Despite all the efforts of the Ministry of health to combat additions in gostinicah, less fraud becomes. As shown by informal validation of information from personal accounts of patients to the website of the Moscow Fund of obligatory medical insurance (MGTS), one third recorded in their medical services actually rendered were not. In the Fund say there’s nothing they can do about it and just publish information about those services receive the account of the Moscow clinics.
Informal information inspection of personal accounts was held by the activists of the Moscow branch of the onf. The occasion was the complaint of the residents noticed in their personal offices of registry. The community members checked on the website and tried to sign in to their personal accounts. 15% of participants monitoring generally are unable to do so because of problems with authorization. Of those who managed to log in to your personal account, more than 35% detected registry. Moreover, it was not only a record of the passage of prophylactic medical examination, vaccination against influenza and the many visits to the therapist and narrow experts, but even about the anaesthetic and application of plaster.
Attempts to self-correct erroneous information or do it with the help of the site administrators were not successful. Theoretically, in a private office can make a note of the fact that a particular service was not provided. However, after the registration of personal accounts of participants in the monitoring have not gone away, and they never found out, it was considered whether their complaints, and whether there was any effect. In mgfoms activists explained that only publish information about those services receive the account of the Moscow clinics.
The only instrument of control
At the meeting with the participation of the Department of health, Central research Institute of organization and Informatization of health care and insurance companies, where they discussed the situation, the Foundation’s representatives stated that a personal account of the insured is the only instrument of control over the work of the clinic.
“Employees of mgfoms assured that you can see all requests and respond by sending experts to the medical institutions, which citizens find home – said a member of the Moscow headquarters of the popular front, head physician of GKB of im. Vinogradova Olga Sharapova. But to check whether this is the case, it is impossible. Everything we see is a list of such services that are still in our private offices. All this greatly undermines the trust of citizens in the compulsory health insurance system”. The meeting asked mgfoms to establish online feedback system, to inform citizens about the measures taken to remedy the situation and to complement the easy customization option to remove the additions.
By law, every insured under mandatory insurance, contact the insurance company to provide him a statement about the services rendered.However to do this there weren’t many. The situation changed in September 2015, when the Moscow city mandatory medical insurance Fund opened for Muscovites access to their database. Since in the press and social media continually shows information about the discovered there the additions.
Annotations, as an integral part of the system
Although, of course, the complaints of people accidentally discovered in his medical records (which are in hospitals try not to give in hand) annotations on call ambulance, doctor visits and completed the clinical examination did not start today. Health system evolyutsioniruet so that fraud increasingly becoming an integral part thereof. And the doctors just adapt to circumstances, adapting to the system.
So, in 90-e years the majority of fraud was related to vaccinations. To execute the plan and not to spoil the statistics in terms of mass rejection of the vaccination staff in many clinics, not seeing in this particular crime, did the corresponding entries in the cards, and the vaccine was poured into the sink. (It backfired ten years outbreaks of measles, rubella and other diseases).
Later came the data on false reporting and forgery of medical documentation for the purpose of receiving and realization of the “side” of expensive drugs. Another form of fraud was the concealment of heavy diagnosis to claim disability. The leaders of the hospitals explained to the doctors that the state has no money, so a small heart attack should be recorded as an attack of severe angina.
With the introduction of the MMI system always barely reduced ends meet hospitals have started to attribute to “volumes”.As soon as it was announced that the clinic will receive money for services rendered – their number momentarily increased. Even more the situation worsened by 2009, when the country abolished the single tariff scale (ETS) the pay of state employees and introduced a new system where most of the salary consisted of the so-called “incentive payments”. They were urged to accept more (that is, to ascribe) of non-existent patients, not to forget to send them to the polls and ultrasound tests, and visiting patients who came to the reception first time to record as house calls. And such tricks have been set.
Not being able to cope with such situations, the government has gone on radical measures – translated ambulatory network contrary to the principles of insurance capitation.But this did not help: the clinics still have the plans for loading personnel and visits to the er, the possibility of manipulation, “unattached contingent,” and prevention efforts and a program of medical examination and all have separate, not related to the “Bogushevich” financing.