Experts predicted the reduction in the number of hospitals up to the level of 1913
Optimization of health has led to the mass closure of hospitals in Russia and a decline in the quality of care, experts say. In 2020, the country in the number of hospitals can reach the level of the Russian Empire.
Hospital of the Russian Empire
2000-2015 number of hospitals in Russia has halved from 10.7 to 5.4 thousand thousand estimated by experts of the Center for economic and political reforms (CEPR) based on Rosstat data (a copy of the study, capr is at the disposal of RBC.) In its report “Health care. Optimization of the Russian health care system in action” experts say that if the authorities continue to close hospitals pace (353 hospital per year), by 2020 the number of medical institutions in the country will reach 3 million, that is, the level of Russian Empire in 1913.
Health care reform began in 2010, when a law was passed on compulsory medical insurance, reminded the RBC Director of research Institute of health organization under the Department of healthcare of Moscow, David Melik-Guseinov.
It consisted in the optimization of costs due to the closure of inefficient hospitals and the use of high-tech medical institutions.
The report’s authors explained that they took 15 years as the period when they were in power, Vladimir Putin, including his Prime Minister’s term. In addition, active reform and optimization of health began in 2003-2005, which is evident from statistics on the number of hospitals and clinics.
After the hospitals for 15 years reduced the number of hospital beds. On average, the number decreased by 27.5% to 1.2 million, according to CEPR. In rural areas, the reduction of places noticeable — almost 40%. This data confirms the Director of the Foundation of independent monitoring “Health” Eduard Gavrilov. According to him, only in 2013 the hospitals was less than 100 thousand
Number of hospitals and beds is reduced, agrees Melik-Guseinov, but these numbers cannot be linked to the availability of medical care and quality of patient care. The main indicator — the number of hospitalizations, and it is growing, he says. This means that although the seats getting smaller, they are used more efficiently. Each berth should be loaded on 85% -90%, the expert emphasizes: if it is idle, it is necessary to get rid of.
Maneuver not in favor of outpatient clinics
The downward trend in the number of hospitals and beds can justify the redistribution of resources to the level of the clinics, indicate in capr, but in Russia, close them. Their number 2000-2015 decreased by 12.7% to 18.6 thousand institutions, and the load has increased from 166 persons per day in 2000 to 208. “The declared maneuver in the transfer of load and resources from hospitals to clinics has not happened — the situation in the field of inpatient and outpatient treatment,” conclude the report’s authors.
In his report, CEPR references both the validation results of the optimization of health by the chamber of accounts, the results of which the experts came to the conclusion that the reform has led to reduced availability of services.
As noticed in capr, 2000-2015 increased morbidity: complications during pregnancy and childbirth has increased 39.1% of the identified tumors — by 35.7%, diseases of the circulatory system — by 82.5%.
The availability of medical care in the regions, the experts have verified personally. The authors of the report tried to make an appointment with a therapist in a small Russian town, for example, in Rybinsk, Yaroslavl region. If they were real patients of the doctor, they would have to wait 21 days. In addition, experts point out, in hospitals there is no number of medications: dipyrone, phenazepam, ascorbic acid, etc.
You can not focus on the data on morbidity as indicators of deterioration of health of Russia, said Melik-Guseinov. He notes that we are not talking about disease in General, and about the diagnosis. And the fact that the detection rate increases is good.
Money level fast food
The lack of medicines in hospitals reflects another problem in the Russian healthcare system, its underfunding, say the experts. The government has consistently said the growth of health care costs, but adjusted for inflation, these costs, on the contrary, are falling. CEPR refers to the analysis of the budget of the Federal compulsory medical insurance Fund. Experts estimate that the real costs in 2017 will be reduced by 6% in the comparable year 2015 prices.
Drew the attention of the authors of the report on remuneration of medical staff. Per hour the doctor with all the overtime gets 140 rubles., and health workers and Junior managers — 82 and 72 rubles, respectively. “The payment of the doctor in an hour, could be compared with the hourly rate of that employee fast food chains McDonald’s (around RUB 138). The cafe Manager of this network receives about 160 rubles per hour, that is more of a qualified physician with higher education,” the notice in Capri. According to the survey of the Fund “Health”, conducted among 7,5 thousand doctors from 84 regions of Russia in February 2017, about half of doctors earn per bet less than 20 thousand rubles, told RBC Gavrilov.
Rates the MLA does not cover the actual cost of medical assistance, indicate in Capri.
For example, a basic blood test costs about 300 rubles, while in the OMS clinic earned him an average of 70-100 RUB.
This increases the volume of paid services: for example, from 2005 to 2014, he increased to 109.8 billion to 474,4 billion.
The system of health insurance is inefficient in Russia, concludes the author of the report. Given the extensive and sparsely populated area you can not tie the money to patients — this leads to underfunding and “the inevitable degradation of the medicine in small towns and rural areas”. “We need to raise the question of the reform of health insurance, with partial return to previous in the USSR, the principles of formation and financing of health network”, — concluded the experts.
RBC is awaiting a response from the Ministry of health.
Expert opinion
It is more correct to talk about reducing the number of beds not up to “indicators of 1913”, and to world values.
The power of the Soviet doctor liked this approach: “Well, you go to the hospital, we booblegum”. Slowly, over the week, do tests, in the second week sometime to heal, another week to “watch”. This scheme is dictated by the Soviet inability to count money and to respect other people’s time, still sits firmly in our head.
All over the world think nothing of sitting around in a hospital bed. Time is money, should be treated rapidly and intensively and economically. Sections becomes less drugs – more effective treatment methods stipulate that the patient should make haste to put on his feet and return to normal life without exposing him to the risk of nosocomial infections or loss of employment.
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