25 january 2013

Government Meeting


Dmitry Medvedev: Colleagues, today, we will be discussing issues that are directly related to the quality of life of our citizens. I am talking about the issues of healthcare and support for families with children.

The first issue concerns the implementation of the regional healthcare modernisation programmes between 2011 and 2013. As you know, we have set very ambitious goals for this timeframe. We need to carry out current and major repairs of outpatient clinics and hospitals, complete the construction of healthcare facilities that are nearly ready (80% or more), furnish them with modern medical equipment, and adopt up-to-date medical care and information technology standards.

The Minister of Healthcare and the heads of Buryatia and the Pskov Region, Vyacheslav Nagovitsyn and Andrei Turchak, who have been invited to attend the Government meeting, will report on the results of this work.

I will briefly discuss some of the key issues on which I have given instructions some time ago.

First. Almost one third of all the resources under the regional programmes have been allocated for the modernisation of children’s healthcare facilities. These funds were used to develop new pediatrics areas, particularly neonatal surgery. Doctors are now additionally able to operate on sick children even before they are born, and right after. Mobile resuscitation obstetric teams have been set up in practically all regions of the Russian Federation. Palliative care is being developed; medical services for children who are in critical condition and require special care have been organised. In the past, parents had to carry this burden. Children’s rehabilitation is also being developed. We are making decisions to this effect. We are also engaged in disease prevention. Some 2.3 million 14-year-olds (that is, practically all of them) have undergone standard medical examination, and more than 1.5 million have received treatment under individual programmes.

Secondly, we are working to make medical aid more accessible to rural residents. This is a very urgent issue for this country, primarily as regards outpatient care. Village first-aid stations are being upgraded. We have organised about 600 inter-municipal centres on cardiology, oncology, traumatology and diagnostics for expecting mothers. The number of units for video-consultations has been increased four-fold, which is also very important in this country. The purchase of 187 mobile complexes for standard medical examination has made specialised medical aid much more accessible for people in rural and remote areas. About 8,000 young doctors have come to work in villages in the last two years. This is a good result but it is very important to make sure that they settle down in rural areas rather than move away after working for a few years. We must continue this work. I’d like to recall that after the adopted decisions, support measures will also be spread to doctors in worker’s settlements.

Third, we are providing IT support for healthcare in the regions. Installation of computers is not an end in itself. It is important to use them properly, primarily for further modernisation. Many clinics are introducing electronic medical records, and they give patients the ability to book a doctor’s appointment or exam online. They are also developing a remote monitoring system. Naturally, there is still a lot to be done. I would like both federal ministers and regional governors to pay attention to this.

Almost 20,000 ambulances and 2,500 dispatch offices (this is more than 95%) have been equipped with the GLONASS satellite navigation system. This allows them to render aid much more quickly, thereby saving more lives.

The programmes have been financed from several sources – federal and territorial funds of mandatory medical insurance and regional budgets. In all, almost 700 billion roubles were spent on them as of January 1, 2013. Nonetheless, I have been told that the majority of the regions have not completed their programmes in full – just by 75% or probably 80%. In some cases this was due to objective reasons and in others, because of red tape and simply because of management problems. I’d like to draw your attention to the need to complete measures planned for 2011-2012 in the first half of this year.

The allocated funds have provided an impetus for the development of healthcare in the regions. In 2013 we must complete the implementation of regional programmes for healthcare modernisation, paying close attention primarily to upgrading the level of medical aid for children and rendering timely and professional aid to their mothers. In the next few years we should make medical aid accessible to all people regardless of their place of residence. This is one of our fundamental tasks.

And the last point on this subject. It is important that we continuously monitor all actions in such a sensitive sphere as medicine and consider the wishes and needs of our people. We must also pay attention to critical remarks and proposals that are being made all the time. Finally, we need public control in the sphere that can be done through the Open Government and other instruments.

The second issue is also linked with healthcare. It concerns amendments to 57 federal laws. These amendments are necessary in order to tailor certain standards to the law On the Fundamentals of Public Health Protection in the Russian Federation, which was passed in 2011. In particular, these amendments specify institutional and legal forms of medical institutions, the rights of patients and terms of receiving medical aid, including the procedure of obtaining a patient’s consent for medical intervention or refusal to accept it, especially when it comes to teenagers. Patients with HIV who receive outpatient treatment in public federal and regional medical institutions will be provided with medicines for free.

Professional training of medical workers will also undergo changes. In coordination with the Ministry of Education and Science, the Ministry of Healthcare will receive the right to endorse provisions on internships and clinical residencies, including the order of admission and procedures for training medical specialists. I hope these draft laws will have a positive impact on the health of many people.

