After a certain series of destructive events for the Russian Armed Forces, which have already received the common name "Serdyukov-Makarov reform", perhaps the most difficult thing is military medicine, where only decrees and orders cannot quickly restore lost specialists and the well-established work of medical institutions and medical schools. And yet the situation, albeit slowly, is getting better.
RECOVERY OF LOST
In reforming military medicine, it was not only the military who suffered. Undeservedly forgotten were veterans of military service, many of whom, after the closure of a number of garrison hospitals, were forced to attach themselves to civilian medical institutions - hospitals and clinics. However, according to the Ministry of Health, no money was allocated for this, so the veterans were in limbo. In addition, civilian polyclinics did not always have the same range of medical equipment and services that existed in military institutions.
Moreover, these problems sometimes affected the entire population of individual settlements in remote regions, where there was no medicine at all (beyond the Urals, in the Far East) and where exactly military doctors were engaged in the treatment, prevention of citizens and even delivered childbirth. The new leadership of the Ministry of Defense took a different path. The Main Military Medical Directorate developed optimal recommendations and proposals for the restoration of the damaged. What did you manage to do in 2013?
As the head of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation, Alexander Fisun, said at the international business congress "Security and Protection of the Individual, Society and State", over the past year, considerable changes have been made to the medical support management system of the Russian Armed Forces. In particular, the Main Military Medical Directorate now includes military medical institutions of central subordination, medical services of military districts, types and arms of troops (moreover, medical services of types and arms of troops were restored during 2013), institutions of higher professional education, sanatoriums complexes, as well as research organizations of the medical service of the Armed Forces of the Russian Federation. The Institute of Military Medicine is being restored, which today is part of the Military Medical Academy (St. Petersburg).
A three-tier system of medical care has been built in the domestic Armed Forces. The first level is the medical units of the military echelon. The second level is the medical institutions of the military districts (in 2013, they were downsized). The third level - medical institutions of central jurisdiction, which previously included the Main Military Clinical Hospital named after Academician N. N. Burdenko, Medical Treatment and Scientific Center named after P. V. Mandryki, Third Central Military Clinical Hospital, Medical Academy, Medical Center of the Ministry of Defense of the Russian Federation.
At the same time, it is especially noted, unfortunately, the fact that the organizational decisions that were previously made to change the organizational and legal forms of military medical institutions did not give the desired result.
“Therefore, the Minister of Defense supported our initiative to restore three military medical institutions of central subordination in the status of budgetary ones,” stressed Alexander Fisun. - And today, work is being completed on the transformation into budgetary institutions of the 3rd Central Military Clinical Hospital named after A. A. Vishnevsky, the Military Medical Academy, the 9th diagnostic and treatment center of the Ministry of Defense of the Russian Federation.
What is expected from this in the leadership of the Main Military Medical Directorate? First of all, improving the quality of medical care and the number of patients treated. In those years when the organizational and legal form was, as they say, state-owned, there was a sharp decline in both the number of patients and the economic benefit received, in terms of the amount of earned funds. Preliminary calculations showed that if the department starts working in a new organizational structure and becomes a budgetary organization, then by the end of 2014 it will reach the figures for about 2010, and by the end of 2015 - at the figures for 2011.
If the medical institutions of the Main Military Medical Directorate had been working in the budgetary system for the last two years, these figures could have been even better. And this, in turn, would have a positive effect on the growth of wages of employees, and on the improvement of the material base of institutions. In the Military Medical Academy, for example, over the past two years (2012–2013) there have been practically no incentive payments. But by the end of 2014, incentive payments to employees of the academy, as announced, will reach 19 thousand rubles, and the salary of employees of the academy will exceed the average in St. Petersburg.
Approximately the same calculations are available for other medical institutions. With proper organization of funding, adequate drafting of state assignments and their implementation, the Main Military Medical Directorate expects to improve the situation by the end of 2014. Now there is an analysis of the activities of medical institutions, which can also become budgetary in the military districts.
