Автор:
Дата публикации: 03.09.2006
Источник: Russia Profile
According to official Soviet ideology, all medical care and education were supposed to be free and almost all individual payments to medical professionals were considered to be bribes. The situation has changed since 1991, though much of the Russian healthcare system remains public.
Polls show that the number of people who rely solely on public health services is declining. In a nationwide survey published by Rossyiskaya Gazeta, 49 percent of those questioned said that they had used private healthcare services at least once. Of those under 35, 62 percent had seen a private doctor. According to the polls conducted by the MosMedClinic research center in Moscow, 64 percent of people 25-34 years of age have used paid medical services. The small difference between Moscow and the rest of the country, where private medical services are not always available, may be explained by Moscow’s higher prices, which make private healthcare unaffordable to the elderly.
According to the ABARUS Market Research center, Moscow represents $1.2 billion, or 28% of the Russian market for private medical services. ABARUS notes, however, that this is only the “legal” market. If unregistered payments made by patients under the table are included, the size of the market would grow from $4.6 billion to $5.5 billion. The company stressed, however, that the estimate of this “shadow” market at the level of $1.3 billion can only be approximate, as these payments are never registered.
Not all paid medical services are provided by private clinics. According to MosMedClinic’s research, while private clinics provide the largest volume of paid services, state-owned local clinics (rayonnye polikliniki) and the clinics owned by various ministries and state companies (vedomstvennye polikliniki) also often require money from their patients for certain services. In fact, these formally state-owned institutions are in a privileged position compared with private clinics.
“The clinics owned by rich state companies do not have to pay all their utility costs, and they sometimes get the medical equipment for free or at half-price,” said Konstantin Chernikov, the head physician of the Meditsinskiye Uslugi private clinic in the center of Moscow. “We have to buy everything ourselves.”
Chernikov’s clinic is located in a building that formerly belonged to City Clinic 2, founded in 1928 and named after Nikolai Semashko, Lenin’s comrade-in-arms and one of the first Soviet health ministers. The clinic prides itself on being the oldest paid medical institution in Russia; some of its services were provided for money even during the Soviet period. Due to its longevity, the clinic provides a broad choice of services, and its doctors have learned to withstand tough competition from the state-supported clinics that still dominate the market niche of general medical services.
According to the estimates of the Association of Private Medical Clinics, 70 percent of private clinics in Russia provide dental care, 20 percent specialize in skin care, urology and gynecology and only 10 percent provide the general medical services of the type offered by Meditsinskiye Uslugi. In Chernikov’s opinion, his clinic is capable of sustaining competition with state clinics because of its polite approach to patients and the absence of corruption.
“I offered a job in our clinic to many doctors in state clinics whose official salary was much lower than ours, but they refused,” said Chernikov. “What does it mean? It means that the difference in salaries was probably compensated by the money they received from patients. In our clinic we fire doctors who are impolite to patients or who put patients’ money into their own pockets.”
According to the Rossyiskaya Gazeta poll, about one-third of Russians admitted to paying for medical services that are supposed to be free. Most of those polled blamed doctors, accusing the physicians of extorting bribes. The doctors themselves are more inclined to blame the system, which claims to offer a lot of medical services free while not providing enough funds for them.
“An official salary of, say, a children’s optometrist in a state clinic is just 2050 rubles ($76), which is less than the salary of a cleaning woman in a bank,” Olga Michudo, the chief physician of Children’s Clinic 3 in Chita, wrote in the Argumenty i Fakty weekly. “If we divide this amount of money by the number of patients a doctor is supposed to treat, a child’s visit to a doctor would earn him slightly more than 2 rubles, which is about $0.08. Meanwhile, even the cheapest haircut costs about 32 times more than this amount. And don’t forget to compare the time that a hairdresser and a doctor spent on their education.”
Insurance payments, which provide the bulk of clinics’ revenues in other countries, are still underdeveloped in Russia. Private clinics have access only to the funds of the private insurance companies that operate in the framework of the Voluntary Medical Insurance Program (DMS). Meanwhile, all Russian citizens are supposed to benefit from the Obligatory Medical Insurance Program (OMS). These funds, however, are distributed by the local authorities, which often tend to make the use of OMS unprofitable for private clinics.
“The state estimates that a 24-hour-long stay in a clinic like ours costs 120 rubles ($4.50) and offers me this amount from the OMS funds if I put this patient in my clinic,” said Nadezhda Alexeyeva, head of the private Cardio Clinic in St. Petersburg. “But this is laughable! I need at least 700 rubles for this kind of service in order to stay in business. If I charge a patient the remainder, the state excludes me from the OMS program. What we need is to defend a patient’s right to use his OMS as a part of his payment to a private clinic and to pay the rest from his pocket.”
“I do not have any dealings with private or state insurance,” said Meditsinskiye Uslugi’s Chernikov, reflecting a deeper problem of private clinics, which rely mostly on their own financial resources instead of insurance payments in order to maintain their profit margin of 10-20 percent.
At the moment, medical professionals continue to put their hopes in the state, which promised to increase the overall financing of health care by 60 percent next year. The Association of Private Clinics of St. Petersburg decided not boycott the national project for healthcare, suggesting that the project might put the OMS funds to better use.
“The modernization processes should involve both the state health care system and the medical services provided by private companies,” said First Deputy Prime Minister Dmitry Medvedev, who is also responsible for the implementation of the national projects, at a meeting of the G8 health ministers this summer. “The state has allocated some very decent amounts of money for this. In earlier epochs, the same amounts of money were never even earmarked.”