Without giving a clear answer to the sacramental question “where are the plantings?” Russian authorities, it seems, are in a hurry to finally rid society of illusions regarding their readiness to break the “backbone” of corruption, writes the Free Press portal. Judging by the results of the plenum of the Supreme Court of the Russian Federation, the “caste of untouchables” (the presence of which was demonstrated by the scandalous “Serdyukovgate”) is not limited to high-ranking persons. It seems that the authorities also have no plans to fight so-called “everyday corruption”.

On the eve of Medical Worker Day, which this year falls on June 16, the state made a truly royal gift to domestic physicians, essentially legitimizing the practice of extortion, which is slyly called “gratitude” from patients. Supreme Court The Russian Federation reviewed a draft resolution on corruption crimes and decided that payment for the exercise of professional skills, for example, for treating a patient or providing educational services, should not be considered a bribe. From now on, only money received in exchange for the exercise of power and administrative and economic powers will fall under the definition of a bribe. Thus, an indulgence is issued and criminal immunity is granted to hundreds of thousands, if not millions, of health workers and teachers who are in the habit of accepting “gifts in envelopes.”

The resolution is silent about the difference between voluntary gifts and forced offerings, and administrative activities from professional ones. This is quite strange, considering that the right of a “professional” doctor to write a prescription for an expensive medicine under the DLO (additional drug coverage) program, to give a referral for hospitalization to a specialized medical institution of a higher level, or to issue a coupon for an ultrasound scan is, by and large, the same thing administrative resource. With all the ensuing consequences in the form of thriving (albeit camouflaged under the concept of “gratitude”) corruption practices.

By and large, the new interpretation of the concept of bribery revives and legitimizes the feudal tradition of “feeding”. The chronic underfunding of the medical and education sectors is being resolved through a repeated (after payment of all due insurance premiums) “dive” into the wallets of taxpayers. Another manifestation of touching concern for the peace of mind of potential bribe takers is the refusal to consider a bribe a crime if it was provoked by employees law enforcement. Apparently, there are strong suspicions that many bribe takers will not resist the temptation to take marked bills as a “thank you” from disguised law enforcement agents.

To be fair, it is worth noting that the Supreme Court ruling states that the transfer of a bribe under the control of operatives (if the victim himself contacted law enforcement agencies) should be distinguished from amateur checks. The latter are outlawed. In addition, the Supreme Court agreed to recognize that “responsibility for receiving, giving a bribe, mediation in bribery occurs regardless of the time an official receives a bribe - before or after he commits actions (inaction) in his service in favor of the bribe-giver or the persons represented by him, as well as regardless of whether these actions were preconditioned by a bribe or an agreement with an official to transfer a bribe for their commission.” However, we repeat that these progressive innovations apply only to officials (chief physician, department heads, head of the health department, and so on).

Lawyer of the League for the Defense of Patients' Rights Dmitry Ayvazyan agreed that the actions of ordinary doctors who are not vested with authority do not fall within the definition of a bribe, since they are not officials. If a specialist promises to provide medical assistance, despite the fact that the medical institution does not have such an opportunity, or if in fact this is a completely different procedure, and the money has already been received, then we should not talk about a bribe, but about fraud. However, there are cases when the doctor tries to influence the treatment process in the spirit of - thank him, then you will receive good treatment. Or you will pay, and then there will be at least some treatment. In such a situation, it is more appropriate to talk about failure to provide medical care (Article 124 of the Criminal Code) or leaving one in danger (Article 125 of the Criminal Code). More precisely, we are talking about an attempted crime. The problem is that these articles do not imply such harsh sanctions as taking a bribe, so the investigation does not like to apply them. So, practically no criminal cases are initiated based on these charges.

“SP”: - It turns out that in order for these articles to work, the punishment needs to be toughened?

I don't see any other way out. And our legislators, if you ask them such a question, will respond unequivocally, “Well, of course, it is necessary.” What else can they say? If you ask this question to the poor guy who was in an accident or his relative, and he was taken to the “trauma” on a Saturday evening or on a weekend and there is only one doctor at the appointment, then he will begin to pull out everything he has in his pockets.

“SP”: - Why do many patients prefer to “thank” doctors? “An impulse of the soul” or rather the notorious “if you don’t help, you won’t go...”?

As a rule, this happens when it comes to a life-threatening patient condition. Sometimes you hear “if I had paid the money, my son would have lived.” But either there were no funds, or the person was unconscious and there was no one to notify relatives. When it comes to life and health, no one thinks about starting to “download your rights.” This is called a “one-sided game” - “if you thank me”, the person will live, but you won’t give...

“SP”: - How to explain the reluctance to fight everyday corruption?

This is a systemic problem. No matter what, all areas of our country are super-corrupt. Let’s say we start burning out corruption with a “hot iron” in a particular segment of medicine. This will lead to nothing in conditions where human life in our country, unfortunately, is worth almost nothing. Formally, compensation for death in criminal cases in some regions is no more than 60 thousand rubles. Compensation for serious injury to health from government and municipal institutions- it's actually pennies. Yes, Insurance companies within the compulsory medical insurance system, clinics and hospitals are mercilessly fined for overspending medicines. They also carry out an examination of the quality of medical care. In general, the system works, but it no longer works for the patient, but for the insurance company’s wallet. The criteria for the quality of medical services, according to the insurance company’s standards, are not directly related to the patient’s recovery.

“SP”: - How to deal with this?

