Vladimir Putin, President of the Russian Federation Photo: kremlin.ru

To create a system of affordable and high-quality medical care, it will be necessary to increase healthcare spending to 4-5% of GDP, said Russian President Vladimir Putin, addressing the 14th annual address to the Federal Assembly on March 1, 2018. During his speech, the head of state highlighted the development of healthcare as one of the priority areas of the government's work.

Putin also outlined areas of healthcare that require attention: these are the medical care system for the elderly, the oncology service, medical examinations, telemedicine, the availability of medical services in remote areas, and the level of doctors' salaries.

All these measures, as well as other social and economic factors, should, by the end of the 2020s, contribute to an increase in the duration healthy life Russians up to 80+ years old, as in Japan, France and Germany.

Vladimir Putin negatively assessed the implementation of the decree on optimizing the network of medical institutions, noting that in some cases local administrations got too carried away and left people without hospitals at all.

“In sparsely populated and remote areas, they began to completely close medical facilities, leaving people without medical care and, in fact, without offering them an alternative. During 2018-2020, villages with 100 to 2 thousand people need new FAPs and outpatient clinics, and villages with up to 100 residents should be equipped with mobile mobile complexes - vehicles with high cross-country ability and the necessary equipment,” the head of state said. He instructed the All-Russian Popular Front (ONF) to control the availability of primary medical care. Later, on March 2, at the ONF media forum, Vladimir Putin announced the amount of additional subsidies from the budget that the government would allocate to resolve this issue: 1.3 billion rubles would be spent on the creation of paramedical stations, another 2.5 billion rubles - on mobile first-aid posts.

At the same time, all medical institutions in the country should be combined into a single "" so that all the possibilities of Russian medicine are involved in the treatment of patients.

Speaking about the system of treatment and diagnosis of oncological diseases, the President stressed that it is necessary to develop a special nationwide program that will help unite the efforts of scientists, doctors and representatives of the pharmaceutical industry.

Vladimir Putin also considers it impossible to develop medicine without science. "We must go out on principle new level development of science. Create new research centers that can benefit our economy. We are obliged to involve international research teams. It is important to focus them on important projects, including genomic research, which will help in the diagnosis and treatment of diseases,” he said.

In the previous, 13th message, the President of Russia, the work of primary health care is one of the main problems of the country, and also promised to provide retraining of doctors on the basis of federal and regional medical centers and universities.

Similar figures were previously presented by the Center for Strategic Research (CSR) of former Finance Minister Alexei Kudrin in the report Healthcare: Necessary Responses to the Challenges of the Time. At the same time, the authors of the study believe that government spending on medicine, which should grow from 3.2% of GDP in 2016 to 5% in 2035, will still be small - it is necessary that the solvent part of the population join the financing, and benefits for those in need citizens would be saved.

In a survey conducted by the ONF, it was found that every fifth physician receives a salary of less than 10,000 rubles. This is despite the fact that the living wage for an able-bodied citizen is 9976 rubles. The cuts in the health care budget in 2017 will push this part of health workers beyond the brink of survival, and low-income patients will be forced to cope with problems on their own. Fortunately, our country is large, you can collect medicinal herbs. Plantain will replace surgeons, chamomile will replace the therapist. It will be possible to guess on it, if I survive - I will not survive.

This is how the situation appears at first glance. But how are things really, is it really worth stocking up on plantain?

Naked facts

The State Duma approved a reduction in health care spending from 544 to 362 billion rubles. This is exactly 33%. This reduction will result in:

1. Stationary services will be reduced by 39% - from 243 to 148 billion rubles.
2. Outpatient medicine - in 113.4 to 68.99 billion.
3. Sanitary and epidemiological — from 17.473 to 14.68 billion.
4. Scientific research - up to 16.028 billion, or 21%.

It's not even horror, it's a disaster. It happened against the backdrop of last year's growth of spending by 4.3% with inflation of 14%. Taking into account inflation in 2016 at a predicted level of 7%, it turns out that in 2017 the state will spend half as much on healthcare, in real terms, than in 2015. This is how the health care budget for 2017 looks like, the latest news about which does not give reason for optimism at all.

