Russian government attacks public health system
24 June 2013
The Russian government is pushing through massive cuts and privatisation in the health care system. The country’s health care system is already starved financially. Health spending in Russia represents just 3.4 percent of gross domestic product (GDP). Now, this is to be further reduced. According to announcements made last year, the state budget for 2013-2015 envisages reducing health care spending by from 506.5 to 373 billion roubles.
The assault on health care comes alongside deepening attacks on public education, where the imposition of austerity measures means that one in five colleges and 30 percent of high schools are to be closed due to “inefficiency”. Layers of the ruling elite have also long eyed Russia’s pension system as a target for cost saving. Last week, Putin called for tightening the country’s fiscal policy.
The planned cuts to the health care system and other social benefits are deeply unpopular. In a poll by the Levada Centre in 2012, most respondents reported that the miserable state of the health system was the country’s main problem. Across the country, demonstrations, strikes and hunger strikes by thousands of patients, doctors and nurses against the closure of medical facilities, wage cuts and the elimination of free health care have taken place in recent months.
In many cities, public health facilities have been privatised since the beginning of the year. In May, Moscow announced the partial privatisation of one of the city’s main hospitals. Forty percent of hospital facilities now belong to the city, while 60 percent were sold off to a private investor, where services will be provided for a fee.
The Russian daily Gazeta.r u reported that the share of facilities held by the private investor is expected to increase. The Moscow city government has already stated that this privatisation is only the prelude to a comprehensive restructuring of the city’s hospitals.
At the same time, departments are being closed in state hospitals and maternity facilities nationwide. Rural areas in particular are affected. For example, in the central Russian region of Yaroslavl, departments have been closed in dozens of maternity centres. In many villages and small towns, pregnant women are without any medical care. Due to the collapse of the infrastructure since the 1990s, the nearest cities for villagers are hard to reach. For pregnant women or the sick, in particular, it is all but impossible to travel long distances on the poorly maintained roads.
Since the beginning of the year, as part of the “restructuring” of the health system, the payment of medical staff has been outsourced from the state budget and delegated to region governments. The result has been wage cuts and staff reductions. In many regions, doctors and nurses saw their wages slashed by up to 10 percent at the beginning of the year.
While the Ministry of Health has set a minimum salary of 33,000 roubles (about €775) for physicians, a doctor from a town near Moscow who participated in the April demonstrations reported that he now receives only 15,000 roubles (€350), plus 4,000 roubles (€94) as a bonus, after 30 years of service.
The impending cuts to the health care system will also exacerbate the already serious shortage of specialists in medicine. The Ministry of Health said it lacked some 152,000 workers last year.
Legally, a free health care system still exists in Russia. In truth, however, there is a two-tier health system, in which only the upper middle class and the wealthy can afford access to appropriate medical treatment. Many state hospitals have been privatised since the collapse of the Soviet Union, and those that remain are largely inaccessible to the majority of the population. At the same time, state-run clinics are overcrowded, their staff underpaid and their technical equipment obsolete.
In parallel with the free treatment supposedly provided in public hospitals, patients can purchase additional services. According to a survey by the ROMIR Centre, last year 65 percent of all Russians paid for medical treatment and 20 percent paid their doctors “informally”. The services offered by state institutions are usually so bad that payment is unavoidable, with patients seeking treatment in private institutions in cases of serious illness or rare diseases.
Moreover, access to medicines is often extremely difficult, if not impossible. In Moscow, following the latest cuts, only 50 percent of the required medications for patients at public institutions will be available. Currently, drugs for patients suffering from rare diseases are simply not available. Overall, Moscow lacks an estimated 6 billion roubles (€141 million) needed to meet the existing demand for medications, according to the city’s health department.
The cuts and privatisation are exacerbating a vicious circle that has been developing for years: The new privatisation measures will worsen health care in the remaining state institutions, which are diminishing in number, and at the same time, generally push up prices for medical care. For many people, hospital stays and treatment are no longer affordable. At the same time, salaries for medical staff continue to fall to the level of hunger wages, so that doctors and nurses are forced to take “informal” payments from patients merely to be able to survive.
The aim of this policy is to eliminate free health care. Given the prevalence of poverty in Russia and the precarious financial position of many more, this means denying access to medical care for the vast majority of the population.
The destruction of the already dysfunctional health care system is especially dramatic given the poor level of health of the population. Decades of brutal poverty and social attacks have ruined the health of a large part of the population. A survey by the Moscow Higher School of Economics reported 46 percent of respondents aged 15 years and older were chronically ill. Between 1990 and 2010, the overall sickness rate increased continuously year over year. Only since 2010 has there been a slight decline.
The illness rate is higher the younger the generation. In 2008, only 10 percent of Russian children and adolescents were perfectly healthy, according to the online Russian medical journal Medcom. Overall, the mortality rate is 1.4 times higher than the EU average, and life expectancy for men is lower than in third-world countries such as Bangladesh and Algeria. The Moscow Higher School of Economics also found that among the working-age population, the probability of dying is almost twice as high as in Europe. Since the collapse of the Soviet Union, the number of cases of mortality due to curable diseases (nutritional deficiencies, infections or parasites) has risen. For men, the number of such cases has doubled since 1990 and tripled in women.
Miserable working conditions also contribute to the high death rate. According to official figures, about one third of all employees are in jobs that do not meet minimum safety standards.
Living conditions for the population have deteriorated dramatically as result of the social counter-revolution of the last two decades. According to Medcom, half of Russia’s 140 million people in 2008 had no access to clean water, and a large part of the working population cannot afford a healthy diet. Fresh vegetables, fruit, fish, milk and meat are a luxury for many.
Official data indicate that almost 1 percent (0.8) of the population between 15 and 50 is HIV-positive; last year alone, the incidence rate increased by 12.5 percent. The mortality rate for HIV patients in 2012 grew by 14 percent. Tuberculosis has also spread enormously. In the last 15 years, the number of tuberculosis cases has more than doubled. Russia is ranked 13 in the world for countries with the highest levels of tuberculosis.