We should also discuss amendments to a number of federal laws on support for families with children. It is necessary to protect them against the embezzlement of maternity capital and similar crimes. For the most part, this happens during the signing of a mortgage contract. Some companies abuse people's trust and resort to all kinds of illegal deals, as a result of which these people lose their money and a chance to improve their housing conditions. Such crimes are rather frequent and this is why I suggest revising the existing procedure that allows people to sign mortgage loan contracts with any organisation. The amendments will specify the list of organisations that are entitled to deal with maternity capital, including banks, microfinance institutions, and credit unions, as well as organisations fulfilling mortgage-insured commitments.

The second draft law concerns monthly childcare allowances. Today the allowance received by mothers that are dismissed during their child-care leave amounts to 40% of their average salary. Those who are dismissed during their maternity leave receive a fixed sum. The Constitutional Court has ruled that this is unfair and the draft law will establish the same approach to both allowances – 40% of the average salary.

And the last point I’d like to make now. Today is Tatyana’s Day, a holiday for students. I’d like to convey my heartfelt congratulations to all Russian students and wish them good health, optimism and, of course, persistence in achieving their goals. Student years will pass quickly and it is important to concentrate and receive knowledge and competence. This is, of course, not an easy time. The Government relies on the knowledge and energy of all Russian students. Congratulations to all those who deal with students, to parents of students and all others as well! Congratulations to all of you.

Okay, let’s get down to work. Let’s discuss modernisation programmes. Ms Skvortsova, please take the floor. Our colleagues from among the governors will follow suit. Go ahead please.

Veronika Skvortsova (Minister of Healthcare): Mr Medvedev, ladies and gentlemen. In 2010 the Government adopted very important decisions – to increase insurance premiums to the system of mandatory medical insurance by two percentage points and to use these funds for the healthcare modernisation programmes in the regions of the Russian Federation.

These programmes were necessary not only because it was necessary to update the healthcare infrastructure, but also because it was necessary to optimise the technological process involved in healthcare, to create conditions for implementing, starting January 1, 2013, uniform healthcare standards throughout Russia. Over 704 billion roubles are planned to be allocated from all sources, including 460 billion roubles in subsidies from the Federal Fund of Mandatory Medical Insurance. Over the last two years, 98% of the allocations were used, taking into account the economising as well as the funds that came in during December 2012. To improve the efficiency of the operation of the regional executive bodies, in June 2012 the Ministry of Healthcare decided to conduct comprehensive field inspections in regions with the participation of the Federal Fund of Mandatory Medical Insurance and the Federal Service for Healthcare Supervision. They visited 65 regions, and conducted field medical inspections in the Northwestern, North Caucasus and Central federal districts. Following the results of the inspections, the Ministry of Healthcare as well as the Russian Government held regular conference calls with regions, which were conducted by Deputy Prime Minister Olga Golodets.      

The key effort of regional modernisation programmes was to optimise healthcare logistics based on an efficient three-tier healthcare system, a full cycle of medical assistance including preventive medicine, early diagnostics, intensive therapy and complete medical and social rehabilitation.

The programmes pay special attention to improving the accessibility and quality of healthcare in rural and remote areas. To improve primary healthcare the programmes provide for the more efficient work of 48,471 dispensaries, general practitioner’s offices, rural health centres and midwifery units. Of these, 48,240, or over 99.5%, are already operating. The percentage of doctor assistance has considerably increased in the primary healthcare structure. 4,534 ambulatory care centres were updated, which exceeding the plan by 8%. One hundred eighty seven mobile ambulatory care centres were launched for field work. These include mobile midwifery units, health centres, mammography and fluorography equipment, and other instruments.    

To improve the quality of specialised and emergency care, a network of inter-municipal centres was created; it takes between 30 and 40 minutes – a maximum of one hour in regions with a low population density – to reach a patient. Over the past two years, the number of these centres has redoubled, from 571 to 1,169.  A decision to pay a 1 million-rouble subsidy to young doctors to attract them to rural areas has had a noticeable effect. These subsidies went to 7,758 doctors. The improvement of the primary tier of the healthcare system has led to a considerable improvement of the whole medical care structure. The number of visits to ambulatory care centres increased by 3%; the number of patients treated in day hospitals increased by 6%. The number of ambulance calls decreased by 2.1% and the number of patients treated in hospitals decreased by 2.6%.

In late 2010, 124 medical institutions in 50 regions provided high-tech medical care to 34,000 people; and in late 2012, 140,000, or four times as many people, received high-tech medical care in 221 hospitals in 59 regions. Eighteen regional medical institutions have begun to conduct transplant, sophisticated high-tech operations. Currently up to 40% of kidney transplants are carried out in regions.   

