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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Bull World Health Organ vol.82 n.5 Genebra May. 2004

http://dx.doi.org/10.1590/S0042-96862004000500015 

NEWS

 

Ailing Russian health-care system in urgent need of reform

 

 

Andrei Shukshin

Moscow

 

 

The Russian Federation needs to overhaul its corrupt and inefficient health-care system if it is to provide regular medical assistance and help the country fight an AIDS epidemic, officials have said.

"We just cannot go on like this — slowly dying — any more. We need to keep the best of what has been achieved but finally bring the system in line with market realities," said Tatyana Yakovleva, Chairwoman of the Health Protection Committee in the State Duma lower house of parliament, a body responsible for the drafting and examination of health-related bills before they are put to vote.

Although communism collapsed in the country thirteen years ago, the Soviet free-for-all health care system has survived virtually intact — a system which the government and the public agree makes bad use of limited budget resources, leaving millions of people without basic services and forcing doctors — many of whom earn under US$ 100 a month — to accept bribes.

Russians who can afford fees charged by the private sector tend to stay away from state-run facilities where patients are routinely driven to bribing personnel to obtain services which are supposed to be dispensed free of charge. Research carried out by Moscow's INDEM think-tank shows that Russians spend some US$ 600 million a year on such under-the-counter payments.

Complaints about the poor quality of medical services, crumbling infrastructure and blatant mismanagement appear almost daily in the Russian media. Many hospitals, especially in remote areas, have no hot water and some have no running water at all; even the most basic medicines are often in short supply.

The quality of medical assistance also varies considerably between Russia's 88 administrative regions depending on local economic conditions.

"The majority of the population have no access to quality health care," said Oleg Shchepin, a member of the Russian Academy of Medical Sciences and director of a research institute. "To give you one example, the number of people suffering from kidney diseases and bronchitis among Russia's have-nots is six times higher than among our better-off citizens."

Putting additional strain on the already ailing health-care system are the unhealthy lifestyles of many Russians. Life expectancy among Russian men has fallen to just 58.5 years — the lowest in the developed world — as the chaotic market reforms of the 1990s marginalized millions of people and led to an upsurge in heart disease, alcoholism and drug abuse. The latter is seen as a key cause of the country's AIDS epidemic.

According to a report by the United Nations Development Fund (UNDP), released on 17 February 2004, growth rates of new HIV infections in the Russian Federation are among the world's highest. Currently, an estimated one million people in the country are HIV-positive. According to the World Bank, this figure could rise to 5.4 million, in an "optimistic scenario," and to 14.5 million in a "pessimistic scenario." The UNDP report warned that, without action, the HIV/AIDS epidemic could cost the Russian Federation 20 million lives and 14% of its GDP by 2045.

Reforms drafted by the Russian Government involve scaling down to a bare minimum the range of free medical assistance guaranteed by the state, closing down a large number of hospitals, putting emphasis on primary care, and increasing doctors' salaries by paying them for dispensed treatment rather than the amount of hours spent at the desk.

Igor Sheiman, head of a team of experts advising President Vladimir Putin on health-care reform, believes the system is suffering not so much from a lack of finance as from an extremely inefficient allocation of resources, the bulk of which is spent on an absurdly vast network of hospitals at the expense of primary care.

"Not even the richest country in the world can afford that. Our people go straight into hospitals," Sheiman said. "Experts believe that up to 30% of all hospitalizations are unjustified. That entails enormous losses."

According to Sheiman, it has been proved that between 80–90% of illnesses can be dealt with at the primary health-care level which would produce a much cheaper national treatment bill. "The whole world saves on that — beefing up primary care — while we have the highest rate of hospitalizations in the world," said Sheiman.