A liability insurance mechanism must be operational. And not the institution as a whole, but also specific doctors. Then the specialist will think a hundred times whether it’s worth getting involved and extorting money. Because in this case he risks not only his salary, but also his profession. This would be the most effective method. However, such initiatives are not even put forward. Because doctors and teachers receive meager salaries. The state seems to be telling them: “we pretend that we are paying, and you pretend that you are treating them.” There cannot be good quality medicine with chronic underfunding. In turn, in conditions of corruption, no matter how much you pour into medicine, the money disappears into a “black hole.” The situation is complicated by the growing process of commercialization of medicine. In our country nothing can be cured without money. I believe that as long as the majority of the population is insolvent, the commercial model in healthcare has no right to exist.

Member of the Expert Council under the Government of the Russian Federation, member working group on anti-corruption Sergei Strelnikov draws attention to the fact that in the decision of the Supreme Court there is one more important point. From now on, bribe-takers in white coats caught red-handed will be exempt from prosecution if it is proven that they were “provoked” by law enforcement agencies to accept a bribe.

“SP”: - What could this lead to?

Law enforcement agencies have learned to use this tool to identify corrupt officials. Many “landings” simply would not have happened if law enforcement officers had not been able to catch a person red-handed while accepting a bribe. Today, when a victim of blackmail is extorted for a bribe, he can contact the relevant structures and ask for this fact to be documented. If there is no such opportunity, then people will simply stop contacting law enforcement agencies in order to expose the extortionist. The wording “provoked” sounds quite vague.

"SP": - Another one controversial point in the resolution there is a poorly distinguishable line between “administrative” activities and purely “professional” ones.

In my opinion, the state thereby admits that it is ready to fight official corruption, but does not know what to do with everyday corruption. A professional also makes decisions that affect the quality of medical care. Sometimes it is difficult to define the line between professional duty and additional professional activity. Regarding the same doctors professional duty is comprehensive. It is impossible to be a more professional or less professional doctor. You are either a doctor or you are not a doctor.

“SP”: - In this context, are the notorious “thank yous” a bribe or not?

Of course it's a bribe. People find themselves in unequal conditions: those who do not have money cannot count on high-quality free medical care and educational services. Refusal to fight everyday corruption means deepening social inequality. All this does not add to social stability. This approach frees the hands of those people who previously accepted “offerings” with some caution. And they felt guilty when they took “gifts”. Now they will profit without a twinge of conscience. It would be better if judicial practice it came under the article “bribe”. For many people this word has a warning effect. This would be an effective prevention of corruption. And now everyone imagines themselves to be great professionals who are underpaid by the state. And who, accordingly, have the moral right to claim gratitude from patients.

The head of the National Anti-Corruption Committee, Kirill Kabanov, believes that the main drawback of the new interpretation of the concept of a corruption crime is the insufficiently clearly defined concept of mediation in accepting a bribe. “It is not clear how to establish whether a person gave money as a bribe,” the expert noted. According to him, the fact of extortion can be established operationally (based on material from wiretaps, for example). But those who are accused of taking a bribe also need a detailed procedure to avoid violations by law enforcement officials.

“SP”: - What are the advantages of the proposed interpretation?

The fact is that the Supreme Court banned the practice of incitement to receive a bribe. He also excluded the category of doctors and teachers from the category of bribe takers. I believe that everyday corruption should be eradicated by other methods. It is provoked by a state that does not fulfill its social obligations. When doctors or teachers complain that they don't get paid enough and therefore don't mind gifts, that's true. If a doctor extorts money, then this is a different article and a different composition. Previously, this composition was included under the article on bribery. We need to pay people normal money. Today, paramedics, as we learned from a direct line with the president, sometimes receive less than 4,000 rubles. And they are discussing whether to add another 300 rubles to them. It is easy to get rid of everyday corruption using non-repressive methods, but simply by increasing the amount of money. Another thing is that our law enforcement officers used to report on the fight against corruption, adding cases of “gifts” to doctors and nurses to their reports. And now that won't happen. Now we will need to fight real corruption.

According to Investigative Committee Russian Federation, in 2011, investigative authorities prosecuted 362 healthcare workers for corruption. Charges were brought against both ordinary doctors and high-ranking officials.

Corruption crimes in the healthcare sector

3. Corruption in payment systems. Here, corrupt practices may include free service, falsification of insurance documents or use of funds medical organizations in the interests of certain privileged patients; illegally billing insurance companies, government agencies, or patients for services not provided in order to maximize revenue; falsification of invoices, receipts, consumable documents or registration of fictitious patients.

4. Corruption in the drug supply system. Drugs can be stolen at various levels of the distribution system. Government officials may demand “remuneration” for issuing permits for the sale of products or the operation of certain structures, for conducting customs clearance, or for setting favorable prices.

Violations of market codes of conduct may result in doctors being forced to give preference to certain drugs when writing prescriptions. Various concessions may be extorted from suppliers on the condition that prescriptions for their products are issued. It is also possible to issue permits to trade counterfeit or other low-quality medicines.

5. Corruption in organizations providing medical services. Can take many different forms:

• solicitation or consent to receive illegal remuneration for services officially provided free of charge;
• charging for special privileges or medical services;
• solicitation or consent to receive bribes for interfering with the hiring, licensing, accreditation or certification practices of certain structures.

Taking into account the above classification corruption crimes These forms of corruption in the healthcare sector can be presented as follows.

Main group of corruption crimes:

1) abuse of official powers (Article 285 of the Criminal Code of the Russian Federation);

2) inappropriate spending of budget funds and funds of state extra-budgetary funds (Articles 285.1, 285.2 of the Criminal Code of the Russian Federation);

3) entering obviously false information into the unified state registers (Article 285.3 of the Criminal Code of the Russian Federation);

4) abuse of official powers (Article 286 of the Criminal Code of the Russian Federation);

5) bribery (Articles 290, 291, 291.1 of the Criminal Code of the Russian Federation);

6) official forgery (Article 292 of the Criminal Code of the Russian Federation);

7) illegal issuance of a passport of a citizen of the Russian Federation, as well as the entry of knowingly false information into documents, which resulted in the illegal acquisition of Russian citizenship (Article 292.1 of the Criminal Code of the Russian Federation);

8) abuse of power and commercial bribery in the field of private medicine (Articles 201, 204 of the Criminal Code of the Russian Federation).

