It seems that the authorities are serious about putting an end to the practice, when social assistance is rendered under the guise of medical.
In the Russian regions often issued disability “poverty”: this source of income, and the only way to obtain free medication. Now, when the state decided to “close shop”, thousands of Russians went way overboard. In disability denied even to those who have previously had this status. Why, for many, disability is not so much a question of rehabilitation, as that of survival, and what to do with it, in the framework of the project “All inclusive!” “Rosbalt” was told by the experts.
“Recently began a shift towards the reduction of disability. And achieving rehabilitation. Cracks began to even those who have previously had this status. For people it is very painful, especially in the regions where there is no work, and disability pension is probably the main source of income,” — admitted conversation with the correspondent of “Rosbalt” the lawyer of the legal team of the Center for curative pedagogics Paul Kantor.
Of course, we can consider this phenomenon as the “excesses on the ground”, but people with disabilities themselves think about the new requirements and rules of carrying out medico-social examination. Recall that the scandal erupted in March. Then it was that a new order (1024-N), adopted in December 2015, deprived of the special status of the over 200 thousand Russians. The Ministry of labor, in turn, argued that the reason for those “excesses”, as well as the natural population decline. What happened actually?
According to the expert, the classification and criteria of establishment of disability has varied more than once. So, the last order 1024-N was released in December of 2015, until then, was the order of the 664-N from September 2014, and before him the order of 1013-N from 2009, the order 535-N — from 2005.
“I advise families with children with disabilities. The main issue with which the parents come, sounds like this: “we Have a diagnosis, code of ICD (international classification of diseases)-so if we are disabled?” And we explain that the disability concept is not medical, but social. It is a question of need of the person in various types of aid. In other words, the disease in different people can be different and be expressed differently. With the same diagnosis, one person may require assistance and the special status and the other does not. While there are cases when doctors cannot put the exact diagnosis, but this does not mean that the person is not in need of help,” said Kantor.
According to the lawyer, the principle of “needs” and guided from time to time mediko-social examination. But the pressure from the public and calls “not fooling” worked: people with disabilities have received something for so long insisted. “The legislator, unfortunately, in this direction, bend, and since 2005 every next order was increasingly focused on nosology (diagnosis, — “Rosbalt“). Everything seemed to be correct: need is subjective, while objective diagnoses. But in this situation there will always be those who “correct” the appropriate diagnosis. Despite the fact that the problem is not expressed so clearly, he will get disability. But there will be those who “correct” diagnosis is not set, even though the need for aid is, the disabilities he now will not give,” — said “Rosbalt”.
In principle, the new order differs from the previous one not so much, he said. “Neither the parents nor the professionals — no one has been able to demonstrate a specific case where under the old criteria, the disability is established and no longer new. I admit that if there are such cases, they are isolated”, he said.
Thus, according to experts, the new order with the March unrest is not related. However, the approach to disability has definitely changed, he said.
“It seems that bodies mediko-social examination (MSE) was given the command to reduce disability. Unofficially, of course. We see many cases where the disability before the person had, and now it’s gone. These facts are either people with disabilities themselves and their parents is associated with the new order, or the staff of medico-social examination refer to the document. The truth is that the organs of the ITU are simply using the order as an excuse to deny disability, especially in borderline cases”, says Kantor.
In this sense, according to the source of “Rosbalt”, it is highly indicative of the situation with diabetics. “If the person controls the medical records, on time taking medication, watching the diet, technically it can have severe diabetes, but in the strict sense it is not disabled: he controls the situation, the diagnosis does not prevent him neither to walk nor talk nor work nor study. He leads a normal life with complete control. But as soon as the control is weakened, due to age or other reasons, you should insulin shock, hospitalization, and then we can talk about disabilities,” he explained.
And in such borderline cases the Commission today often make decisions not in favor of the applicant.
“But this is not due to the new criteria for the establishment of disability, and General setting for reduction of disability that is directly connected with the economic situation in the country”, — concluded the expert.
“Was this practice, especially in the “fat years” to consider disability as a measure of social support. In the regions gave a disability “for the poverty”. See that the family is in a difficult material situation and “pull” disability. Here and pension and benefits and now easier to live. Now, apparently, was ordered to cover the bench, and give a disability is strictly for medical reasons”, — he said.
The alignment of the practice regional ITU. Where before she was a liberal, now became harder.
In some sense the source of “Rosbalt” with the position of the authorities agree. “Disability should not be a subsistence benefit. Institute of disability should be an institution providing specialized care in rehabilitation, habilitation. And we are often able to survive physically, ” said Kantor. The idea is to bring order to the disability and to give status only to those who really need it, right. But this is speaking about an abstract society. In our real society in parallel with this task, the task of combating poverty, not only among people with disabilities. Then the problem will be solved “controversial disability. The people themselves will not be part of this. Will only those who really need specialized care, rehabilitation. We have the same people treat the bodies of the ITU, from poverty, from hopelessness, and it is difficult to blame”.
There is another side of the issue. Disability is free medicines, thanks to which many owners of the title and manages to maintain itself normal. “Now the picture looks thus: a child’s treat, he’s getting better, it is removed from disability, deprived of medication, rehabilitation, as long as it becomes worse, and it again can be written in the disabled!” — writes in his petition, Marina Nizhegorodova from Magnitogorsk — the mother of Danila with a genetic disease.
“The whole system of preferential drug supply in our country is flawed. In 90% of cases, with the exception of HIV programmes and the “7 nosologies” she is tied to patient disability. And should be tied to disease diagnosis. In this case, the early initiation of treatment may lead to prevention of disability. By linking right to a remedy with the status of a disabled person we are encouraging millions of people, drive them to medical-social examination. In many ways they are going to apply for disability only due to the medicinal benefits. If they knew that in any case will get the necessary drugs free of charge, the number of those wishing to apply for disability has significantly decreased”, — noted in turn, the co-chair of the all-Russian Union of patient associations Yury Zhulev.
According to the source of “Rosbalt”, this issue has been brought up when discussing the strategy of drug supply. Then it was announced the two approaches: the full provision of medicines by the state or co-financing. But authorities for such changes was not ready.
“We understand that this is a financial question. That part of the program that we offered, required additional funding, because it meant the expansion of the list of beneficiaries. But nobody has considered the economic effect that the program could bring. People would not receive pensions and other benefits — only need them for a normal life drugs,” he stressed.
According to Goleva, in many countries this practice is already in place. There is a gradation of the disease: some state is ready to Finance completely, the other — on the terms of the 25-50-75 percent co-financing.
“Disability is a failure. This means that we were not able to stabilize the human condition and leave it healthy. And in order to stabilize, must, in particular, to give him medicine. We have broken the concept of medical aid and provision of medicines”, — said the expert.
“The theme that the government supposedly “pulls the plans,” a long time. No facts confirming it, no. Don’t think that’s the issue at the Federal level. But we understand that every person who receives disability, cost money. We see that with the same disease in the same region give peace a disability, not in another”, — he concluded.
