OREANDA-NEWS. April 14, 2011. Vladimir Putin's address: Good afternoon, friends. Let me first thank you for inviting me to take part in your forum.

We have been discussing issues of national healthcare development at the federal level and on almost all federal TV channels for at least half a year already. However, in my everyday communication with friends, many of whom are healthcare workers, it has become clear that the medical community itself is only faintly aware of this. That is why it is necessary to hold such a meeting with experts from all regions of the Russian Federation and to allow medical workers to be better informed of our plans in healthcare directly by our experts and the Ministry of Healthcare and Social Development. And as for our experts and the authorities, they can listen to you and correct the current plans in time, if necessary.

I would like to cite Solzhenitsyn, who called the preservation of the nation the key priority of any state. There is no doubt that this is our most important goal. We have been gradually increasing our investments in the social sphere, education and healthcare. Since 2006, as you know, we have also been implementing national projects, each of which has a clear demographic component.

We have managed to handle the most acute issues, indeed. First of all, we have curtailed the destructive tendencies that posed a threat to the state's existence and development and that were leading us to real catastrophe if left unaddressed. Despite our numerous efforts, the country's population decreased by 500,000: these are serious figures. However, we should remember that Russia lost about 700,000–800,000 each year in the 1990s, and sometimes the figures came to a million.

At present, we have stepped back from this point of crisis – this precipice. There is much work yet to be done, but nevertheless, we have proven that demographic problems can be solved however complicated they might seem. Since 2005, the life expectancy in our country has grown by almost four years, with a 19% increase in the birth rate and a death rate that has dropped over 11%. There is also a considerable (one third) decrease in infant mortality. Life expectancy in Russia grew from 65.3 to 68.9 and stood at almost 69 years in the period of 2005–2010.

There is no doubt that the economy and economic progress are the basis of social wellbeing. However, we cannot accept an approach to the achievement of economic prosperity at the expense of concurrent social initiatives. It is my strong conviction that we should both develop the economy and support the social sphere, keeping them in harmony to a certain degree.

We will continue investing our resources in human and family wellbeing, the creation of conditions for a full life, and the self-actualisation of our citizens through housing programmes, education, and the protection of motherhood and childhood. The government certainly doesn't intend to give up these plans. However, it was extremely difficult to solve these problems – especially under the conditions of the world financial crisis. It was hard to make the decision to allocate such considerable funding for the further development of education, with regard to a great number of uncertainties in the world and in national economies.

As I have already mentioned, I believe that it is possible to ensure both economic growth and the improvement of social standards. In due time, there were many of those who doubted our decision on the Health national project in 2005. Many experts questioned whether the efforts were necessary at all. They said: "It is necessary to follow the plan without any extraordinary solutions or pouring in money. As a rule, extraordinary actions do not achieve their intended results, but the money will be drained away and that's that." However, subsequent events have proved that we made the right decision at that time.

We can now review the results we have achieved due to the joint work of the federal and regional authorities and those present, including your colleagues – the medical community.

There have been fewer citizens dying of tuberculosis and traffic accidents. Mortality from vascular system diseases and cancer has begun falling.

Mortality from tuberculosis dropped by 16.2% between 2008 and 2010, when a number of preventive measures and treatments were put in place. And the measures on the establishment of a system for delivering medical care to the sites of traffic accidents helped bring down the related death rate by 20% during the same period. It is a considerable achievement.

Mortality from vascular diseases has also dropped. The figures are much more modest, at only 4.5%, but they stand for the lives of real people.

About 10,000 medical institutions have received up-to-date medical equipment and ambulance services have received over 13,000 new, well-equipped cars. The period of waiting for diagnostic tests in outpatient clinics has become three times shorter; the arrival time of emergency personnel has been cut almost in half.

We have paid special attention to pregnant women and newborns. About eight million women and four million babies received medical care as part of the maternity certificate programme. It should be noted that an efficient and competitive environment has been already established in this healthcare sector: a woman has the right to choose the maternity clinic that will provide her with the most comfortable conditions for her care.

In a way, these initiatives have influenced the income level of medical workers as well. The average salary of the doctors who participate in the maternity certificate system has increased by 20%. In addition, 11 new perinatal centres equipped with modern facilities were opened in 2010. Another 12 perinatal centres will be commissioned by the end of the year. I believe that those of you who visited these centres were convinced of the appropriateness of the programme. As for me, I have a feeling of pride when I see the people who work there and the conditions under which they work. This is quite a different level of care that at times even leaves our European neighbours behind.

We will continue increasing the affordability of high technology in medical care. Over one million patients have received high-tech care over the last five years.

That is, of course, significantly more than in previous years, but it is still not enough. When I think of those who were denied assistance, my heart bleeds because this is about people’s fates and lives.

Even so, seven high-tech medical centres are already working; they are located in Penza, Cheboksary, Astrakhan, Khabarovsk, Krasnoyarsk, Chelyabinsk and Tyumen. Five more such centres are to be opened this year.

On the whole, healthcare services received an extra 780 billion roubles under the Healthcare national project. I would like to stress that this is over and above current funding, which has also been increasing, not dropping. We will continue implementing all measures included under the national project: the federal budget will disburse 788.7 billion for these purposes before 2013.

Let me emphasise that our collective work on the national project has laid the groundwork for a sweeping modernisation of Russian healthcare. But we are well aware that many problems still remain and that medicine still calls for massive financial support.

Last year, when the country was just emerging from the crisis, we also heard a lot of arguments about our further plans for the development of the healthcare service. We decided to launch a new social project in the sphere and start large-scale healthcare modernisation projects in the Russian regions. To understand the inherent logic and motives of our actions, one simply has to face reality, face the truth.