It was also possible to change the very ideology and return to military medicine specialties and specialists who had been reduced, in particular, military psychiatrists, neurologists, therapists, and a number of others. And if it is possible to redistribute the staff, change the organizational structure, then officers' positions of doctors, positions of nurses, and emergency departments will also be introduced.
Now almost 7 million people are under the supervision of the military medical service. 14% of them are military personnel, 75% are members of their families and veterans of the Armed Forces, 11% are civilian personnel. But the reality is that not all persons who are eligible for medical care are assigned to military medical facilities. So that they do not find themselves without help, in 2013, 299 contracts were concluded with organizations of the municipal health care system, and the Ministry of Defense of the Russian Federation financed these contracts in full. Now the Main Military Medical Directorate has no debts for unproven medical care.
As for the health status of servicemen, it remains approximately the same as in recent years. Although, in comparison with 2011-2012, there was a slight decline in the number of people with chronic diseases. To a certain extent, this, of course, was influenced by the recent organizational staff measures, as well as the principled position of the command of a number of military units and formations. Thus, persons who do not fulfill the standards for physical training and do not pass professional psychophysiological selection are subject to dismissal from the ranks of the Russian Armed Forces.
“We believe that some efforts of the military medical service are behind this figure,” Alexander Fisun expressed his opinion. - This is medical examination, and post-hospital treatment, and sanatorium provision.
WHY SANATORIUM IS RELEASED
But with the health of conscripts, the situation is somewhat different. The most frequent problems of conscripts are diseases of the respiratory system, as well as among contract soldiers. In second place are diseases of the skin and subcutaneous tissue (conscripts), the musculoskeletal system (contract soldiers). Further, in descending order, there are diseases of the digestive system, cardiovascular, nervous systems.
In 2013, 216 thousand people (29%) received a respite from conscription due to illness. Of these, 13% are mental disorders, which often manifest themselves in single-parent families, where drunkenness and drug addiction are frequent. Bone tissue diseases account for 18% - the result of detraining of children who were not involved in physical education and sports at school in their time. 10% - diseases of the digestive system (chronic hepatitis associated with the consequences of drug addiction, improper or insufficient nutrition, life in single-parent families). On the whole, this is a reflection of the situation that has developed in society.
Despite all the funding problems, high-tech medical care is increasingly being provided in military medical institutions. Today, it turns out annually to more than 13, 5 thousand people worth more than 1 billion rubles. (although in recent years, military medicine has not received a single ruble from the Ministry of Health or a quota). 19% of them are conscript and contract servicemen. Such assistance is also provided to pensioners who have general civil medical policies of compulsory health insurance.
The main burden of providing high-tech care to patients lies with the N. N. Burdenko (more than 50%), the Military Medical Academy, the A. A. Vishnevsky, Medical Center named after P. V. Mandryka. The Main Military Medical Directorate is ready to further build up such work, especially since the leadership of the Ministry of Defense has allocated more than 1 billion rubles this year. for these purposes. Although, we repeat, the issue of financing has not been resolved for many years, and now it is not so easy to make up for lost time. In 2012, for example, not a single penny was allocated at all.
In 2013, it was possible to complete the formation or to take the initiative to create regulatory legal acts that are directly related to medical support. These are changes in government decrees on dental prosthetics, providing military personnel and military pensioners with medicines, as well as the adoption of the Regulation on military medical examination, the development of the Regulation on the All-Russian Service for Disaster Medicine, the draft resolution “On Approval of the Rules for Payment of Expenses Related to Providing Medical Care to Citizens Abroad . In general, today medical assistance is provided to 42 thousand military personnel and almost 500 thousand military pensioners.
Modular structures allow deploying mobile hospitals equipped with the most modern equipment in combat areas
In the last 2-3 years, there have been many complaints about the sanatorium-resort provision of servicemen, their families and veterans of military service. It turned out to be far from what was desired and even from what it was just a few years ago. This situation was the result of those very destructive "reforms of Serdyukov-Makarov". But, despite the organizational arrangements, the Main Military Medical Directorate managed to preserve a number of sanatoriums in almost perfect condition. In particular, "Marfinsky", "Arkhangelskoye", "Volga", "Paratunka" and "Sochi".
