Topic number
№ 4 . 2019
Above all

Healthcare financing in Russia (2021-2024). Facts and suggestions


General information on the volume and structure of state and personal health care expenditures in the Russian Federation is given, comparisons of these costs with EU countries are made. The dynamics of government spending on health care in the Russian Federation for the period 2012-2018, as well as for the planning period 2019-2021, is analyzed. The conditions have been determined under which it is possible to achieve the national goal of increasing the life expectancy (life expectancy) of the population of the Russian Federation to 78 years by 2024. It is shown that to achieve this goal, along with a focused policy aimed at reducing the consumption of hard alcohol (decrease by 45% by 2024), it will be necessary to annually increase government spending on health by 15% at constant prices. An increase in government spending of 10% per year at constant prices under the same conditions will ensure an increase in life expectancy up to 77 years. This growth rate of public health spending will correspond to 5% of GDP in 2024, which is at the level of the "new" EU countries, in which the level of life expectancy today has reached 78 years. A comparison is made of health care expenditures required (to achieve life expectancy of 77 years) and provided for in the state program "Healthcare Development" until 2024. It is shown that from 2019 to 2024 (over 6 years) an additional 6 trillion rubles will be required. Proposals are given on priority areas for spending these additional funds.

Actually today

Accessibility and quality primary health care


Primary health care (PHC) is the most widespread type of medical care in the Russian Federation, where the most episodes of medical and preventive care to the population begin and end. In the Russian Federation, there is currently a significant shortage of primary care workers: doctors of the district service are 1.5 times less than the required number, average medical personnel working with them - 1.8 times less than necessary, paramedics - 1.9 times less than necessary. Such a deficit against the background of the population's growing need for medical care leads to a high workload of medical workers and to a decrease in the quality of PHC provision.

The article analyzes the problems associated with the provision of PHC; considers the measures for the development of this type of assistance provided in the National project "Health"; proposes additional measures and calculates the necessary resources for their implementation. The key proposals to solve the problems of primary care are: the elimination of the shortage of doctors by increasing their wages (the ratio of 1.5 to the base salary and additional 1.3 to the base salary of personnel working in the rural areas), as well as providing additional social benefits; changing the organization of PHC by switching to the model of General practitioner for the adult population; mass training of medical workers; modernization of payment methods of medical organizations providing PHC.

Neoplastic diseases - the main threat to human life in perspective


In the article comparative analysis of mortality rates from cardiovascular and oncological diseases in the Russian Federation and other countries of the world is represented. It points to catastrophic situation in Russia in regards to cardiovascular diseases control (the incidence is 3-3.5 times higher than in developed countries, and 1.5-1.6 times higher than in advanced post-socialist countries from Central and Eastern Europe and top ten developing countries). Cost analysis of reducing mortality rate due to cardiovascular and oncological diseases, according to the Healthcare national project, elucidated that the main cause of mortality in Russia (cardiovascular diseases) is of secondary importance and minimal funds have been allocated for it (only 79.2 billion rubles). The cost of reducing cardiovascular mortality per patient for 2019-2024 (according to the National project) is 135 thousand rubles, and from oncological diseases is 12.9 million rubles (95 times more). To achieve the national goal of increasing life expectancy to 78 years by 2024 (Decree of the President of the Russian Federation of May 7, 2018 No. 204) it is necessary to increase expenses on protection from cardiovascular diseases by ten folds. According to the author's calculations if in the Russian Federation out of 30 million people 10 million are subjected to serious diagnostics for detection of certain types of cancer in clinics equipped with the appropriate equipment and devices, as well as highly skilled doctors, then malignant tumors will be detected in approximately 50 thousand new patients, moreover in a significant part in the first stages. This will require up to 150 billion rubles of additional costs for such a complex and massive diagnosis. But due to the cheap treatment of the initial stages of cancer and preservation of life of a significant part of identified patients, 230 billion rubles will be saved, which will make it possible to recoup the costs. It is also proposed to radically improve organization of cancer patients accounting, their condition monitoring, and optimize organization of timely and high-quality treatment. To do this, it is advisable to formulate management of anti-cancer measures according to the program-targeted principle.

Effective management

Center for Healthy Children work organization using lean production tools


In 2018, the children's consultation office of the "Vsevolozhsk Clinical Interdistrict Hospital" entered the "Economical Polyclinic", "Creation of a New Model of Medical Organization Providing Primary Health Care", and "Organization of Internal Quality Control and Security of Medical Care" projects. On March 12, 2018 the doors of a new child health center "Center for Healthy Children" opened. A separate building was allocated for it. Unbundling was carried out with allocation of 3 large divisions: consultative and diagnostic; pediatric; preventional. During a visit to the clinic, a child of any age can be vaccinated under the program of the national vaccination schedule. It is also possible to carrying out the tuberculin diagnostics. In addition, routing of periodic screening of children was designed and implemented.

Guzel E. Ulumbekova
MD, MBA from Harvard University (Boston, USA), Head of the Graduate School of Healthcare Organization and Management (VSHOUZ)
Оргздрав-2022. Эффективное управление в здравоохранении
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