On behalf of the Prosecutor General of Russia Igor Krasnov, a check was organized in the regions in the field of health care for minors: the department reports that the number of citizens’ appeals to the authorities is growing due to the violation of children’s rights to affordable and high-quality treatment. Experts say that the problem is systemic, and the problems of pediatrics and health insurance in general need to be addressed.
Violations are on the rise
The order, as reported by the Prosecutor General’s Office, is due to “monitoring the data of state statistics on the health of minors.” In addition, the number of appeals to the prosecution authorities on this matter is growing. “In 2019, compared to 2018, there was an increase in the number of citizens’ appeals on violations of children’s rights, including in the field of protecting their life and health (55.8 thousand and 56.3 thousand appeals, respectively). In the first half of 2020, this figure was 24.8 thousand, “the Prosecutor General’s Office told Izvestia.
At the same time, the number of violations in the field of life, health, protection of the family, motherhood, fatherhood and childhood is significantly increasing every year, the prosecutor’s office emphasizes. In 2018, 346.8 thousand violations were suppressed, in 2019 – 351.2 thousand, and in the six months of this year already 418.7 thousand.
They will check “the completeness and sufficiency of legal regulation in the field of child health,” the implementation of state programs for the prevention of morbidity, the availability of all types of medical care, “especially in rural areas”, preferential provision of medicines.
The Prosecutor General’s Office explained that the last time a similar check was carried out about five years ago.
Photo: TASS / Natalia Fedosenko
Misleading statistics
According to statistics published in June, in 2008 there were 48.6 million cases of morbidity among children aged 0-14 years by the main classes of diseases, and in 2019 – already 57 million. This number is consistently growing, as is the number of diseases in children. between the ages of 15 and 17.
The Ministry of Health notes that this statistics is deceptive: in terms of per 100 thousand population, the incidence of children aged 0-14 years has decreased by 5% over 11 years, but increased among children from 15 to 17 years.
“The recorded slight increase in the overall incidence of adolescents in these years is primarily associated with the growing up of children with the disease and their transition to the age group of adolescents, as well as with an increase in the number of people seeking medical help, which indicates an increased quality of medical care in the country.” , – said the Ministry of Health.
The department explains that the increase in the number of citizens’ appeals on the rights of children to affordable treatment “is caused, among other things, by the need to provide children with orphan diseases with extremely expensive drugs.”
“Due to the low prevalence of rare diseases, the cost of drugs for their treatment is up to 100 million rubles per patient per year. In 2019, 55.7 billion rubles were allocated for the purchase of drugs for the 12 most high-cost nosologies (VZN), ”the ministry notes.
According to the Ministry of Health, the list of such diseases is expanding, since 2020 two more diseases have been included in it, and the amount of funds allocated from the federal budget has increased to 61.8 billion.
A system, not an incident
Experts propose to look at the problem more broadly. “Pediatric care in Russia is very far from being perfect,” emphasizes Yan Vlasov, deputy head of the coordination council of the Public Chamber of the Russian Federation on health care and social development. – We have an insufficient number of general pediatricians, an insufficient number of specialized pediatricians. And most importantly, their distribution over the territory of Russia is also insufficient. “
He notes: even in some cities in which 80-100 thousand people live, there is not a single pediatric surgeon. “The city is located somewhere in the forest, 300 km from the district hospital. And if God forbid a child has appendicitis, then he needs to travel 300 km in a state of acute illness. And this is no longer an incident, it is, unfortunately, a system, ”he says.
A similar incident occurred at the end of July in the Tver region. A nine-year-old child from the village of Rokotovo with appendicitis was first taken to the Toropetsk Central Regional Hospital, but the surgeon was not there, and he was sent to the Tver regional hospital. In total, the child had to travel 370 km with acute pain. This ugly story ended well, the operation was successful.
And in Sol-Iletsk, Orenburg region, on July 6, the day after surgery to remove appendicitis, a six-year-old child died. The media reported that a week before that he underwent surgery on his arm after a fracture, and he was discharged, according to his parents, with a slight fever. The cause of death, as reported by the child’s parents, was toxic shock due to septicemia, that is, blood poisoning.