But today the Department of Sanatorium and Resort Support has been disbanded. Instead, a separate Directorate of Medical and Psychological Rehabilitation and Sanatorium Treatment was created in the Main Military Medical Directorate. The military sanatoriums "Yalta", "Svetlogorsk" and eight sanatorium-resort complexes located abroad are closed on it. There are no subordinate sanatoriums left in the military district, although this is probably wrong. After all, sanatoriums have always served as hospitals for lightly wounded when deploying a hospital base in wartime, rehabilitation centers, bases of medical and psychological rehabilitation. It's a paradox, but in order for the commander of the flotilla in Kamchatka to get places for the medical and psychological rehabilitation of his subordinates in Paratunka, this has to be coordinated with Moscow. And this is also a consequence of the "reforms of Serdyukov-Makarov".
“We see the positive aspects that have appeared in military medicine in recent years, but we also know about the negative ones,” notes Fisun. - Among the positive ones, one can note the optimization of the control system.
Now the procedure for obtaining vouchers has changed. To do this, you need to register on the website of the Ministry of Defense. The reconstruction of sanatorium and resort complexes is underway, the introduction of modern forms of service. But excessive centralization also has its drawbacks. Thus, the system of interaction between the medical service of the district and a specific sanatorium was disrupted. There is no proper control over the correct referral of the patient to the spa treatment. Sometimes people are sent to the sanatorium who have direct contraindications to being in its climatic zone.
Today, the work of the system of medical and psychological rehabilitation of servicemen has also been disrupted, it is practically nonexistent. The planning and organization of sanatorium provision occurs in the absence of an understanding of the true need and the algorithm of the applied standards in relation to such services. Their quality has been reduced, which leads to a huge number of complaints. The cost of vouchers has increased. The medical staff has been reduced.
All this led to the fact that if in 2008 215 thousand people were treated in medical institutions of the Ministry of Defense, then in 2012 it was already 143 thousand, and the share of military personnel among them has completely decreased by more than 10 times. Specialists of the Main Military Medical Directorate conducted a comparative analysis of the cost of the voucher and the amount of the serviceman's salary. The results were disappointing. If in 2008 the share of expenses for the purchase of a voucher in a serviceman's wallet was 29%, today with the growth of their cost and the abolition of benefits - 52%. Of course, this is expensive. If a serviceman travels with his wife and children, then triple. Against this background, the offers of various travel agencies to spend their holidays in Turkey, Egypt and Thailand look much more attractive. Therefore, they are more in demand by our servicemen than military sanatoriums. If, of course, they have the right to travel abroad.
How can this situation be corrected?
The Minister of Defense supported the initiative of the Main Military Medical Directorate to freeze the cost of vouchers until 2016. In addition, those services that are paid for by the RF Ministry of Defense will be excluded from their prices. As a result, the share of travel expenses in 2016 will remain the same as in 2008. In addition, since 2013, the cost of children's vouchers has been reduced. The Minister of Defense supported the initiative of the leadership of the Main Military Medical Directorate so that Suvorovites, Nakhimovites, cadets without parents could rest in children's health camps and rest homes for free. This also applies to cadets of military higher educational institutions.
Centers of sanatorium and resort provision will be created in the districts, the system of terminals, where you can submit documents for obtaining a voucher, will be restored. Direct communication with such a center, according to the head of the Main Military Medical Directorate, will be more productive than with a polyclinic. But he also admitted that “there are still not enough terminals where you can turn to and get a ticket”. And there is something to work on.
The development of a new Concept for the development of medical and sanatorium-resort provision for military personnel and veterans of military service is now being completed. It must be approved by the Minister of Defense and provides for the issues of medical support for participants and invalids of the Great Patriotic War, as well as participants in hostilities in military medical institutions of the Ministry of Defense of the Russian Federation.
“In the near future, we must attach more than 300 thousand front-line soldiers to us, to whom we will provide medical assistance as part of the implementation of state guarantees, and in some cases, high-tech medical care,” explained Alexander Fisun.
