"Efforts should be made to ensure that every woman in labor has access to anesthesia during childbirth. The introduction of an adjustment coefficient by the National Health Fund may favorably affect the actual availability of anesthesia during natural childbirth and thus contribute to improving the comfort and safety of the parturient," writes the Supreme Chamber of Physicians. As NIL points out, the proposed order of the President of the National Health Fund is a response to the appeal of the medical self-government.
NIL: Every woman in labor should be given access to anesthesia during childbirth
Published May 10, 2024 08:55
At the end of January, the Supreme Council of Physicians sent an appeal to the Prime Minister to take comprehensive organizational, financial and legal measures to increase the availability of anesthesia during childbirth. The Presidium of the NRL, after reviewing the draft order of the President of the National Health Fund, amending the order on defining the terms and conditions for the conclusion and implementation of contracts in the type of hospital treatment and inpatient treatment, gives a positive opinion on the assumptions of the project, which provides for the introduction of changes to improve access to services related to anesthesia for deliveries completed by natural means.
At the same time, the Presidium of the Supreme Medical Council proposes several changes, including simplification of reporting mechanisms The described method of determining the correction coefficient and the moment from which the coefficient will be applied is, in the opinion of the NRL, overly complicated and unintuitive. The Presidium of the NRL also believes that it is necessary to promote with the correction coefficient those facilities that have achieved a certain percentage of deliveries under anesthesia, and not only those that are steadily increasing the percentage of natural deliveries under anesthesia.
The medical association proposes lowering the threshold at which a hospital will reach the maximum value of the adjustment factor, independent of the quarterly increase in the percentage of anesthesia for natural deliveries. The draft under review stipulates that the threshold is the achievement of 50 percent of natural childbirths with anesthesia in the quarter preceding the quarter that is the basis for calculating the coefficient. This threshold should, in the opinion of doctors, be lowered to 40 percent. Lowering the threshold is also making it more realistic. Doctors stress that some patients will not expect anesthesia for childbirth or there will be contraindications to its use.
In addition, the medical government is calling for an increase in the valuation for each of the coefficients and thus allocating more funds to implement the order. The amount of 25 to 60 million mentioned in the draft may prove insufficient, in the NRL's opinion. Implementation of this change, which is important for women giving birth by natural means, requires a higher level of outlays that will allow hospitals to provide adequate anesthesiological care for the increasing percentage of anesthesia for deliveries.
The doctors' reservations are also raised by the proposed idea of setting a correction coefficient of 0.95 for providers providing obstetrics and gynecology services related to natural childbirth, if the share of births completed by natural means with epidural or subarachnoid anesthesia was less than 5 percent. The medical association points out that the right solution to improve the accessibility of women giving birth to anesthesia during childbirth is only to create an incentive mechanism for providers, not a sanction mechanism in the form of a reduction in funding for entities that do not achieve an improvement in the percentage of births with anesthesia. The introduction of a correction coefficient of 0.95 will worsen the situation of health care providers in this regard, which, given the general underfunding of health care facilities, may further exacerbate the degree of indebtedness of hospitals.