But if you study the situation more closely, then everything is not as scary as it seems at first glance. The fact is that the Compulsory Medical Insurance Fund (FOMS) operates in the country.

What is FOMS

Each working citizen contributes 5.1% of his salary to the fund. A significant part of the population does not even know about it, since the employer pays from the fund wages. At the moment, 69% of all medical expenses come from the MHIF, and not from the state budget.

The total amount to be spent by the fund on health insurance will amount to 1.738 trillion. rubles, which is 10% more than last year. Due to the fact that in 2016 the savings of the MHIF amounted to 91.3 billion rubles. That is, in fact, medicine will not cut costs, although there is no growth, the absolute figures of 2016 and 2017 will be approximately the same.

The only difference is that the state spends less and entrepreneurs spend more. Since 2010, when the unified social tax (UST) was abolished, the amount of insurance premiums for medicine, pensions and benefits has been increased from 26% to 30%.

Share of GDP and life expectancy

The World Health Organization conducted a study that showed that spending on health care is directly related to life expectancy. The more the state cares about medical care, the longer people live:

1. Less than $500 a year is in countries where life expectancy is 45-67 years.
2. Spending between $500 and $1000 results in an expected duration of 70-75 years.
3. More than $1000 provides a life expectancy of 75-80 years.

In Russia, according to Minister of Health Veronika Skvortsova, the norm per person is 11,900 rubles, or about $200. At the same time, the average life expectancy is 72.06 years. Probably, the notorious plantain helps to get out of the world statistics.

Although we are still far from Germany, where this figure is 81 years old, or the USA, where this age is 78.7 years old. Perhaps, the fact that the budget for medicine in 2017 in the Russian Federation is 3.6% of GDP, in Germany - 10.4, and in the USA - 15.7.

Health spending averages over $4,000 per person per year across the OECD, or 9% of GDP

Health expenditures, which have been on the rise in OECD countries above, represent mainly current spending on final consumption of health goods and services. They include all funds from public and private sources spent for these purposes, as well as for the implementation of various health programs and covering administrative costs.

For comparability between countries, per capita health care expenditures expressed in national currency units are recalculated into a single currency (US dollars) of a certain year, taking into account deflators and purchasing power parities (PPPs) established during cross-country comparison rounds.

According to preliminary OECD estimates, in 2016 health spending averaged US$4,003 per person per year across the OECD35, ranging from US$1,080 in Mexico to US$9,892 (Fig. 11). US health care spending has been substantially higher than other OECD countries for many years. In 2016, it was 2.5 times the OECD average and 25% higher than the next highest-ranking OECD country. high level spending on health care in Switzerland ($7,919 per person), 80% more than in Germany ($5,551), and twice as much as in Canada, France and Japan. At the other end of the range, next to Mexico, are Turkey (1088) and Latvia (1466).

Among OECD partner countries, Lithuania (1970) stands out as the highest spending on health care, and to a lesser extent Costa Rica (1390 in 2014) and Russia (1351 in 2015). In other partner countries, their value is about 1000 US dollars (South Africa, Brazil, Colombia) or three times less (Indonesia, India). In China, health spending is about 20% of the OECD35 average of $733 in 2014.

On average across the OECD35, about three-quarters of health spending is public spending and funds received from compulsory insurance? 73%, or $2,937 per person. Own funds of the population, including funds for voluntary insurance, amounted to 27%, or 1066 US dollars per person. The share of own funds in total health spending ranges from 15-16% in Norway, Germany, Japan, Denmark and Sweden to 51% in the USA. In addition to the United States, Mexico (48%), South Korea, Latvia and Greece (42-44%) also have a high share of their own funds.

In OECD partner countries, the share of own funds in total health expenditure ranges from 25% in Colombia to 70% in India.

Figure 11. Health spending in OECD and partner countries, 2016 (or close), PPP USD per capita

Source: http://dx.doi.org/10.1787/888933604191 .
Date of circulation - 01/27/18.