PROSPECTS
Since 2014, a number of military sanatoriums, which will become budgetary, should be closed on the management of medical and psychological rehabilitation. On the district - the Center for Medical and Psychological Rehabilitation, which acquires the status of an independent state institution, and the sanatoriums of the district subordination will be included in it as branches. All holiday homes will be closed only to the district.
In 2012, by the decision of Serdyukov, the work of 25 children's health camps was stopped. Today, this type of activity is partly implemented on the basis of the Central Military Children's Sanatorium, as well as the sanatorium-resort complexes "Podmoskovye", "Anapsky", "Privolzhsky" and "Dalnevostochny". In the future, the system will be changed, and the recreation of children will be organized on the basis of seven children's health camps, which will be subordinated to the medical service of the districts. Some of the health camps scheduled for closure will be retained, while the functions of others will be transferred to existing holiday homes. Their material and technical base will also change, additional positions of educators will appear.
Much work is being done to build and reconstruct facilities in 13 military sanatoriums of the Russian Ministry of Defense: Okeansky, Zolotoy Bereg, Aurora, Sochi and others. But many veterans are especially actively interested in the fate of the formerly prestigious sanatorium named after J. Fabricius, which was visited by the Minister of Defense on May 10, 2013. The concept of its restoration was adopted. After the Winter Olympics, reconstruction work will begin there. It is planned that in 2015 the sanatorium will open as an independent budgetary institution.
Recent events in the country have shown that military medicine is needed and copes with the assigned tasks. For example, during the flood in the Far East, special purpose medical units (MOSN) deployed there even earlier than some of the engineering structures of the Ministry of Defense and other departments. During the flood alone, more than 23 thousand people were vaccinated, medical assistance was provided to almost 2,500 who applied. Military doctors also strengthened the All-Russian Center for Disaster Medicine, where they showed themselves from the best side.
New means of evacuation of the wounded are being developed. After visiting the Integrated Security 2013 exhibition, the Minister of Defense set the task of developing a universal vehicle that could operate on land, in the air and at sea. Kazan Helicopter Plant has prepared a project for such a tool. It will be equipped with special monitoring systems and other emergency aid facilities. It is planned to be tested in April 2015. New automated means of tracing and evacuating the wounded, as well as stopping bleeding are also being created.
Of course, these large-scale tasks cannot be solved without trained personnel. For many years there was no recruitment to the Military Medical Academy located in St. Petersburg. And last year more than 600 people were admitted to it. 41 of them - for postgraduate education. Since the beginning of 2013, more than 80 medical officers have been returned to service from the reserve. Several dozen more personal files are under consideration. Until the end of 2013 alone, 100 reserve medical service officers were re-commissioned. More than 20 of them are paramedics who were previously dismissed on organizational staff events. Officers-pharmacists, officers-dentists, on whose training the state has spent a lot of money, will also return.
Priorities have also been defined in the construction and reconstruction of military medical institutions. So far, hospitals in Vladikavkaz, Ryazan, Tver, Perm, Orenburg, Penza are in a difficult situation. It is planned that by 2018 they will be completely reconstructed. In the same Military Medical Academy, 12 facilities are under reconstruction. Each of them receives a monthly report to the Minister of Defense. Funds are allocated for this. If in 2011 not a single penny was allocated, then in 2012 - 15 million rubles, and in 2013 - already 163 million. It seems that no less funds will be allocated at the end of 2014 as well.
Until 2017, special pneumo-frame structures will be purchased for medical companies, four medical aviation squads, and seven medical special-purpose squads. By July 2014, one pneumo-cage will appear for a medical company, a separate aviation medical detachment - for a preliminary assessment of their effectiveness.
In October 2013, the Minister of Defense made a decision to return the historical names to a number of military medical institutions. It is impossible to cross out what has been done by predecessors over the years. Historical names are being returned or have already been returned to the Kronstadt Military Hospital, the 25th Central Military Clinical Hospital of the Rocket Forces, the 7th Central Clinical Hospital in Sokolniki, the 32nd Naval Hospital, 1029 Airborne Forces Hospital (Tula), and a number of others. Thus, historical justice and the memory of entire generations of military doctors who have invested in their creation and long-term work, and their talent, and the fire of the soul, will be restored.
