| Mikhail Zurabov calls not to wait for a quick improvement in the healthcare system The unprecedented increase in expenditure items in the 2006 budget for health care is a kind of loan from the state, and the authorities expect that citizens, realizing this, will also invest money in taking care of their own health. Moreover, the government promises to actively participate in the management of the medical industry in the future, possibly taking on the functions of a regulator of pricing policy in the pharmaceutical sector. However, in parallel, the White House intends to ensure that contributions from enterprises and regions to compulsory health insurance funds increase, and government allocations are supplemented with funding from extra-budgetary sources. Yesterday’s speech by Minister of Health and Social Development Mikhail Zurabov to State Duma deputies who wanted to get acquainted with the government’s plans for health care reform was structured in this vein.
It is noteworthy that yesterday’s visit of Mr. Zurabov to Okhotny Ryad, unlike previous ones, which inevitably resulted in verbal battles, was quite calm. Which is not surprising at all. Both the draft federal budget 2006, in which healthcare costs were increased by 89% compared to 2005, and the promise voiced recently by Vladimir Putin at a meeting with members of the State Council and parliamentarians to double the salaries of local doctors and nurses allowed the head of the Ministry of Health and Social Development to feel very confident yourself in a conversation with deputies.
And in his report, Mr. Zurabov continued to pour in promises, specifying the president’s statements. In particular, he said that next year 10-12 thousand new ambulances equipped with the latest medical technology will be put into operation in Russia; large oncology centers will be completed in Moscow and St. Petersburg in the next two years and Krasnodar, the number of high-tech operations, on which, as a rule, matters of life and death for patients, will significantly increase. The minister assured that the federal center will not ignore clinics and hospitals that are in regional and municipal ownership, that is, as he put it, “regardless of whose formal obligation to provide citizens with free medical care.”
However, at the same time, Mikhail Zurabov did not radiate much optimism and gently warned that the government’s decision alone to increase budget spending on healthcare from the current 53.5 billion rubles. up to 101.1 billion in 2006 does not at all guarantee fundamental changes for the better. In fact, he admitted that the increased allocations next year are a patch designed to close the most painful points in the industry: primary health care and poor material and technical equipment of district clinics and hospitals.
“It will not take six months or a year to modernize healthcare; now we are trying to cope with current problems,” Mr. Zurabov emphasized and warned against excessive optimism. “The danger is that even if funds are added to healthcare, there will be no immediate effect in improving quality,” the minister said, comparing the possible developments in his industry with what is happening in the housing and communal services sector, where “total payments increase, but quality remains at the same level.”
In Mr. Zurabov’s opinion, it is possible to overcome the threat of development according to such a pessimistic scenario by increasing, in parallel with government spending on healthcare, funding for the industry from insurance and other non-budgetary sources. According to him, in order for the program of state guarantees for the provision of free medical care to be balanced with the financial capabilities of Russian healthcare, it is necessary to be more demanding of those who are required by law to pay insurance premiums for their employees or the non-working population. According to him, contributions for 53 million Russians today are paid by their employers in the form of unified social tax. At the same time, according to calculations by the Ministry of Health and Social Development, for 11 million workers, practically no contributions to the compulsory medical insurance system are made due to the use of a simplified taxation system at their enterprises. The same applies to the 12 million Russians whom statisticians classify as the so-called “self-employed population.” And regional administrations do not always fulfill their obligations regarding payments to compulsory medical insurance funds on time and in full.
As a result, as First Deputy Director of the Federal Compulsory Medical Insurance Fund Yuri Yakovlev told State Duma deputies yesterday, in the eight months of 2005 only 82% of the expected tax revenues were received. At the same time, for their part, health insurance funds are forced to underpay clinics. Even by using reserves (or rather, by reducing contributions to the normalized safety stock), the funds provided medical institutions with financing at the level of 87.5% of the planned amount. “The situation is not very rosy,” admitted Mr. Yakovlev, following the head of the Ministry of Health and Social Development, recalling that today the center - in this case, the FFOMS - is trying to use its resources to equalize the situation in regions that finance their medical programs differently.
Mikhail Zurabov’s call not to rely only on dividing up the oil pie that is swelling by leaps and bounds and increasing budget expenditures, but to begin structural changes in the health care system and compulsory medical insurance, providing, along with strengthening state regulation and the expansion of market mechanisms in medicine, apparently, to the deputies The State Duma didn’t really like it. The left traditionally accused the head of the Ministry of Health and Social Development of commercializing the social sector entrusted to him and even of “an attack on the constitutional principles of the welfare state.” United Russia, judging by the words of Vice-Speaker Lyubov Sliska, rated the report a “C plus” - apparently for the lack of proper optimism and the lack of the appetite that the phrase “stabilization fund” evokes among Russian legislators. Oleg VOLKOV |
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