The country's healthcare system is the most affected by bribery. Inappropriate spending of budget funds allocated for healthcare needs is also common. The Accounts Chamber published the results of an audit of the effectiveness of the use of funds allocated for the modernization of healthcare, according to which only a little more than half of the money (59.3%) was spent for its intended purpose.

An additional group of corruption-related crimes in the healthcare sector is represented mainly by three subgroups of crimes:

1) crimes against personal freedom: illegal placement in a mental hospital (Article 128 of the Criminal Code of the Russian Federation);

2) crimes against property: fraud using a person's official position(Part 3 of Article 159 of the Criminal Code of the Russian Federation), misappropriation or embezzlement using official position (Part 3 of Article 160 of the Criminal Code of the Russian Federation);

3) crimes against public health: illegal production, sale or transfer of narcotic drugs (NS), psychotropic substances (PS) or their analogues, as well as illegal sale or transfer of plants containing NS or PS, or their parts containing NS or PS (228.1 of the Criminal Code of the Russian Federation); illegal issuance or forgery of prescriptions or other documents giving the right to receive NS or PV (Article 233 of the Criminal Code of the Russian Federation); theft or extortion of NS or PV, as well as plants containing NS or PV, or their parts containing NS or PV (Article 229 of the Criminal Code of the Russian Federation).

Most often, officials holding senior positions in healthcare authorities commit theft using their official position. This is exactly the situation presented at the beginning of our article.

In conclusion, we note that the general provisions on the liability of the previously mentioned subjects of corruption offenses (crimes) are contained in Art. 13, 14 of Law No. 273-FZ. According to Art. 13 citizens of the Russian Federation, Foreign citizens and stateless persons for committing corruption offenses bear criminal, administrative, civil and disciplinary liability in accordance with Russian legislation.

Wherein individual who has committed a corruption offense, by a court decision, may be deprived in accordance with the law of the right to occupy certain positions in the state and municipal service.

Thus, all corruption offenses (crimes), which are the basis for imposing legal liability, are contained in industry legislation.

Last year allowed my business to reach a pseudo-new level. New - because I received federal customers. Pseudo - because the federal ones now have less money than the regional ones used to have.

The year is 2008. High level corruption.

The degree of high-level corruption in the regions is about 50% - this is what the governor gave back to Moscow from various programs, subsidies, and subsidies for the opportunity to receive them. That is, right away. To whom - one can only guess, but any guess rests either on the relevant minister, or on the prime minister, or on the president - well, who else can the governor of the region roll back to?

Further, the cutting continues at the level of the governor, then the relevant committee steals (in this case - Health), then the contractor does not forget to steal the money for himself (does anyone believe that commercial organizations earn according to the law? “ha ha” three times. Here’s an easy example, very easy), it will also roll back into the compulsory medical insurance funds and other supervisory and distribution structures, if they are involved in controlling the spending of this money.

As a result, billions are allocated for the pharmaceutical supply of city hospitals, and there, when a patient is admitted, his relatives are told: “We have enough dressing material for two days, then either bring your own, or we will use old bandages.” This is in St. Petersburg, one of the few surplus regions of the country. Already in the Leningrad region there was hell, the Holocaust and a branch of Odnoklassniki. And then - treatment with prayers and spells. Looking ahead - yes, it’s better now, at least in St. Petersburg and in some places in the region. Even despite the complete chaos going on in the country.

Generics, empty ampoules and physical. solution
A few words about grassroots corruption and how it works. One option is stealing medications. There are expensive drugs, but it’s easy to deal with them - the original one is written off and the patient is given a generic (cheap analogue). And there are super-expensive ones, 1-2-3 thousand dollars per ampoule. There are no such generics, what should I do? The doctor takes an ampoule, injects a commercial patient for half the price, then goes to a “free” patient and injects him with saline, showing him the empty ampoule. Sleight of hand! But there is a nuance - if this happened in the Russian Federation, the ampoule almost certainly initially contained saline solution; the production of fakes has been established for almost all extremely expensive medicines.

Medical equipment
With honey equipment is even simpler - used equipment is purchased instead of new, or a cheaper model that is ineffective or outdated. Or the same model, but without accessories at a fully “packaged” price.

Jewelry box
Another great scheme is the so-called “jewel box”, when hundreds of millions of drugs are stuffed into a small box - Herceptin, Velcade and all that delicious stuff. A hundred copies of shipping documents are made for this entire batch of goods for various contractors, and they are taken to the first hospital on the list. She receives it, comes to the hospital pharmacy, immediately writes it off to the departments - and the box, unopened, is returned to the courier who delivered it, who carries the same order further, to the next health care facility. They also come there, immediately write off and send it to the next one. As a result, it returns to the pharmaceutical company's warehouse until next year - even expiration dates may not be checked.

The state pays the company billions for supposedly supplied medicines. The pharmaceutical company, of course, shares it with all participants in the scheme. And in hospitals there aren’t even syringes on patient wards, as a result.

How did he know about this?

But then a miracle happened, as I now evaluate it. Having worked half presidential term, Medvedev suddenly, suddenly finds out about this! Apparently, he had just begun to master the Internet, where sometimes they write all sorts of interesting things. "erupted" The case of tomographs", although not at full strength, it still turned out well.

It is clear that the revealed level of theft excluded low-level corruption, since they looked at it from the presidential chair. Thefts were discovered at a level of 50-60%, although in reality more was stolen. But the start was given, and the fight against corruption in the healthcare sector began, and it was completely real.

