Operation on medicine

The President authorized a new stage of health care reform

A new stage of health care reform , which the Kremlin and the White House have not dared to undertake in recent years, will begin in the first year of Dmitry Medvedev’s rule. Yesterday, during a retreat in Klin, the head of state made it clear to the heads of relevant ministries that the level of medical care provided under the state guarantee program in the healthcare sector is not satisfactory either for the majority of Russians or for him personally.

The President, in fact, ordered to speed up work on a package of fundamental bills providing for adjustments to the compulsory health insurance system, treatment standards and principles of financing hospitals and clinics. It is noteworthy that the inevitable increase in budget expenditures does not bother Mr. Medvedev - for once, the first person in Russia admitted that the financial issue is not a priority, and the priority should be “providing qualified and timely medical care.” “There was enough time for approvals, it’s time to make decisions,” Mr. Medvedev told the leaders of the Ministry of Finance, the Ministry of Health and Social Development and the Ministry of Economic Development, while acknowledging that such a serious reform would be “a big challenge for all of us.”

The readiness of the head of state to make political decisions on health care reform, however, does not at all mean that these transformations have already been prepared . Despite the fact that the conceptual basis for the transformation of the medical industry was discussed at the end of Vladimir Putin’s first presidential term, discussions about the direction in which it should develop continue to this day. The head of the Ministry of Health and Social Development , Tatyana Golikova, explained yesterday that two packages of fundamental documents are just being prepared - a medium-term state program for the development of healthcare until 2012, which is, in fact, a continuation of the national project “Health” and involves “pumping up” the industry with finances and equipment, as well as a long-term concept for the development of healthcare until 2020 .

By 2020, Mr. Medvedev assured, Russia will spend several times more on medical care for its citizens than it does now. The President believes that it is precisely the prospect of such a significant increase in the total healthcare budget that today requires reasonable management of investments and capital expenditures. Therefore, in parallel with increasing allocations, the government must improve the compulsory health insurance system, making the compulsory medical insurance policy a truly guarantee of quality care and using insurance companies not as an intermediate financial institution, but as a representative of the patient’s rights in relationships with doctors.

Russians still don’t really understand why insurance companies are needed at all, admitted Dmitry Medvedev. “For most people, policies are just pieces of paper, divorced from the health care system,” the president believes. Calling on members of the Cabinet of Ministers to urgently improve the compulsory medical insurance system , the head of state once again made it clear that the reservations with which the White House and the Kremlin previously tried to explain the need to delay the long-overdue reform are not very appropriate in conditions of financial and political stability. “We can’t wait any longer,” he repeated.

Naturally, there was no need to persuade the ministers, who understand that only at this level the go-ahead for reforms can be given. As Deputy Prime Minister Alexander Zhukov explained after the meeting, a decision has already been made to significantly adjust financial flows within the healthcare system. Clinics that today combine estimated funding from budgets, allocations under various regional and federal programs and insurance payments must switch to single-channel funding through compulsory medical insurance funds. The transition to a single-channel financing system should be carried out by 2010-2011, Mr. Zhukov assured.

The White House and the Ministry of Health and Social Development hope that the transition to payments at the so-called full insurance rate will make state medical care programs attractive for private clinics. And the emergence of competition will lead to an improvement in the quality of services and expand the choice for holders of compulsory medical insurance policies. “We need to make sure that people, having an insurance policy in hand, can independently choose a medical institution,” says Alexander Zhukov. However, Dmitry Medvedev, who even when he was first deputy prime minister and curator of the national project “Health” was faced with the inability of officials to resist the pharmaceutical and medical lobby, immediately made a reservation that the allocation of additional funds from the state budget should be accompanied by reciprocal concessions from the professional community - and in particular, refusal work according to standards that seem to be specially developed to please individual pharmaceutical companies and medical equipment manufacturers. “The state is ready to make these expenses, however, the quality of the medical standards themselves must be fundamentally different - it must be impeccable,” the president emphasized.

Ivan GORDEEV