Exactly eight years ago, that day, I was lying in a bed in the Luga maternity hospital. meadows. Did you hear that? “In the world there is the city of Luga of the St. Petersburg region …” In general, that’s it. And I got there in the middle of pregnancy with severe pain. The doctor honestly said: with a complete placenta previa I need to go to St. Petersburg, if anything, they will not save me in Luga, saving the child is out of the question. Immediately, without delay, St. Petersburg: in case of bleeding there is a chance of survival.
My husband picked me up and we went right away because St. We have a residence permit and an apartment in St. Petersburg. And in the ward was a peasant woman with a residence permit with me. He was waiting for a quota to the perinatal center. While waiting, the child inside died. Mine goes to school. He – died in the womb. Registration price.
Over the years I have forgotten this story. Until I again had to face a powerful god named Propiska: Having lived outside the city for many years, I finally decided to separate myself from the St. Petersburg clinic and attach myself to the Novgorod clinic, as it was closer. To do this, St. I need to replace the St. Petersburg policy with a local policy. And then I got scared.
Although this God in Russia is gradually losing its strength due to the leveling of the standard of living in the country, it is still strong. Registration in Russia is a matter of life and death. Besides money. Because high-tech medical care, timely examination, diagnosis still depend on them … In Russia, many people still live only in Moscow or St. in Petersburg.
They can even live in Moscow, but in the absence of a residence permit, it will be difficult for them to connect to a good polyclinic where all doctors are present. For example, to do this, you need the approval of the district doctor. Probably, if you say that you live in Petrovka, you can attach yourself to a local clinic. However, the St. When you rent a room in the St. Petersburg new building ghetto, it is unrealistic to get the approval of the local doctor because there is a crowd of patients and he does not need new ones.
Even if they take a state with complex problems to a local clinic in capital cities, he will have to get a quota for treatment in a cardio center, an oncology center, a hematology hospital through TFOMS, for which he will most likely have to go to his small homeland.
It will be even more difficult for a Muscovite who does not have a capital residence permit to go to the capital’s state medical center for a complex surgery or expensive treatment than for his brother who stays at home, because the first will have to go home and be examined. Again, examination, first through a polyclinic, a district dispensary… There will also be a quota for those who stay at home.
In principle, now it is not the 90s, it was impossible to go to the hospital even in one’s own city, and the patient often acted as an element of the food supply for the doctor. I will never forget for the rest of my life the doctors extorted money from me to operate on my mother in 1997. I was 12-13 years old even though we lived with him. The doctor just came to me in the lobby and said I need to bring money. I said that I will go to the prosecutor’s office. And to the newspaper. And it’s gone. By the way, I also became a journalist.
For my career start, of course, thanks to our medicine. But still, it’s good that everything is different now. However, rapid access to specialized clinics for quotas and provinces is still difficult.
Life is really balancing. And now many people in the countryside go to Moscow and St. Petersburg: if there is work and housing, then it turns out much cheaper and calmer. The environment has changed, internet distribution has made everyone equal in consumption. What remains in the province of cons? Medicine!
Of course, there are no 5,000-person cardio centers in regional towns and villages in the countries that are often cited as examples. I was also faced with a tragedy when there was no news on duty in any hospital in the Italian region, where I went to the seaside on a weekend evening. So, really, there were no doctors in the whole area. I do not remember where the malignant otitis found me: in Liguria my ear hurt and I had to go to Piedmont or vice versa. But it happened, and no one in Italy was angry that there were no doctors for the whole region.
Maybe they have brought another system instead of the quota, of course, and they transport people to hospitals quickly in case of severe illness. Or maybe the system is even worse and they wait for a year to be transferred to the capital’s hospitals and they don’t get angry again.
Maybe our expectations and requirements are high, but the scenario that a person with a suspected malignant tumor waits for months for examination instead of the guaranteed two weeks makes us rebel.
Everyone knows that if you live in the country and have a serious illness, you will have to splurge on private examinations and bribes first, because there are not many specialist doctors in outpatient clinics, there are long queues for them. centers. For example, in Novgorod there was only one pediatric allergist for all polyclinics. There doesn’t seem to be a pediatric proctologist. Less routine options than coronavirus vaccines. Until January, there were no combined operations on ships here. There are no MRI pathologies of the placenta.