The level of health care spending is largely dependent on the economic situation, and its increase slows down significantly during periods economic crisis, which was observed more recently in 2009-2011. However, despite the contraction in GDP, health spending in OECD countries continued to rise slightly in real terms. In general, for 2009-2016, the average annual growth rate of per capita spending on health care in the OECD-35 was 1.4% against 3.6% per year over the previous six years (Fig. 12). In some of the countries most affected by the crisis, strong growth rates in health care spending have been replaced by rapid declines: -5.0% per year for 2009-2016 in Greece versus 5.4% per year for 2003-2009, less dramatically in Portugal (-1.3% vs. 2.2%) and Italy (-0.3% vs. 1.6%). In the rest of the countries, there was no reduction in health spending until 2016. In 2009-2016, health care spending grew most rapidly in Chile and South Korea (about 6% per year).

Figure 12. Average annual growth rates of per capita health spending in real terms in OECD countries, 2003-2016 (or close), %

Source : Health at a Glance 2017: OECD indicators, http://dx.doi.org/10.1787/888933604210 .
Date of circulation - 01/27/18.

Another way to compare health spending across countries or over time is to compare it with gross domestic product (GDP). Health spending has averaged around 9% of GDP in the OECD35 over the past few years, after a period of rapid growth due to the economic recovery of the 1990s and 2000s.

Among OECD countries, the value of the indicator varies from 4.3% in Turkey to 17.2% in the United States, and among partner countries - from 2.8% of GDP in Indonesia to 9% in Costa Rica and South Africa (Fig. 13) . In Russia, they amounted to 5.6% of GDP in 2015, 38% less than the OECD average.

Figure 13 Health spending as a share of GDP, OECD and partner countries, 2016
(or close) year, %

Source: Health at a Glance 2017: OECD indicators, http://dx.doi.org/10.1787/888933604229 .
Date of circulation - 01/27/18.

Health spending as a share of GDP declined slightly on average across the OECD35 in 2006–2007 and 2010–2011 (Figure 14). A more pronounced decrease was observed in Greece (2012-2014) and, to a lesser extent, in Mexico, Germany, Switzerland. Despite this, compared with the beginning of the new century, the amount of health care spending has increased in all the compared countries, including Russia. The largest increase was observed in the United States (nearly 5 percentage points of GDP), slightly smaller in the South Korea (3.7) and Switzerland (3.0). In other countries and on average for the OECD-35 it was more moderate (less than 2 percentage points), the lowest in Mexico and Greece (by 1 percentage point). In Russia, the growth for 2000-2015 was 0.6 percentage points.

Figure 14. Health spending in selected OECD countries and Russia, 2000-2016, % of GDP

Source: Health at a Glance 2017: OECD indicators, http://dx.doi.org/10.1787/888933604267 ;
http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT Date of circulation - 01/27/18.

Health care costs are paid from different sources of financing, as already discussed in in general terms mentioned above. In some countries these costs are covered mainly by public health services, the services of which are automatically available to all permanent residents of the country, in other countries - through various schemes of compulsory or voluntary insurance. Own funds of the population play a less significant role, covering from 7% of health care costs in France to 42% in Latvia (Fig. 15).

In all OECD countries except the United States, the majority of health care costs are covered by public funding and mandatory insurance funds. In Denmark, Sweden and the UK, public spending – at central, regional and local levels – accounts for 80% or more of all health spending. In Germany, Japan, France and Slovakia, more than 75% of health care costs are covered by compulsory insurance. Voluntary insurance pays a relatively small part of health care costs: from 0 in Norway, Turkey, Iceland, Slovakia, the Czech Republic and Estonia to 10-15% in Australia, Israel, Canada, France and Slovenia. A notable exception is the United States, where voluntary insurance funds cover 35% of all current health care costs.

Figure 15. Distribution of health spending by type of financing in OECD countries, 2015 (or close), %

Source: Health at a Glance 2017: OECD indicators, http://dx.doi.org/10.1787/888933604286 .
the date appeals - 27.01.18.

