The law on mandatory medical insurance was recently adopted, bringing to an end the so-called ‘patient bondage’ in Russia’s healthcare system. Formerly, someone in need of medical care could not freely choose a doctor but had to apply for medical assistance at the healthcare institution in the district where he/she was registered. Today, whilst the mandatory insurance policy is valid throughout Russia, the implementation of the new regulations requires some additional measures.In the past, residents of one region could not obtain medical assistance in other areas because inter-territorial payment schemes were not adjusted. Healthcare funding was not sufficient in ‘poor’ regions, which means that, for their residents, medical treatment in a clinic situated in a ‘rich’ district of Russia was not affordable.
According to Deputy Minister of Healthcare and Social Development, Veronika Skvortzova, the new law will abolish these differences in healthcare funding. Moreover, it will introduce unified quality standards for medical care. The standards were drafted on the basis of clinical protocols and guidelines and present principal elements mandatory for healthcare in defined profiles. A standard allows evaluation of the costs of medical care on a minimum/maximum scale and the definition of an average. Officers in the Ministry of Healthcare affirm that the above mentioned measures for the first time will enable them to calculate the actual funding requirements of Russian healthcare. It has always been common practice in Russia to finance public healthcare from budget leftovers and the estimates by healthcare officials were based chiefly on the amounts allocated by the government. The new legislation also aims to remedy numerous problems that have accumulated in the Russian healthcare sector during the past 18 years. For example, finally pharmaceuticals might become available for patients suffering from ‘orphan’ diseases. Furthermore, the law will ban euthanasia and it includes a presumed consent provision for organ donation.
The bill also proposes physicians’ accreditation to improve the quality of care. Nearly every single provision of the proposed law provoked controversial public debates. Professional associations of physicians, for instance, expressed their discontent with the mandatory accredita-tion at the Ministry of Healthcare and Social Development. At the same time, the most essential problem of Russian healthcare is not solved: insufficient funding. The funding gap expected for the coming years is estimated at 20-25% of the budget. The members of Duma, who are now debating the bill, have many issues to consider. The parliamentary working group is expected to meet daily.