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State Council Presidium meeting on increasing availability and improving the quality of medical care in the regions

July 30, 2013, Novo-Ogaryovo, Moscow Region

Vladimir Putin held a State Council Presidium meeting on tasks for the Russian regions to increase the availability and improve the quality of medical care.

The issues discussed at the meeting included the organisation and funding of free medical assistance, problems in the sphere of compulsory medical insurance, ensuring availability of medical care in remote areas, and staffing issues.

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President of Russia Vladimir Putin: Good afternoon, colleagues,

Today’s meeting will address the challenges faced by the regions in increasing the availability and improving the quality of medical care. Authorities at all levels are giving their constant attentionto resolving problems in this area.

Recently, we have made major upgrades of the legal framework as regards healthcare, compulsory medical insurance, medicine circulation, and control of smoking. We have implemented programmes to modernise healthcare in Russia’s regions.

With regard to demographic policy, we are putting particular emphasis on providing incentives to families striving to have children, and developing a system for protecting maternity and childhood. However, people are assessing the state of Russia’s healthcare based on their personal experience. There are certainly some positive assessments, but the overall picture is not that simple. Only 35.4% of our citizens are satisfied with the quality of medical assistance provided.

To implement the May executive orders, the Government adopted a state programme at the end of last year to develop healthcare along with an action plan aimed at increasing the efficacy of healthcare and a programme of state guarantees for providing free medical care.

The successful implementation of a roadmap and the state guarantee programme depend directly on the work of regional authorities. Today, during our meeting and our discussion, let’s analyse how medical care quality and accessibility are ensured at a local level. I will stress several key areas.

The first is organising and financing free medical assistance. Every territory currently has its own programmes, but there is a major deficit in their funding. In 2012, 66 regions had a combined deficit of 164 billion rubles [about $5 billion]. This year, the situation has improved somewhat, despite tight budgets, but it remains complicated. The total deficit in 54 regions is over 120 billion rubles. Again, last year, 66 regions had a combined deficit of 164 billion, and this year, 54 regions have a combined deficit of 120 billion.

Let me stress that the funding for free medical care must correspond to the volume of care. If regional programmes guarantee a certain set of services but the funding for them is not made available, that means there are no guarantees.

We need to work on structural changes in healthcare, increase the volume of urgent services in clinics and develop a system of day patient facilities. The medical facilities themselves are a great resource for the rational use of funding. We can and must be more resolute in eliminating ineffective management methods, when funding is directed toward maintaining costly in-patient services. And as the doctors themselves say, and you know this as well, if they were paid for results, there would be far more healthy people. This is the direction in which we should steer the healthcare sector, measuring the quality of the work based on the number of recovered and recovering patients. We must also be more active in seeking additional sources of funding for state guarantee programmes at the federal level.

The second topic we must discuss is the condition and prospects of private and free medical care. First of all, I want to draw your attention to the fact that the regional state guarantee programmes must include a clear list of free services, as well as rules on how they are to be provided, which should be clear to every patient. The lack of clarity on these issues leads to corruption and extortion, forcing people to pay for services that should be free in accordance with the Constitution and the law. As a result, people’s faith in the healthcare system and the authorities is undermined. We need to eliminate the very possibilityof paid medical services replacing free ones. Currently, many such cases occur. More than 70% of requests for paid services are made because people know nearly nothing about the state guarantee programme and the conditions for providing free medical care.

It is imperative to provide people with access to this information, to make it clear, without any ambiguity, in order for everything to be transparent.

Naturally, it is important to develop and support private, pay-per-service medical care as well. This approach serves the interests of our nation’s citizens, who must have not just the right to select their medical facility, but also a real opportunity to make that choice. Today, such opportunitiesare extremely limited. State medical organisations outnumber private ones by three to one. More importantly, private medical centres are usually small, have a narrow focus and sometimes limited equipment. Naturally, there are some outstanding private facilities, but overall, they account for only 2.2% of our nation’s medical services.

I will add that our system of compulsory medical insurance is still not at a modern level; it is not insurance in the full sense of this word. For the most part, health insurance companies only fulfil the role of intermediaries in transferring payments. In addition, they are not motivated to improve the quality of medical assistance provided and carry almost no responsibility for it. I am asking the Healthcare Ministry to tackle the challenge of improving the compulsory medical insurance system. We have already discussed this many times.

Another problem is the affordability of medical services. I must admit that during the height of the healthcare spending optimisation wave, many paramedic centres and local and district hospitals were shut down. As a result, residents of rural areas were deprived of even basic medical assistance.

I have said many times that assuring medical care remains affordable is a priority objective; Governors and relevant agencies are required to focus careful attention on achieving it, creating mobile health centres, developing air ambulance services, and implementing remote medical care options. Incidentally, these elements are being actively implemented in many regions in the Russian Federation.

Another important topic concerns medical personnel, their numbers, qualifications and training. We are used to the term “medical services,” but healthcare is not a service sector. In the past it was referred to as the art of healing; therefore, working as a doctor or a nurse means devoting oneself to helping people. In our nation, many medical professionals carry out this noble mission honourably. Compassion, attention, kindness toward patients and generosity will always be valued in this domain. Teaching these qualities to medical students should be given the same level of priority as imparting modern scientific knowledge. It is imperative to select carefully among applicants to universities and vocational schools teaching medicine. The students at these institutions must be individuals who view medicine as their calling. The report by the State Council’s working group contains a detailed analysis of the entire range of staffing problems in healthcare, and there are suggestions on ways to resolve them. We will certainly address this topic today.

Colleagues, I have mentioned just a few of the challenges that we will need to resolve. Let me stress again that the regions must play the primary role in increasing access to and improving the quality of medical assistance. This concerns both carrying out their own initiatives and implementing measures we have adopted jointly at the federal level. I am requesting that we organise our work today in this spirit.


July 30, 2013, Novo-Ogaryovo, Moscow Region