Protecting the health of citizens in Russia is a set of measures of a political, economic, legal, social, cultural, scientific, medical, sanitary-hygienic and anti-epidemic nature, aimed at preserving and strengthening the physical and mental health of each person, maintaining his long-term active life, providing him medical care in case of loss of health [1] .
The number of hospital facilities at the end of 2010 was about 6.3 thousand, hospital beds - 1339.5 thousand (93.7 per 10 000 people) [2] . The share of private clinics in Russia does not exceed 5-10% of their total number [3] . In Russia, 707 thousand doctors of various specialties (at the end of 2007) [4] .
Total health care spending in Russia in 2006 amounted to 3.9% of GDP (of which 3.2% of GDP is government spending, 0.7% of GDP is private), 2007 - 4.4% of GDP [5] [6] . In 2016, total health care expenditures from all sources in Russia amounted to more than 6% of GDP [7] .
Total health care spending in Russia in 2007 amounted to (in absolute terms) $ 493 per person. This indicator includes government spending on medicine (amounting to $ 316 per person in the same 2007), medical services paid for at the expense of the patient, and services paid through the medical insurance system (compulsory and voluntary medical insurance) [8] . In 2012, the corresponding indicators were $ 913 (total expenses) and $ 467 (government expenses) [9] .
Government and nongovernmental costs of public health services for the treatment of tobacco-related diseases amounted to 42 billion rubles, or 13.1% of the total costs of public health services for the treatment of respiratory diseases, and 83 billion, or 20.8% of the total costs of public health services for the treatment of diseases of the cardiovascular system (data for 2003) [10] .
History
Healthcare in Soviet Russia
In the Soviet period, Russia achieved significant success in creating an effective health care system , which, together with a general increase (in comparison with the pre-revolutionary state) of the standard of living, literacy and socio-hygienic culture of the population, in particular, had a significant positive effect on the dynamics of mortality . In this process, the Soviet concept of public health development was of particular importance, "focused on mass prophylaxis and prevention of infectious and epidemic diseases, on vaccination and immunization of the entire population." As a result, the country, which experienced many shocks in the 20th century, reached the average European level of life expectancy (about 70 years) by the mid-1960s [11] .
Moreover, all dangerous infectious and parasitic diseases , diseases of the respiratory and digestive organs , infant and maternal mortality were put under fairly effective social control; as a result, the main tasks of the first stage of the epidemiological revolution were solved, and the country entered its second stage, which was already dominated by chronic pathologies , including diseases of the circulatory system and neoplasms (which is characteristic of a post-transition society). At the same time, mortality from accidents, poisonings and injuries , as well as other exogenous causes of morbidity and mortality, remained quite high [11] . In Russia (unlike most Western countries) it was not possible to provide reliable control over risk factors and an effective fight against cardiovascular diseases and cancer; therefore, since the mid-1960s, growth in life expectancy has been replaced by a period of stagnation [12] .
Health Care in Post-Soviet Russia
After the collapse of the USSR, along with the decentralization of power in the country, the decentralization of the healthcare system also took place. In November 1991, the USSR Ministry of Health was abolished. The Ministry of Health of the Russian Federation acted (until 1991 - the RSFSR).
In 1993, the law "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" was adopted, which became the main governing document. In January 1994, the Ministry of Health and Medical Industry of the Russian Federation was established. In fact, it simply combined the two former ministries - the USSR Ministry of Health and the RSFSR.
In August 1996, the Ministry of Health and the Medical Industry was transformed into the Ministry of Health of the Russian Federation. Issues of the medical industry were referred to the Ministry of Industry of the Russian Federation.
In March 2004, the Ministry of Health and Social Development of the Russian Federation was established on the basis of the Ministry of Health of the Russian Federation and the Ministry of Labor and Social Development of the Russian Federation .
In November 2011, the law adopted Federal Law of November 21 , 2011 No. 323-ФЗ “On the Basics of Protecting Citizens' Health in the Russian Federation” .
In May 2012, the Ministry of Health and Social Development of the Russian Federation was transformed into the Ministry of Health of the Russian Federation and the Ministry of Labor and Social Protection of the Russian Federation.
