Priority balance

Tatyana Golikova named irreducible expense items

Even if the government manages to keep the amount of funding for medicine and social support at the level envisaged in the draft updated budget for 2009, the money may still not be enough to satisfy all those in need. Therefore, it is impossible to do without a “clear definition of priorities” and “increasing the efficiency of spending” in the social sphere, the head of the Ministry of Health and Social Development Tatyana Golikova warned the heads of large medical institutions. The minister spoke at an extended meeting of the department's board on Friday.

In fact, Ms. Golikova conveyed to her subordinates the decisions that had been made the day before at a meeting of the Cabinet of Ministers and recorded in the draft “Program of Anti-Crisis Measures of the Government of the Russian Federation for 2009.” These measures include counteracting the growth of unemployment, strengthening social protection for citizens with children and people with disabilities, and improving drug provision. But the main thing is the continuation of large-scale changes in domestic healthcare that began during the years of financial prosperity. “A crisis is not a reason to abandon accepted social obligations,” Ms. Golikova repeated the main mantra of recent months.

According to her, first of all it is planned to continue the national project “Health”. Prevention should become an absolute priority and include not only medical examination and vaccination, but also “a large-scale program to promote a healthy lifestyle.” For this purpose, it is planned to open special prevention rooms in regional treatment and preventive institutions, whose responsibilities will include both sanitary educational activities and the collection of information on “key indicators of a healthy lifestyle.” According to the Ministry of Health and Social Development, by 2015 the clinical picture of the bad habits of Russians will be fully described. Representatives of the medical community are also ready to support this approach. “Today, in the structure of mortality of Russians, 87% are factors associated with alcohol abuse,” explained the famous surgeon Leo Bockeria, chairman of the Public Chamber commission on promoting a healthy lifestyle, sports and tourism, in a response speech. According to him, in conditions where medical capabilities are limited, it is extremely important to adopt a system for assessing the health of citizens, introduce a special index, as proposed by the ministry, and engage in propaganda. “But if until 2015 we only establish criteria for a healthy lifestyle, many will not live to see this,” Mr. Bokeria noted.

The second cost item that the government intends to maintain is drug provision. According to Tatyana Golikova, several “events” are planned to stabilize the situation with drug prices. Among them are the mandatory registration of maximum manufacturer selling prices for vital drugs, the minimization of maximum wholesale and retail trade markups at the level of federal subjects, and the organization in the Federal Tariff Service of a special unit to monitor compliance with the size of these markups. It is also planned to review the minimum range of drugs that should be in every pharmacy - the latter measure is designed to prevent the “washing out” of inexpensive drugs, which, even with the current surcharges, are not particularly profitable for distributors to transport to remote regions.

Another important area is high-tech medical care, which is currently provided according to quotas. “In 2009, 30 thousand more people will receive high-tech care than in 2008,” the minister noted, promising that the waiting time for patients in line should be reduced. Tatyana Golikova did not explain how this will happen. And that is why her words did not go unnoticed by doctors. “We have excellent high-tech centers, but they cannot replicate their experience,” Leo Bockeria doubted the ability of the authorities to fulfill such a promise. In his opinion, it is possible to improve the availability of expensive medical care only by changing the scheme for distributing money in the field of high-tech government procurement. “There is an institute of chief specialists, but it would be necessary to introduce an institute of chief medical institutions for each specialty. And entrust them with control over those huge funds that now—we know for sure—responsible organizations are using in a completely different way than we would like,” he gave his recipe. In times of crisis, disputes between doctors and health officials about “high” medicine are likely to only intensify.

The Ministry of Health and Social Development is ready to increase spending on one of its most effective projects - stimulating the birth rate with the help of birth certificates, all kinds of child benefits and maternity capital. According to official statistics, 1,717.5 thousand children were born in Russia last year, which is 6.7% more than in 2007. “Now it is important to consolidate these results by adjusting the amount of benefits,” Ms. Golikova noted. First of all, the package of benefits associated with the birth of children will be “pre-indexed” (one-time at the birth of a child, when registering in the early stages of pregnancy, monthly for child care up to 1.5 years). Since January 1 of this year, this “package” has already been increased by 8.5%, but now it is planned to recalculate it with an increase of 13%. The amount of maternity capital will also be revised - up to 312 thousand 162 rubles. More than 26 billion rubles have been allocated from the federal budget for these purposes. In addition, about 3 billion rubles will be allocated additionally to increase benefits. Social Insurance Fund.

The increase in benefits will be supported by the State Duma and approvals will pass smoothly, the Ministry of Health and Social Development is confident. “The State Duma Committee on Budget and Taxes will consider the bill on changing the budget of the Social Insurance Fund at the beginning of this week in order to recommend it for the first reading as quickly as possible. We are all interested in the bill quickly passing all the necessary procedures,” Galina Karelova, deputy chairman of the Committee on Budget and Taxes, confirmed to Vremya Novostey. It is especially important, according to the deputy who previously headed the Social Insurance Fund, that all benefits will be recalculated retroactively, i.e. from January 1 this year.

Galina PAPERNAYA