State budget funds go to different purposes, which, therefore, always compete in a certain way. The amount of public spending on health care is determined by a number of factors, including, among others, the demographic composition of the population (primarily age), the characteristics of the epidemic situation and the organization of the health care system. In addition, budget "priorities" can shift depending on political decisions and economic effects.

According to the latest data available, the share of public spending devoted to health (through public financing and mandatory insurance schemes) averages around 15% across the OECD35, ranging from 8.9% in Greece and Latvia to 23.2% in Japan (Fig. 16). In addition to Japan, they exceed 20% in Switzerland, New Zealand, the USA and Germany. On the other hand, no more than 10% of public spending goes to health care in Greece, Latvia and Hungary. It should be noted that, according to Rosstat data for 2016, healthcare spending in Russia exceeded this level, increasing to 10% of total government spending (against 9.6% in 2015 and 9.2% in 2014) .

Figure 16. Share of public spending on health and compulsory health insurance in total public spending by OECD countries, 2015 (or close), %

Source: Health at a Glance 2017: OECD indicators, http://dx.doi.org/10.1787/888933604305 .
the date appeals - 27.01.18.

The population's out-of-pocket funds cover about one-fifth of overall health spending across the OECD-35, and this share has changed little in recent decades, amounting to 21.9% in 2000, 19.9% ​​in 2009 and 20.2% in 2015 – 20.2% (Fig. 17).

In Greece (35% in 2015), South Korea (37%), Mexico (41%) and Latvia (42%), out-of-pocket funds cover more than a third of all health care spending, while less than 7% in France, Luxembourg and USA - about 11%.

The pursuit of universal health coverage has led to a reduction in the proportion of out-of-pocket spending on health services compared to the turn of the century in most OECD countries, but the crisis has forced many governments to once again shift some of the financial responsibility to patients themselves in order to balance the public budget. In some European OECD countries, the share of household out-of-pocket in total health expenditure has increased markedly (in Greece by 6.2 percentage points, in Spain by 4.7, in Portugal, Latvia and Hungary by about 3 percentage points). However, in other countries their share continued to decline. The largest reduction for 2009-2015 was noted in Mexico (by 6 percentage points), and noticeably smaller in Israel and Chile (by 2-3 percentage points).

Figure 17. Share of out-of-pocket health spending in OECD countries, 2000, 2009 and 2015 (or close) years, %

Source: Health at a Glance 2017: OECD indicators, http://dx.doi.org/10.1787/888933604324 ;
OECD Health Statistics 2017 - Frequently Requested Data/ November 2017. http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT .
Date of circulation - 01/27/18.

The American financial agency Bloomberg, in its review, indicated that Russia occupies the last, 55th place in the healthcare efficiency rating.

According to the study, life expectancy in Russia is 70.37 years. Health care spending - 7.07% of GDP, or $893 per person. The health system efficiency ratio is 24.3.

Bloomberg analysts placed the Russian Federation in the group of countries that, according to their health standards, which are difficult to call developed, along with Brazil, Azerbaijan, Jordan and Colombia. Ahead, according to the standards of medicine, the "southeastern tigers" are named - Hong Kong, Singapore, South Korea, as well as Japan and Spain.

It is noteworthy that the ascertained 7.07% of the Russian GDP, going to health care, is not comparable with 5.4% of this indicator in Hong Kong. And life expectancy there is creeping up to 84 years, but here it is up to 70.37 years, according to Bloomberg calculations.

The monitoring involved data from 55 states and administrative regions, in which more than 5 million people live. Such a study itself has been regularly conducted for 4 years.

- The mistake that was made - we do not know whether it was conscious or not: official statistics were not used, but data provided by the World Bank were used. They are overestimated very seriously, somewhere by 50%, - this is how the Minister of Health of the Russian Federation commented on the situation Veronika Skvortsova.

For the key figure (60% of the volume) in determining the place occupied by the country in the list, Bloomberg experts, according to the Russian Ministry of Health, took the life expectancy of an average citizen. In addition, the share of health spending in total government spending (30%), as well as total per capita spending (10%) is taken into account. Based on such arithmetic, as a result, those countries where lower costs ensure longer life expectancy came to the forefront of the ranking.

