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POPULATION MEDICINE PROGRAMS IN THE RUSSIAN FEDERATION
Grigoreva Iraida 1
№ Graduate student of the Institute of Pharmacy of Kazan State Medical University (KSMU)
Email address: giagr@yandex.ru
To cite this article: Grigoreva I.A. - Programs of medical support of the population in the Russian Federation//News of scientific achievements. Medicine and pharmacy. - 2019. - № 1. - S. 60-65. DOI: 10.36616/2713-1718-2019-1-60-65 URL: https://vestind.ru/journals/medicine/releases/2019-1/articles?pdfView&page=60
Received: November 20, 2019; Accepted: November, 22, 2019; Published: December 28, 2019
Abstract: The issues of drug provision is the most important issue of the medical and pharmacy organization, as well as the organization of the country's annual territorial and regional budgets. The competent organization of drug supply programs makes it possible to supply medicines to all categories included in these programs during the year.
Keywords: drug provision, ONLS program, «7 nosologies» program, outpatient drug provision.
1. Introduction
Medical support (LO) of the population of the Russian Federation in outpatient conditions (medicines prescribed by a doctor) at the expense of public (state) funds in the Russian Federation amounts to about 132.1 billion rubles and is made up of several sources.
• The ONLS program, formerly the DLO program, is funded by the federal budget. Expenses in 2012 amounted to 41.4 billion rubles (about 4 million people).
• Centralized purchases ofexpensive medicines under the programs: «7 nosologies» (for the treatment of cystic fibrosis, hemophilia, pituitary nanism and other diseases), is implemented at the expense of the federal budget. The total volume of funds - 36.8 billion rubles for 117 thousand people.
• Targeted programs («Prevention and control of social diseases,» Immunoprophylaxis of infectious diseases «).
• The provision of medicines in accordance with the Resolution of the Government of the Russian Federation No. 890 is realized at the expense of the budgets of the constituent entities of the Russian Federation for a total amount of 37 billion rubles (about 15 million people).
Total expenditures on state drug programs in outpatient conditions amounted to 132.1 billion rubles in 2012. Coverage of the population eligible - 20.3 million people. Received LP -9.3 million people, or 6.5% of the population of
the Russian Federation. In developed countries, including most «new» EU countries, all needy citizens receive medicines on prescription of a doctor free of charge or with a small supplement, in the Russian Federation - only certain categories of citizens, mainly disabled, most of whom refuse medicines in favor of monetary compensation. In OECD countries, the population surcharge is no more than 40%. In the Russian Federation, 81% of the total costs of LAN (497 billion rubles) are covered by the funds of the population in outpatient conditions.
Total (public and private) expenditure on outpatient medicines (LF) and medical supplies (excluding LF expenditure in hospitals) in Russia is a 21% of total health funds; In developed countries, the same number. 2. Materials and Methods VOLUMES OF DRUG SUPPLY IN THE RUSSIAN FEDERATION
However, in absolute values in the Russian Federation, these values are very small. Thus, in 2011, in the Russian Federation, total (public and private) per capita expenses for LAN in outpatient conditions amounted to 238 $PPP, which is 2.2 times less than in OECD countries (515 $PPP). State sources in the Russian Federation cover only 19% of total costs for LAN - 46 $PPP, which is 6.7 times less than in OECD countries on average (309 $PPP), where these costs amount to 60% of total (Figure 5.8).
In terms of relative indicators (share of GDP),
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public expenditure on LAN in the Russian Federation is 0.22%, in developed countries it is 4.1 times more - 0.9% (Figure 5.9).
When comparing LAN expenditures with «new» EU countries that have GDP close to the Russian Federation (Czech Republic, Hungary, Poland, Slovakia), in the Russian Federation total LAN expenditures in absolute values ($PPP) are 1.9 times less than in these countries (they have 446 $PPP), and in the share of GDP - 1.7 times less (they have 1.9% GDP). When comparing only government expenditures on LAN in outpatient conditions in the Russian Federation, they are 5.5 times lower than in these countries in absolute terms (253 $PPP), and 5 times lower in the share of GDP (they have 1.1% GDP).
All this shows a significant state underfunding of LAN spending in outpatient conditions, which reduces the accessibility of modern LAN to the population, increases the burden on hospital treatment and increases the financial burden of the population spending on medicines.
3. Discussion
In total, in 2011, about 11 million people, or 8% of the population, actually received free medicines in the Russian Federation.