State system
Primary Health Care
The most popular type of medical care is outpatient care. One of the main problems of Russian healthcare is related to the lack of access to medical care at the outpatient level [13] .
Since 2009, another element has appeared in the primary health care system - health centers [14] .
Specialized Help
- TB service (TB dispensaries, tuberculosis hospitals and sanatoriums)
- Dermatovenerologic Service (Dermatovenerologic Dispensaries)
- drug treatment service (drug treatment clinics)
- psychiatric service (neuropsychiatric institutions)
Obstetric and gynecological care
Maternity hospitals, maternity hospitals of municipal hospitals.
Medical assistance for children
Medical assistance to children is provided in children's clinics and childcare centers, central district and city hospitals.
High-tech medical care
High-tech medical care (VMP) is medical care using complex and unique medical technologies based on modern scientific and technical achievements, provided by highly qualified medical personnel. VMP is provided in specialized medical institutions that are licensed to provide this type of care.
This is, first of all, open-heart surgery, transplantation of the heart, liver, kidneys, neurosurgical interventions for brain tumors, treatment of hereditary and systemic diseases, leukemia, severe forms of endocrine pathology, surgical interventions of high complexity.
Every citizen of the Russian Federation has the right to VMP. The main criterion for receiving such assistance is medical indications.
The list of types of high-tech medical care, as well as federal quotas for VMP for medical institutions, is approved by order of the Ministry of Health of Russia.
Sanatorium treatment
The Ministry of Health of the Russian Federation is responsible for a large number of various sanatoriums providing spa treatment.
New technologies in healthcare
Since 2013, in Moscow, in the framework of the Information City program, on the basis of the Decree of the Government of Moscow of April 7, 2011 No. 114-PP “On the Program for the Modernization of Health Care in the City of Moscow for 2011-2012” (as amended by the decree of the Government of Moscow of 05.21.2013 No. 1322-PP), the Unified Medical Information and Analytical System ( UMIAS ) system was launched . The system aims to make the use of free medical services affordable, high-quality and convenient for citizens, to save medical workers from paper routine and give them simple and convenient access to the necessary information to provide medical care, and the management of institutions and the industry - a reliable and operational analysis tool and effective management of the health system.
EMIAS is a complex information system that automates patient records in clinics and the activities of medical workers in Moscow. The system includes online registration with doctors, an electronic medical record and an electronic record of prescriptions. The system is based on cloud technology , which easily allows you to access the necessary information from any electronic gadget, but sometimes it leads to the complete impossibility of recording or referring to doctors in any way throughout the city. Paper cards continue to be used and lost, but the clinic itself is losing them; they do not give out cards to their hands (they claim that the property of the clinic, although sometimes patients manage to require copies or extracts that are compulsory to be issued at the patient’s request) and are not transferred between branches of one clinic.
Live queues continue to be used:
- In wardrobe.
- In the offices and "windows" without a record (reception, stamp, arrange sick leave, pharmacy).
- In offices where the recording is used only formally (a nursing post of 1-2 workers who replaced all the nurses on the floor).
- In doctors' offices, when a patient is sent for another doctor’s signature or documents lost by the clinic. In such cases, patients themselves come up with each other's queue order, sometimes not coinciding with the doctor’s intention.
At present, EMIAS is one of the largest medical systems in Europe, including more than 600 medical institutions, 23 thousand medical workers. About 6 million people use the system. For the first year of operation, more than 114,000 transactions were recorded in the system.
Drug Supply
At the beginning of 2016, the media reported on the shortage of drugs from the list of vital and essential drugs on sale in pharmacies , as well as medicines and vaccines in healthcare facilities [15] . At the same time, in 2/3 pharmacies, the buyer is offered much more expensive imported drugs instead of providing the Russian drug [16] . A shortage of domestic medicines is indicated as the reason, but another reason lies in the fact that it is more profitable for pharmacies to sell more expensive imported products, and first of all to offer them to customers, since a third of pharmacies completely refused to buy domestic drugs, relying on imports [17] .
One of the measures of social support for citizens is preferential drug provision from the federal budget (LLO) [18] and additional drug provision at the expense of budget funds of the regions of the Russian Federation (DLO) [19] . LLO includes the provision of drugs to the population both within the framework of state social assistance and under the program of seven high-cost nosologies [18] .
