FAMILY DOCTOR AS A WAY OF CUTTING DOWN ON MEDICAL BILLS

People in this country are largely unaware of the institution of family doctor. Some may recall the classical literature of the 19th century with plots featuring a doctor called up to treat the protagonist of a novel. As it turns out, the doctor used to treat the protagonists mom and dad. Such medical professionals became an extinct species in the Soviet Union.
The average Soviet citizen had to go to a local hospital where treatment was ostensibly free and medical records were filled and kept in a sloppy manner.

The system of family medicine is being revived in todays Russia at a much more level than it was available to the Russian population before 1917. Peytr Yaverbaum, deputy director of the Center of medical insurance operated by ROSNO JSC speaks with a correspondent of Mednovosti News Agency about modern family-oriented medicine:

Q: What are the advantages of going to a family doctor as opposed to a traditional system of health care?

A: Let me start by reminding you of a few things relating to the actual health care system. Wed normally go to see a medical specialist if theres a health problem. We need to see an ophthalmologist if our eyes hurt, we pay a visit to an otologist if we feel pain in our ear etc. A dense network of district clinics for out-patient treatment was established to ensure that the population has maximum access to specialized medical services. On the face of it, the system should work right and smoothly. But statistics show that 35% of the direct visits to specialists are useless.

How does it happen? The reason lies in the patient. A person can only guess the nature of his trouble when hes about to see a doctor. A disease quite often affects one organ while hiding in another. Such a situation leads to the treatment of consequences of a disease as the cause of it remains overlooked.

Who can effectively tackle this problem? Its obvious that it should be a specialist who has an eye for the human body in its entirety, the one who knows enough of a patients habits and lifestyle. It should be a doctor whos not only aware of a patients condition but also has background medical information with respect to a patients parents. That, in a nutshell, is a family doctor. In other words, its a health-oriented doctor, not a disease-oriented doctor. The doctors principal goal is to keep his patient healthy as long as can be.

Q: What kind of training is required for such a doctor?

A: The family doctor is a general practitioner who must be trained in basic specialties – surgery, ophthalmology, otology and laryngology, neuropathology apart from being an internist. This kind of training enables him to perform a preliminary diagnosis of a problem more precisely and administer a treatment. He can also make sure that a patient
sees a specialist if need be.

Q: Youve mentioned before that 35% direct visits to medical specialists were useless, according to statistics. To what extent can a family doctor curtail the number of such visits?

A: Statistics show that a general practitioner (family doctor) can take care of 22.7% of visits to a surgeon, 36.4% of visits to an ophthalmologist, 41% of visits to an otolaryngologist, and 46.6% of visits to a neurologist.

Q: Whats the situation in the family medicine here and abroad?

A: The family medicine has been around in most developed countries for a long time. According to a resolution adopted by the World Health Organization in 1978, the first medical aid rendered by general practitioners (family doctors) is to be viewed as the most important level of a health care system.

Our country couldnt ignore such international practices. Weve got a bunch of rules and regulations stipulating lots of things, from the legal status of a general practitioner to financing methods to additional training. The state standards for training of general medical practitioners (family doctors) were approved. The Development Plan of Health Care and Medicine in the Russian Federation declared a special role of the institution of general practitioners (family doctors). As for legislation, everything has been recognized.
Still, a family doctor is just a dream to the majority of Russians.

Q: Why?

A: Its hard to reshuffle the existing health care system plagued by the lack of funds, poor coordination between the hospitals and so forth. Though family doctors are starting to show up in some common out-patient clinics. The system of family medicine is being implemented at a better pace in private medical institutions in the form of paid medical services and voluntary medical insurance programs.

Q: Whats the difference between the alternatives?

A: The medical insurance programs with services rendered by a family doctor have mostly the same advantages as those of the voluntary medical insurance programs.
First and foremost, an insurance company provides an additional protection of a patients interests. Secondly, the cost of an insurance policy is considerably lower than the limit covering charges for services rendered to a patient. In short, your insurance program may cost you a few hundred U.S. dollars while your bills may come to a few thousands.

Q: In other words, people can cut their medical bills by taking a medical insurance policy based on the family medicine programs, cant they?

A: Absolutely. Youve got a back pain problem, for example. How should you know which way to go for help? Should you seek advice of a surgeon, neurologist or neuphrologist? Going from one office to another is likely to make your bill longer. And how could you have good judgement of a diagnosis and therapy administered? Is the treatment is adequate or youre simply paying too much? Your medical insurance can help you out.

Besides, a medical insurance policy for services rendered by a family doctor will cost you less than a regular medical insurance policy. A family doctor performs part of the job of medical specialists thus cutting down the cost of the insurance program. At the same time, the quality of services goes up thanks to a higher degree of succession of a treatment i.e. preliminary diagnosis. The same applies to a level of prevention.

Q: Could you provide any figures showing the popularity of the ROSNO medical insurance programs? Why some are more popular than others?

A: ROSNO is the first Russian insurance company that began the active development of the family medicine with a view to offer medical services of a new quality to its customers. The company took part in the establishment of the first Moscow Family Clinic No1 opened in Grokholski St. back in 1996.

The volunteer medical insurance programs applicable to Moscow family clinics are the most the most popular deals with ROSNOs customers. The programs from a Family medicine series are quite popular too. An opinion poll shows that 74% of our customers believe that this system can guarantee a high service level and save up a good amount of time.

The medical insurance programs for children are also very popular since a family medicine system enables to launch programs oriented toward consultation and treatment at home. A toddlers parents find it very handy. They dont have to bring a child to hospital every time they feel theres something wrong with it. They can get a consultation from their family doctor by phone. If a home visit is necessary, the doctor can do a more detailed examination of the child because he normally brings along lots of diagnostic equipment.

.. - NEKTO 2009.


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