The participants in the discussion, which took place within the framework of the SPIEF, noted that the task is complex, approaches are still being sought all over the world. The main problem is the assessment of the quality of diagnostics, treatment and other types of medical care. Now the quality is controlled mainly by the compliance of the treatment process with standards and clinical guidelines. But the patient’s condition after treatment – in simple terms, “it helped or not” – remains out of the picture.
“The value-oriented model is not only prices and tariffs, it is, first of all, the transparency of medical institutions, it is the organization of work within the institution, around the patient and his problems, it is an assessment of patient satisfaction, and in the long term,” said First Deputy Minister of Health of Russia Vladimir Zelensky: When the hip replacement program was introduced in Sweden as one of the first attempts to use bundled payments, they decided to evaluate not only the surgical stage, but also further rehabilitation. “.
Therefore, according to Zelensky, the continuity of medical care is important in the new model: expensive high technologies should be supported by high-quality aftercare and rehabilitation.
The first steps in building a value-oriented approach were taken this year in the MHIF.
“Since 2022, we have established uniform performance indicators for the work of primary care medical organizations, supplementing funding on a per capita basis,” said Ilya Balanin, chairman of the MHIF. “Now, in addition to funding, depending on the number of attached population and the number of services provided, medical organizations will receive an additional 10% of the base per capita standard, taking into account the health indicators of patients. Thanks to this approach, the doctor will be interested (including financially) in the early detection of diseases, high-quality treatment, and the life expectancy of patients, Ilya Balanin noted. And an important function of the polyclinic is not only work on the fact of the appeal of the sick, but also prevention, dispensary observation. “Of course, the financial model needs to be changed,” says Evgeny Shlyakhto, head of the Almazov National Medical Research Center, academician of the Russian Academy of Sciences. “Today, doctors are interested in treating more patients, but it should be profitable for them to have fewer people in need of treatment. This is possible if hospitals and polyclinics work as a whole.” The criteria for assessing the quality of work should also be the same, then it will be possible to compare and rank clinics.