Life Expectancy
In 2009, the average life expectancy in Russia was 62.77 years for men and 74.67 years for women [22] . The average life expectancy in Russia at birth is 68.67 years, which is almost 10 years less than the general average for the European Union or the United States [23] .
An article by Murray Feshbach in the Washington Post in October 2008 stated that according to the UN, the average life expectancy of men in Russia was 59 years, 166 places in the world, women average 73 years, 127 places [24] .
At a meeting in the government of the Russian Federation on the results of the implementation of national projects in 2009, Deputy Prime Minister Andrei Zhukov said in February 2010 that in 2009, life expectancy had increased to 69 years: “ For several years now, the average life expectancy in Russia , - said Zhukov. “ In 2009, this indicator grew by more than 1.2 years and averaged over 69 years for both men and women .” According to him, the increase in life expectancy is a success of priority national projects : "The results of the implementation of national projects in 2009 can be called quite successful ... This follows from the indicators that have been achieved, in a number of areas we have quite good results ." According to Zhukov, this primarily concerns the national project "Health" and population policy [25] .
First Results of Health Care Reform
In the report of the special commission of the Accounts Chamber of the Russian Federation (prepared in the spring of 2015), the healthcare reform in Russia launched in January 2015 was declared a failure: it not only did not improve the quality of medical services provided to the population, but made them less accessible for the population. The “optimization” envisaged by the reform already in 2014 led to a reduction in medical personnel by 90 thousand people, which, with an increase in the number of consumers of services by 152.7 thousand people, worsened the quality of medical care and a significant (24%) increase in the volume of paid services. 33 757 hospital beds were reduced, 29 hospitals were closed; while mortality in hospitals throughout the country increased by 2.6%, and in 49 regions (in which there was a decrease in the number of hospitalized patients) - by 3.7% [26] [27] . According to [28], the implementation of the new health care reform in 2014–2015. carried out in a form contrary to the interests of patients.
Despite these conclusions made by the auditors, the “optimization” of Russian healthcare continues. By February 2015, more than eight thousand doctors were already unemployed. In 2015, 41 hospitals are to be liquidated, and in four years the total number of hospitals is planned to be reduced by 77%, polyclinics - by 7%. True, the Ministry of Health did not agree with the claims of the Accounts Chamber and stated that the positive results of the reform are already being felt in several regions of Russia (not named) [26] [29] .
Already in early November 2014, mass protests began in various regions of Russia, caused by reduced funding for medicine and the dismissal of a significant number of medical workers. The first rallies were held in Moscow (November 2 [30] , November 30 [31] and December 14 [32] 2014) [29] ; within a month, doctors from St. Petersburg , Rzhev , Mozdok , Ulyanovsk , Izhevsk , Ufa , Perm , Yekaterinburg , Omsk , Irkutsk , Vladivostok took part in protests [33] . At rallies, demands were put forward to stop the "pseudo-reform", to provide health workers with "decent pay", to put an end to reductions [30] [31] . The most active doctors carried home-made posters “ Let's die ”, “ Be treated with cats ”, “ Putin, send troops into healthcare ”. The protesters were supported by about 10 parties and public organizations [34] .
Speaking at the State Duma of the Russian Federation on September 22, 2015, Chairman of the Committee on Natural Resources, Environmental Management and Ecology, Academician of the Russian Academy of Sciences V. I. Kashin noted that as a result of reforms, approximately 48% of health care costs are borne by the population, medical facilities are being massively closed and reduction of doctors [35] . At the same time, according to the end of 2015, the number of practicing doctors in the Russian Federation was 22% less than what is required by staffing standards, and the shortage of beds in hospitals was 23%; the availability of medical care for Russians decreased due to a number of factors, and in the village, where the medical supply is 3.5 times lower than in the city, the mortality rate in 2014 was 15% higher than the urban one. One of the few positive aspects was the simplification of patients' access to pain medications (although the patient is not always able to get the medication prescribed by the doctor) [36] . As of the end of 2016, the deficit of district therapists in Russian clinics was 27 percent. The deficit of pediatricians was 18 percent [37] .
