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Russian health service reform painful but unavoidable

November 19, 2014, 16:17 UTC+3 Alexandrova Lyudmila
© ITAR-TASS/Sergey Bobylev

MOSCOW, November 19. /TASS/. The reform of Russia’s health service is going tough. Nobody doubts that fundamental changes are vital, but many are critical of the way they are being enforced. Popular discontent is mounting steadily. Both medics and their patients have repeatedly taken to the streets across the nation to protest against the “optimization” of the health service, which envisages the closure of some hospitals and job reductions. The funding is scarce and cuts are unavoidable, experts warn.

Russia this year took last, 51st place in Bloomberg’s annual ranking of the effectiveness of health service systems. “One has the impression we are at a banquet on board the Titanic: the disaster is due any moment,” the RBC Daily quotes Daniil Stroyakovsky, chief of the chemotherapy department at Moscow’s hospital N. 62 as saying.

The Audit Chamber has found that in 2013 the financing of clinics across Russia fell 19 billion rubles short of the target (the current exchange rate being 47 roubles per dollar). As a result, 35,000 hospital beds, 76 outpatient clinics and 306 hospitals were axed. In Moscow alone, 4,000 hospital beds were reduced.

In the Russian capital, the situation is worse than elsewhere. In October, a list of Moscow’s clinics to be abolished emerged on the Internet. Seven thousand doctors of retirement and pre-retirement age may be fired.

“We had no wish to make it public. We just kept quietly dropping tears inside our offices. But since it has now spilled over into the public space, let’s be mourning together,” Moscow’s deputy mayor Leonid Pechatnikov, a career medical doctor with an impressive professional record, said about the leaked document.

He argues that Moscow lacks more than 13,000 doctors, but there is an oversupply of specialists, who will be invited to undergo retraining.

About 30% of beds at Moscow’s hospitals are used ineffectively, so the optimization will be continued, the chief of Moscow’s health service department, Alexey Khripun, said on Tuesday.

Nobody makes a secret of the fact that the reform has to be harsh due to the shortage of funds. As of 2015, Russia is to complete the transition to financing the health service at the expense of the system of mandatory medical insurance. Its reserves are formed entirely by employers’ deductions from the wages of their employees. In 2014, the fund’s deficit rose to above 55 billion rubles, and by 2017, it may soar to 400 billion rubles.

As of next year, the authorities will be stripped of the opportunity to co-finance hospitals from local budgets. What makes the situation still worse is the presidential decree of 2012 that requires raising the salaries of medical personnel considerably, which will inevitably entail cuts in other medical spending articles.

The sole way in a situation like this is to raise the effectiveness of the health service. Pechatnikov argues that 40% of patients at Moscow’s hospitals may easily receive medical treatment at outpatient clinics. The city authorities see a future health service system in large medical clusters consisting of a major diagnostic center and affiliated outpatient clinics in residential areas.

“The ongoing reform is reasonable. The country cannot afford to keep the current health service system as it is,” the daily Vedomosti quotes the general director of the company RESO-med, Anatoly Sandimirov, as saying. The main cuts are still ahead, he says with certainty.

The reform has had a shell-shock effect on Moscow’s medical doctors. Proper preparations should have been made first for transition to a new system before eliminating the old one, says one of the architects of the mandatory medical insurance system in Russia, Vladimir Grishin. “The staff of ‘ineffective’ hospitals should have been briefed on employment opportunities they have before warning them of the forthcoming closures and dismissals.”

On Tuesday, President Vladimir Putin for the first time expressed his attitude to the situation in public. At a meeting with activists of the All-Russia People’s Front Putin criticized the Moscow authorities for ill-considered moves. “The underlying reasons were basically correct and intentions fine, but all that could have been arranged differently,” he said, promising to keep a close watch on this problem, acute in Moscow and elsewhere.

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