Head of the Department of Public Health and Communications of the Ministry of Health Oleg Salagay, according to RBC, he also said that our country was on the list at an undeservedly low level due to the fact that Bloomberg employees used unreliable materials. Thus, the average life expectancy in the Russian Federation in the monitoring results is underestimated (70.37 years instead of 72.06 years), while the relative health care costs are overestimated (7.07% of GDP instead of 5.7% of GDP).

Any ratings imply, first of all, knowledge of the methodology of the calculations, says Senior Research Fellow, Institute for Strategic StudiesNikolai Troshin. — It would be possible to give an example of the Global Competitiveness Index as a counterargument to Bloomberg, where Russia is by no means in last place, but in the middle of a list of 138 countries. So not everything is so bad in our country.

"SP": - Why, with 5% of GDP in Hong Kong allocated for healthcare, this country is among the top five in terms of the level of development of the sphere, and Russia is in the "honorary first" from the end?

- In such calculations, one should look not at percentage indicators, but at the weight of GDP itself. In addition, comparisons in terms of population size, in terms of its structure - all such strange comparisons require a very careful selection of what can really be compared. And when we begin to draw parallels, we must be sure that the authors of such a study were honest with themselves and would not, figuratively speaking, compare apple trees with tomatoes.

The general critical attitude of the agency's analysts can be understood, because, in fact, we need to increase spending on this important social sphere for a long time. Moreover, during the economic crisis, problems become aggravated and become more prominent. But in any case, the numbers given in the Bloomberg survey are not certain. In my opinion, his technique is not explained.

- In general, Soviet medicine was considered quite good by world standards, - says Senior Research Fellow of the Institute economic policy them. GaidarSergey Zhavoronkov. - The "bottleneck" of domestic medicine (both in Soviet times and now) is oncology. Cancer patients who have money tend to be treated and operated on in the West, mainly in Germany and Israel. But in most disciplines, our doctors are not inferior to world analogues; although there certainly is a huge, gigantic gap between public and private medicine.

In our public sector, as Bloomberg rightly notes, in terms of spending per patient, we are somewhere in the hundredth places in the world, worse than African countries. And there is the private sector, which, I note, is relatively inexpensive, and quite effective. And I personally know that many people from Europe and the USA go to Russia to do bone and joint surgeries, because, even taking into account the flight, it is much cheaper than theirs.

Of course, good doctors go to the private sector, and state medicine absorbs personnel who, in essence, have nowhere to go. So the main conclusion that should be made by those who determine the health care strategy in our country is the need for a serious increase in spending in this area. The deplorable state in which it is now, in connection with which the American agency assigned her a place in the group of the “five worst” in terms of the level and accessibility of medicine, is a clear confirmation of this.

“When evaluating a review, you need to understand, as they say, from whom to choose,” believes member of the Federation Council of the Federal Assembly of the Russian Federation, deputy of the State Duma V-VIconvocations, pediatrician by educationAnton Belyakov.- If 55 developed and relatively developed countries with serious healthcare costs are ahead of us in the ranking, this is one story. If the list contains countries with more than modest industry indicators, then this is different. It is very important what specific criteria were taken as the basis of the study. For example, for some time, the ONF assessed the level of healthcare in the regions by the time it took to stand in line to see a doctor and, if possible, make an appointment with a doctor via the Internet.

"SP": - An impeccable criterion - especially for those doctors who do not treat, but only take.

- In fact of the matter. In principle, such an approach has the right to exist, but it must be understood that it will never give a complete assessment of the level of medical care. Nevertheless, such a criterion was also introduced, and soon it also had its own rating.

In my opinion, we really have a curve for the efficiency and organization of health care, as well as a curve for the availability and quality of medical services, are going down. We are clearly not among the leaders in all these indicators. If we talk about the availability of medical care, the so-called unification of medical institutions has led to their geographical distance from settlements, to acute underfunding of rural health care. Today we have tens of thousands (!) of settlements, which in fact are simply deprived of affordable medical care.

