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Декларация с врачом: пациентов-саботажников финансировать не будут

Пока украинцы вместе с Ульяной Супрун в Facebook активно разбирались со здоровым питанием («Когда мы говорим «здоровое питание», то подразумеваем не раскрученные и дорогие авокадо, годжи, чиа, киноа и лосося, а родные и доступные сало, яйца, смородину, гречку, тыкву, селедку и лен. И кучу других продуктов стоимостью до 50 грн/кг»), а затем живо делились рецептами и сравнивали цены на «здоровую еду», в этот же день, 3 апреля, проходило первое после выборов заседание Кабмина, где обсуждали важные медицинские вопросы.

Владимир Гройсман пообещал снизить цены на лекарства, бороться с подделками препаратов, обнадежил внедрением программ по борьбе с серьезными заболеваниями, например, упомянул о страховании от рака…

Описание светлого будущего прервала уполномоченный по правам человека Людмила Денисова, выступившая категорически против досрочного прекращения финансирования пациентов, не подписавших декларации с семейными врачами (так называемый красный список; в «зеленый» входят пациенты, заключившие декларации).

Омбудсмен, глубоко ознакомившаяся с изнанкой трансформации медицины (о чем свидетельствует последний отчет о состоянии соблюдения защиты прав и свобод человека в Украине), заметила, что такой шаг лишает украинцев права на бесплатную медпомощь, которая гарантирована ст. 49 Конституции. Категорически против выступил и Киевский городской профсоюз работников здравоохранения.

Несмотря на все «но», проект утвердили. Правда, с условием доработки, на которую Минздраву дали три дня и рекомендовали привлечь представителей профсоюзов.

Минздрав спешит и настаивает

Напомним, что медицинская реформа началась с первичного звена медицинской помощи, с 1 июля 2018 года деньги начали ходить за пациентами. Вкратце процесс выглядит следующим образом: вы выбираете семейного врача (или терапевта, или педиатра для ребенка) и подписываете с ним декларацию. Национальная служба здоровья начинает платить за вас медучреждению, в котором работает ваш избранник (вовсе не напрямую врачу, как думают многие). Сумма варьируется в зависимости от возрастных коэффициентов от 370 грн (за пациентов 18–39 лет) до 1480 грн (за детей до пяти лет) в год.

В переходном периоде медучреждения, подключившиеся к реформе, получали два вида оплаты: за пациентов, подписавших декларации («зеленый список»), и за тех, кто декларацию с врачом не заключил («красный список»), но проживал на территории обслуживания данного медучреждения. Тариф за неподписантов в 2018 году составлял 240 грн в год на человека независимо от возраста, с января 2019-го — 120 грн.

С начала кампании «Врач для каждой семьи» декларации заключили 26 млн наших сограждан. В Минздраве считают, что динамика подписания сейчас очень высока, поэтому переходный период решили завершить досрочно. То есть полностью перейти на оплату медицинских услуг по принципу «деньги идут за пациентом».

Об идее досрочного прекращения финансирования по «красному списку» с 1 апреля 2019 года вместо планируемого 1 июля (то есть на три месяца раньше) Минздрав скромно сообщил в начале марта, опубликовав на своем сайте для общественного обсуждения соответствующий проект постановления Кабмина. Интересно, что обсуждение должно было проходить до 7 апреля, а изменения, согласно документу, вступают в силу с 1 апреля. То есть на заседании Кабмина документ принимался задним числом.

Почему решение принималось столь «скоропостижно», да еще и во время выборов, когда в информпространстве другим темам практически не осталось места?

В пояснительной записке к проекту постановления говорится, что на такой шаг пошли «с целью экономии бюджетных средств, выделенных на первичную медицинскую помощь, путем ускорения перехода учреждений здравоохранения, оказывающих первичную медицинскую помощь, на полное финансирование по «зеленому списку»».

