Guarantees of medical care will include post-Covid and psychologists in clinics

The Ministry of HEALTH presented a draft program of state guarantees of free medical care for 2024–2026. Experts explained what will change for patients Rehabilitation after covid

On the evening of October 10, the Ministry of Health presented for public discussion a draft government resolution “On the Program of State Guarantees of Free Medical Care to Citizens for 2024 and for the Planning Period of 2025 and 2026.”

As RBC was informed by the press service of the Ministry of Health, the document provides for an increase in spending from government sources of funding for the provision of all types of medical care provided to citizens free of charge, primarily emergency medical care, prevention, medical rehabilitation, medical care in day hospitals, and high-tech medical care. . In particular, it is planned to increase the volume of preventive measures by more than 20%, including medical examinations and medical examinations.

Regions will be required to conduct screening for the detection of viral hepatitis C, as well as diagnostic studies using PET-CT (positron emission tomography) for the purpose of early detection of cancer.

For the first time, the project provides means for dispensary observation of patients with the most common chronic diseases that affect disability and mortality, which include cancer and cardiovascular diseases, as well as diabetes.

The document describes for the first time the scope of medical rehabilitation in an outpatient setting for groups of diseases that are the most common causes of mortality. We are talking about rehabilitation after COVID, cardiovascular diseases, as well as diseases of the central NERVOUS SYSTEM, musculoskeletal system and peripheral nervous system.

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As noted by the Ministry of Health, for the first time, the scope of medical care for long-term rehabilitation of patients with severe damage to the central nervous system and with combined multiple injuries is established for the hospital.

Psychological consultations in clinics and new tariffs

As part of state guarantees, from 2024, clinics will be required to provide consultations with a medical psychologist for patients, including those receiving palliative care in hospices and nursing homes.

The volume of primary health care, including pre-hospital and medical care (visits for palliative care, including at home by visiting teams, are included in the standards for the volume of primary health care in outpatient settings), according to the project proposed by the Ministry of Health, will be in total 0 03 visits per person, as in the current state guarantee program, but with a change in the amount of funding, noted the Vera Hospice Fund.

The average standards of financial costs per unit of volume of medical care for a visit for palliative care, excluding home visits by patronage teams, while maintaining the average standard for the volume of medical care equal to 0.022 visits per resident, in 2024 will be 506.4 rubles, in 2025- m - 548.3 rubles, and in 2026 - 593.8 rubles. The current state guarantee program includes 467.6 rubles for the current year, 486.3 rubles for the next year, and 505.8 rubles for 2025.

The average standard financial costs per unit volume of medical care for home visits by visiting visiting teams, while maintaining the average volume of 0.008 visits per resident, will be 2.5 thousand rubles in 2024, 2.7 thousand rubles in 2025, and in 2026 - 2.9 thousand rubles. The current state guarantee program includes 2.33 thousand rubles for this year, 2.43 thousand rubles for the next year, and 2.5 thousand rubles for 2025.

In the list of high-tech medical care (HTMC), the tariff for coronary bypass surgery under compulsory medical insurance will increase compared to the previous version from 415 thousand to 445 thousand rubles. However, Stepan Babeshko, a cardiovascular surgeon at the Center for Thoracic Surgery at the Research Institute of KKB No. 1 named after Ochapovsky, considers this increase to be insignificant, since prices for all consumable imported materials have increased significantly.

The draft state program for the first time provides for the introduction of a new list of VMP - VMP IV separately for the wards of the state fund “Circle of Good”. The list includes operations in the profiles of “cardiac surgery”, “oncology”, “children’s surgery”, “medical rehabilitation”, “traumatology and rehabilitation”, as well as “thoracic surgery” and “surgery (transplantation of organs and (or) human tissues) "

Screening for hepatitis

According to the executive DIRECTOR of the organization “Together against Hepatitis” Nikita Kovalenko, this year the state guarantee program simply stated that each region is obliged to treat hepatitis C under the compulsory health insurance program; the draft state guarantees for 2024 define a specific number of patients who need to be cured.

“We did the math, and it turned out that almost all regions need to expand coverage,” Kovalenko noted. The organization fears that if we follow the criteria of the order of the Ministry of Health and the checklist recently distributed by the Federal Compulsory Health Insurance Fund, the regions simply will not recruit enough patients to meet the requirements of the new state guarantee program . However, a final conclusion about the rationality of fears can only be made after analyzing the situation with treatment coverage for the current year, says Kovalenko.

In addition, the executive director of the Municipal Public Organization “Together Against Hepatitis” noted that experts had previously discussed the issue of introducing mandatory screening for hepatitis C and dispensary observation of Russians born between 1966 and 1986 into state guarantees. It is in this age group that most patients suffer from chronic viral hepatitis. Given that most cases are detected by chance and when hepatitis has already seriously damaged the liver, such a measure could help reduce the number of hidden cases and reduce the pent-up burden on the health care system, Kovalenko says. The proposed document does not contain this clarification and states that the procedure for organizing preventive medical examinations, including screening tests for viral hepatitis C for certain categories of citizens, is established by the Ministry of Health.

Kovalenko also noted that for the last year in a row there was no place for hepatitis D in the document, despite the presence of an effective domestic drug for the treatment of this disease. “At first we were told that there were no clinical recommendations, then - standards. Now all this exists, but the situation with drug provision for patients with hepatitis D has not improved,” he added.