The programmes paid special attention to improving the accessibility and quality of healthcare within the system of maternal and child care. About 186 billion roubles, or 28% of total funds, were allocated to this end. The decisive factor in the efforts to reduce infant mortality is adequate intensive therapy for newborns. Over the last two years, the number of high-tech intensive therapy beds for newborns has increased from 3,000 to 3,900. In 14 regions the number of such intensive therapy beds for newborns meets the recommendations of the World Health Organisation: four beds per 1,000 births. Mobile intensive therapy midwifery units have been created in all regions under the modernisation programme in order to provide modern medical care. As a result, infant mortality has fallen from 7.5 in 2010 to 7.3 in 2011 per 1,000 live-born children. In 2012, with a transition to new live birth criteria (registration of 500-gram infants, from the 22nd week of pregnancy), experts predicted a considerable growth of infant mortality: Russian experts expected growth of 30%-35%, and foreign experts and WHO experts expected growth of up to 100% of infant mortality. According to the results of eleven months of 2012, the growth of infant mortality was 18.9%, or up to 8.8 deaths per 1,000 live-born children. Moreover, in regions with prenatal centres and a formed three-tier system, infant mortality continued to decrease, and reached 6.5 deaths.   

In order to monitor the health of adolescents going through puberty – because their health influences the reproductive potential of the nation – medical examinations were conducted of all 14-year-olds. A medical examination of over 2.3 million (99% of the total number) of these teenagers has been conducted. According to the examinations, emergence diseases were detected among 55% of those examined, or among 1.3 million teenagers. To date, over 1.5 million teenagers have been treated, including for diseases that had been diagnosed earlier. At the start of the programmes, 47% of medical institutions (or 4,354 institutions) participating in the system of mandatory medical insurance were in need of major repairs. The modernisation programmes included 4,000, or 92% of total medical institutions needing major repairs. The programmes envisaged new medical equipment for 5,060 medical organisations, or over 60% of the total number of organisations operating within the mandatory medical insurance system. The number of institutions due to conduct major repairs increased by 105, and the number of purchased equipment increased by 37.5% or by 97,000 units due to economised tenders.    

Of 288,300 units of purchased equipment, only 16% units costing 18 billion roubles were produced in Russia. Taking into account the adoption of standards for equipping medical institutions, standard procedures of medical assistance, and taking into account the efforts to create an understandable and sustainable demand for medical equipment, jointly with the Ministry of Industry and Trade, we have now begun large-scale work on developing additional measures for a further increase of the proportion of Russian producers on the medical equipment market. By 2013, the total funds of state and municipal healthcare institutions grew by 60% on 2011, from 7,700 roubles up to 12,900 roubles per square metre of floor area of a facility.     

Under the concept of creating a Unified State Information System, nine basic services have been developed in the healthcare sector. In late 2012, all regions received the ability to use these services, to have local control over medical activities and to conduct statistical recording. By early 2013, the number of computer equipment units in medical institutions increased by 1.65 times. Two hundred eighty thousand computers were supplied. Before the launch of the modernisation programmes, computer programmes had been used fragmentarily and only in a few offices. To date every institution creates its own network and forms a common information space. The number of local network ports increased from 300,000 to 930,000 – they more than tripled. And the number of units of equipment making it possible to hold telemedical consultations and conference calls has more than quadrupled. On December 1, 2012, an electronic appointment with a doctor on the website of public and municipal services was launched. To date, 3,920 healthcare institutions have introduced this service.       

It was important for the healthcare sector to equip ambulances with the GLONASS system, which reduces the period of transporting a patient to hospital and makes it possible to monitor the route of the ambulance; at the same time, GLONASS makes it possible to provide distant consulting, including with images, and to transmit electrocardiograms. Currently 19,302 ambulances and 2,552 first-aid stations are equipped with GLONASS.   

Modernising the healthcare institutions enabled us to introduce, on a pilot basis, 98 standards of medical care for the most fatal diseases. An average 20 standards , on a pilot basis, were introduced in every region. More than 12.3 million patients at over 80% of medical institutions within the mandatory medical insurance system have already received treatment in accordance with these standards. This allowed us to increase doctor’s salaries at these institutions from 32,000 to 37,700 roubles (17.5%), and of mid-level medical personnel from 18,600 to 21,600 roubles (16.1%). The range of measures aimed at making outpatient medical care more accessible, including specialised primary medical assistance, has allowed us to increase salaries for primary level doctors from 28,500 to 33,100 roubles (16.1%), and of mid-level medical personnel from 17,400 to 20,000 roubles (14.9%).

