Violations in medical institutions

2022

The number of violations in the provision of medical care to "cores" in Russia increased by a third

In 2022, 370 thousand violations were recorded in Russia in the provision of medical care to patients with cardiovascular diseases (CVD), which is a third more than a year earlier. This was reported in mid-May 2023 by the All-Russian Union of Insurers (ARIA).

According to him, in 2020, insurance companies recorded 260 thousand violations in the provision of medical care in the "cardiology" profile, in 2019 - 324 thousand. The SCC explains such a temporary improvement in the situation by a decrease in the number of planned hospitalizations during the COVID-19 pandemic. In 2022, the volume of planned medicine recovered: for example, the number of visits to a doctor as part of a dispensary observation increased by about 20%.

In Russia, 370 thousand violations were recorded in the provision of medical care to patients with CVD

One of the significant violations in the provision of medical care is the exceeding of the waiting period for diagnostic instrumental studies and the untimely setting of the patient for dispensary observation. Also, insurance companies note continuity problems in treatment, the lack of necessary consultations or consultations and poor-quality performance of diagnostic and laboratory tests. To solve this problem, it is necessary to carry out comprehensive measures aimed at improving the quality of medical care for patients with cardiovascular diseases, experts say.

As noted by the vice-president of the ARIA Dmitry Kuznetsov, 2022 was a record year not only in the number of violations in the cardiological direction. There are also a large number of complaints from patients with CVD about the quality of medical care provided to them. So, in 2022, about 140 thousand such appeals were noted, which is 3.5 times more than in 2021. In particular, patients are unhappy with the provision of assistance, the difficulty in making an appointment with a specialist, as well as the long wait for a doctor or study. Those insured under compulsory medical insurance in the segment "cardiology" also noted the need to pay for medical care, which should be financed from the budgets of territorial compulsory medical insurance funds.^[1]

Loss of 23 billion rubles on fines for poor-quality provision of services

Financial sanctions against medical organizations based on the results of medical and economic examinations (MEE) and examinations of the quality of medical care (ECMP) in Russia in 2022 reached 23.1 billion rubles against 19.2 billion rubles in 2021. Such statistics are given in the presentation of the head of the Federal Compulsory Medical Insurance Fund (MHIF) Ilya Balanin, presented at the board of the Ministry of Health.

According to the publication "Medical Bulletin" with reference to this document, the share of financial sanctions based on the results of the MEE and ECMP for the revealed violations in the total volume of paid medical care increased from 9.5% in 2021 to 12.5% in 2022. In 39 subjects, the total amount of fines exceeded 0.9% of the total amount of bills accepted for payment for medical care. These figures were record in the Chukotka Autonomous Okrug (3%), Baikonur (3%), the Republic of Crimea (5.5%) and Sevastopol (2.7%).

The publication reminds that medical and economic examination and examination of the quality of medical care are mandatory: when receiving complaints from the insured; during antitumor drug therapy in cancer patients; untimely placement of insured persons for dispensary observation; deaths; providing assistance to patients with COVID-19 and concomitant diseases.

According to Ilya Balanin, the frequency of failure to provide primary medical documentation confirming the fact of providing medical care in the total number of violations increased from 7.9% in 2021 to 15.2% in 2022.

The publication also says that in the first 10 months of 2022, medical institutions in Russia received fines for violating licensing conditions by almost 3 million rubles. Most of the checks (60%) involved patient deaths or other harm. In 26% of cases, inspectors revealed a failure to comply with the standards for equipping medical institutions.^[2]

2021

Failure to comply with clinical recommendations - frequent violation in medical organizations of Russia - MHIF

Failure to comply with clinical recommendations was the most frequent violation in Russian medical organizations in 2021. Such data of the Federal Compulsory Medical Insurance Fund (MHIF) were released in early April 2022.

Non-compliance with the clinical recommendations that have become mandatory since 2022, as well as the procedures and standards for the provision of medical care in 2021, accounted for 65.4% of the total number of violations identified during the re-examination of the quality of medical care in the compulsory medical insurance system. According to the report, 81,200 violations were recorded within the framework of medical care in the direction of "oncology" (excluding minor patients), which amounted to 4.1% of cases. In the situation with pathologies of the cardiovascular system, this figure was 295,900 facts (15%).

Failure to comply with clinical recommendations became the most frequent violation in Ross medical organizations

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In addition, violations of the very conditions for providing assistance to patients were admitted in tested medical institutions. This recorded 11,600 episodes of failure to wait, 6,000 cases of premature termination of clinical events. Also recorded 2,000 non-core hospitalizations and 1,800 cases when insured citizens were not included in the groups for dispensary observation. It is worth noting that in terms of improper conditions, violations turned out to be less than in last year's reporting period. In 1,760 (0.1%) episodes, the audit revealed the collection of fees for assistance under the compulsory medical insurance program. At the same time, 79 violations were recorded according to the profile oncology"."

According to the results of the initial examination of the palm of the championship, it was the failure of the Kyrgyz Republic, which accounted for 59.9%. According to current data from Roszdravnadzor, in 2021, almost half (49%) of the detected violations in checking the quality of hospitals were cases (3,269) of violation of the rights of citizens guaranteeing them medical care.

Most often, expert reports included facts of unreasonable charging for services under the compulsory medical insurance program (1,410 episodes), failure to provide emergency (395 episodes) and planned (267 cases) care. In addition, 220 times were unreasonably denied attachment to the hospital.^[3]

Roszdravnadzor named the main violations in the work of hospitals

In mid-March 2022, the Federal Service for Supervision of Healthcare (Roszdravnadzor) named the main violations in the work of hospitals at the end of 2021. We are talking about the annual report of the department on the implementation of federal state control (supervision) of the quality and safety of medical activities (CCBMD). The list looks like this:

• 49% of cases of violation were related to non-compliance with the rights of citizens in the field of health protection (3269 facts);
• violations of the procedure for the provision of medical care accounted for 17% of all violations (1125 cases);
• violations in the organization of internal quality control of medical care, 938 cases;
• violations of the procedures for conducting medical examinations, medical examinations and examinations - 672 cases;
• non-compliance with professional restrictions on working with pharmaceutical companies - 578 cases;
• violations of the organization and implementation of departmental quality control and safety of medical activities, which were identified in 38 inspections.

Roszdravnadzor named the main violations in the work of hospitals in 2021

In total, Roszdravnadzor in 2021, within the framework of the CCBMD, in relation to 3935 medical institutions, carried out 4845 control measures, including 714 planned and 4131 unscheduled. In the work of 2369 medical organizations, 6620 violations of mandatory requirements were revealed.

Roszdravnadzor revealed 935 violations of the procedure for providing medical care in 2021. In 359 cases, hospitals did not comply with the criteria for assessing the quality of medical care according to the conditions of its provision and groups of diseases (conditions). The lack of the necessary equipment was recorded 290 times, and the discrepancy between the staff number - 34.

In 190 inspections of medical organizations, employees of the supervisory authority revealed violations of standards of medical care. Of these, in 127 cases, a violation of the completeness of the provision of medical services provided for by the standard was recorded, including 113 times when providing medical services with an average frequency of their provision "1" and 14 times for services with a frequency of less than "1."^[4]

Notes