In 2017, there was information that the central district hospitals were on the verge of bankruptcy. So, in the Altai Territory alone, the debt of these hospitals in 2017 amounted to 860 million rubles [38] .
In 2018, mass protests of health workers continued against increasing the cost of residency training, depriving doctors of grace age for retirement, and reductions in medical staff [39] .
Health Care Reform in Moscow
According to experts, no serious calculations were made in the development of the Moscow healthcare reform [40] . Now the share of hospital beds in the Department of Health in the overall structure of the hospital bed in Moscow is steadily declining. If in 2013 there were 75.4 percent, in 2015 only 68.2 [41] . The number of visits to health clinics in the department of health has decreased, and the number of visits to clinics in the private sector has increased, approaching 23 million in 2015 [41] .
Assessment of the quality of healthcare by the population of Russia
Sociological studies show that today, not more than a third of the population are satisfied with the work of medical institutions in Russia [42] [43] [42] :
| Are you satisfied with the work of medical institutions in your city? | 2012 year | 2013 year | 2014 year | 2017 |
|---|---|---|---|---|
| Yes, completely satisfied | 9 % | 9 % | 9 % | 9% |
| Yes, rather satisfied | 25% | 27% | thirty % | - |
| No, rather dissatisfied | 35% | 32% | 35% | - |
| Completely dissatisfied | 32% | 33% | 26% | 54% |
| The proportion of those who are fully or mostly satisfied with the work of healthcare in Russia | 34% | 35% | 39% | 37% |
See also
- National project "Health"
- Ministry of Health of the Russian Federation
Notes
- ↑ Fundamentals of the legislation of the Russian Federation on the protection of public health Section I. General Provisions
- ↑ Hospital facilities . // Federal State Statistics Service. Date of treatment September 6, 2013.
- ↑ Medicine: from Soviet to Russian, 11/26/2007 (Inaccessible link) . Date of treatment March 5, 2008. Archived January 1, 2008.
- ↑ The number of doctors in certain specialties . // Federal State Statistics Service. Date of treatment October 8, 2009. Archived August 21, 2011.
- ↑ Russia 2020. The main tasks of the strategic development of the Russian Federation Archival copy of June 5, 2016 on the Wayback Machine // Ministry of Economic Development of Russia, March 2008
- ↑ Plan of measures to achieve quantitative and qualitative indicators established for 2008 for the Ministry of Economic Development and Trade of the Russian Federation (inaccessible link) // Ministry of Economic Development of Russia
- ↑ Alla Astakhova. Priorities of lean years . Health Blog (01/18/2017).
- ↑ World Health Statistics. 2010 year . - World Health Organization , 2010. - 177 p. - ISBN 978-92-4-456398-4 . - S. 134-135.
- ↑ World health statistics. 2015 . - World Health Organization , 2015. - 161 p. - ISBN 978-92-4-156488-5 . - P. 130-131.
- ↑ Global Adult Tobacco Survey. Russian Federation, 2009 Country Report
- ↑ 1 2 Zakharova O. D. Demographic crisis in Russia: lessons of history and prospects // Sociological studies . - 1995. - No. 9 . - S. 99-109 .
- ↑ Mele F., Shkolnikov V.M., France Mele, Hertrish V., Wallen J. What are they dying of in Russia and in France? // World of Russia. - 1997. - T. 6, No. 4 . - S. 12-18 .
- ↑ Alla Astakhova. Priorities of lean years . Health Blog (01/18/2017).
- ↑ Open Day at the Health Center, November 8, 2011 (inaccessible link)
- ↑ Gordeeva, Katerina. Is it possible to experiment on patients? On the shortage of drugs in Russia . // Online publication " Meduza " (02/12/2016). Date of treatment February 16, 2016.
- ↑ Kulikova, Anna. It is difficult to buy inexpensive Russian medicines in pharmacies . // Network publication "Big Moscow" (02/23/2016). Date of treatment February 28, 2016.
- ↑ In Russian pharmacies there is a shortage of cheap drugs . // Network publication "Express-News" (02.22.2016). Date of treatment February 28, 2016.
- ↑ 1 2 Medicines . Preferential drug provision . Roszdravnadzor . Date of treatment July 28, 2019.
