By Paul Goble
The principles governing the financing of medical care in Russia are moving in exactly the opposite direction that these measures are going in Western countries, and as a result, Russian healthcare is deteriorating rather than improving, according to new research by the Russian Academy of Economics and State Service.
Writing in “Vedomosti” today, Denis Sokolov, one of the experts behind this research, says that “crudely” healthcare systems in the developed world have passed through three stages. Until the early 20th century, people who were ill turned to doctors and paid them out of their own pocket (vedomosti.ru/opinion/articles/2016/11/23/666543-meditsina-revolyutsii).
Then there was an effort by the governments to provide medical care for all, a system that has broken down in many places because of the uncontrolled growth in costs, a problem Russia avoided in Soviet times because “there was no money” available to make such increases in expenditures possible, the researcher says.
“In the last quarter of the 20th century, a third stage began,” he continues. It involved “the development of science and technology” and systems of medical business and insurance which opened the way for the introduction of enormous sums of money into medical care because profits were to be had” and “the methods of administration, characteristic for high tech firms … led in medicine to the very same leap.”
Tragically, he argues on the basis of his research, “Russian healthcare institutionally is situated somewhere on the path from the second period to the first: it hasn’t been able to introduce the insurance principle, private clinics work mainly” in only some specialties “and on the periphery continues the eternal battle” for medical points to provide basic services.
In Russia today, Sokolov says, doctors are treated in most places as government employees with their salaries far too low and set according to bureaucratic standards rather than their skills and willingness to improve them. Indeed, the system fails to provide opportunities for doctors to keep up with medical breakthroughs or share experiences with colleagues.
As a result, most doctors in Russia are “at the edge of life and death” and have to work for basic needs “under conditions of military mobilization.” Some grow into heroes, but “the majority are being transformed into an indifferent mass” who do not provide good services to their patients despite receiving much the same pay that the good ones do.
That opens the way to corruption and the politicization of the system, with those who can afford it buying the services of those who are able to provide it and those who have the equipment and skills they need possessing them only because they have learned how to play the government bureaucracy effectively.
Far more money must be put into the system, something the increasingly impoverished state cannot afford, and consequently, the system must be radically transformed so that there will be profits for private investors rather than remaining or becoming even more so a bureaucratic disaster.
Around the country, Sokolov says, “approximately 35 percent” of the money spend in medical facilities is spend to “create a barrier between the patient and his potential doctor” by tracking him into the arms of those medical time servers who in fact are not able to provide adequate care. Only about 10 percent of the money spent goes to those who do the real work.
According to the researcher, “the patient must have the opportunity to purchase or receive via insurance services” as needed rather than accept what the state gives. For that to happen, the patient must understand that “medicine isn’t free” and thus must help finance things by co-pay arrangements and the like. That is what other countries are doing, but not Russia now.
Pay for doctors must increase by 300 to 500 percent and it must go to those who are most qualified and allow them to keep up with developments in the field by purchasing medical journals and having access to the latest technologies in their part of medicine. That will cost a lot, but if that money isn’t spent, people will suffer.
“As is the case in education, municipal administration, or housing,” he says, “an effective reform of healthcare” will involve “a social revolution which will involve all the participants, the patients, the doctors and the administrators.” At present, that isn’t happening. Instead, what is occurring is a counter-revolution which is leaving almost everyone worse off.