In a couple of years, we managed to squeeze out a terrible abscess - a court pharmaceutical company, nurtured by Aunt Valya and owned by the Georgian mafia. It has taken over almost all supplies of pharmaceuticals in St. Petersburg and the Leningrad region to regional healthcare facilities, as well as to preferential categories of citizens. Until 2010, the conditions of the competitions were directly written for this company, so that others could not even bother. And then the arctic fox suddenly came, and Aunt Valya turned away from her beloved child. Clearly not by herself. It was not possible to imprison anyone, the owner found a way out onto a steep Moscow roof, but the prosecutor’s office knows and remembers everything.

And fake prescriptions for hundreds of millions, sold under the DLO (Additional Drug Supply Program), but never dispensed drugs for cancer patients, and fake documents from suppliers, and much, much more. These “successful businessmen” were excommunicated from the feeding trough - the company with a turnover of 15 billion a little later went bankrupt with considerable debts. Seryozha M. was smart enough to get away from them in time.

And then things got really interesting. Even the chief doctors, who had previously been considered completely untouchable and passed on their positions by inheritance without hesitation, began to receive slaps. Started working for a while 94 The federal law, Federal Law 223 appeared and started working immediately.

Any company has the opportunity to actually participate in government procurement, regardless of connections, cronyism and luck. Just according to availability best prices- not only in healthcare, of course. Unfortunately, this did not reach the largest contracts, but at the level of a strong medium-sized business it worked quite well.

Million-dollar contracts were actually played out almost fairly for a couple of years! Billions, as before, were distributed directly, alas.

In 2013 everything returned to its place

Now, in 2016, hundreds of thousands no longer really play. In any case, in 2013, all this crap suddenly stopped. The heads of medical institutions began to reject uninvited suppliers, threatening them with connections with one well-known odious deputy of the Legislative Assembly of St. Petersburg. To sell anything in the state. The institution began to need, if not connections, then at least the introduction of a trusted person - so that later it would be clear through whom to accept “gifts” from you.

Unpleasant holes were discovered in Federal Law 223, the first of which was the lack of stipulated liability for its violation. By the 94th Federal Law, dozens of ways to get around it were invented, and no one was bothered by an attempt to patch them up. Instead, Federal Law 44 was adopted, seemingly with the best intentions, but I never saw it working for my business.

On the contrary, it contained new mechanisms that would allow me to be removed from the government procurement market - why? There is only one answer - to leave only “our own”. However, today it is also perceived as certain rules of the game, but not its essence. That is, in case of significant procurement for state-owned companies, it is known in advance who will become the supplier; the conditions are simply prescribed in such a way that they comply with the law. ABOUT real competitions everyone has already forgotten.

The fight against corruption has remained only at the lowest level, ordinary doctors, cops, and teachers. And today it is possible to accurately determine the period when corruption receded - it completely falls on the second half of D. Medvedev’s reign. That is, it is possible, in fact, to fight corruption in the Russian Federation when there is no moth in power.

I am not at all a supporter of Medvedev, for me he is a clearly negative character in terms of the sum of his qualities. I do not accept the concept of the “lesser evil”, considering it necessary to always choose only good, regardless of the chances of victory. Then it will definitely win sooner or later...

You can sometimes come across statements that Putin has not been able to defeat corruption in 15 years. No. It was he who was able to raise her over the years. And as soon as Putin retired a little, his beloved fell ill, and they began to crowd her. Only by taking power completely into his own hands again in 2012, he was able to restore and increase the main basis and idea of ​​his regime.

The word “corruption” in our country has long ceased to surprise anyone. Numerous reports that corruption has penetrated into all spheres of public life, politics, economics, and especially the civil service - have become commonplace and familiar to Russians. And there is only one thing that is scary and difficult to come to terms with - the concept of “corruption” has become familiar to medicine.

In the health care industry, corrupt practices include bribery of regulators and health care providers, falsification of clinical drug trial results, diversion of pharmaceuticals and other resources, corruption in government procurement, and overbilling of insurance companies. Corruption here is not limited to the abuses committed by government officials, since in many cases society entrusts the execution of the most important government functions in the field of health care to private business entities. In cases where hospital executives, insurers, doctors, or pharmaceutical company executives are enriched as a result of unfair practices, they are not technically abusing their official positions. However, they abuse the powers entrusted to them and steal valuable resources that are necessary for the development of health care.

The “corruption infection” has penetrated almost all branches of medicine, which is recognized at the highest level state level. Committee State Duma on security, having analyzed the materials of the Prosecutor General’s Office, the Ministry of Internal Affairs, Federal service on supervision in the healthcare sector came to disappointing conclusions - corruption is growing both in quantitative and monetary terms.

The facts of fraud and enrichment at the expense of public funds in the field of health care undoubtedly have the most serious impact on the quality of medical services, but there are even worse things. Preparations containing narcotic substances. In small doses they are indispensable in the treatment of a number of diseases. But due to the corruption of those responsible for the safety of storage and distribution of such drugs, they end up on the drug market in large quantities. Every year, law enforcement agencies record more and more cases of theft of potent psychotropic and narcotic drugs by employees medical institutions, people dedicated to saving lives and restoring health. The only disappointing conclusion that can be drawn from this is that corruption in medicine, namely the situation associated with narcotic, psychotropic and other potent drugs, threatens the health of the nation. Are such facts acceptable? Who should be held responsible for the lack of control over compliance with regulations, staff selection and storage of prescription forms?

Non-medical consumption of narcotic and psychotropic drugs is steadily growing, which entails the growth and development of drug market structures, crimes committed on this basis and the involvement of young people in criminal activities. Such developments can only be interrupted by improving the entire system of law enforcement agencies to combat illicit drug trafficking, establishing strict control, as well as serious penalties for violating the rules established by law.