I must point out, however, that not all the regions have been equally successful in implementing the modernisation programmes even though they have themselves designed and defended them. Slide 11 shows the most successful regions, and those that are behind schedule in implementing the programmes. The main aim of the regional healthcare modernisation programmes is to improve the performance of the healthcare system in general and above all to reduce the mortality rate for the main groups of diseases. During 2011 and 11 months of 2012, compared with 2010, the fatality rate from cardiovascular diseases dropped by 9.5%, including a 13.9% decrease from diseases involving brain blood vessels, 19.6% from tuberculosis, and 1.7% from malignancies. Overall, the mortality rate dropped 6.3% from 14.2 to 13.3 per thousand within two years. Thus, 130,000 lives were prolonged. Against the background of the continued increase in the birth rate (by almost 135,000), a natural population decrease was replaced by an increase of about 4,600 in 2012.

It’s important that the patients too have noticed improvements in the quality of medical care. During the past two years insurance companies have conducted surveys of the insured within the mandatory medical insurance (MMI) system that revealed that the percentage of people satisfied with the quality of medical care rose from 53% to 72% in December 2012. Thus, the modernisation progammes have laid a solid foundation for the regional healthcare development programmes to 2020 that are being worked out and for the further improvement of the organisation of healthcare in the regions.

When the issues of modernisation were discussed, it was decided to allocate 50 billion roubles out of the MMI system’s reserve fund to modernise healthcare in 2013. Therefore, as Mr Medvedev has noted, our main tasks are to complete the measures envisaged under modernisation programmes for 2011-2012 in the first half of the year, to implement the 2013 modernisation programmes on the basis of the road map currently being developed to enhance healthcare efficiency and the regional healthcare development programmes to 2020 and the list of measures with a special emphasis on improving medical care for children and during rendering obstetric aid. We will submit 83 packages of measures to improve the human resources policy, on schedule.

Thank you.

Dmitry Medvedev: Thank you. Please be seated. Who would like to comment on the report?

Mikhail Abyzov (Minister of the Russian Federation): Mr Medvedev, esteemed colleagues. Regarding item 3 of the draft decision, I think it would be practicable, since we are talking about creating a unified state information system, to combine it with the open data concept being developed by the Government for 2013. So I think it would be appropriate to add the Ministry of Telecommunications (I will seek the Minister’s opinion on this matter) and myself as the officials responsible for the implementation of item three. I would like you to make a note of the fact that the report on the fulfillment of the programme which, according to Veronika Skvortsova, costs 704 billion roubles, and that  the money mentioned by her was used in less than during18 months because the main tenders were held in September 2011… The rate of use of the allocated money is quite high and the submitted data on the results of using that money include several tens of thousands of parameters and figures. Of course it is impossible to monitor efficiency based on these rafts of numbers and one would like to see a more simple system of indicators by which the effectiveness of the funding on such a socially sensitive issue could be measured.

Dmitry Medvedev: Thank you. I think we might look at the minutes. What else? Are there anymore comments? No questions? Very well. The proposed decision on item one is adopted. I would like to hear from our colleagues. Vyacheslav Nagovitsyn (Head of the Republic of Buryatia).

Vyacheslav Nagovitsyn: Thank you, Mr Medvedev. Esteemed cabinet members. As of 1 January 2013, the Republic of Buryatia has spent 91.4% of the allocated sum. Thanks to the healthcare modernisation programame cardinal changes are taking place in the Republic of Buryatia and the efficiency, quality and accessibility of medical care is growing. In the last two years alone the healthcare system has received more than 2,000 units of medical equipment. Major repairs have been carried out at 37% of healthcare facilities, including 80% of inpatient centres, 40% of the polyclinics, and 42% of the outpatient centres. All the polyclinics have introduced online appointment systems, video conferencing facilities and are in the process of introducing an electronic medical card. To this end a regional data processing centre has been set up. All the ambulances in the republic are equipped with the GLONASS system. Forty-six medical care standards have been introduced, a new remuneration system envisages incentive pay for high quality and efficiency. As a result, wages in the healthcare system have increased significantly in 2012. Doctors’ salaries increased  by 60% by the end of 2012 and those of mid-level personnel reached 85% of the average wage in the Republic of Buryatia.

The results of healthcare modernisation are very visible in our republic. The natural population decrease recorded at the time the modernisation programme was launched, has been replaced with a natural increase of 4.9 persons per thousand. Life expectancy has increased from 62.4 to 66.1 years – in fact we have presented our people with four extra years of life. The birth rate has increased by14%  and it’s  17.4 per thousand now. This result has been achieved through a package of measures, including those of a social nature. Simultaneously with the growth of birth rate, the fatality rate from socially significant diseases has dropped. The overall fatality rate has thus dropped to 12.46 per thousand, which is 7.5% below the average for Russia.

Mr Medvedev, special thanks to you from our mothers for modernising the maternity and child welfare service. Under that programme, the republic has a three-tiered system of medical assistance for mothers and children. The infant mortality rate in 2012 stood at 8.5 per thousand. Maternal mortality dropped to 6 cases per 100,000 live newborns, which is almost three times less than the average for Russia. Much of the credit for this should be attributed to the fact that 27% of maternity homes and 24% feldsher-midwife stations (FAPs) in Buryatia have been refurbished and a centre for the medical and social support of pregnant women was opened.