You can drive 30 kilometers in some regions of the European part of the country, and not only get specialized medical care, but it’s hard to find a paramedic. In terms of the quality of services, there is an increase in the burden on each medical worker, especially when it comes to specialists; and this cannot but lead to a decrease in the time for each patient and, consequently, to a drop in the indicators of the quality of communication between the doctor and the patient.

Another scourge is the absolutely obvious decrease in the parameters of medical education. To date, the very level of qualification of medical workers, both junior, secondary, and medical units, has fallen sharply. In addition, in terms of technological equipment, we lag behind the leading countries, except for a few breakthrough, piece "sprouts" on the map of the country, several cities with worthy, up-to-date level, institutes and clinics.

As for percentages of GDP, there is a certain cunning in this methodology, because the money allocated for healthcare is formed in our country, on the one hand, at the regional level, and on the other hand, there is also a federal share. And in that money there are two intermediary links. The first one is Insurance companies, whose hands - like in that joke about a sausage sandwich that is passed around in a circle - become sticky. So, according to some estimates, at least 10% of the total healthcare budget sticks to the hands of representatives of insurance companies.

"SP": - What is the future fate of these 10%, which on a national scale would not be superfluous for both patients and health workers?

“Consider that this is just money thrown away from the direct financing of the health care system!

The second link is the CHI funds themselves. The fact is that the Compulsory Medical Insurance Fund has its own cost. And as if no one had ever considered it, although according to some expert estimates, over the past 2-3 years, it has reached 50 billion rubles. And this, mind you, is also money “as if” gone from healthcare. So, how much is actually allocated as a percentage in the budget - 3.5%, 5% or 2% in terms of GDP, as Bloomberg writes, is still a big question. These figures require additional and qualified verification. In any case, I am a supporter of a return to direct financing of health care, without insurance companies and without intermediary links.

Russian health care is on the brink of disaster.

The implementation by the Ministry of Health of the so-called optimization, which boils down to the reduction of beds and specialists, the transition to single-channel financing, sanctions against foreign medicines, shifting responsibilities to the regions - caused many problems.

The industry has been experiencing a severe funding gap for many years: compared to European countries, Russia spends 3-4 times less on healthcare. Recently, the Ministry of Finance proposed to cut this budget further - to reduce the additional spending on health care envisaged by the anti-crisis plan of the Government of the Russian Federation by three and a half times - from 46 to 13 billion rubles. The initiative has drawn sharp criticism from the professional community.

Leading experts discussed the most pressing problems of Russian healthcare during the round table "Financial condition of public healthcare", which was held at RIA Novosti.

Funding cut again

The “budget maneuver”, which is carried out by the Ministry of Finance and means the redistribution of federal budget funds to the detriment of the social sphere, involves a reduction in healthcare funding. If in 2013 in Russia the share of healthcare accounted for 3.8% of GDP, in 2015 3.7%, then in 2016, according to the budget adopted by the State Duma, only 3.6% of GDP will remain. Moreover, the Ministry of Finance proposed to cut this figure as well: it is planned to reduce the additional spending on health care envisaged by the anti-crisis plan of the Government of the Russian Federation by three and a half times - from 46 to 13 billion rubles.

“Today it is difficult to talk about healthcare financing, because everyone understands the state of the economy. Where to get the money, few people know. But we're not talking about that. I'm talking about the trend and the position of the Ministry of Finance in this matter. Not a single country of old Europe - Germany, France - could stand it if 3.6-3.7% of GDP were allocated for health care. There we are talking about 10-12%. Having 3.6% of GDP for healthcare is a shame,” said the director of the Research Institute of Emergency Children's Surgery and Traumatology, the president of the National Medical Chamber, the famous doctor Leonid Roshal.

