Russian Health Service Needs Reform

How is Russia's public healthcare faring after eleven years of market reforms? Where do 140 million Russians get their medical treatment and how good is it? The answers are as follows: the picture is a mixed one, and Russians get what treatment they can and where they manage to.

In the Soviet Union, which vanished from the world's political map at the end of 1991, medical care was state-administered and free. But accessibility and quality were things that the Soviet health services failed to provide. It was budget-financed as a last priority and had no resources for development. In the 70s years that the country was in isolation, the equipment, technologies, materials, medicines and techniques used in Soviet public medicine fell well behind the level of developed nations.

For ordinary people this meant long queues in outpatient clinics, shortages of the most basic medicines, and a lack of effective and quality medicines. In fact, the official Soviet public health system had a "shadow", unofficial paid counterpart. Those who could afford it sought good specialists, good clinics and hospitals, employing personal connections and ... money. The saying "free treatment is free of effect" was coined in Soviet days.

The healthcare system in Russia is still state-administered. And all Russians are entitled to its services. In 1996, a law on mandatory health insurance was passed. Citizens received free health insurance policies. The assumption was that Russian public medicine would adopt market mechanisms and its institutions would compete for patients and their money. But the policies made no difference. The system, market-orientated at face value, has remained rooted in the Soviet past and is cumbersome, irrational and non-cost-effective.

The mandatory health insurance scheme runs a constant deficit: it has a budget hole of almost one and a half billion dollars. Finances for the state health service come from two sources. One is enterprises that pay insurance contributions for their employees under a unified social tax, and the other - for non-working people such as children, pensioners, the disabled and others - comes in the form of the federal and regional budgets. However, employers try to minimise insurance payments by handing the staff their wages in envelopes, while stretched regional budgets often fail to make any contributions because of a lack of money. Funds allocated for treatment are either dissipated before reaching the patients or reach them in miniscule amounts. The lion's share of budget funds and insurance payments is spent by medical institutions to pay communal bills.

The quality and accessibility of state-provided medical care have not improved over the past seven years. There are still the same long lines at the outpatient clinics. Hospitals badly need modern diagnostic and medical equipment. The list of free medicines offered to patients within this system has been becoming shorter with every passing year. Moreover, only simple and primary medical services are free. If a patient requires a serious operation or a long course of expensive treatment, the state policy is of no help.

However, patients can opt for highly qualified medical assistance in the non-state clinics which abound in Russia, if they are ready to pay. Few, however, can afford such a luxury. For example, a blood test in a private clinic costs about 3 dollars, and consulting a therapist between 7 and 10 dollars. The average wage in Russia is roughly 180 dollars.

True, many prosperous companies buy health insurances for their personnel covering outpatient clinic treatment, spa accommodation, and periods in hospital. But they are few and far between. Clearly, for the next 10 to 15 years the state-run health system will remain the only possibility for the overwhelming majority of Russia's population.

The country's health services are in for a major overhaul. Economic Development and Trade Ministry specialists, after making a study of the state of affairs in the medical branch, have come to the conclusion that the main problem is not a lack of funds, but their extremely unpractical use. The main goal of the reform is to make the system more efficient. To this end, there are plans to finance the health services from one source and pay for medical services according to the results, i.e. the number of patients treated, rather than according to estimates, as is the current practice.

Russia's Deputy Economic Development and Trade Minister Mikhail Dmitriyev, who is responsible for health reform, believes that the new scheme will force medical establishments to sell off unnecessary buildings and premises, and cut back surplus personnel and superfluous equipment. Moreover, the deputy minister is convinced that the Russians themselves should contribute to treatment costs out of their pockets and he does not doubt that the middle class will back this reform. This will inspire them to take better care of their health.

Marina SHAKINA, RIA Novosti

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Author`s name Petr Ermilin