Nevertheless, we have not solved all the problems. We have been nursing babies weighing 500g, however, the republic does not have a perinatal centre with the second stage of the nursing, and the whole operation is housed in a converted building dating back to the 1960s which of course falls short of the requirements. I would like to ask you, Mr Medvedev, if possible, to include in the state programme of healthcare development the building of a perinatal centre in Buryatia in 2013. We have the land and the project documentation.

Mr Medvedev, because the responsibility for primary medical assistance has been delegated to the regional level, the republic is building up a vertically integrated healthcare system. It is no secret that when healthcare was under municipal jurisdiction every municipal head tried to control it and adapt it to the needs of the district, oblivious to the fact that the exact same facilities existed in the neighbouring district. Therefore the challenge today is to create new healthcare districts consisting of inter-municipal diagnostic centres in combination with a network of general practice centres within walking distance of the local population and not tied to the administrative boundaries of the district. This issue is particularly important for sparsely populated areas. We have the necessary number of properly equipped diagnostic centres but we are woefully short of general practice centres. The republic has built 74 offices where 99 general practitioners are working, but to provide enough family doctors in accordance with the Healthcare Ministry directive of 15 May 2012, we need to build 92 more offices for 101 doctors.

Considering the critical importance of the issue, especially for rural areas, we are asking you, Mr Medvedev, to consider the possibility of building general practice centres either under a separate federal programme or as part of the Healthcare Modernisation programme. As you know, under the programme we are allowed to build feldsher-midwife stations (FAPs), but not general practice centres, so we are unable to complete this vertical structure. The solution of that issue along with the Local Doctor programme would solve several problems at once. First, it would make healthcare very accessible, second, it would provide the healthcare system with personnel, and third, it would optimise the structure of the healthcare system and make it more efficient. Medical personnel is another problem. The Local Doctor programme has proved to be highly effective: during 2012 alone 332 doctors moved to rural areas, but at the same time 86 practicing doctors have left the cities. The republic is very short of doctors, and yet Buryatia does not have a medical school, and because of our harsh climate and remoteness from the western part of the country, we cannot expect more than 10-15 graduates of higher medical education institutions from other regions to come to the republic every year...   

Viacheslav Nagovitsyn: …So I would like to ask you, Mr Medvedev, to issue instructions to the Education Ministry to address, jointly with the Healthcare Ministry, the task of providing the requisite equipment and opening a medical institute under the auspices of Buryat State University.

Finally, I would like to once again convey our deep thanks to you, Mr Medvedev, and to you, Ms Skvortsova, on behalf of all the citizens of the Republic of Buryatia, for the very real care that the Government of Russia and the Healthcare Ministry are showing with regard to the people. Thank you.

Dmitry Medvedev: Thank you. Mr Turchak, please.

Andrey Turchak (Governor of the Pskov Region): Mr Medvedev, esteemed colleagues. It is true that we are one of the problem regions in terms of demography. That’s why it is so important for us to be taking part in the healthcare modernisation programme. Our region clearly shows the main results of the programme as set forth in Ms Skvortsova’s report: it’s true that real conditions have been created for improving the quality of healthcare and making it more accessible. As of 1 January of this year the programme was 85% completed and as of today it is 91% completed. Just today a maternity ward at the regional maternity home was opened in Pskov. Speaking of targets, the programme for introducing standards has been 99% completed and of informatisation, 91% completed. We have not managed to complete all the planned repairs. Two facilities in Velikiye Luki – the surgery ward at the city hospital and a building at the city children’s hospital – have yet to be completed. Both will be finished in the first half of 2013.

On the whole, 58 healthcare facilities and 1,100 units of medical equipment have been repaired, and new standards have been introduced at the majority of medical institutions in the region. The regional programme enabled us to provide a 66% increase of the required equipment at healthcare institutions, and to provide 80% of necessary equipment for general practitioners’ offices (the figure was 40% when the programme was launched). We have increased the number of beds that meet all the standards by 4.5 times, that is, 92% of the total number of beds. These measures have allowed us to increase the number of polyclinic visits by 10% and the number of patients who have received high-technology assistance by 72%.

The regional programme was focused on raising the salaries of medical workers. The region introduced a new remuneration system in 2010. The programme’s remuneration targets have been met: the average monthly pay in 2012 was 16,500 roubles, while the target was 15,500 roubles. The real average doctor’ salary in 2012 was 30,000 roubles compared with the average wage in the region of 18,900 roubles. The region has introduced an additional social package for medical workers that includes the purchase of housing in rural areas, a relocation allowance and free treatment at sanatoria and health resorts. This slowed the drain of personnel, and we have seen graduates returning to us, although I must say that there is still a shortage of doctors in the region.