He stated that he did not understand the position of the Ministry of Finance. “After our criticism of the Minister of Finance Siluanov regarding the reduction of anti-crisis spending by the Ministry of Health by three and a half times, his assistant spoke. She answered approximately the following: “We are not reducing healthcare funding in Russia, but rather increasing it by 83 billion rubles ( The department said that the budget for the current year, including the funds of the Compulsory Health Insurance Fund, includes about 2 trillion. rubles, infox. en)". I am not a financier - I am a children's doctor, but I immediately took a pen and paper and calculated: 83 billion is 4.1%, despite the fact that inflation is 10-12% today. Therefore, we are not talking about any real increase,” Leonid Roshal emphasized.

According to him, Russian doctors are doing a great job, and there are successes - they managed to achieve a reduction in maternal and infant mortality, well-organized care for patients with cardiovascular diseases. “But now all this can be destroyed,” said Leonid Roshal.

At the same time, he added that the medical community has sounded the alarm more than once. “The Union of Patients and the National Medical Chamber in 2015 addressed an open letter to the Government of the Russian Federation, the Federation Council, the State Duma, the Ministry of Finance and the Ministry of Health, in which they demanded not to reduce healthcare costs next year. There was no response to this appeal,” says Leonid Roshal.

Not enough money

Russian health care is seriously underfunded, even without subsequent budget cuts, says David Melik-Guseinov, director of the State Budgetary Institution Research Institute of Health Organization and Medical Management of the Moscow Department of Health.

“We took the standards of the Ministry of Health, which are minimal, and even they are underfunded by 4.5 times in the whole country. Why do we see that we do not have a deficit in the reports of officials? It's simple - there are tariffs that are artificially "twisted", greatly underestimated so that there is enough money for the entire contingent," says David Melik-Guseinov.

The problem of underfunding is especially acute today in oncology - this is one of the most financially costly areas in medicine.

Russian Cancer Research Center. Blokhin, the country's leading specialized institution, is funded by only a third of its needs, said the head of the institution, chief freelance oncologist of the Ministry of Health, Academician Mikhail Davydov.

“The success rate of breast cancer treatment in the US is nearly 100%. In Russia - about 60%. A 40% difference is huge. But the secret of success is simple - timely detection of the disease and timely treatment with effective drugs. Detect oncological diseases early stages should specialized screening programs. There are none in Russia. Dispensary does not solve this problem. Secondly, effective modern medicines are needed. Their availability for Russian patients is from 2 to 5%. Therefore, we have such a result,” says Mikhail Davydov.

The goal is not to heal, but to earn

Back in 2014, the Ministry of Finance proposed to solve the problem of financing healthcare through optimization - the elimination of institutions that are inefficient from a financial point of view and the reduction of medical workers. The Ministry of Health supported this idea. In 2014 alone, 90,000 doctors were laid off, including 12,000 doctors of clinical specialties - those very specialists. This measure caused a huge public outcry, there were many rallies of doctors and patients. There was no response to the public protest.

“The patient has long been destitute and understands that no one is going to do anything for him. When the provision of medical care was equated to trade relations, when a doctor provides not assistance, but a medical service, it became clear that the direction of medical care is being developed not with the aim of improving the quality of life of patients, but with the aim of making money in the healthcare sector,” said the President of the All-Russian public organization disabled - patients with multiple sclerosis Yan Vlasov.

He noted that in many regions, due to optimization, the situation is very difficult. “For example, in the Kurgan region, a doctor has to work on two rates - this is 24 hours a day. It is clear that this is impossible. People are leaving medicine, where the salary of a doctor is 15,000 rubles. As a result, the quality of medical care is reduced. Patients are not getting help. We very much hope that there will be no social explosion,” says Yan Vlasov.

Regions are failing

A few years ago, another way out of the difficulties with financing health care was proposed - it was decided to shift the obligations to the regions. The so-called "regionalization" of health care was carried out. Now it has become obvious, and this is noted by many experts, that this concept is untenable - the management of the healthcare system in Russia should be as centralized as possible.

“Regions are not able to meet the standards that the federal center gives them - neither in personnel, nor in ideological, nor in practical terms. It is impossible to transfer responsibility for health care to the regions, just as it is impossible to shift the issues of ensuring the country's defense capability to the regions. As a result, we have a situation where the regions are not fighting for the patient, but are fighting for money,” said Mikhail Davydov.

