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Special attention was given to the need to reduce inefficient spending in healthcare and improve the efficiency of medical institutions, as well as issues pertaining to wages in the healthcare sector.

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President of Russia Vladimir Putin: Good afternoon, colleagues,

At the meeting of the State Council in December of last year, we heard a report from the Ministry of Education and Science on the development of education, and one from the Ministry of Construction, Housing and Utilities on the housing market. We will continue discussing our plans, including those set out in the executive orders of May 2012 and at meetings with Government members. This is the way we agreed to proceed earlier on.

Today we will discuss the state of affairs in healthcare. We have managed to get a few things done in this area last year, and this some of them were quite significant and deserve praise. Thus, mortality has gone down in general, and due to cardiac ailments in particular. Why do I separate the two? Because in the first 11 months of last year overall mortality went down by 1.5% compared to the same period in 2012, while mortality due to cardiac ailments went down by 4%. This is impressive.

“In the first 11 months of last year overall mortality went down by 1.5% compared to the same period in 2012, while mortality due to cardiac ailments went down by 4%.”

In line with the set targets, the salaries of doctors and paramedics are going up. Nationwide doctors’ salaries make up 136% of the average for the economy, which was roughly 29,000 rubles a month last year, while doctors were paid an average of 39,500 rubles.

Paramedics’ salaries went up by 78%, while those of medical attendants – by 45%. Our targets, incidentally, were somewhat lower: 29.7% for doctors and 75.6% for paramedics. As I have said, the increase was a bit higher here, while we failed to meet the target for medical attendants, which was 50.1%, while the actual figure is 45%.

I would also like to note that in 2013 we have completed the healthcare modernisation programme, which was launched in 2010 and completed in 2013. We have significantly upgraded the materials and equipment in hospitals and outpatient clinics in a number of regions and we created conditions for the introduction of medical care standards. However, I would like to single out the fact that at some clinics the medical equipment has not been made operational yet due to the absence of qualified staff and materials.

Undoubtedly, we must continue our efforts to develop healthcare. This is one of the most sensitive areas of life. Primarily we should continue the structural reform in order to do away with inefficient spending, to optimise the network of hospitals and outpatient clinics. This, in turn, can serve as a basis for further growth of salaries and, most importantly, of the quality of medical care.

A particularly sensitive area is optimising the network of state financed medical facilities. We know well what can happen if a purely superficial, formalistic, bureaucratic approach is applied. Remember the reaction of the public to the closure of hospitals and maternity homes in small towns and villages where these were the only medical facilities available. Such restructuring measures are inadmissible, of course.

I would like to reiterate that we need considered and justified solutions, we need to maintain a constant open dialogue with the public, but the analysis must be reasonable. What is also required is firm control on the part of federal and regional authorities. With this in mind, we should create understandable and efficient mechanisms for managing structural change in the healthcare sector.

We will come back to this today. I have spoken of the problems, of the possible pitfalls, as they say, but we cannot do without clear, justified and appropriate actions either. We have to bear this is mind and we should develop corresponding plans in this area.

Next. The transition to funding healthcare through the system of Mandatory Medical Insurance (MMI) should be carefully analysed, specifically the funding of capital repair and construction of medical facilities. So far, the Mandatory Medical Insurance rates only cover maintenance costs, not those of repair and construction. However, the new quality of medicine envisages further improvement of medical facilities’ material and equipment supply and the creation of modern hospitals and outpatient clinics.

Obviously, simply adding investment costs to the MMI tariff is risky and complicated. This could increase the burden on business and the public. However, financing the development of the medical infrastructure only through state funds is also quite complicated, inefficient, and costly, and in some cases, this is purely a waste. Therefore, we need to search for a solution in various types of partnerships between the state and private companies, to create attractive conditions for business. I suggest we discuss possible solutions today as well. However, I would like to point out: all the potential risks connected with the measures to be taken should be carefully considered.

There is another important topic I would like to touch upon today: the ‘submersion’ of high technology medicine into the MMI system. To date, all 12 high-tech medical centres are in operation. Very good, excellent teams have been formed: experts were scouted for across the country, even brought back from abroad. Last year alone they conducted over 50,000 high-tech surgeries. Overall, more than 505,000 such operations were conducted nationwide. In comparison, in 2005 the number was almost 10 times lower. Each of these high-tech medical centres can service 20–25 regions, and in some cases over 50 regions, like in Tyumen.

The funding for high technology surgeries from the federal budget has grown since 2006, as I have already mentioned. Thus, in 2006 it amounted to 9.9 billion rubles, while in 2013 the figure was 55.6 billion.

“All 12 high-tech medical centres are in operation. Last year alone they conducted over 50,000 high-tech surgeries. Overall, more than 505,000 such operations were conducted nationwide.”

At the same time, despite all the achievements, high technology medicine has to continue growing. In the next three years, we expect to increase the scope of such medical aid by at least 50% compared to 2013. This should guide us in all our decisions on funding. This also goes for the transfer of federal healthcare centres providing specialised advanced medical assistance to the regions. These issues come up regularly and we discuss them.

Here I would like to draw your attention to the fact that federal healthcare centres have good material and technical resources, qualified staff and good research potential. They were created to provide medical assistance to all people in this country regardless of their location. Therefore, we can only speak of transferring federal clinics to the regions if the latter are ready to undertake the costs related to the upkeep of such centres, to maintain the quality of services provided both for local residents and for those coming from other Russian regions. We should have a clear understanding here, specifically on the part of the governors.

Many want to have these clinics moved to their regions. However, in that case are you prepared to receive patients from 25, 30 or even 50 regions of the Russian Federation, like Tyumen does? Are you prepared to provide appropriate funding and maintenance of the clinics? They should definitely not be turned into regular hospitals or outpatient clinics.

Obviously, regular hospitals and outpatient clinics should operate at a high level as well. However, specialised centres, called upon to provide advanced medical care should enjoy special treatment. Huge funds have been invested, top experts have been brought to work there, and this level should be maintained. Therefore let us all carefully consider all the issues put forth for discussion today. If there are any other topics you would like to raise, please do so. We will discuss anything you think is of importance for this meeting.

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