Modernization of healthcare: like a dead poultice

Medicine Disease
The funds allocated for healthcare, if not stolen, are spent without taking into account the opinion of doctorsEvgenia Zubchenko, Novye Izvestia, 29.11.2012-11-29

Last week, the government extended the current healthcare modernization program and pledged 42 billion rubles for its implementation in 2013. In the previous two years, more than 600 billion rubles were spent for the same purposes.

Meanwhile, the result of financial injections into medicine is noticeable only to officials. Doctors and patients claim that the declared state support does not affect either the work of the former or the health of the latter. Moreover, it is not always about theft.

Ignorance is often the reason for inefficient spending of funds. Expensive devices can stand idle for years, since no one trains doctors to use them.

The budget approved yesterday by the Federation Council for 2013-2015 provides for a reduction in healthcare costs from 554.7 billion rubles in 2012 to 507 in 2013.

For comparison: under the section "National Defense" expenses will amount to 2.1 trillion rubles, "National security and law enforcement" – 2 trillion rubles, "National economy" – 1.7 trillion rubles.

Officials, however, assure that the total amount of government spending on medicine will increase. As it became known last week, the healthcare modernization program in Russia has been extended for 2013, and more than 42 billion rubles will be allocated from the budget of the Federal Compulsory Medical Insurance Fund (FMS) for its implementation. Additional funds will also be allocated by the regions.

The healthcare modernization program was designed for two years, and a total of 635.7 billion rubles were allocated for its implementation in 2011-2012. Since 2011, the regions have received money to strengthen the material and technical base of this sphere (repair of medical institutions, purchase of medical equipment), informatization and transition to uniform standards of medical care.

However, in the summer, the Board of the Accounts Chamber (SP) of the Russian Federation announced the results of an expert-analytical study "Analysis of the effectiveness of the use of public funds for the modernization of the healthcare industry in 2011 and the expired period of 2012."

Monitoring of the joint venture showed that in 2011 the regions spent only 177.2 billion rubles, that is 59.3% of the total amount of planned funds. At the same time, in some regions, the amount of disbursed funds amounted to no more than a third.

The issue of the effectiveness of spending public funds in the healthcare sector is very acute, confirms Leonid Arkhipenko, Director General of the Association of Honored Doctors.

"We know a lot of facts when money goes for other purposes, or the financing is formal, which leads to no less deplorable results than in the first case," Mr. Arkhipenko told NI. – That is, expensive equipment is being purchased, which for various reasons, often for technical reasons, cannot be used. It has been idle for months or even years, sometimes even unopened. Either it is impossible to connect it, or doctors do not know how to use it."

The doctor is convinced that it is the formal nature of funding that aggravates the already bleak situation in our healthcare. "The doctors themselves should order the equipment and guarantee that it will be used," the expert says, "then we can expect that the funds will be fully used for their intended purpose. That is, the initiative should come from below. The head physician must approve that this technique will be used. Also, the head of healthcare in the region should provide advanced training for employees who will work on this equipment. In other words, this system will work if there are responsible people."

The list of developed countries with the largest share of healthcare costs in GDP is headed by the United States. Over the period from 1960 to 2010, the share of total healthcare expenditures in GDP increased in this country from 5.1% to 17.9%. In Russia, these indicators are much more modest. There is a program "Development of healthcare of the Russian Federation until 2020", developed by the Ministry of Health.

Presenting the program at a government meeting in mid-November, the head of the Ministry of Health Veronika Skvortsova said that a million Russians may not live to 2020 if the government does not double the funding of this state program. It now has 2.7 trillion rubles embedded in it. it will not be enough to fulfill the decrees of President Vladimir Putin, in which he demanded to significantly increase life expectancy and improve the quality of medical services. The initial scenario of the program requires an increase in healthcare spending to RUB 3 trillion by 2015 (3.7% of GDP), and to 6.5 trillion by 2020. (4.7% OF GDP). The Ministry of Finance insists on other figures: 2013 – 2.24 trillion rubles, 2015 - 2.48 trillion, 2020 - 3.4 trillion.

Experts draw attention to the fact that the state not only allocates catastrophically little money for healthcare, but also distributes it incorrectly. "When allocating budget funds, we have a predominant bias towards high–tech inpatient care," the head of the Institute of Health Economics of the Higher School of Economics Research University (HSE) told NI Larisa Popovich. – Because at the outpatient stage we do not do the actions that are necessary. We do not ensure the availability of treatment, first of all we are talking about providing medicines at the outpatient level. If a patient has been prescribed a good medicine, and he does not have the opportunity to buy it, then naturally there will be no benefit from such treatment. The unavailability of medicines is the most common problem. Unfortunately, the expert community cannot prove to the government in any way that investing in drug provision will be the most effective expenditure of funds."

Before modernizing healthcare, the authorities implemented the national project "Health" for several years, for which they spent more than 300 billion rubles. Officials were satisfied with the result. As previously reported by NI, while still in the post of Deputy Prime Minister, Alexander Zhukov reported that thanks to the national project "Health" over the past five years, the natural decline of the population in Russia has decreased 3.5 times, the infant mortality rate has decreased by almost a third, the maternal mortality rate has decreased by 13.4%. In addition, more than 10 thousand clinical institutions were equipped with modern diagnostic equipment, about 70% of the ambulance fleet was updated, which reduced the waiting time from 35 to 25 minutes.

However, in practice, the attitude of Russians to the situation in the healthcare sector has not changed in recent years. According to a survey by the Analytical Center Yuri Levada, 61% of Russians are not satisfied with the current health care system. For comparison, about the same number of people answered the same way in 2002. "In all development programs, it is much more effective to invest in people, not in walls," Daria Khalturina, an expert of the Commission of the Public Chamber of the Russian Federation on social issues and demographic policy, told NI. – In particular, we have a problem that specialists in the field of medicine lag behind the level of education of modern world science due to the "Iron Curtain", the language barrier, and so on. In some cases, our doctors make non-existent diagnoses." According to the expert, the authorities need to focus on training personnel, internetization of the entire sphere, on creating websites where Western treatment protocols will be laid out. Finally, we need to work on motivating doctors. "In particular, to introduce a system of retraining, retraining of personnel," Daria Khalturina suggests. – For example, in the USA, doctors regularly take an exam that allows them to extend their qualifications, we do not have this." Leonid Arkhipenko, General Director of the Association of Honored Doctors, in turn, adds that funding should go based on the results obtained. "Doctors and everyone who works in the healthcare system in the region should be clearly interested in ensuring that the provision of medical services is at a high level," the NI interlocutor adds.

Portal "Eternal youth" http://vechnayamolodost.ru29.11.2012