“Pediatrics has always been a persecuted industry, this is a stepdaughter for whom much less money is allocated,” Vlasov said. – The post of ministers was occupied by people who were not involved in medicine. And, in my opinion, it was under Mikhail Zurabov that they tried to merge pediatrics with the rest of medicine according to the Western model.
The expert explains: the officials did not try to “do it badly” – on the contrary, they decided to take a model that, in their opinion, was working and stable. However, in the West, pediatrics as a separate specialization does not exist – in contrast to Russia, where it has been developing for over 100 years.
“At first they wanted to eliminate children’s departments altogether, but somehow we defended them. However, they were so cut that there was practically no one left. The program was killed, ”Vlasov is sure.
According to statistics, in the past four years the number of pediatricians in the country has been increasing, but now there are still less of them than even in 2015 – 61.7 thousand in 2019 against 65.2 thousand in 2015. In 2008 there were 69.8 thousand of them.
Underestimated
Indirectly, the severity of the problem is also confirmed by the number of high-profile incidents in which a medical error could have caused the death of a child. So, on July 28, an infant died in Buryatia, who in early June fell into a coma due to an infection in the brain. Parents blame doctors, believing that the infection could have been brought in at the hospital, the hospital denies this. The Investigative Committee opened a criminal case, the Ministry of Health of Buryatia is conducting its own check. The ministry refused to comment on the course of the inspection to Izvestia, citing medical confidentiality.
In the Bryansk region, the case is being investigated into the death of a 12-year-old girl from the village of Trosna, Zhukovsky district, who swallowed a battery. In July, the mother of the deceased girl published a large open letter to the governor, in which she said that her daughter had swallowed the battery on May 14. After that, the woman repeatedly tried to insist on a deep examination and treatment of her daughter, but the doctors each time reassured that everything was fine – until May 23, when the girl’s condition deteriorated significantly. She died the next day.
The accusations from the parents in each individual case could be attributed to emotions, but the supervisory authorities are taking their side. For example, in mid-July, a check by Roszdravnadzor confirmed violations in the work of a doctor at the Bratsk Perinatal Center (Irkutsk Region): in April, during childbirth, a woman almost died of blood loss, and her daughter died a month later due to cerebral edema. Judging by the conclusions of Roszdravnadzor, the maternity hospital underestimated the condition of the woman in labor and did not carry out a cesarean section. A criminal case has been opened.
There is also another opinion. Head of the Department of Polyclinic and Emergency Pediatrics, Russian National Research Medical University named after N.I. Pirogova Boris Blokhin believes that incidents in the regions are not an indicator of the systematic nature of problems. “There may be some individual characteristics of doctors, there may be some particulars: an incorrect interpretation of the diagnosis, untimely treatment of a patient. But this happens everywhere – not only in our country, but also in Western European countries and in America, ”he emphasizes.
“Not people” from the point of view of medicine
“The medical insurance program, when it was launched in 1993, was underfunded by 30–40%, and now up to 50%,” Vladimir Grishin, founder and first director of the Mandatory Medical Insurance Fund, told Izvestia. – According to calculations, a child and a pensioner need 2.3-2.5 times more money in health care than an adult. And this should be reflected in the budget of the federal fund. But our picture is the opposite. “
Another Izvestia expert, speaking on condition of anonymity, noted that it is necessary to speak not only of children: the country as a whole has not created a normal social insurance system. Ideally, it should be financed half by the employer and half by the employee himself from his own salary, and the state pays for the non-working population. Moreover, money does not go into one pot, but through different sources, which is why the availability of assistance differs significantly depending on the place of residence.
Photo: TASS / Valery Sharifulin
Grishin confirms that the health insurance program has not been properly calculated, and a lot has been transferred to paid services. “Our state, and everyone recognized this, put on paid medical services,” says Grishin. – Previously, paid services could only be obtained outside of medical institutions, but now each head physician has a financial plan that they must actively implement. Children need massages, therapeutic exercises, prevention, and all this has been transferred to the category of paid services. “
In theory, the problem should be solved by the national project “Health”. Within its framework, the federal project “Development of Children’s Health Care” is being implemented. However, experts are skeptical about it. The same Grishin draws attention not to the fact that the project focuses mainly on cancer care (more than 950 billion out of 1.7 trillion rubles), rather than on children themselves.