As a result of all the measures I have mentioned – repairs, equipment and new standards – for the first time in years we have a positive dynamic in the main demographic indicators. During the last two years the overall fatality rate dropped by 7% and the birth rate has gone up 6%, so the rate of population decrease has dropped from 16,700 to 11,800.

Opinion surveys have shown that 58% of the population was satisfied with healthcare service in 2012, which is 10% more than at the time the programme was launched.

In conclusion I would like to report our plans for 2013. For us, modernisation of ambulance services is a pressing issue. In 2013 we are planning to purchase 150 ambulances, including some for neonatal resuscitation, at a total cost of 230 million in regional budget money. We are prepared to develop airborne medical assistance. Considering the population distribution and the size of our region we are counting on the support of the Healthcare Ministry.

Maternity and children welfare service and care will be a particular area of concern in 2013. We have met our commitment to allocate over 25% of available funding to obstetric aid, and we have completed 100% of medical checkups for teenagers. A maternity home in Velikiye Luki has been reopened after an overhaul and another maternity home after an overhaul is being opened in Pskov.

The increase of the number of births is an important result of our work. In 2012, 7,274 babies were born, the highest number since 1995. At the same time infant mortality indicators have been unstable. Infant mortality was 6.2 per thousand in 2011, but rose to 9.8 in 2012 due to the adoption of the new recording criteria. We desperately need a new perinatal centre, we are currently working on this together with the Ministry. A parcel of land has been designated, design work is in the finishing stretch and expert evaluation of the project has begun. We would like to ask you, Mr Medvedev, to support us on this issue; it would give a big boost to our region. This brings me to the end of my report.

Dmitry Medvedev: Thank you. Any more comments? Ms Golodets, please.

Olga Golodets: The main result of our programme is that today the healthcare system is poised to move to a new standard of medical care. The material infrastructure, the equipment and the standards have been prepared for the delivery of modern medical services. But we have to keep in mind that, first, not all healthcare institutions are ready to deliver this assistance. We have accomplished a breakthrough and we are ready to take on the most challenging of tasks, but it has to be understood that we have covered only half of the journey. And secondly, we have a clear understanding of our problems because we have in effect carried out a diagnosis of the entire healthcare system and we are aware that the health indicators and vital statistics that we have can be significantly improved. Indeed, we should set ourselves more ambitious targets because we have all the necessary resources to meet these targets: to improve the situations with infant mortality, the rate of deaths in childbirth, the fatality rate from tuberculosis and all the other indicators listed in the programme.

However, we should dovetail our healthcare modernisation programmes with the goals set under the Healthcare Development national programme. We need to eliminate the discrepancies that exist. We should focus on the tasks set under the Healthcare Development programme and build up momentum. Because every year of decisions postponed means human lives: if we have reached new indicators, that means 130,000 human lives saved… I would like to urge the financial authorities to pay more attention to the problems of healthcare development.

Dmitry Medvedev: Thank you. Any more comments? If there are none I suggest that we approve the draft resolution on the implementation of healthcare development programmes in the constituent entities of the Russian Federation in 2011-2012 and the objectives for 2013. 


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Minister of Healthcare Veronika Skvortsova takes questions from journalists following a Government meeting

Question: Ms Skvortsova, speaking at a meeting with President Putin, you stated that healthcare workers’ salaries increased in 2012, and the average doctor's monthly salary is now 33,000 roubles, and the average nurse's monthly salary is 19,000 roubles. Federal Service for State Statistics' data for the past 10 months show that the average doctor’s salary is 22,000 roubles and the average nurse's salary is 13,000 roubles. What is the reason for this discrepancy?

Veronika Skvortsova: There is a discrepancy because Rosstat provides data only from a single government source. As for the executive order about increasing salaries, it includes all salary data from all sources. Thus, the information that we submitted to President Putin is accurate and reflects the state of affairs as of December 2012.

Question: What period did you mention?

Veronika Skvortsova: This is the average salary for 2012 compared with 2011, respectively. The average salary at pilot institutions working under Mandatory Medical Insurance standards was even higher – the average doctor's salary was 37,000 roubles and the average nurse's salary was almost 20,000 roubles. Each region has implemented over 20 standards on average. Thus far, 775 standards covering all major types of diseases have been developed and adopted. They will start being introduced in 2013 onwards, and we expect the salaries of doctors and nurses to rise steadily.

Question: What’s your forecast for late 2013?

Veronika Skvortsova: I mentioned our rough estimates during a meeting with President Putin. We would like the figure to be at least 7%.

Question: An executive order signed by the President to improve the living conditions of kids in children’s homes was recently released. Have any medical measures been included in this order to cure children of diseases? Perhaps, an expanded list of diseases or equipment?

