Results of 2023 for Russian healthcare » Medvestnik


Director of the Center for the Study of Problems of Financing, Organization and Interterritorial Relations in Health Care of the Financial University under the Government of the Russian Federation Alexander Ragozin:

— At the “National Health 2023” congress, the head of the Ministry of Health Mikhail Murashko stated the need to move from the term “medical service” to “medical care” and change the entire paradigm of the healthcare system – from now on it should not only treat diseases, but also manage the health of each person. The importance of this thesis lies in the recognition of the transition from “finished case medicine” to “life cycle medicine”.

If in the 20th century the structure of morbidity was dominated by infections, injuries and other diseases that ended in either recovery or death, today patients who previously could not be born or died at an early age have the opportunity to live almost normal lives thanks to the constant support of the healthcare system. At the same time, the main resources are spent on helping citizens who have not one main disease, but a cluster of three, four or more often incurable chronic diseases.

A classic example of a comorbid cluster is a combination of metabolic syndrome, arterial hypertension, diabetes mellitus and coronary heart disease (CHD). Effective treatment of multimorbid pathology requires multidisciplinary care, which is provided throughout life and essentially continuously.

What does government recognition of a paradigm shift mean for the organization and financing of healthcare? “Complete case medicine” is easy to standardize, evaluate its effectiveness using so-called evidence-based medicine, and correctly calculate the cost. Personalized multidisciplinary “life cycle medicine,” on the contrary, requires a radical revision of the principles of standardization and evidence-based medicine, does not allow us to operate with the concept of “completed insurance case,” and does not make it possible to correctly calculate its cost and, based on it, a fair tariff. Therefore, if the insurance mechanism of payment for services was quite effective to finance “finished case medicine” of the 20th century, then “life cycle medicine” makes it objectively unprofitable and excessively expensive.

Official recognition by the minister in 2023 of a paradigm shift in the development of medicine seems extremely important, since it opens up a broad front for searching for the best solutions for transforming Russian healthcare and adapting it to a changing reality.

Head of the Higher School of Healthcare Organization and Management:

— The year was not as difficult as the pandemic, but still very difficult. The number of doctors has not increased, and the number of nurses has decreased. Medical workers have accumulated great fatigue over the past three years.

Compared to 2019, the workload on doctors has increased as a result: the additional flow of patients consists of those who need rehabilitation after coronavirus infection (according to statistics, this is about 20% of those who have recovered from COVID19) and those who postponed receiving medical care in previous periods.

Nevertheless, Russian doctors have achieved an increase in life expectancy to 73 years, in fact to the pre-pandemic value. Mortality from cancer has decreased by almost 5% over the past four years. This is also a victory for medical workers, and also a clear example of the fact that if conditions are created for doctors to work – they increase funding, volumes of assistance and tariffs, then the result will always be the lives of Russians saved.

The good news is that the health care budget in 2024 will not be reduced and will even increase at the rate of inflation. Some volumes of medical care will also increase, for example, medical examinations, and new volumes will appear for the treatment of patients with hepatitis C in day hospitals. Almost all tariffs are increased by 8% at current prices. But additional funds are not provided in the budget for the coming years to solve fundamental problems with staff shortages and increase wages for health workers, as well as to create a system of universal drug coverage. Government spending on medicine will remain at the level of 3.7% of GDP, which is 1.5 times lower than in EU countries close to Russia in terms of economic development.

Director of the Institute of Health Economics of the National Research University Higher School of Economics:

— It seems to me that the most important trend of the outgoing year is the beginning of powerful integration of Russia with the CIS countries in the development of healthcare. This movement is especially important under sanctions.

The event that, in my opinion, runs like a red thread throughout the year is the meeting of the Expert Council on Healthcare at the Interparliamentary Assembly of the CIS Countries. During the event, large and important framework laws for Russian healthcare began to be discussed: on drug provision for the population, on rehabilitation.