The following are the most common types of bribes in the healthcare industry:

• - For receiving a certificate of temporary disability and various certificates: about unfitness for military service, about fitness to drive vehicles, about permission to perform certain works, about permission to engage in one or another sport, about exemption from physical education;
• - For high-quality performance of the operation on the patient (i.e., not “like everyone else,” but with an individual approach). In this case, the patient is guaranteed high-quality preoperative and postoperative care, the use of the best medications, sutures and dressings;
• - For confirmation or concealment of certain medical facts (most often - beatings and other bodily injuries);
• - For issuing the “necessary” prescription;
• - For distorting the true cause of death (this conclusion is given by a pathologist). The size of such bribes is one of the largest in medicine, since in many cases they are directly related to the commission of crimes;
• - For the early discharge of a patient from the hospital or, conversely, for prolonging the patient’s stay in the hospital.
• - For issuing “necessary” certificates about the patient’s mental state.

In some large metropolitan hospitals, management positions appear to be for sale. There are cases when positions are sold to people who are illiterate and simply lack medical education. Isn't this one of the worst manifestations of corruption? Pseudo-leaders are completely ruining entire sections of medicine and medical care in general.

Three specific aspects of this issue in the field of health are significant:

• 1) characteristics of the work environment;
• 2) characteristics of employees;
• 3) conditions and processes of their interaction, the state of social control in the field of healthcare.

Corruption occurs at all levels of the health care system - from district nurses to high ranks in the ministry. The higher the floor, the greater the scale of abuse we are talking about: if in the offices of ordinary doctors corruption begins with a hundred rubles, then at the very top it already reaches hundreds of thousands of dollars.

Let us examine in more detail how corruption occurs in practice in the healthcare system, according to its types.

“Prescribing the “necessary” medications. The essence of such fraud is simple - the patient is prescribed, in addition to the main drugs that are included in the standard scheme treatments, several additional ones that you can do without. You can suspect fraud if your doctor sends you to a specific pharmacy. From the purchase of the “necessary” medicine, the doctor receives a percentage from the pharmacy. This ranges from 5 to 20%, as family doctor D.I., convicted of taking a bribe, told the court. Pasterin: “For example, I cooperate in this way with two companies. I get 10% for a medicine of 50 rubles. - that's 5 rubles. and 20% for medicine for 80 rubles. - that's 16 rubles. My profit per month is between 300 and 400 rubles.” The same applies to the so-called dietary supplements (dietary supplements), which some doctors offer as additional treatment. But dietary supplements do not cure. These drugs have not been formally studied and their effectiveness has not been documented. Telling the patient that without this “medicine” recovery will not be complete is PR for dietary supplements, nothing more. “To treat the threat of miscarriage “according to standards”, progesterone preparations, vitamin E, antispasmodics are prescribed, and some doctors add dietary supplements (based on cat’s claw, etc.) to this standard treatment in the amount of 400 rubles, with a kickback from these drugs are 15-20%. Thus, patients do not pay 100 rubles. for standard therapy, and 400.

"Forgery of certificates." The second common scheme practiced by ordinary health workers is the sale of certificates. According to unofficial sources, for example, a “fake sick leave” for a week in the regions of Russia on average costs 150-300 rubles. for one day. In addition, parents often ask for a forged certificate of vaccinations for their child. Such a document costs on average 300-400 rubles. The income from this “part-time job” is more than from prescribing medications - for a month it turns out from 800 to 1200 rubles.

More complex documents are also forged, for example, about unsuitability for military service. In this case, the share includes several doctors, and accordingly, such a document costs more - from several hundred USD. i.e. up to several thousand. Fake certificates of pregnancy and confirmation of beatings are also very popular. average cost $300-500.

Separately, it is worth mentioning the registration of disability. This is a very long process, so the costs are quite high. To obtain such a document, you need to undergo several rounds of examinations and confirm your professional incompetence. If a person is really sick, he is usually given a group, but a temporary one (for 2-3 years). Then you need to confirm your status, otherwise your disability status will simply be removed. To do this, they undergo a more expensive examination or, at a minimum, you have to pay a bribe. The amounts of such extortions vary from region to region and range from a couple of hundred to a thousand dollars.

"Bribery for transactions." This type of corruption is bread for surgeons. If this is some kind of urgent operation, then it is done, as a rule, without discussing payment. Although even in this case, relatives are told before the operation that only the team on duty operates for free, but you can “ask” a good surgeon to pay attention to you for money. Or after the operation they tell you how much you need to pay for it. If any planned operation is to be performed, they will not operate without an envelope. The cost of a simple operation is at least 600 USD. e. The money is divided into the brigade: lion's share- to the surgeon, something to the anesthesiologist, something to the nurse.

“Deriban of charitable contributions” is typical for doctors at a higher level - chief doctors, as well as chief accountants. In order to understand how charitable money is divided, let us remember that in every state medical institution today there are officially so-called health insurance funds, to which each patient, when applying for any kind of medical care (from a consultation with a therapist to a complex surgical operation), contributes a certain amount of money. Doctors tell you exactly how much you need to pay: the amount ranges from 200 to 600 rubles, and if you pay less, the medical staff will treat the patient accordingly. The goal is good - to use the received contributions for employee salaries, purchase of equipment, repairs, etc. However, in reality, money often goes for other purposes, but into the pockets of the head physician, chief accountant and further down the line. And this is in addition to the “contribution” into the doctor’s pocket (from $100), say, for a good room - with a refrigerator and one neighbor.