Adequate provision of free LAN to the population makes it possible to reduce the number of exacerbations of the disease and to avoid the use of expensive types of treatment (emergency and inpatient medical care). If it is even possible to achieve a sufficient number of doctors in outpatient and polyclinic institutions, but the patient will not receive the necessary medicines, there will be no effect from the doctor 's visit.
Free medicines are especially relevant in connection with the residence of more than half of the population (50% in 2011) for an income
of less than 15,000 rubles per person per month, provided that there is an increase ahead of the inflation rate, tariffs for housing and utilities, prices for food, education of children and other priority items of the family budget. Moreover, Russian citizens spend a larger share of their health care from their pockets than their betteroff neighbors in EU countries - 32 and 27% of total health spending, respectively. Thus, it is impossible to impose expenses on medicines on citizens of the Russian Federation, it is necessary to do this at the expense of public sources of financing - budgets of all levels and funds of OMS.
Providing with drugs is out-patient
In practice, in outpatient settings, medicines are usually purchased independently by citizens at their own expense, except for preferential categories of citizens and cases of certain
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categories of diseases.
According to the law, primary health care is provided to citizens in outpatient and day hospital conditions (art. 33, para. 6, of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Foundations for the Protection of Citizens 'Health»).
Within the program of the state guarantees of free rendering medical care to citizens primary health care, including pre-medical, medical and specialized is provided (Paragraph 1 of Part 1 of Article 80 of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Foundations for the Protection of Citizens 'Health»).
At the expense of means of obligatory medical insurance within the basic program of obligatory medical insurance it appear to the insured persons primary health care (Paragraph 1 of Part 1 of Article 80 of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Foundations for the Protection of Citizens 'Health»).
Insurance in accordance with the basic compulsory health insurance programme is established on the basis of the standards of medical care and the procedures for providing medical care established by the authorized federal executive body (para. 4. Article 35 of the Federal Law of the Russian Federation of 29 November 2010 326-03 «On Compulsory Medical Insurance in the Russian Federation»).
Medical care will be organized and appears according to the orders of delivery of health care obligatory for execution in the territory of Russia by all medical organizations and also on the basis of standards of medical care (Paragraph 1 of Article 37 of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Foundations for the Protection of Citizens 'Health»).
The Law reiterates more than once that the program of state guarantees of free medical care for citizens is formed taking into account the procedures for the provision of medical care and on the basis of standards of medical care (article 80, paragraph 7, of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Foundations for the Protection of Citizens 'Health»).
The medical organization is obliged to carry out medical activity according to legislative and other regulations of the Russian Federation,
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including orders of delivery of health care and standards of medical care (subparagraph 2 of Paragraph 1 of Article 79 of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Foundations for the Protection of Citizens 'Health»).
Since the provision of primary health care is based on approved standards, which are mandatory under the fear of even criminal punishment, and the primary health care itself is provided to citizens free of charge at the expense of OMS, it can be said surely that the presence of the drug in such a standard is the basis for its free provision of patients, for example, rheumatoid arthritis in outpatient conditions.
According to paragraph 34 of the Procedure for the Administration and Prescribing of Medicines, when providing primary health care, the administration and prescribing of medicines to citizens entitled to free receipt of medicines or to receive medicines with a discount is carried out by a medical worker in cases of a typical course of the patient 's disease on the basis of the severity and nature of the disease according to the standards of medical care approved in accordance with the established procedure.
This paragraph applies only to citizens who are entitled to receive medicines free of charge or to receive medicines at a discount, but, as mentioned above, all outpatient care should be provided free of charge. Then the formula of this order and decree looks like this: there is already a right to free outpatient assistance, but for preferential categories of the population there is even more free right in the form of medicines. However, there is no limiting rule for the free preparation of medicines in the outpatient unit, and the permitting ones, as shown above, are.
The same logic is used in the norm of the law (Part 2 of Article 80 of the Federal Law of the Russian Federation No. 323 of 21.11.2011. «On the Basics of Protection of Citizens 'Health»), which states that when providing free medical care to citizens in day hospital and in urgent form within the framework of the State guarantees programme, Citizens are provided with medicines for medical use included in the list of essential and essential medicines in accordance with Federal Act No. 61-ФЗ of 12 April 2010 on the circulation of medicines.
Outpatient care is not mentioned here, and the
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above norm applies to other conditions of care (day hospital, etc.), but outpatient care is mentioned in other norms as free according to standards, and the standards include medicines.
So, for example, if you need drug A, you can see, for example, in the legal system «Consultant Plus,» what standards it is included in.