An international expert academic working group began to consider a proposal to create a medical code following the example of the one created in Kazakhstan. Colleagues were able to create a unified code of legislation on healthcare instead of the many often contradictory regulatory documents that we now have. They managed to unite all this, remove all contradictions and created a global health code. I believe that now we will seriously consider introducing such a practice in Russia.

Co-chairman of the All-Russian Union of Public Associations of Patients, President of the All-Russian Hemophilia Society:

— A serious problem of the outgoing year is the current situation with the lists of subsidized drugs, primarily life-saving drugs (VED) and high-cost nosologies (HCN). A significant number of medications needed by patients, which had already been voted on by the Ministry of Health commission on the formation of drug lists, were not included in the government’s thematic order. But an even larger number of drugs cannot even be considered, since the commission’s meetings have been repeatedly postponed throughout the year. In the end, she never got ready.

As a result, more than 30 innovative drugs were not included in the List of Vital and Essential Medicines. This is a huge problem that worries not only the patient community, but also doctors who do not understand whether they will be able to prescribe new drugs to patients. We are also talking about drugs that provide new opportunities to a cohort of patients for whom previous therapy is no longer effective. Serious areas are affected, including cardiovascular diseases, oncology, hematology, HIV, orphan diseases, severe systemic autoimmune diseases, pulmonology, nephrology and many others. This is more than 80 thousand patients.

Although territorial programs of state guarantees, which, according to the requirements of Law No. 323FZ “On the Fundamentals of Health Protection,” must be formed in a volume not less than the List of Vital and Essential Drugs, in 2023 they were not implemented in many regions. It is not clear to us why the regional list is being agreed upon in a volume less than envisaged.

Starting from 2024, the state guarantee program approved by the government, in terms of compulsory medical insurance tariffs for drug therapy, includes only those drugs that are already on the Vital and Essential Drugs list. Thus, the availability of these drugs may be further limited not only within the framework of preferential drug coverage, but also within the compulsory medical insurance system. I would like to see these problematic issues resolved in favor of patients in 2024.

Co-chairman of the Interregional Trade Union of Health Workers “Action”:

— The main result of 2023, which I see, is the level of workload on doctors and the intensity of their work only growing. The “optimization” of medical institutions continues.

Although the problem of shortage of medical personnel is recognized at all levels of government, the Ministry of Health has begun to use a new term – “supply of personnel to the population.” And in this context, the situation does not look very bad. But we believe that this indicator is inadequate – it is related to the staffing levels of health workers, and staffing levels have been reduced.

An objective picture is provided by data on the total number of medical workers: according to Rosstat, for 9 months of 2023 the number of doctors amounted to 565 thousand people, paramedical staff – 1.23 million, junior – 262 thousand. There are open data for the 1st half of 2022, based on which just a year ago there were 572 thousand doctors (minus 7 thousand), paramedical staff – 1.274 thousand (minus 4 thousand), junior staff – 279 thousand (minus 17 thousand). In total, despite supposed attempts to resolve the issue of personnel shortages, Russian healthcare has lost almost 30 thousand medical workers. This is the main result.

The situation with real wages has also worsened. Rosstat, which reports a slight increase, gives the overall temperature for the hospital and does not take into account the level of load, the combination coefficient and the expansion of the service area. For the most part, the official salary in statistics consists of two or more rates.

If we take the level of payment for one rate, then, according to our observations, salaries are decreasing – mainly due to the reduction of some incentive payments.

Among the positive achievements of the past year, I can note the appointment of special social payments: for some health workers, they still provide a little support and help make ends meet.

Another achievement is that the government has made changes to the procedure for conducting a special assessment of working conditions (SAL), which establishes the level of harmfulness of work. Previously, it was only recommended to take into account the biological hazard class, but now this is enshrined in the regulatory framework. It is not yet clear how this will be applied in practice, but I hope that it will allow health workers to more successfully seek increased leave and a shorter working week.



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