"Misuse of funds." If the four previous schemes are skillfully veiled, which is why they rarely become the subject of investigations by government services, then, starting from this level, it becomes increasingly difficult to hide the awl in the bag. We are no longer talking about thousands, but about tens and hundreds of thousands of rubles. Violations in the financial and economic activities of hospitals exceed hundreds of thousands of rubles. The schemes used here are very different. For example, they carry out fraud with the payment of salaries: they must pay from one fund, but they pay from another, from which smaller contributions go to the state, as a result, part of the saved amount goes into the pocket. Or they add extra positions to the staff. For example, a job requires 6 laundry washing operators, but 17 are hired. Their salaries cost 226 thousand rubles. This is already interpreted as waste.

"Pushback on procurement." This scheme is no longer used by doctors, but by medical officials. Kickback is when a procurement official receives a bribe for ordering a certain product with public money. As a rule, a product is several times more expensive than its analogue on the market, or is not really needed by doctors at all. The bribe is given by a company interested in selling this product. An example of purchasing a not very suitable product is an ambulance. For example, we purchased ten new ambulances - vans designed for four people - a driver, a doctor, a paramedic and a nurse. Has anyone asked practitioners whether they need such a quantity? And do we really need such machines? Most likely no. But, if they asked, they would find out that we no longer need vans, but cars, because in nine calls out of ten, even one doctor can help a patient. And in order to quickly get to the patient, he needs a fast car. This is how they work in many countries. As a result, the institution is forced to feed not only the doctor, but also an overstaffed staff of drivers, paramedics and nurses, and also buy twice as much gasoline as would be needed for cars. If ambulances, although not entirely suitable, are used, then a lot of purchased equipment is completely idle. Back in 2012, at an expanded board of the Ministry of Health, information was announced that, according to the inventory, new medical equipment was identified that was not in use, worth over 130 million rubles. It is the corrupt procurement schemes that most significantly rob our healthcare. According to unofficial data, of what the state allocates for healthcare, officials manage to put every third ruble into their pockets.

Sale of prohibited substances. Facts of fraud are often recorded in the pharmaceutical business. Today, almost any medicine can be purchased at a pharmacy without a prescription, with the exception of psychotropic and narcotic drugs. These drugs are dispensed strictly on special prescription forms No. 3, which must contain the stamp of the medical institution, the personal seal and signature of the doctor. But, despite this, such drugs in large quantities end up in the illegal drug market. The reasons for this should be sought not in pharmacies, but at the top of the pharmaceutical business or among manufacturers and wholesalers. Pharmacies operate more primitive schemes: some drugs in large doses have a narcotic effect, but we are obliged to sell them, just one package per hand. And it’s easy for “high lovers” to go to several pharmacies and buy the right dose. For example, in the composition of syrups that are widely used to treat upper respiratory tract include pseudoephedrine or codeine. In concentrations exceeding the daily dose, they act like a drug. Another trick of the pharmaceutical business is the sale of prescription drugs by persons who do not have a license to do so. This primarily concerns online pharmacies. Some of them sell illegal drugs without prescriptions.

"Pseudo-diagnoses". The issue of treating non-existent diseases is, of course, pure commerce in medicine. IN Lately More and more patients are turning to consultations to get a second opinion. All of them, as a rule, come with “pseudo-diagnoses” - mycoplasma or urepals infection, chlamydia, made only on the basis of questionable tests. The fact is that these microorganisms live in minimal quantities in almost every organism, and highly sensitive methods catch them. But this is not a reason to treat a person with a course of heavy antibiotics costing from 400 to 1500 rubles.

According to official data on corruption in medicine provided by the Department public relations Ministry of Internal Affairs, during 2009, 319 crimes were solved in healthcare institutions and organizations. Of these, 218 are serious and extremely serious (failure to provide medical care, sterilization, abortions without indication, treatment without a license, etc.). Most of the crimes relate to the sphere of official activity - 241, of which 130 are related to bribes. In addition, 58 cases of misappropriation and embezzlement of state property were identified.

The state of medicine in the Russian Federation in general is a vivid example of what corruption can do to healthcare. Today, the capital's medicine, once one of the best in the country, has completely collapsed. And this is not about ordinary doctors - those small thanks that patients give them only help them somehow survive. The main corrupt officials are in the government.

Thus, we can conclude that corruption in healthcare developed in conditions of official extremely low salaries for workers, irregular payments, an unclear legal basis for providing additional benefits to workers, the actual participation of healthcare structures and their employees in private practical activities that do not arise from tasks and legal status of the relevant health care structure. There are many different types of corruption. All of them cannot be solved by one regulatory legal act, or some kind of inspection followed by punishment and conviction of those guilty of corrupt acts. A thorough study of anti-corruption mechanisms is necessary, starting from the very bottom and ending at the top of the government.

Introduction

corruption healthcare legal

Corruption has been and remains one of the global problems facing the international community. Russia is one of the most corrupt countries in the world. In addition, Russian companies are the most active in the world in paying bribes in developing countries, and they use them “in huge, unacceptable amounts.”

Corruption permeates all spheres of society, including healthcare. The importance of the healthcare sector can hardly be overestimated: it allows achieving such goals as natural increase population, a decrease in morbidity, an increase in labor productivity, an extension of the working period of workers, which contributes to the growth of the country’s national income and an increase in the well-being of the people. At the same time, corruption in health care prevents the implementation of these tasks, which are priorities for the socio-economic policy of any state. This is the relevance of this topic.

The purpose of the abstract is to analyze corruption in Russian healthcare. To achieve this goal, it is necessary to solve the following tasks:

consider types of corruption in healthcare;

identify the causes of corruption in healthcare;

analyze corruption in the Russian healthcare system;

give examples of measures used to prevent corruption in healthcare.

