Window on Eurasia: Moscow Could Afford to Improve Health Care But Hasn’t, Doctor Charges

Paul Goble

Baku, April 6 – Because of its earnings from the sale of oil and gas, Moscow has all the money it needs to improve medical care, according to the chairman of Social Chamber’s health commission, but it has not done so, thus creating a highly “unsatisfactory” situation that violates the requirements of the Russian Constitution.
Indeed, Leonid Roshal’, the director of the Moscow Research Institute on Emergency Pediatric Surgery and Traumatology, told Expert.ru this week, Russia spends only three percent of its GDP on health, a figure that is only half of what it should spend and one that puts Russia near the bottom of developed countries.
But the government is falling down in yet another way even as it celebrates the amount of money it has: The authorities have failed to crack down on corrupt doctors, who because they are poorly paid by the state, feel they have the right to extort money from their patients (http://www.expert.ru/articles/2008/04/03/zdr_prroshal/ ).
“Today is a favorable moment for Russia,” Roshal’ said. “There are both money and the chance to do something.” But on the basis of Moscow’s recent actions, he lamented, there is little reason for anyone to expect that any significant increase in funding will occur any time soon.
The prominent doctor warned that “if we will [continue] to have this level of financing, then we will never loser mortality rates” or raise life expectancy, goals both Vladimir Putin and Dmitry Medvedev have frequently said they are committed to achieving.
According to Roshal’, officials up to the ministerial level agree with him that Russia must double its spending on health over the next four years, and he noted that his commission has prepared a draft program showing how such an increase will more than pay for itself because of improvements in the health of the population.
Additional funds are needed not only to improve the technology available to doctors but also to train additional medical professionals, both general practitioners and specialists. At present, Russia has only 200,000 of the 600,000 doctors it needs, and Moscow lacks some 600 pediatricians and 1,000 emergency room doctors.
Roshal’ said his commission wants to pay for the training of doctors who in exchange will sign contracts to work in government health institutions, a policy that the doctor said incoming President Medvedev has indicated he supports, and also boost doctors’ salaries by 30 to 40 percent.
In addition to better funding, Roshal’s called for a broad scale attack on corruption, something he suggested is much worse among doctors who treat adults than among pediatricians. If higher incomes and better supervision do not end this plague, he said, then the authorities should encourage denunciations.
The most immediate task for Russian public health, he continued, is to save the country’s polyclinics. Over the last 15 years, these institutions have been “subjected to destruction,” actions that all too often have left large groups of the population without any medical treatment nearby.
But at the same time, Roshal’ said that he is unalterably opposed to the efforts of “young reformers” now working with and at the direction of the International Bank of Reconstruction and Development and the World Bank who in the name of saving Russia’s health care are in fact destroying it.”
That patriotic, even nationalistic tone may win Roshal’ some friends and supporters among the very senior officials he began by criticizing for failing to provide enough money for the country’s health care system and thus preventing ordinary Russians from getting the health care they need.