ambulance, the Penza region, where our trade-Union organization is leading a campaign to raise wages, the demand to reach the average medical personnel (paramedics, nurses and nurse anesthetists) 100% of the average for the region on a single bet. Until may, when the trade Union “Actions” declared “Italian strike”, they salary was $ 16 thousand on a bet. It is absolutely inadequate money for such a complex, physically and emotionally exhausting work. The miserable salaries that do not ensure normal living standards of workers, not to mention their families. As a result, now we have achieved the introduction of 100% of increases in base salary for work in understaffed team, surcharges resuscitation teams, but the negotiations continue. Today the goal of the working group — 100% of the average salary in the region] to the rate declared in the official Protocol on the results of the “Italian strike”.
— In your opinion, how many doctors today budget sphere should really get?
— Salary rate in normal regions of the Central Russia, i.e. without the regional (Northern and other) allowances, must be on a single bet doctors have not less than 45-55 thousand rubles, nurses — 28-38 thousand rubles, younger — from 20 to 28 thousand rubles. I want to stress that wage labor in Russia is generally underestimated. Underpaid everyone, not just physicians. But the health workers especially suffer from such a policy. I’m not talking about the features of medical profession and that is not only physically hard work, but highly skilled, requiring up to 10 years of schooling, if we take doctors, and constant maintenance of the level of qualifications throughout working life.
— While the method of “Italian strike” ball is involved only in some cities. And can it join in a mass protest against the General tension in the society?
— Since the severe situation of health workers was the result of administrative errors Federal power, and methods of overcoming it involve decision-making at the national level. I believe that we are on the verge of a broad, nationwide campaign to change the state policy in the field of health. And not only by health care providers themselves, but in Union with a population of patients, and various community organizations. Our Union, at least to such a campaign is being prepared. For example, as in our series, a lot of ambulance staff, we have created a section inside the ambulance Union’s “Action” in which we prepare the program of the Russian requirements for the ambulance service. Moreover, we advocate the subjectivity of such a campaign — doctors, patients, citizens. Because I don’t think a situation in which a wide protest campaign on health will try to embed in someone’s narrow political project.
— What is the responsibility of physicians during the “Italian strike”? After all, someone may not receive in time medical aid, thus his illness is worse, someone can even lose life.
— When we cook the “Italian strike”, we are working on all the issues, including the prevention of negative consequences for patients. Due to the fact that at the moment, the strikes involved a small number of employees, there is no such threat. Very “Italian strike” is arranged in such a way that the responsibility for providing adequate medical help is not on rank and file employees, and officials of the departments, ministries and management of medical institutions. They must create the conditions so that doctors could perform their functions. We as a Union always warn about that preparing for such action, and, accordingly, allow time for some compensatory measures. In the Penza about the strike was known for a week. And administration of the station, for example, attracted to work in teams of nurses of the regional hospital.
Far more dangerous are the spontaneous outbursts of protest when the doctor’s nerves, he gets up and leaves, saying that more can not stand. And he has a queue of patients at the reception. Rollers with such situations can be found on the Internet. Actually sabotage the normal operation of the health care system does not create independent trade unions, and officials and deputies, not providing full funding of medicine.
“Health care should retain its public character”
— Is there pressure on your Union?
— At the Federal level we don’t feel pressure, but definitely we feel the arbitrariness of the employers and administrations of institutions that with a lot of stress perceive the emergence of independent unions, and sometimes trying to organize some sort of problem or just to provide moral and psychological pressure. But most of us in the trade Union people, already entered into an acute socio-labour dispute with the employer. Many of them already know how to defend their rights. After receiving our information, legal support, these people are usually successful in protecting myself and change the situation. There are examples when we come to a level of constructive interaction with the employer.
Often our activity is not like the regional authorities — we interfere with their plans of “optimization” of medical institutions. We have the information and attempts to attack us — be accused of “rocking the boat” and undermining political stability. Of the latest know-how — declare us “Union Bulk” that, of course. has no relation to reality, we enter into the Confederation of labour of Russia, which we support.
Prime Minister Medvedev has repeatedly advised teachers to go into business if they don’t like their profession. Similar can be said about doctors. But physicians, unlike the teachers, more opportunities — in the country there are many commercial clinics. This could be the solution?
— We have a significant portion of medical graduates has long served the precepts of Dmitry Medvedev about the need to go into business. A significant portion of graduates are in the sales agents of pharmaceutical companies, instead of going into medicine. Another part goes to health insurance companies, which de facto do not perform useful functions for society, but draws off part of the money. There are those who are indeed doctors in the commercial sector. This, for example, dentistry, cosmetology, plastic surgery and so on. But, of course, yet not all graduates go there due to the fact that in the regions this sector is not yet as developed. But I’m sure that health care should retain its public nature and the commercial medicine should not replace.
I believe that all such statements Medvedev, Golikova and someone else — it all just bursts of irritation from the inability and unwillingness to establish normal operation of these socially significant spheres.
— What is your prediction of the existence of health in the coming years if nothing will change?
— This forecast, it seems to me, now nobody can give. In any case, the healthcare industry requires the most serious changes in the interests of health workers and the public. To facilitate this the mass independent trade Union movement, which have yet to be created. We, the trade Union “Action” for such a task. Over the past four months we have nearly tripled the number of our Union, the number of regions that have established our structure, made up of forty. I believe that we stand on the threshold of the organizational breakthrough that will allow us to raise the protection of labor rights of workers and the public health to another level.
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