The assault on health care in Russia

David Levine

According to a document recently leaked to the Russian news outlet RBC, an agreement has been reached between the Russian Ministry of Health and the Moscow city government to lay off approximately 14,000 doctors in 2015-2017. This follows the axing of 9,500 health care jobs in the Russian capital in 2014.

Last month, the Accounts Chamber of the Russian Federation (SPRF) released a report revealing that policies depicted by the government of President Vladimir Putin as an effort to improve social conditions have led to a decline in access to social services and a worsening of the country’s infrastructure, particularly with regards to health care. As a consequence of so-called “optimization” measures, Russia last year experienced a 3.7 percent growth in the number of deaths in hospitals, a 2.6 percent increase in the mortality rate in hospitals, and “a deterioration of the quality of life of the population.”

The SPRF report also found a rise in the number of patients dying at home and an increase in the number of emergency calls that failed to result in the provision of care. The reaction time of emergency services in many areas exceeds the regulatory maximum several times over. The waiting time for non-emergency services is also excessively long in many regions. In Penza Oblast, for example, patients routinely wait more than six weeks for an ultrasound screening.

Approximately 17,500 towns and villages in Russia have no health care infrastructure whatsoever. Over 11,000 of them are located more than 20 kilometers from the nearest medical institution where a physician can be found.

Accounts Chamber auditor Aleksandr Filipenko explained: “879 small towns have no local health center or general practitioner’s office. This deficit is not being compensated for by mobile services. A number of regions of low population density (e.g., Omsk Oblast, Kamchatka Krai and Primorsky Krai) have no mobile medical teams at all.”

Furthermore, as the SPRF report points out, 35 percent of all Russian cities, towns and locales are not covered by public transportation services.

The total number of hospital beds in Russia fell by 33,757 in 2014, continuing a long-term trend, as did the total number of employed medical personnel, which dropped by about 90,000. According to the SPRF, the country now faces a deficit of tens of thousands of doctors and nurses. While there is some indication that earnings for health care workers have increased, according to the SPRF this is largely the result of employees working multiple jobs.

A few weeks after issuing its report, the Accounts Chamber stated that during the first quarter of 2015, Russia’s Mandatory Medical Insurance Fund had collected only 22 percent of its expected income. The fund’s budget has a 76 billion ruble deficit for the first quarter alone, even though the planned deficit for the entire year had been 43 billion rubles. While thus far the deficit has been covered by borrowing from the country’s reserves, this emergency financing will soon run out.

The report adds, “Under conditions where the accessibility of medical care for the population is declining, the growth of for-pay medical services may indicate that free medical care is being replaced with for-pay care.” In 2014 alone, there was a 24.2 percent increase in the total volume of for-pay services provided.

Cuts to medical services in Russia have been met with protests. In Ufa, a city of over 1 million people with only one emergency medical station, physicians at the station went on hunger strike on March 19. Their demands included an end to discrimination and “administrative pressure” on workers, the hiring of new emergency medical personnel, and the restoration of pediatric emergency teams. The physicians continued working during the strike. Of the 13 participants, some were hospitalized before the strike ended on April 27.

In Moscow last year an estimated 5,600 people participated in a street protest against the layoff of doctors. The demonstration was held in response to an announcement that several hospitals in the country’s capital would be closed and 7,000 physicians thrown out of work. Moscow doctors have continued to plan protest actions, demanding, among other issues, an increase in government support for medical institutions, an end to layoffs, and the allocation of time for doctors to make home visits to patients.