Medical care in Russia is facing daunting challenges. In the context of objective funding constraints, reliable performance measurement of the healthcare system becomes a burning issue. An accurate assessment of the industry’s current status will help re-calibrate priorities as needed and re-allocate resources where appropriate.
The share of Russia's consolidated budget healthcare spending in the GDP has been stable over the past years: 3.5% in 2014–2015, around 3.3% in 2016 (according to estimates by the Ministry of Healthcare and Rosstat, the Federal State Statistics Service). This year, the Ministry’s forecast stands at 3.5% (RUB 3,035.4 billion).
The EU benchmark was 7.5% in 2014, the US – 8% (according to the World Health Organisation).
- Russia's key demographics are improving, but are still much inferior to Western countries. Life expectancy in Russia at birth grew from 70.93 years in 2014 to 72.06 in 2016 (according to Rosstat). In the EU countries, this metric fluctuates around 80 years. Mortality rate in Russia is approximately 13 per 1,000 people (vs 9.7 in the EU).
Amid financial constraints, the key factor to upgrade Russia's healthcare sector is improving management practices in order to maximise performance and contain spending.
- Russia demonstrates a wide diversity between its regions in terms of funding, affordability and availability of medical care, and life expectancy.
- Amid an increasing proportion of senior people, in the short term the nation’s healthcare system will have to withstand more pressure.
Given the social component, measuring the healthcare performance cannot only be subject to economic feasibility. Basically, there are three dimensions of healthcare performance:
- prevention,
- medical care and rehabilitation,
- industry management, including investment size and performance.
In Russia and globally, several multi-factor models for assessing the performance of the healthcare system are used.
- These assess the outcome of certain initiatives and track changes in the main generally accepted health metrics: life expectancy, mortality rate (including breakdown by cause that could be potentially eliminated with timely medical intervention).
- Healthcare spending (per capita, based on purchasing power parity of currencies, etc.) is reviewed.
- Per capita resources (number of hospital beds, number of doctors and nurses, etc.) are measured.
- "Variable" factors associated with the environment and lifestyle behaviours (smoking, alcohol consumption, food, income).
The difficulty of benchmarking all these factors obviously hampers performance measurement in the healthcare system.
- So, Russia often ranks last in relevant global ratings, which really highlights major gaps in the sector. However, the validity of assessment criteria and the relevance of the data used are questionable. Purely "arithmetic" models disregarding other factors misrepresent the overall picture significantly. For example, in its recent healthcare system rating Bloomberg ranked Russia last (#55). However, it determined performance as high life expectancy at low costs. As a result, Hong Kong and Singapore, where costs are below those in large countries for obvious reasons, lead the pack. Note that the US sits almost next to Russia in this ranking (#50).
- Russian healthcare ratings face similar problems. For instance, according to the Higher School of Health Care Organisation and Management and Rosstat, Dagestan, Stavropol Territory and Kabardino-Balkaria are the leaders of the healthcare performance index of Russia’s constituent entities, with Moscow ranking only 23rd.
So, ongoing collection of systematic data on the national healthcare system and an appropriate methodology to compare metrics is decisive for taking the right path to higher healthcare performance.