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Russia’s fast-tracked health service reform sparks protests

October 21, 2014, 16:16 UTC+3 Alexandrova Lyudmila
© ITAR-TASS/Pavel Smertin

MOSCOW, October 21. /TASS/. Russia’s reform of the health service, well into its second year, has resulted in the closure of many medical institutions to draw protests from both professional medics and their patients. As such the reform is crucial, but it has been too fast, poorly considered from the standpoint of its implementation, and utterly inadequate to the Russians’ current financial capabilities.

The public movement Together for Decent Medicine is going to stage a large-scale rally by medical workers in Moscow on November 2. The demonstration will be in protest of the draft reform of Moscow’s health service envisaging the reorganization or elimination of many medical institutions.

According to the draft published on the Internet five thousand employees of Moscow’s medical institutions, including fifteen hospitals, will be laid off and their equipment will be handed over to other organizations. A number of clinics may be merged with larger hospitals and the vacated buildings put on the balance sheet of the Moscow Mayor’s Office. Reductions of hospital staff and beds are going on in other regions of Russia. Officials argue the health service has to be reorganized, because it is costly and inefficient.

The medical community is angry the reform was drafted without its advice. For example, the list of medical institutions to be shut down in Moscow mentions Hospital No. 11, which last year was merged with the city’s clinical hospital 24. “We have been reorganized already and, judging by the draft, nothing will be left of us by next spring,” the daily Kommersant quotes the hospital’s neurologist, Semyon Galperin, as saying. “All of a sudden the ineffectiveness label has been attached to hospitals in the center of Moscow taking the most expensive plots of land,” Galperin says.

Doctor Natalya Semyonova is worried the health service is now putting greater emphasis on outpatient clinics. “The task is clear - to treat and examine more people at outpatient clinics, where it is less costly. But the current condition of outpatient clinics as it is, it will be just impossible. The doctors already have too many patients to take care of.”

The critics of the Moscow authorities’ initiative fear that the reorganization may result in the dismissal of 7,000 medical personnel.

As Moscow’s deputy mayor for social development, Leonid Pechatnikov, has told the media, the authorities plan not reductions, but reorganization and measures to make the city’s medical institutions more effective. He argues it is very wrong to say the number of hospital beds in Moscow is bound to shrink. Instead of smaller, ineffective hospitals there will emerge major multi-functional ones.

Russia’s health service is to make transition to a pattern of financing based on the mandatory medical insurance as of 2015. Pechatnikov says hospitals should master the skill of living on the money they make, while budget funds will be available only for fundamental repairs and purchases of equipment worth over $2,500.

The chief of the cystic fibrosis department at the children’s city hospital No. 13, Viktoria Sherman, complains that the mandatory health insurance tariffs will be not enough even to pay salaries.

“The hospital will have to fire part of its staff and begin to provide some services on the commercial basis,” she says.

“This is a nation-wide trend. It’s an attempt to commercialize the health service,” the deputy chairman of the medical documentation committee at the Russian Academy of Medical Science, Professor Pavel Vorobyov, has told the daily Novyie Izvestia. “We are being told that we have too many beds in hospitals and that nearly all diseases can be treated at outpatient clinics. All this is very interesting to hear but very hard to imagine, the realities being what they are.”

“Some say it is modernization of medicine. Others call it optimization. The way I see it, I’d call it utter collapse,” Vorobyov said.

Nobody has taken the trouble of hearing advice from the medical community, he complains. “We are emphatically against the introduction of such technologies. There have been protest demonstrations, hunger strikes and open letters. Medical personnel are demonstrating across the nation, from Kaliningrad to Ufa.

The current criticism of the measures being taken is fair and unfair at the same time, says Professor Lyubov Khrapylina, of the Russian Presidential Academy of the National Economy and Public Administration. “In a market economy environment the firm vertical chain of command, with everything being determined from Moscow has to be changed, of course,” Khrapylina told TASS. “But the reform envisages transition to pay services to the maximum extent, while the state undertakes to finance the minimum through the mandatory medical insurance system.”

“If only the population had enough money, everything would have been just fine just in accordance with theory,” Khrapylina said. “The reform was ill-considered from the standpoint of its introduction and at the moment it is detrimental to the population.”

“It is too fast, it is inadequate to the people’s capabilities. It must be evolutionary and systematic. There must be social advertising and close contact with the medical personnel and the population. At the moment nobody understands the new rules of the game,” she remarked.

In the current situation somebody with enough powers must take the responsibility “to make a decision to postpone some measures, to identify the groups of people who cannot afford to get medical assistance on the proposed conditions and to better calculate financial resources.


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