- ↑ Additional drug provision . GOBUZ "Borovichi Central District Hospital". Date of treatment July 28, 2019.
- ↑ Life expectancy of the Russian Federation since 1950
- ↑ Life Expectancy of the Russian Federation since 1992 Retrieved on May 29, 2008
- ↑ Russian life expectancy figures Rosstat Retrieved on October 30, 2009
- ↑ European Union . Central Intelligence Agency. Date of treatment January 20, 2008.
- ↑ Feshbach, Murray. Behind the Bluster, Russia Is Collapsing . // The Washington Post (10/10/2008). Date of treatment November 18, 2013.
- ↑ Bazhenova, Anna. Life expectancy in Russia has increased by more than one year . // AMI-TASS (02.17.2010). Date of treatment November 18, 2013.
- ↑ 1 2 Health care reform 2015 - increased mortality in Russia, criticism of the Accounts Chamber, year results . // Information portal "News of Russian regions" (04/14/2015). Date of treatment November 18, 2015.
- ↑ Prikhodko, Vladimir. Krasnodar Territory: medical failure . // Internet publication "Kavpolit" (08/07/2015). Date of treatment November 18, 2015.
- ↑ Leonid Alekseev. Incompatible with life (Russian) // A.A. Prokhanov Tomorrow . - Moscow, 2017. - September 17 ( No. 37 ). - S. 4 .
- ↑ 1 2 Health care reform was considered a failure: Russians die more often, and the quality of services has deteriorated . // News Agency " NEWSru.com " (04/13/2015). Date of treatment November 18, 2015.
- ↑ 1 2 A rally of doctors is being held in Moscow against the enlargement of hospitals and job cuts . // News Agency " NEWSru.com " (11.2.2014). Date of treatment November 18, 2015.
- ↑ 1 2 A procession and rally of doctors against medical reform took place in Moscow . // News Agency " NEWSru.com " (11/30/2014). Date of treatment November 18, 2015.
- ↑ In Moscow, the next action of doctors against reform and reduction was held . // News Agency " NEWSru.com " (12/14/2014). Date of treatment November 18, 2015.
- ↑ Borta, Julia. No beds, somehow? Optimization of medicine - at the expense of doctors and patients // Arguments and facts . - 2014. - No. 50 (1779) for December 10 . - S. 41 . (Retrieved November 20, 2015)
- ↑ Buyanova, Daria. Moscow doctors took to the street // Metro Moscow . - 2014. - No. 136 of November 5 . - S. 4 . (Retrieved November 18, 2015)
- ↑ The country is experiencing a systemic crisis! // Truth near Moscow. - 2015. - No. 61 (971) for September 24 . - S. 1 . (Retrieved May 7, 2016)
- ↑ Govorova, Anna. Russian healthcare 2015: one step closer to disaster . // Network publication "KM.RU" (01/01/2016). Date of treatment May 7, 2016.
- ↑ Alla Astakhova. Multi-punch . Health Blog (06/16/2017).
- ↑ Alla Astakhova. There was a knock from below . Health Blog (07/21/2017).
- ↑ Natalya Chernova. Doctor of the people // New newspaper . - 2018. - No. 115 . - S. 15-17 .
- ↑ Alla Astakhova. On the bunks! . Health Blog (03/28/2015).
- ↑ 1 2 Alla Astakhova. The best city of the earth . Health Blog (05/17/2017).
- ↑ Prikhodko, Vladimir. Quality of life in Russian cities in 2014 (inaccessible link) . // The site of the Department of Applied Sociology of the Financial University under the Government of the Russian Federation . Date of treatment November 18, 2013. Archived November 2, 2014.
- ↑ Zubets A.N. Private financing of healthcare in Russia // Finances. - 2014. - No. 2 . - S. 56-58 .
Links
- " What is sick with medicine? We find out from experts how to treat the healthcare system ”- the release of the television program“ Reflection ”dated 04/18/2019 from the television channel“ OTR ”.
- Healthcare in Russia, 2011, statistics
- Collection “Activities and resources of health care institutions” (table of contents) Appendix (zip / doc)
- Public Health Model in Russia
- Dynamics of key indicators of financing the health care system in Russia for 2000-2008