The way out is paid clinics or megacities. In the case of the same cancer, both options are unsuccessful, because then if you manage to get treatment quickly under compulsory health insurance, you still have to take retests in exactly the vertical where the policy nails you.
Even without a long bribe, if you pass an exam in your city and they give you a quota, it will take time to wait. And the farther a person is from his registered settlement, the longer his journey to the operating table will be. The capital is Moscow and St. Petersburg residents should not waste this time and can immediately begin treatment. And in the whole region of Novgorod we do not have some specialists, therefore, with serious doubts, even to collect primary history and prescribe primary treatment, you have to wait for a quota. A peasant will receive a referral to the district hospital, which will send him to the regional hospital, from the regional hospital they will give a referral to the St. Petersburg clinic, where you should already wait for a quota. Each stage has a registration and waiting period. In some cases, months may be decisive.
There is a problem of distance, neither in the Pskov region nor in Italy, when there is no neurosurgery in the village, and no matter how angry it will be. Therefore, in an accident, those who have an accident in a big city survive more often – they get to the surgeons faster.
But there is also the problem of quotas, the distribution of expensive medical resources. If you have placental abruption and live near a perinatal center, you and your baby will most likely survive: an ambulance will take you to the operating room right away. If this happened to you with your grandmother in the village, you may also have time: the main thing is to get you to the city. There are times when a family charters an ambulance plane. Brought to the capital – they will immediately undertake to save. But if you are a village woman, you will be taken to the district maternity hospital, where they cannot operate. They will want a place in the regional maternity hospital, although the conditions for salvation are bad even there. In such a situation, it is extremely difficult to enter the perinatal center of the capital due to the bureaucracy and the bed distribution system.
There are many diseases and injuries where having a residence permit in the capital is an advantage in treatment. For example, retinal detachment. The provincial must wait for a quota, the longer he waits, the less chance he has to regain his sight. The Muscovite will be put into operation immediately. It will be enough for a Muscovite from the province to get on a plane, fly home and call an ambulance.
Therefore, Moscow and St. Petersburg is still very valuable. You can change your place of residence, but you cannot lose your registration. For example, my plan is this: we take out compulsory health insurance policies from Novgorod and here we treat a routine runny nose. However, if something serious happens, you should urgently return to the clinic at the place of registration. Because if – ah! Ah! Ah! – what, then wait for the quota, it will only take time for the exam.
Now there are a lot of metropolitan immigrants in cities such as Novgorod. Someone has roots here, someone agreed to do a good job, and someone moved in tired of being stuck in traffic jams for three hours. There is a large population outflow from the capitals, people wanted to live in small comfortable cities. But they keep their residence permit until the end. Especially summer house owners who have retired to village houses.
Villages around major cities have long been revived by summer residents and returning locals. But few people are ready to enroll in the village precisely because of medicine. The registered village is a forest plot, although there is firewood in a private house. However, there are very few people who want to treat a heart attack patient in an inter-provincial polyclinic. What is the registration is especially clear in the “cottage” villages: all retirees clearly distinguish who has medical privileges of the capital, and who – with a local residence permit. This does not contribute to the friendliness of neighbors, because the allocation of settlements also takes into account the number of registered people, the more people are permanently registered in the village, the more money in the local budget, the better the roads. And expats Moscow and St. They hold their St. Petersburg residence permit with their teeth. Because several…
And it’s not just about medicine. Benefits. “Governor” payments for children. The benefits are different. Housing for people on the waiting list. Housing for orphans. The elementary apartment bought in Moscow will cost more than in Ivanovo. employment again. So far in the job postings they write: “only Moscow / St. We have a residence permit in St. Petersburg” …
The registrar is available in many countries. Finns have strict requirements. What is the name of the registration in Poland, I even know – meldunek, I had to apply for it when I came to visit!!! Probably there, too, medical care is dependent on a residence permit, and villagers usually do not expect to be referred to the capital’s hospital.
But it seems absurd to me that in the modern world, the order of access to treatment and the amount of assistance depend on whether your family has a residence in the capital, and you cannot register there. Somehow, perhaps it is necessary to change the approach to the distribution of medical quotas. There should be a mechanism that equates people on the right to life and does not subject them to registration.
The author expresses his personal opinion, which may not coincide with the editors’ position.