Posted on Apr 19, 2011 by Sergio Ulloa
Speaking last week at the All-Russian Forum of Medical Workers, Russian Prime Minister Vladimir Putin addressed the country's continued health care problems and outlined the substantial investments required in the health system to improve outcomes.
The crisis in Russia's healthcare system has been a persistent problem for many years. Despite an elaborate hospital network and an ample staff of trained health professionals, the medical system has remained unable to provide most citizens with acceptable levels of health care services. The quality and accessibility problems have been principally due to the continued lack and uneven distribution of funds, medical equipment and supplies in the healthcare infrastructure in Russia. These factors coupled with ineffective governance and the poor health and lifestyle choices of many Russians, has resulted in health standards that trail below Western European standards.
The All-Russia Medical Worker Forum, held for the first time at the Russian cardiology research and production center, was called to asses development initiatives involving the Russian healthcare sector, including improving medical workers' contribution and education, regional healthcare modernization programs and the implementation of medical insurance schemes. Prime Minister Vladimir Putin, alongside several other government ministers, headlined the event and offered a thorough analysis of Russia's health status in the premier's address.
Mr. Putin first acknowledged that the demographic crisis, in which Russia lost 700,000 to upwards of a million people annually throughout the nineties, had abated but there was still much work yet to be done. "We have curtailed the destructive trends½But despite all our painstaking efforts, the population in the country has shrunk by 500,000 people over the past five years: these are serious figures," Putin said.
Life expectancy in Russia has increased from 65.3 to 68.9 in the period of 2005-2010. The birth rate increased 19 percent while the death rate dropped over 11 percent during the same period. In recent years thousands of Russian medical institutions and ambulatory services have received new updated medical equipment and vehicles, cutting both waiting times for diagnostic tests and emergency response time by over half. There has also been a substantial one-third decrease in infant mortality due to improved concentration on maternity care. Despite these positive trends, Mr. Putin remarked that Russia was still too far behind Europe in their health outcomes: "We have spoken about some positive trends in the healthcare system and we have something to show for it. Yet the average lifespan in our country is 8-10 years lower than in neighboring European countries, the death rate from cardiovascular diseases is 4-5 times higher," Putin said.
The Prime Minister then went into detail describing the poor condition of many hospitals in the country, highlighting that almost a third had no running hot water, let alone up-to-date and clean medical equipment. "A quarter of all the medical facilities in the Russian Federation are in need of overhaul," Putin said.
An additional deterrent to improving healthcare quality in Russia has been the paltry salaries offered towards medical workers, which Putin admits "are barely above the subsistence minimum." The tendency has been towards rewarding seniority and this has resulted in excessive management staff and a shortage of necessary primary care workers operating in the healthcare sector. This inadequacy needs to be fixed in order to better allocate resources and improve efficiency in health provision.
In the second half of his address, Mr. Putin put forth his solutions for the healthcare system. The Prime Minister argued for improved and decentralized healthcare funding, culling the oversized management staff, improving conditions for young doctors and modernizing Russia's medical information systems through the introduction of electronic databases.
First and foremost, considerable investment has been promised to the healthcare sector. Mr. Putin remarked that the government now has the necessary framework to ensure that positive effects of increased health spending will be widespread. "I am 100% sure that we made the right decision in creating a financial basis for the regional programs. Over the next two years, we are now able to continue to invest in the healthcare system - that is, over and above current financing to the substantial tune of 460 billion rubles (US $16 billion) - in order to reinvigorate the network of medical institutions in Russian towns and villages." Under this extensive spending plan, over 40 percent of federal and municipal medical facilities will be repaired and upgraded. The healthcare system, as a whole, will receive more than 100,000 units of modern medical equipment. The funds will be reportedly be covered by the recent rise in insurance premiums from 3.1 to 5.1 percent.
The government has earmarked 788.7 billion rubles (US $28 billion) for the 'Healthcare National Project' which will run through to 2013. The initiative was launched in 2005 to improve Russian health outcomes and measure the quality of medical services in the country. Since its inception, the project has overseen the construction of 7 high-tech medical facilities and 11 maternity clinics across the country, which have provided care for over a million Russians.
To encourage regional responsibility in local healthcare development, the government is in the process of establishing a 30 billion rubles (US $1 billion) incentive fund. Mr. Putin proposed an additional medical system monitoring mechanism through the introduction of an annual ratings project, whereby medical institutions and insurance companies would be judged by customers and agencies for the quality service they provide. "I think that the information about the real state of affairs in medical institutions and the results on studying citizens' complaints should be open," Putin said, adding that "it is absolutely inadmissible to conceal unpleasant facts and mistakes." The process of modernization in the Russian healthcare system will be faster, if more comprehensive and objective information is obtained, Putin claimed.
Mr. Putin was adamant that the excessive number of healthcare executives and their inflated salaries would need to be tackled. The salaries available to valued medical staff are often dependent on the number of managers and directors present. There were 28,000 medical superintendents and deputies in the Russian system last year, salaries account for over 15 billion rubles ($530) annually. "Quite a few medical superintendents have up to 10 deputies on top of aides, personal assistants, you name it½ At the same time we witness an unjustifiably large gap between the salaries of a medical institution's directors and its medical specialists. In some regions, it's a five- to seven-fold difference," Putin said.
There will have to be a reduction in healthcare officials and executive staff, bringing the number down into compliance with the real needs of the industry. Putin identified that doctors, paramedics and nurses constitute the core of the healthcare system, and "we should base our payroll decisions on this understanding." Putin further stated that doctor's work should be made more efficient through the introduction of comprehensive electronic patient database systems, at the expense of the current arduous paperwork process, which delays treatment. Health Minister Tatyana Golikova confirmed that a relevant law, necessitating electronic tracking integration, had been drafted and sent for the government's deliberation.
In his closing statement, Vladimir Putin remarked that the road to comprehensive reform would be demanding but that Russia must overcome these obstacles to guarantee their future prosperity:
"The accessibility of high-quality health services, doctors' and nurses' living and labor conditions, and the way they do their jobs all have a lot to do with the lives of specific patients and their families, and with Russia's future in general. The price of the purported reforms is very high, but the hopes and expectations of millions of Russian people have an even higher price. Our common goal is to live up to these expectations and the trust of the Russian people. I think we are in a position to achieve this goal."
Russia is far from the only country currently embarking on substantial healthcare initiatives and reform. The American healthcare system is structured in a fundamentally different manner from Russia's system. In the United States, health care is predominantly offered through the private insurance companies while public sector facilities provide primary care for the poor. The US system however has encountered problems of its own as more and more US citizens remain uninsured
and the disparity of medical services and health outcomes widen along income lines. The 2010 US Health Reform law
mandates that by 2014, American citizens must have health insurance coverage or otherwise pay a US$695 annual fine. It is projected that the Health Reform Law will reduce the number of the uninsured Americans from 19 percent in 2010 to 8 percent by 2016.
Although different from the United States, Russia's healthcare problems are not exceptional. Countries that traditionally have relied on a state healthcare system tend to suffer from shortages and misallocation of resources, declining quality, and as a result: waning health standards. Health care reform in Russia will have to take into account both local expertise and international experience in improving their healthcare system.