According to Larisa Popovich, director of the Institute for Health Economics at the National Research University Higher School of Economics, the healthcare development program is almost 80% focused on money coming from the regions. In the structure of regional budgets, spending on health care is very different and ranges from 11 to 35%. And this despite the fact that only five subjects of the Russian Federation are not subsidized. According to the expert, in order to improve the situation, it is necessary to stop shifting to the regions those tasks that they are not able to solve.

Results…..

Unfortunately, the sad results of optimizing health care, underfunding the industry and shifting responsibilities to the regions are already visible.

As stated by the head of the Higher School of Organization and Management of Healthcare, MD. Guzel Ulumbekova, mortality in Russia has increased over the past three years.

“According to Rosstat, the crude mortality rate (CCR) or the number of deaths per one thousand of the population was -13 in 2013, and 13.1 each in 2014 and 2015. In reality, according to the results of 2015, the overall mortality rate increased in 32 regions. And, alas, there are no prerequisites for the fact that the death rate in the country will decrease. The real situation in healthcare is not conducive to this,” says Guzel Ulumbekova.

According to her, in Moscow, the death rate increased by 3.9%.

David Melik-Guseinov also cited sad figures - in Russia, patients with chronic diseases (diabetes, oncology) live 20-25 years less compared to developed countries.

And, finally, we add that Russia is still one of the last places among European countries in terms of life expectancy.

Meanwhile, officials report on their achievements.

Direct speech: Minister of Health Veronika Skvortsova

On March 10, at a meeting with President Vladimir Putin, Veronika Skvortsova said that infant and maternal mortality in the Russian Federation in 2015 decreased by 12% and 11%, respectively, and the life expectancy of Russians increased.

Summing up the results of the last year, Veronika Skvortsova named the reduction in infant and maternal mortality as one of the important indicators. "Infant mortality has decreased by 12%, even more," the minister said. “Maternal mortality has fallen by more than 11%,” she added, noting that the rate has reached an all-time low. Skvortsova also said that the life expectancy of Russians has increased to 71.2 years, to a greater extent this applies to men, and the difference between life expectancy for men and women has decreased. Skvortsova said that the number of deaths in Russia this year has decreased by more than 2 thousand people.

“Over the year, the number of deaths has decreased by 2,200 people,” Skvortsova said. She noted that this is due to the fact that it was necessary with great difficulty to level the rise in the incidence of influenza, which was in the first quarter.

“This year we passed safely, with minimal losses, and already in January we have a decrease in the number of deaths by more than 5 thousand people, so there is hope that this year we will move quite closely in this direction without any additional obstacles - decline,” said Skvortsova.

Speaking about the provision of high-tech medical care, Skvortsova noted that now 816 thousand people receive it, it has become more diverse, it is widely provided in Russian regions.

“I would like to note that high-tech assistance has become more diverse, it is really replenished high technology, the most modern. Moreover, it is not only federal agencies, but high-tech assistance is also provided quite widely in the subjects of the Russian Federation,” Skvortsova said.

Direct speech: Deputy Mayor of the capital for social development Leonid Pechatnikov

The average life expectancy in Moscow has reached 77 years, which significantly exceeds the national figures. This was announced by Leonid Pechatnikov, who is quoted by the official city portal.

"Moscow has reached 77 years in terms of average life expectancy, while in Russia, and also, I emphasize, taking into account Moscow, it is 71 years," Pechatnikov said.

According to the official, over the past three years, life expectancy has increased by an average of three years, and such growth rates "have not been known by any country in the world in history."

“In three years, we have also increased life expectancy by three years. That is, for a year - a year of growth. Yes, we have not yet reached the level of old Europe, but, according to the European experts themselves, no other country in the world has known such rates of increase in life expectancy as now in Moscow. By the way, according to the results of 2015, women in Moscow live an average of 81 years,” the deputy mayor explained.

As Pechatnikov said in February at a meeting with doctors, the number of deaths in the capital of Muscovites is decreasing every year. Now it is mostly people over the age of 70 years. This was achieved, in particular, thanks to the creation of an infarction network.