The real Russian revolution
It occurred in Russia’s medical world at the end of 2010, some experts say, but then they add ‘It’s only a paper revolution’. EH Correspondent Olga Ostrovskaja reports
Two serious new laws were passed at the end of 2010, one regarding obligatory medical insurance the other the ‘83 Federal Law’, which changes the rules of State regulation of the social sector. Some experts believe that the 83 FL will be the death warrant for accessible education and healthcare in Russia.
This law suggests a division into three parts of all social services -- schools, universities, hospitals and cultural institutions must become Government (funded by the State), Budgetary (funded by the state and patients) or Autonomous (with economic and organisational freedom).
The law’s authors try to create a system in which money follows the person -- a good physician, for example, will have many patients, whilst a bad doctor will run out of patients; a good, modern hospital will gain many patients, an out-dated one will close.
‘Thus the State seeks to optimise the social accounts,’ experts point out, ‘but there is a huge danger that Russia will have many ruined hospitals because many people’s health is bad and income is low. As a result, many Russians could find themselves without healthcare assistance, especially in rural areas.’
Unfortunately this very important law provides no instructions as to how an actual institution could decide the shape of its future. However, 83 FL came into force on 1st January this year and the process has begun.
Every region has reorganised according to how its leaders have understood their tasks. Altai has declared that every regional medical institution will remain government. Tatarstan, on the contrary, announced the Republic’s hospitals will be autonomous.
Additionally, the first order to be prepared by Ministry of Finance appeared only in January, after the New Year holidays. Also, the Ministry of Health and Social Affairs has prepared several small bills, one of which is about the statement of an order of definition of a payment for medical services concerning the principal aspect of a hospital’s ‘activity’. This is a most difficult and old problem: Every government medical institution has received patients’ money but no law has ever been accepted by the Russian government about this!
Nevertheless, the second law - obligatory medical insurance – has raised medical tax from 3.1% to 5.1%, by which the government plans to gain an additional 230 billon roubles. These billions are to be spent on the modernisation of hospitals and clinics, the development of information technologies and the creation of medical standards. Though, these ‘State dreams’ could become reality if Russian business will be good and the enterprises will be able to pay all the tax.
However, what if the money for a hospital’s development is absent? The new 83 FL permits the sale of equipment -- and even buildings -- to some private person. Thus a government institute could become a private clinic. It looks like the non-apparent ‘revolution’ could become a serious reform of Russian medicine.
22.02.2011