These will be, for example, such standards:
• Order of the Ministry of Health of the Russian Federation No. 1470n dated 24.12.2012 «On approval of the standard of primary health care in case of rheumatoid arthritis»;
• Order of the Ministry of Health of the Russian Federation No. 822n dated 09.11.2012 «On Approval of the Standard of Specialized Medical Care for Ankylosing Spondylitis, Psoriatic Arthritis, Other Spondylarthritis (Day Hospital Maintenance Therapy)»;
• Order of the Ministry of Health of the Russian Federation No. 865n dated 09.11.2012 «On approval of the standard of primary health care for children in case of juvenile arthritis»;
• Order of the Ministry of Health of the Russian Federation No. 866n dated 09.11.2012 «On approval of the standard of primary health care in case of ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis»;
• Order of the Ministry of Health of the Russian Federation No. 649n dated 07.11.2012 «On approval of the standard of specialized medical care for children in case of ulcerative (chronic) ileocolitis (non-specific ulcerative colitis)»;
• Order of the Ministry of Health of the Russian Federation No. 687n dated 07.11.2012 «On approval of the standard of specialized medical care for ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis»;
• Order of the Ministry of Health of the Russian Federation No. 646n dated 07.11.2012 «On Approval of the Standard of Specialized Medical Care for Children in Case of Crohn 's Disease (Regional Entente).»
All standards adopted after 2012 are accompanied by the following note:
«1. Medicines for medical use registered in the territory of the Russian Federation are prescribed in accordance with the instruction on the use of the drug for medical use and the pharma-cotherapy group on anatomological-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into
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account the method of administration and use of the drug.
2. The administration and use of medicines for medical use, medical products and specialized medical nutrition products not included in the standard of medical care are allowed in case of medical indications (Individual intolerance, according to vital indications) by the decision of the medical commission (art. 37, para. 5, of the Federal Law of 21 November 2011, No. 32303 «On the Foundations for the Protection of Citizens 'Health in the Russian Federation» (Assembly of Legislation of the Russian Federation, 2011, No. 48, art. 6724; 2012, N 26, Art. 3442, 3446)).
3. The citizens having according to the Federal law of 17.07.1999 N 178-FZ «About the state social help» (The Russian Federation Code, 1999, N 29, Article 3699; 2004, N 35, art. 3607; 2006, N 48, Art. 4945; 2007, N 43, art. 5084; 2008, N 9, art. 817; 2008, N 29, art. 3410; No. 52, art. 6224; 2009, N 18, art. 2152; N 30, art. 3739; No. 52, art. 6417; 2010, N 50, art. 6603; 2011, N 27, art. 3880; 2012, No. 31, art. 4322), the right to receive State social assistance in the form of a set of social services, when providing medical care in outpatient conditions, is provided with medicines for medical use included in the List of Medicines, including the list of medicines prescribed by the decision of the medical commission of medical and preventive institutions, which are provided in accordance with the standards of medical care according to doctor 's prescriptions (paramedic) when rendering the state social help in a type of set of social services, the approved order of the Ministry of Health and Social Development of the Russian Federation of 18.09.2006 N 665 (Registered by the Ministry of Justice of the Russian Federation on 27.09.2006, registration N 8322), as amended by orders of the Ministry of Health and Social Development of the Russian Federation dated 19.10.2007 N 651 (registration N 10367), of 27.08.2008 N of 451 N is registered by the Ministry of Justice of the Russian Federation 19.10.2007, (Registered by the Ministry of Justice of the Russian Federation on 10.09.2008, registration N 12254), dated 01.12.2008 N 690n (Registered by the Ministry of Justice of the Russian Federation 22.12.2008, registration N 12917), dated 23.12.2008 N 760n (Registered by the Ministry of Justice of the Rus-
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sian Federation on 28.01.2009, registration No. 13195) and No. 1340n dated 10.11.2011 (registered by the Ministry of Justice of the Russian Federation on 23.11.2011, registration No. 22368).»
Provision of medicines in hospitals
Providing with drugs in hospitals according to the law (item 2 and Part 1 of Paragraph 3 of Article 80 of the Federal Law of the Russian Federation No. 323 of 21.11.2011 «About bases of protection of public health») Provided in the framework of the programme of State guarantees for free provision of primary health care to citizens in the conditions of day hospital and in urgent form, specialized (Specialized medical care is provided in hospital and day care (Paragraph 2 of Article 34 of the Federal Law of the Russian Federation No. 323 of 21.11.2011 «About bases of protection of public health») Medical care, including high-tech, emergency medical care, including emergency specialized, palliative medical care in stationary conditions. At the same time, medicines should be included in the list of essential and essential medicines in accordance with Federal Law No. 61-03 of 12 April 2010 «On the circulation of medicines,» and medical products, which are provided for by standards of medical care.