1. Corruption in healthcare and its types

Corruption in healthcare is a recurring and constantly evolving complex negative social and legal phenomenon, which is expressed in the selfish use by medical workers of their official position in the state (municipal) and private systems health care for the purpose of unlawfully obtaining material, intangible benefits and advantages, as well as in illegally providing such benefits to individuals or legal entities, which has caused or is capable of causing significant harm to the interests of society and the state in the field of protecting public health, as well as destroying normal public relations in the sphere of realizing the rights of citizens to health care and receiving medical care.

The level of corruption offenses in this area can vary from extremely high (state government level) to low (doctor-patient system).

There are several most typical species corruption in healthcare:

Waste and embezzlement of health care funds or revenues generated through consumer payments. This can happen both at the state and local levels, and directly in the medical institutions that receive such funds. Medicines, other resources and medical equipment are stolen for personal use, use in private practice or for further resale.

Corruption in public procurement. Involvement in various collusions, bribery and kickbacks in the field of public procurement leads to overpayments for goods and services received or to the inability to ensure the quality stipulated by contracts for such goods and services. Also, hospital expenses may include significant costs for capital construction and the purchase of expensive equipment.

Corruption in payment systems. Here, corrupt practices may include free services, falsification of insurance documents, or the use of funds from medical institutions in the interests of certain privileged patients; issuing illegal invoices to insurance companies, government agencies or patients for unlisted or unprovided services in order to maximize revenue; falsification of invoices, receipts, expenditure documents or registration of fictitious patients. In addition, such forms of corruption as: development own business by creating financial incentives or paying kickbacks to doctors for referring patients to a particular organization; unlawful referral by doctors of patients of public medical institutions for services to their own private structures; carrying out unjustified medical intervention in order to increase one’s own income.

Corruption in the drug supply chain. Drugs can be stolen at various levels of the distribution system. Government officials may demand “remuneration” for issuing permits for the sale of products or the operation of certain structures, for conducting customs clearance, or for setting favorable prices. Violations of market codes of conduct result in doctors being forced to give preference to certain drugs when writing prescriptions. Various concessions may be extorted from suppliers in exchange for prescriptions for their products. Another possible form of corruption is the issuance of permits for the sale of counterfeit or substandard medicines. The problem of combating corruption in the supply of medicines became most acute at the end of 2009, when, due to the swine flu epidemic, prices for medicines were artificially inflated and drugs from individual manufacturers had an advantage in the medicine market.

In addition, corruption in health care providers can take other forms. For example, the most common types of “bribes” are the following:

for receiving a certificate of temporary incapacity for work and various certificates: about unfitness for military service, about fitness to drive vehicles, about permission to perform certain works, about permission to engage in this or that sport, about exemption from physical education;

for the high-quality performance of the operation on the patient (i.e., not “like everyone else,” but with an individual approach). In this case, the patient is guaranteed high-quality preoperative and postoperative care, the use of the best medications, sutures and dressings;

for confirming or concealing certain medical facts (most often beatings and other bodily injuries);

for issuing the “necessary” prescription;

for distortion of the true cause of death (the size of such bribes is one of the largest in medicine, since in many cases they are directly related to the commission of crimes);

for the early discharge of a patient from the hospital or, conversely, for prolonging the patient’s stay in the hospital, etc.

At the same time, we are talking not so much about small bribes in the form of “offerings” to doctors for treatment, but about the increasing frequency of last years more dangerous manifestations of corruption:

artificially creating a “deficit” in the provision of medical services, when people in dire need of certain medical studies are forced to wait for months for them. At the same time, for a certain fee, these studies are carried out more quickly. At the same time, forced payment for medical services does not always guarantee their quality;

the gradual transformation of medical institutions into “trading” institutions, in which honest, qualified doctors are replaced by medical businessmen.

Corruption in healthcare undermines citizens' trust in representatives of the medical community, because initially, in people's minds, a medical worker is a person called upon to help people, often giving the last hope when life and health hang in the balance. However, in reality everything is different: rudeness, negligence, incorrect diagnoses and often a direct hint of bribery. This attitude disgusts people in white coats.

Undoubtedly, there are doctors who work “for the idea,” and there are many of them, but it is the bribe-takers who make up people’s preconceived opinions about doctors. This leads to a decrease in the moral standards of the population. Many have stopped believing that the fight against corruption will bring visible results, and its very manifestation has become a common norm of life.

2. Causes of corruption in healthcare

The causes and conditions that give rise to corruption in healthcare can be divided into the following groups:

Economic (sharp differentiation of the population based on property, economic instability, etc.).

2. Political: underdevelopment of the institution of public control, insufficiently high level of training of management personnel, corruption in training in medical universities, etc.

Social: discrepancy between the growth of needs and the ability to meet them, inequality of working and living conditions of various categories of medical workers, public dissatisfaction with the state of healthcare in the country, etc.

Organizational: shortcomings of control and audit activities, insufficient regulation of the professional activities of medical workers, shortcomings in personnel policies when appointing senior positions in healthcare.

Legal: presence in texts official documents corruption-prone provisions that enable officials to abuse their powers, as well as insufficient legal protection and guarantee of the rights of citizens to provide medical care. Examples of corruption-inducing factors include regulations containing an indication of the breadth of discretionary powers, that is, the absence or uncertainty of the terms, conditions or grounds for making a decision, the presence of duplicate powers of public authorities or bodies local government(their officials).

Moral and spiritual - refraction of moral norms. Finding himself in the role of a patient, a person is ready to give a bribe. And vice versa, once in the role of an official, a medical worker is ready to receive a bribe. Thus, we see the emerging degradation of morality, and on both sides of the corrupt “doctor-patient” relationship: the patient, through his active behavior, can provoke the doctor to bribe, and in turn, the doctor can provoke the patient to give a bribe.

Paying sick doctors for medical care has deep historical roots. The patient’s psychology that if you don’t pay the doctor you won’t get quality medical care is very stable. This is precisely what explains the widespread use of private, paid medicine, even in countries with good public health services. In the public hospitals themselves, this practice was transformed into “gratitude” from the patient to his attending physician in the form of money or a gift.