Veronika Skvortsova: Not only did we plan a series of activities, but we have already started to implement them. We have drafted a Government resolution that extends the Ministry of Healthcare’s authority. Until now, the ministry could oversee only children who had been left without parental care residing in children’s homes and similar institutions. As you may recall, we have been keeping a register of such children since 2009. As of 2010, kids in difficult situations residing in children’s homes have also been entered into that register. We are conducting fairly large-scale annual physical check-ups, and the children see many specialist doctors. Now we plan to introduce a personalised record for each child – not only for kids residing in children's homes who are accountable to the Ministry of Healthcare and children residing in social shelters and boarding schools who are accountable to the Ministry of Labour and the Ministry of Education, but also for adopted children who live with their foster families. We have drafted four orders regulating the procedure for providing this new customised care and conducting annual check-ups to make sure that all children – even the ones who do not have a loving adult taking care of them – will benefit from these innovations.

Order No 3 focuses on improving healthcare, particularly high-tech healthcare. We have removed all of the restrictions to make sure there are no waiting lists for these children.

Order No 4 will provide some relief to foster parents. We have revised the list of diseases and pathological conditions that limit their ability to adopt children, although we will retain our control over all critical issues.

Question: We have heard the Buryatia governor say that his region needs 92 more general practice medical centres. He asked Prime Minister Medvedev why the regional authorities can open rural health posts but they cannot open these centres. Could you please comment on this situation? Is it true that the regions are not allowed to open general practice medical centres?

Veronika Skvortsova: First, all the regions have the authority to provide all medical services, including primary healthcare. However, the federal authorities are helping each region to do so, in particular by providing large financing over the past two years. I have already mentioned that over 45,000 small primary healthcare institutions, such as rural health posts, rural outpatient clinics and general practice centres, have been completely renovated and re-equipped. They have also been nearly fully staffed. I mentioned that the level of provision of primary healthcare in rural and remote areas has increased substantially. In the long run, we would like to see rural health posts gradually replaced with general practice medical offices.

If you ask me whether or not we still face problems today – of course we do. We have screened the healthcare systems in each region and identified all of the problems, and this is very important. We know how to overcome them. It will take some time for us to reach the standard that we have set for ourselves, but we are doing our best to get there as soon as possible.

Question: Does the “92” figure apply to all regions, or are things in Buryatia particularly bad?

Veronika Skvortsova: I will double-check these numbers. I have heard other numbers with regard to professional training and the need to establish another institute at the Buryat University. However, the university already has a licence to provide pharmaceutical training. Since the academic year that began in September 2011, they have been turning out 45 specialists each year... In addition, more than 350 places were allocated to the region to target-train various specialists. Students from Buryatia are pursuing their studies in 11 medical schools. The real problem is that only 75% of graduates can find jobs. The regions and the ministry should encourage and motivate young professionals to stay in their home regions and to take local jobs.

Question: While we are at it, may I ask you a question about young professionals? Could you tell us more about the Rural Doctor programme? What was the outcome for 2012? What do you expect this year? Will you keep working on it? How many graduates went to work in rural areas?

Veronika Skvortsova: Nearly 8,000 professionals under 35 went to work in rural areas during the past period. They will stay there for several years under the contract. One million roubles is a lot of money. They have a house and all of the necessary amenities, a high social status, and a noble service, which is also an important moral component.

The programme will continue this year and extend to industrial communities. We will implement it in conjunction with the regions. This is important because a number of regions complained that certain unscrupulous specialists receive social assistance and social benefits in one region and then migrate to another. In order to control this process, the governors decided to get the regions involved in this process during their meeting in the North-Western Federal District. We hope that this will effectively resolve the issue.

Question: Does one million roubles come from the federal budget?

Veronika Skvortsova: It is provided jointly by the federal and the regional authorities.

Question: How many specialists do you hope to get on-board? There were 8,000 over two years. How many more can you get?

Veronika Skvortsova: We hope that we will at least maintain this pace.

Question: I learned today that the list of companies authorised to deal with maternity capital will be revised because many of them engaged in fraudulent activities. How pervasive is this fraud? What is this list all about?

Veronika Skvortsova: I believe that the Minister of Labour and Social Security is better positioned to answer this question. That is not my area.

Question: How will the Seven Nosologies programme be funded this year? Are there any plans to add other nosologies?

Veronika Skvortsova: You remember that the programme cost was 52 billion roubles in 2012. It will not decrease this year. All of the guarantees provided in 2012 will remain this year.

As for the very important issue of expanding the list, the ministry drafted a special registry last September to cover all patients with 24 specific diseases that fulminate and require expensive treatment. Today, all of the regions except for seven have prepared the required papers and submitted them to the ministry. We have contacted the remaining regions, and we hope that they will do the same within a week and a half or two weeks. This will allow us to get a better idea of the country’s medical requirements for treating these serious diseases. Depending on the information that receive, we will then deal with the issue of expanding the list.