Что ожидает ничейных пациентов

В Минздраве успокаивают, что каждый при необходимости сможет получить медицинскую помощь бесплатно: «С апреля 2019 года пациентам, которые не выбрали своего семейного врача или находятся в отпуске или командировке, семейный врач, терапевт или педиатр окажет бесплатную медицинскую помощь в неотложном состоянии. Это регламентируется приказом Минздрава №503 «Об утверждении Порядка выбора врача, оказывающего первичную медицинскую помощь, и формы декларации о выборе врача, оказывающего первичную медицинскую помощь»».

В крайнем случае, есть экстренная медпомощь — намекнули в профильном министерстве.

Внедрение предлагаемых изменений уменьшит финансирование коммунальных учреждений здравоохранения более чем на 360 млн грн. А ведь на эти деньги там рассчитывали. Эксперты предупреждают, что преждевременное «урезание» напрямую отразится на качестве оказания первичной медпомощи населению, а также ухудшит социально-экономическое состояние медработников.

В профсоюзе работников здравоохранения считают, что «проект постановления не регулирует вопросы оказания первичной медицинской помощи имеющемуся населению, которое проживает на территории обслуживания соответствующего учреждения здравоохранения (пациенты, включенные в «красный список») и официально не задекларировало выбор своего врача».

Поэтому неподписанта при обращении к семейному врачу, скорее всего, будут шантажировать и настоятельно рекомендовать заключить декларацию, в противном случае в предоставлении бесплатной медпомощи могут отказать. Кто-то решит вопрос проверенным путем — деньги пойдут в карман белого халата.

Прекращение финансирования «красного списка» ставит в неравные условия работников частных клиник — участников реформы и коммунальных медучреждений. Частники не лечат бесплатно, а вот врачи в государственных поликлиниках и дальше должны предоставлять медпомощь пациентам, за которых государство уже не платит: согласно нормам действующего законодательства отказать в помощи они не могут.

В профсоюзе медработников резюмируют: нововведение «приведет к уменьшению заработных плат, снижению заинтересованности в работе и сокращению численности штата работников в коммунальных учреждениях здравоохранения».

Дефицит врачей

Многие, читая статью, зададутся вопросом: неужели так трудно подписать декларацию? Правильное решение — саботажников реформы нужно ставить на место! Не все так просто. В Украине дефицит врачей первичного звена. И если в городах это не так критично, то в сельской местности заключить декларацию в некоторых случаях не представляется возможным ввиду отсутствия человека в белом халате.

Например, в одном из сел Бобровицкого района Черниговской области (и таких примеров немало) с населением 4500 человек работает лишь один врач. Все жители подписать с ним декларации не могут, даже если сильно захотят, ведь оптимальный объем практики составляет 1800 пациентов на одного семейника. И хотя с 2019 года было разрешено лимит превышать, это совсем не выход. Во-первых, за таких пациентов государство платит меньше, во-вторых, качество медпомощи будет сильно хромать. Безусловно, проблему местным властям решать нужно, но на это потребуется время.

По мнению заместителя председателя правления Украинского врачебного общества Константина Надутого, в целом по Украине еще не подписали декларации примерно 13 млн человек. Так, в столице узаконили отношения с врачом только 60% киевлян.

Еще один вопрос: хватит ли государству денег, если большинство из 13 млн массово побегут подписывать декларации с врачом? Пациенты из «красного списка» стоят дешевле, чем из «зеленого». Не хотелось бы, чтобы «деньги, которые ходят за пациентом» приходили с опозданием, накапливались долги и медреформа на первичном звене повторила ошибки «доступных лекарств».

Тем, кто еще не подписал декларацию с врачом, можно посоветовать это сделать. Бежать сломя голову не нужно, действуйте без паники и обдуманно. В статье «Врач для семьи — инструкция к применению» мы собрали полезную информацию о том, где искать врача для подписания декларации и на какую бесплатную медицинскую помощь стоит рассчитывать.

Источник: racurs

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