Disproportion in the distribution of information. Medical workers in any case know more about diseases than their patients, and companies involved in the production of medicines and medical equipment, know more about their products than government officials responsible for spending funds for these purposes. This is why providing relevant information can lead to a reduction in corruption.

Uncertainty in the analysis and forecasting of the health status of the population. The lack of such information makes it difficult to manage resources, including the selection, monitoring, measurement and delivery of health services, as well as the development of plans health insurance. The risk of corruption increases even more in cases of large-scale disasters, when the need to provide emergency medical care forces existing oversight mechanisms to be circumvented.

And others.

Some experts believe that corruption in healthcare is also beneficial for the state. Let's consider why? The state is the structures and people who are responsible for the level and availability of medical care in the country. It is impossible to provide adequate medical care with current salaries (and/or organization). Doctors who receive additional income are holding on to their jobs. They agree and treat some patients without bribes, for one salary. This is one of the conditions for obtaining a large total income. Plus, they maintain some more or less level of work from their younger colleagues who work for pennies.

3. Corruption in the Russian healthcare system

In Russia, corruption in the healthcare system has become widespread. Despite the fact that funds are allocated to healthcare (over the last 4 years, expenditures federal budget doubled - from 202.8 billion rubles. up to 413 billion rubles.<#"justify">Often government agencies make negative decisions in the healthcare sector. For example, on June 16, 2013, the state made a truly royal gift to domestic doctors, essentially legitimizing the practice of extortion, which is slyly called “gratitude” from patients. The Supreme Court of the Russian Federation reviewed the draft resolution on corruption crimes and decided that payment for the exercise of professional skills, for example, for treating a patient, should not be considered a bribe. From now on, only money received in exchange for the exercise of power and administrative and economic powers will fall under the definition of a bribe. Thus, an indulgence is issued and criminal immunity is granted to hundreds of thousands, if not millions of health workers who are in the habit of accepting “gifts in envelopes.” Unfortunately, this example is not the only one.

Thus, neither existing legislation nor law enforcement practice can yet effectively combat corruption in the healthcare sector. Therefore, it is necessary to carefully study the problems of qualifying corruption crimes in the healthcare sector, the causes and conditions that contribute to them.

4. Measures to prevent corruption in healthcare

The experience of anti-corruption activities in various countries convincingly shows that it is impossible to completely eradicate corruption. The only question that can be raised is to reduce the scale of corruption to a socially tolerable level.

Among the most commonly used methods to combat corruption are the following:

In the field of socio-economic relations:

carrying out economic reforms aimed at curbing corruption as a means of solving business issues;

improving the remuneration system for medical workers, increasing their social status and prestige of the profession;

informing patients about their rights and responsibilities and a multi-level mechanism for protecting their rights.

In the organizational sphere:

improving control over the efficiency of using budget funds allocated for healthcare;

openness of the activities of medical institutions;

organizational control over medical activities.

In the field political relations:

strengthening statehood;

strengthening democratic principles;

development of public control;

development of interactive systems feedback population with representatives of state and municipal authorities.

In the spiritual sphere of public life:

introduction of mechanisms for anti-corruption education of the population;

development of ideas of social justice;

increasing the level of legal culture of young specialists, developing responsible professional and highly moral behavior of medical workers.

In the field of intellectual technologies and scientific development:

identifying and summarizing manifestations of corruption in healthcare;

constant study of the causes and conditions conducive to the development of corruption;

In the legal field:

clear legislative regulation of anti-corruption measures;

eradication of legal gaps, duplication and ambiguity of law;

continuous improvement of the methodology for conducting anti-corruption examination of legislative acts;

introduction of a system of mandatory consideration of the expert opinion of the medical community when developing and adopting legislative acts in the field of healthcare.

It is also necessary to tighten the responsibility of persons convicted of corruption, to highlight cases of disclosure of cases related to corruption.

The most important thing is the transition to self-regulation in the medical professional community. The medical community itself is most capable of developing strict and effective mechanisms for rejecting corrupt officials, overcoming corrupt practices, and reducing corruption risks within its ranks.

Conclusion

There remains a consistently high level of corruption in the healthcare sector in the Russian Federation. High-ranking officials are most often brought forward as defendants. Every year, more than a thousand cases initiated in connection with corruption crimes and misdemeanors in medical institutions are sent to the courts.

According to international communities, there is a direct correlation between the level of infant mortality and corruption in the country. The lack of medicines and the distribution of counterfeit, substandard medicines lead to suffering for patients and pose a direct threat to their lives. Corruption directly undermines public trust in government institutions.

Detection of corruption-related crimes, including in the healthcare sector, presents a certain difficulty, since most of them are so-called “bilateral”, that is, those where there is no victim - a party interested in identifying such a crime and punishing the perpetrators.

Russian government bodies are adopting a number of important acts designed to combat corruption in general. However, there are very few anti-corruption acts specifically in the healthcare sector. Therefore, neither existing legislation nor law enforcement practice can yet effectively combat corruption in the healthcare sector.

To eradicate corruption in the healthcare sector, it is necessary to continue to improve healthcare legislation (including the introduction of legal norms to protect social rights doctors, nurses, and other healthcare workers), develop legislation in the field of public procurement in order to create an open and effectively functioning system for spending budget funds on medical technology and equipment, fully promote the development of the domestic medical industry, innovations in the healthcare sector, use government tools private partnership for the development of the technological base of healthcare, introduce procedures for disclosure of information, independent public audit, control and monitoring of the expenditure of funds during public procurement, provision of free medical care, provision of free or discounted vouchers for sanatorium-resort treatment to certain categories of patients, etc.