Healthcare is a major hot-button issue in the United States, most particularly among the socialist-minded and liberal ideologues in the country. They have often gone on record decrying the United States’ refusal to grant free healthcare as a right to all citizens, and often the best-looking models of socialist western nations, such as Sweden, are brought to represent examples of such systems working.
While the Internet is full of horror stories about Russian healthcare and hospitals, to assess that the whole country is a medical hellhole is simply ridiculous. Many facilities are in fact state of the art inside, even while the edifices of many hospitals could definitely use some remodeling. However, to the mind of many in Russia, what is inside the walls is far more important than the exterior facade. An average hospital in Moscow built in the Soviet times, now has modern equipment, computer networked records that are very efficient, and beautiful churches (yes, churches!) for both patients and visitors to pray and reflect in.
President Putin’s State of the Nation address discussed the matter of healthcare in Russia, and while it is true that there are elements of what we might call “socialized medicine” in the system, this is largely a misnomer. Healthcare is provided at various levels, but it is not free to the public. This is a part of the socialist myth that is promulgated in the West, and as far as a country like Russia is concerned, it is simply not true.
However, it is the truth that healthcare services in the Russian Federation are also nowhere near as expensive as in the USA, and the quality and technology available in many hospitals is remarkably consistent with the best of 21st century standards. Health insurance is very inexpensive, running on the order of perhaps less than US $700 per year per person in some cases, yet Russia is working on special medical complexes where the most advanced experts – doctors, surgeons and the like – in the world may come to work.
As we examine this part of President Putin’s speech, we may find some interesting surprises. The socialists in the US are apparently not aware of the enormous difficulty in revamping a national medical system away from the blend of market and frankly, legal, forces governing the triad of industries involved in American healthcare: the doctors and the medical practitioners themselves, insurance companies, and attorneys.
As long as they refuse to examine this issue honestly, socialists in America will only make an already burdensome and expensive system worse. President Obama did precisely that, while spinning a massive lie about the easing of costs that would come under his plan.
Russia is doing it differently. As we can see from the President’s speech, there are problems, but there are also solutions and progress:
The next important subject is healthcare. I know that, on the one hand, its current state seems to be improving, and medical treatment is becoming more accessible. Nevertheless, many people are not satisfied. It is easy to understand the reasons for this. As a rule, people judge the healthcare system by its primary component, that is, outpatient clinics and paramedic stations. People voice complaints with regard to their work. Quite often, they have to wait many days to see a specialist, and it is impossible to quickly undergo the required tests free of charge. People in remote communities are even having trouble getting appointments with medical personnel. Yes, the number of paramedic stations and mobile medical units continues to increase, but people in areas where there are no such facilities care nothing about the overall statistics.
I want to emphasise that medical treatment should become accessible for everyone by the end of 2020 in all populated areas across Russia without exception and for all citizens, regardless of their place of residence. For your information, an additional 1,590 outpatient clinics and paramedic stations are to be built or renovated in 2019–2020, and I hope that this will be accomplished.
Today, a number of regions are implementing the Thrifty Outpatient Clinic project. As a result, the waiting time to get an appointment and see a doctor is reduced three or four times over, on the average. I have visited such outpatient clinics, and they are operating very well. Much better conditions are created for people with disabilities and for parents with children. Unfortunately, there are very few such outpatient clinics so far; they are rather an exception than the rule all across the nation.
Considering the best regional practices , and, I repeat, there are such practices, I hereby instruct the Government to approve the high standards of thrifty outpatient clinics by the end of the year and their certification regulations. Next year, you have to team up with the regions to introduce mechanisms incentivising managers and medical personnel to improve the quality of their work. First of all, we have to completely convert all paediatric outpatient clinics to new standards already in 2021. Please note that the sign “Thrifty Outpatient Clinic” is not what counts. Most importantly, people should at long last perceive the state’s respectful and truly considerate attitude towards their health.
Improving IT penetration in healthcare will make it more accessible. Online links between medical institutions, pharmacies, doctors and patients must be streamlined over the next three years. Let me add that social security medical assessment boards must be finally included into this digital network in order to free elderly people, people with disabilities and families with children from waiting lists and the need to produce various certificates that are often useless.
