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Разработанную Минздравом России программу лекарственного страхования для граждан, включенных в систему ОМС, обсудили в ходе состоявшегося вчера в Совете Федерации круглого стола эксперты. Напомним, что министерство предлагает выдавать пациентам по рецепту врача бесплатные лекарства, включенные в перечень жизненно необходимыхи важных лекарственных препаратов (далее – ЖНВЛП). При этом специалисты Минздрава России предлагают предоставить гражданам возможность по желанию приобрести более дорогой препарат, оплатив разницу между ценой препарата из ЖНВЛП и рыночной стоимостью аналогичного лекарства. Однако система еще на практике не внедрена и ее реализация вызывает ряд вопросов у профессионального сообщества. Например, каких расходов потребует внедрение новой системы.
По словам директора Департамента лекарственного обеспечения и регулирования обращения медицинских изделий Минздрава России Елены Максимкиной, общая потребность в финансировании проекта – порядка 500 млрд руб. ежегодно, при этом речь идет об обеспечении лекарствами по перечню ЖНВЛП всех граждан. Однако она не исключает необходимости введения дополнительных программ софинансирования лекарственного страхования, таких как соплатежи или частичная компенсация. «Такая практика существует во многих развитых странах и себя оправдала», – добавила представитель министерства.
Вместе с тем с предложением обеспечить граждан лекарствами только из перечня ЖНВЛП не согласился директор Центра экономики и управления в здравоохранении Московской школы управления «Сколково» Юрий Крестинский. От отметил, что в прошлом году граждане потратили на лекарства 660 млрд руб. При этом из общего объема на препараты из перечня ЖНЛП потрачено лишь 246 млрд руб. Таким образом, по его мнению часть продукции этого перечня не востребована. «Около 20% средств, потраченных государством на закупку ЖНВЛП, расходуются на препараты с недоказанной эффективностью», – считает он.
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Кроме того, он не поддержал идею полного возмещения стоимости лекарственных препаратов за государственный счет, так как, по его мнению, это может привести к бесконтрольному расходованию бюджетных средств. Крестинский предлагает возмещать только 50% от средней стоимости препарата. Такой подход, он считает, позволит гражданам обращаться в медучреждения за льготным лекарством только в случае необходимости.
В целях ответственного использования гражданами такой льготы директор ФГБУ «Научно-исследовательский финансовый институт» Владимир Назаров предложил перенять опыт зарубежных стран. По его мнению, можно создать накопительный счет пациента. То есть, когда часть денег, направленных на медицинское страхование гражданина, направляется конкретно на его счет, а гражданин осуществляет эти расходы тогда, когда это необходимо. «Такая практика позволит существенно повысить ответственность граждан за использование денежных средств, предназначенных на лечение», – считает эксперт.
Концепцию внедрения системы лекарственного страхования поддержал и представитель общественности. Так, по мнению президента Общероссийской общественной организации «Лига защитников пациентов» Александра Саверского, граждане в основном получают инвалидность ради того, чтобы воспользоваться льготами на лекарства. «Только из-за того, что неправильно организовано лекарственное обеспечение, мы тратим 150 млрд руб. на пенсии инвалидам, которые могли бы не получать ее», – считает эксперт.
Помимо обсуждения вопросов обеспеченности населения лекарственными препаратами, специалисты выразили озабоченность проблемой неисполнения пациентами назначений врачей. Отмечается, что это приводит к рецидивам заболеваний и дополнительным расходам бюджетных средств. Начальник отдела защиты медико-социальных прав Аппарата Уполномоченного по правам человека в Российской Федерации Татьяна Рейхман считает, что ответственное отношение граждан к выполнению лечебного режима необходимо закрепить на законодательном уровне, так как асоциальное поведение граждан, невыполнение назначений врача ведет к повышенным расходам бюджета. Она рассказала, что при исследовании результатов одной из городских больниц было выявлено, что 8% пациентов не выполняют врачебные назначения. «Когда за год пролечено 2100 человек, то 8% – это 160 человек. Так, с открытой формой туберкулеза один человек смог заразить еще 14. А для лечения их самих первая химиотерапия на ранней стадии стоит около 20 тыс. руб. за 4 месяца, а после – почти 1,5 млн руб. на каждого пациента. Они не лечатся изначально, потом мы тратим бюджетные деньги», – обозначила проблему ТатьянаРейхман. В связи с чем, по ее мнению, необходимо ввести ответственность граждан, в том числе путем заключения с ними специального договора с условием принудительного лечения в случае обнаружения фактов нарушения лечебного режима.
Добавим, что сегодня граждане обеспечиваются лекарствами в рамках программы госгарантий бесплатно только в стационарных условиях (ч. 7 ст. 35 Федерального закона от 29 ноября 2010 г. № 326-ФЗ «Об обязательном медицинском страховании в Российской Федерации»).
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