The program of State guarantees is formed taking into account the procedures for the provision of medical care and on the basis of standards
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of medical care, as well as taking into account the peculiarities of the sex and age composition of the population, the level and structure of morbidity of the population of the Russian Federation, based on the data of medical statistics (Part 7 of Article 80 of the Federal Law of the Russian Federation No. 323 of 21.11.2011 «On the Basics of the foundations»).
4. Conclusions
Thus, the federal law determines that the fulfilment of two criteria - the existence of LLDCL in the List and the presence of medical care in the standards - includes a drug in the program of state guarantees of free medical care.
Order No. 410n of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development Order No. 410n of 11 August 2008 «On the organization of work in the Ministry of Health and Social Development of the Russian Federation on the development of procedures for the provision of certain types (profiles) of medical care and standards of medical care») established a procedure for the development of standards, which was later cancelled. However, there was no other officially established order.
On the basis of the above, to date the only clear legal possibility to receive a drug that is not part of the standard and list of LLDCs, the appointment of the drug by a medical commission should be considered in hospital.
References
[1] Federal Law dated 21.11.2011 N 323-03 (ed. dated 29.05.2019) «On the Foundations of Protection of Citizens 'Health in the Russian Federation»//Russian Newspaper. - 2011. -N 263
[2] Federal Law dated 29.11.2010 N 326-03 (ed. dated 26.07.2019) «On Compulsory Medical Insurance in the Russian Federation»//Russian Newspaper. - 2010. - N 274
[3] Federal Law dated 12.04.2010 N 61-03 (ed. 02.08.2019) «On the Circulation of Medicines»//Russian Newspaper. - 2010. - N 78.
[4] Order of the Ministry of Health of the Russian Federation No. 1470n dated 24.12.2012 «On Approval of the Standard of Primary Health Care in Rheumatoid Arthritis»//Russian Newspaper. - 2013. - Special issue, N 128/1
[5] Order of the Ministry of Health of the Russian Federation No. 822n dated 09.11.2012 «On Approval of the Standard of Specialized Medical Care for Ankylosing Spondylitis, Psoriatic Arthritis, Other Spondylarthritis (Maintenance Therapy in Day Hospital)»//Russian Newspaper. - 2013. - Special issue. N 123/1,
[6] Order of the Ministry of Health of the Russian Federation No. 865n dated 09.11.2012 «On Approval of the Standard of Primary Health Care for Children in Juvenile Arthritis»//Russian Newspaper. - 2013. - (special issue). N 124/1.
[7] Order of the Ministry of Health of the Russian Federation No. 866n dated 09.11.2012 «On Approval of the Standard of Primary Health Care in Ankylosing Spondylitis, Psoriatic Arthritis, Other Spondyloartritis»// Russian Newspaper. - 2013. - (special issue), N 122/1.
[8] Order of the Ministry of Health of the Russian Federation No. 649n dated 07.11.2012 «On Approval of
МЕДИЦИНА И ФАРМАЦИЯ. N 1. 2019 г. 65
the Standard of Specialized Medical Care for Children in Case of Ulcerative (Chronic) Ileocolitis (Non-Specific Ulcerative Colitis)»//Russian Newspaper. - 2013. - Special Issue, N 128/1
[9] Order of the Ministry of Health of Russia No. 687n dated 07.11.2012 «On Approval of the Standard of Specialized Medical Care for Ankylosing Spondylitis, Psoriatic Arthritis, Other Spondyloarthritis»//Russian Newspaper. - 2013. - (special issue), N 122/1.
[10] Order of the Ministry of Health of the Russian Federation No. 646n dated 07.11.2012 «On Approval of the Standard of Specialized Medical Care for Children in Case of Crohn 's Disease (Regional Enterite)»//Rus-sian Newspaper. - 2013.
[11] Federal Law dated 12.04.2010 N 61-ФЗ (ed. 02.08.2019) «On the Circulation of Medicines»//Russian Newspaper. - 2010. - N 78.
[12] Order of the Ministry of Health and Social Development of the Russian Federation of August 11, 2008 No. 410n «On Organization of Work in the Ministry of Health and Social Development of the Russian Federation on the Development of Procedures for the Provision of Certain Types (by Profiles) of Medical Care and Standards of Medical Care»//Russian Newspaper. - 2008. - N 213
© I.A. Grigoreva, 2019
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