TIMOPHEI NIZHEGORODTSEV: PROBLEMS ON THE MEDICAL MARKET CAN BE SOLVED WITHOUT “DOUBLE LICENSING”

Participants of the medical services market and regulators evaluated assessed a proposal of the Russian Ministry of Healthcare to introduce “double licensing” for private clinics

“Some employees of the Healthcare Ministry were talking in this direction a long time ago but nobody expected that it will touch, first of all, medical services”, started his speech Head of FAS Department for Control over Social Sphere and Trade, Timophei Nizhegorodtsev at an event organized by the “Vademecum” magazine for representatives of small medical business. Discussing “double licensing” proposed by theMinistry of Healthcare, Head of FAS Department suggested to start with understanding the causes or problems that motivated the Ministry to put forward the initiative and “try to find more considerate solutions with regard to private investments in the healthcare sector”.

Timophei Nizhegorodtsev highlighted three key issues on the today’s market of medical services. First, he stressed possibility of unconditional participation of medical organizations of different scale, but offering the same types of aid, in the mandatory medical insurance system.

“There are relatively high-margin and low-margin types of medical aid. In large in-patient clinics they are compensated through cross-subsidizing, while private clinics can focus only on high-margin medical assistance.  If funds are redistributed to private clinics, however, then large in-patient clinics do not have finances to compensate low-margin types of medical aid that are nevertheless necessary for the population. It can lead to financial misbalance of the system”, explained Head of FAS Department.

To resolve the issue, Timophei Nizhegorodtsev suggests putting requirements to clinics that can participate in the mandatory medical insurance system. These requirements should concern public at large and apply to public as well as private clinics.

Second, the market is experiencing lack of effective consumer demand. As a result, both private and public clinics face reduced consumption of more expensive medical services and seriously rely only on demand supported by state programmes.

“That is why the rivalry between them is intensifying: all players are competing for public financing, when the prime costs of medical services often are estimated inadequately”, says Head of FAS Department. “The public entities receive subsidies while private do not get them. It leads to a mutual desire of both private and public clinics to attempt to use administrative resources and squeeze competitors from a shrinking financial pie”.

Third, the speaker focused on a shortage of medical staff.

“Today the funds that in general are allocated for salaries are redistributed to benefit administrative staff and chief medical officers. As a consequence, doctors leave public clinics for private facilities or combine jobs”, described Timophei Nizhegorodtsev. “Private clinics today are the system-saving agents that not only support doctors, paying them decent salaries but, what’s the most important, enabling them to stay in the profession”.

The issue can be resolved setting the requirements for clinics in view of restrictions for combining jobs (i.e., doctors can work either in private or in public clinics) and regularizing the staff issue and the gap in salaries of chief medical officers in hospitals and in-line doctors.

“Overall, FAS does not support administrative regulation of opening and closing private clinics. We believe that the issues, that this measure targets can be resolved by other methods”, summed up Timophei Nizhegorodtsev.

FAS is in favor of “territorial planning” of public and municipal medical facilities as a necessary measures for state guaranteed of free medical assistance.

Earlier FAS reported that it did not support the initiative ofthe Russian Ministry of Healthcare of introducing “double licensing”.