Primary care is understaffed. To address this matter, comprehensive efforts to develop medical education should be accompanied by initiatives that produce immediate results. In this connection, I propose removing age restrictions for the Country Doctor programme so that professionals over the age of 50 can also receive a one-time payment when moving to a rural area or a small city: 1,000,000 rubles for doctors and 500,000 rubles for paramedics.
The most complex surgery is currently performed not only at federal, but also at regional clinics and centres using the most advanced equipment. At the same time, patient recovery is also critical. We have never had a system of this kind, but we have to start with something. A lot has to be done in this area. Let us begin by creating at least two world-class recovery facilities for children, just as we did with perinatal centres, and proceed from there.
This next section is interesting in that it seems to echo US President Donald Trump’s own identical call to fight cancer:
In my last year’s Address, I proposed a programme for fighting cancer. At least 1 trillion roubles will be allocated to this effect over the next six years. This is about providing timely, effective and accessible treatment, using advanced technologies that are effective in most cases and enable people to overcome this dangerous disease. Today, the leukaemia recovery rate for children exceeds 80 percent, and for certain types of cancer, more than 90 percent of patients recover. Not that long ago, in the mid-1990s, this disease was almost untreatable and only 10–20 percent of children could be saved. Russia lacked both the technology and capabilities at the time. In many cases, the only option was to turn to foreign clinics. Those who could afford it did so.
We were aware of how tragic this situation was, which prompted us to focus on improving cancer treatment for children, developing oncohaematology, using the capabilities offered by our research institutions, the healthcare system, and worked proactively with our foreign partners (some doctors simply moved from Germany to Moscow, and spent a lot of time here, and probably still do), which yielded results.
We will continue working to overhaul the system of cancer care. Early detection is of crucial importance. In fact, we have revived the system of health screening and regular medical check-ups. These have to include cancer screening. It has to be made obligatory. People must have the opportunity to make appointments remotely, to choose a suitable time for visiting an outpatient clinic, including in the evening or at the weekend, so that the check-up can be carried out without any additional formalities.
Next, over the next few years we must create a number of new areas combining healthcare with social services. Thus, we must overhaul the system of assistance for people who need long-term help at medical facilities or at home, adjust this system to the needs of specific families and individuals, support people with their everyday needs by assigning district nurses or carers, or training relatives in medical or other necessary skills. The application of these recipient-oriented principles of assistance began last year in Volgograd, Kostroma, Novgorod, Pskov, Ryazan and Tula regions. We must introduce them throughout the country within a timeframe of four years.
Palliative care is a matter of not only medical but also of social, public and moral concern. According to the available information, some 800,000 people need this assistance, and volunteers have told me that the figure is around one million. As you know, in January I visited a children’s hospice in St Petersburg, where we discussed this matter. I know that yesterday the State Duma adopted in the second reading amendments to the legislation on palliative care. I would like work on this law to be completed as soon as possible. We will then monitor its application so we can promptly make amendments, taking into account the opinions of volunteers, whom I have mentioned, doctors, carers, members of the public and religious associations and benefactors, that is, everyone who have long been providing heartfelt palliative care.
To conservatives in America, this probably appears a great deal like the feared and ridiculed “nanny state” of socialism as Americans have been taught to see it. While there are certainly aspects of socialism in play here, Russia is not trying to advance the ideological banner of socialism; rather, it is trying to deal with the reality of life “on the ground,” and some of the mechanisms that are in place now are derived from not only the Communist model, but even from the Imperial models of Tsar Nicholas II that preceded communism.
It is perhaps important to note that nowhere in President Putin’s speech does he talk about the “economy” of the health care “industry.” He instead talks about the needs that the country and her people have and he offers solutions to deal with this. Many of these solutions derive from a model in which there are federal and “state run” hospital facilities around the nation. This is part of Russia’s inheritance. Mr. Putin is simply trying to make what works now so that it works much better and with much greater reach.
In this, Putin, like his American counterpart, are interested in solutions, in solving problems that are affecting the citizens of the country. Ideology does not come into this. For President Putin, it is the state of the Russian people themselves he seems to be most concerned about.