Typically, patient organisations mention mucopolysaccaridosis, especially of Type I and Type II. I would like to note that we have several patients with this disease. Our registry – which again does not include those seven regions – has 150 patients. Depending on the form of the disease, treatment per person costs from 35 million roubles to 150 million roubles and sometimes even 200 million roubles per year. To provide 150 people with all of the required medicine, the state would have to pay over 2 billion roubles per year. I do not mean to say we will not do this. My point is simply that taking a decision in this regard requires great responsibility.

Once we conduct the required analysis, we can think about what needs to be done and make a balanced decision.

Question: Your report contained horrifying figures linked with standard medical examinations of teenagers. Of every 2 million teenagers, 1.5 million were treated for first-diagnosed disease. I have two questions in this regard. First, what are these diseases? Do we have any statistics on them? And second, maybe it makes sense to start having a standard medical examination earlier and to reform paediatric consultation?

Veronika Skvortsova: Indeed, we held a standard medical examination of over 2.3 million 14-year-olds and 55% of them, or about 1.3 million, had a disease. They had locomotor problems, gastro-digestive diseases, which were widespread, and others. Both boys and girls had early sub-fertility problems.

We have drafted individual treatment programmes for every teenager, and we have already implemented them for over 1.5 million children, including some who had been sick earlier. We will complete this work in the first quarter of 2013 on all of the teenagers who were diagnosed in 2012. This is not a random check-up. This January, we launched an annual standard medical examination of all of the children in all 83 regions. We have compiled an individual programme for each age group because each age group requires different examinations conducted by different specialists. An examination for a one-, two-, or three-year-old is different from an examination for a seven-, fourteen-, or fifteen-year-old. All children will undergo a medical examination before reaching the age of 18.

The main point here is that we hope that we will manage to keep the examination informal in cooperation with the regions. It should not end with a disease being diagnosed, and should only be considered over when the child has been cured of the disease and placed under observation if there are any risk factors. Only in such a case, we will be able to substantially improve the health of our children.

Question: You stated yesterday that you will restore the Red Cross in an effort to promote donations and make up for the lack of paramedics. What measures are you going to take and when are you going to take them?

Veronika Skvortsova: We are working actively on this issue. In our huge country, with many religious beliefs, we need a powerful organisation like the Red Cross and the Red Crescent. We need such an organisation if we plan to build an effective healthcare system involving all of civil society, and if we want to teach our entire population to be responsible for their health and the health of their children, their spouses, their parents, and so on.

I should note that several decades ago, our Red Cross was the strongest in the world and set an international precedent. It had the right to train nurses and made a large contribution to the donor movement. I am referring to the handling of blood, plasma, and blood components, to sanitation and epidemiological work, and also to the promotion of a healthy lifestyle. This is why we need the Red Cross, and we hope to make the organisation much stronger in the near future.

Question: What exactly do you plan to do? What measures will you take?

Veronika Skvortsova: We are working in this regard already and we will by all means tell you about them when we are ready.

Question: Donors are no longer paid for their services. Aren’t you afraid that this will lead to a blood shortage?

Veronika Skvortsova: No, we are not afraid because this is the only civilised way to develop the donor system. We will preserve payments in certain cases, primarily for rare blood types and special methods of obtaining blood cells. This applies to immune donors that need to be prepared to donate blood over a lengthy period, as they have to develop an immunity to be helpful to others. We will keep payments in such cases. A list will be revised and endorsed by the Ministry of Healthcare.

As for the donor movement, donorship must be voluntary. We should now allow ourselves to fall victim to biological prostitution. Bio-medicine will develop fast and cell, tissue, and organ donation will soon become topical. Many countries are adopting a system for coding the population using special histotypes. This is a very sensitive subject that is linked with ethical norms and so on. I think that we should devote a separate news conference to this issue, as it would be interesting to everyone. The attitude towards donorship should be… It should be voluntary, but it requires moral incentives and the health of donors should be kept in good shape. They must receive the best nutrition and sufficient rest on the day they give blood.

Question: How much funding has been allocated to regional modernisation programmes this year?

Veronika Skvortsova: Fifty billion roubles. We have extended the directions of the modernisation. In 2011-2012, we worked towards finishing the construction of projects that had ceased at the 80% mark. We held major repair and re-equipment activities and also carried out personnel policy measures. This year, we allowed buildings to be constructed while taking notice of the issues that were uncovered over the past two years and the high wear and tear. This is why we have made leaps forward. Today, I reported that we have increased our fixed state assets by 60% over the past two years, but we haven’t yet fully removed the wear and tear.

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