We have spoken about some positive trends in the healthcare system, and, on the whole, we have something to show for it. Yet the average lifespan in our country is 8-10 years less than in neighbouring (i.e., European) countries. The mortality rates of the diseases that I have mentioned – for example, cardiovascular diseases – are 4 or 5 times higher than in Western Europe, and infant mortality is 1.5 to 2 times higher.

More than 30% of Russian hospitals have no hot water, more than 8% have no running water, 9% have no sewerage. A quarter of all the medical facilities in the Russian Federation are in need of overhaul. As for the technical conditions and equipment, more than 60% of X-ray installations, for example, and nearly half of ultrasound and ECG test equipment have reached the end of their service lives.

The salaries of many medical workers are barely above the subsistence minimum. Such an attitude towards doctors leads to poor quality medical services, that much is obvious. It is, however, equally obvious that we cannot delay a change to the healthcare system or put it on hold by citing the crisis and other temporary difficulties.

Now, as then, I am 100% sure that we made the right decision in creating a financial basis for the regional programmes. Over the next two years, we are now able to continue to invest in the healthcare system – that is, over and above current financing to the substantial tune of 460 billion roubles – in order to reinvigorate the network of medical institutions in Russian towns and villages, which I was talking about just a minute ago. This means essentially investing in human health, upgrading the quality of medical care and making it more accessible, and, of course, supporting the people who every day perform the noble mission of helping the sick.

Major changes are to take place in our healthcare system over the next two years. The important thing is that they become real to the citizens of Russia who should be feeling these positive changes.

Dear friends,

Permit me to dwell on priority issues on which all levels of government and the medical community should be focusing their common efforts.

Under the regional modernisation programmes, we must first of all strengthen the primary level of care – that is, district and city hospitals and polyclinics, rural nursing and midwife centres, and outpatient medical centres, which deliver 80% of medical assistance to the population.

Over the next two years, more than 40% of federal and municipal medical facilities will be repaired, the construction of all the projects in progress will be completed (for your reference, about 8,000 of the 18,000 federal and municipal healthcare facilities are to be repaired). The healthcare system will get more than 100,000 units of modern medical equipment. This range is very broad, covering about 1,400 models and specimens. Over the next two years, 100 billion roubles from the federal budget will be used for these purposes. That is about half of the current annual market of medical technology.

We must build a clear, coherent and transparent process for procuring equipment and repairing buildings, so as to rule out any speculation, fly-by-night firms, and any number of other corrupt practices. Corresponding changes will be made in the legislation. It is important not only to organise uninterrupted supplies and the installation of equipment but also, of course, to train medical personnel to use it, to deliver high quality, and to preserve the equipment that is acquired.

We decided at the congress of the Independent Trade Union Federation in January that the relevant provisions should be included in collective employment contracts. Provisions must be made for internships and residencies at leading centres and clinics, and a concerted effort should be made to continue developing the retraining system.

And one more thing. When we speak about medical equipment, we usually mean sophisticated equipment such as tomographs, ultrasound scanners, automatic micro-analysers, and so on. But it is also very important that every doctor have portable instruments, from compact ultrasounds and ECG sets to elementary blood pressure gauges, all of which makes diagnosis more accurate and improves the quality of medical services and the quality of treatment. A doctor working in remote areas where he needs to make quick decisions and act independently must be particularly well-equipped.

You remember what a shortage of primary-level specialists our healthcare system experienced several years ago. In 2005, precinct services had only 60% of the staff they needed, and in some regions, they had less than fifty percent. Under the Healthcare national project, we have preserved, or rather, revived that level of healthcare and brought in new doctors and mid-level personnel. Salaries were raised for more than 300,000 primary-level medical workers, and more than 50,000 precinct doctors have taken retraining courses and upgraded their knowledge. The percentage of part-time medical workers dropped from 1.6% in 2005 to 1.1% in 2010.

Of course, we need to move forward, above all in changing the principles according to which district doctors work. At present, they spend as much as half of their working time filling out various certificates, referrals, and prescriptions – that is, things that are only indirectly related to…

the process of treatment and diagnosis. As some of my acquaintances in the medical community joke: a doctor remembers everything about his patient, and he writes the papers for the prosecutor. That situation cannot be tolerated and it must be rectified.

The eternal problem of our healthcare system must be solved. Doctors and mid-level medical personnel should be relieved of the chore of filling out often meaningless paperwork, while truly necessary information should be converted to an electronic format, including case histories. The Ministry of Healthcare and Social Development must quickly finalise the procedure for delivering primary medical assistance and determine the duties of precinct doctors and nurses. Ms Golikova (addressing the Minister of Healthcare and Social Development), in your opinion, how much time will it take to develop and introduce that system?

Tatyana Golikova: We have practically everything ready. We spoke about it in part one. We are waiting for the adoption of the law “On the Basic Principles of Legislation in Healthcare,” which will enable us to issue it as a regulatory act on behalf of the ministry.

Vladimir Putin:  When do you expect it to be passed by the Duma?

Tatyana Golikova: The draft law is finished and is pending before the government. As soon as the government approves it, it will go to the Duma…

Vladimir Putin: Let us put it on the agenda of the next government meeting.

Tatyana Golikova: Very well.

Vladimir Putin: Next. In making primary care more efficient and raising the qualifications of precinct doctors, the quality of their services will undoubtedly go a long way towards improving preventative treatment and the early detection of diseases. Medical workers themselves stand to gain from it: considering the current mechanism for funding medical care, in which the money follows the patient, a large portion of the money will remain at the primary care level, which should increase the pay of precinct doctors and nurses.

A few words about rural healthcare. It was agreed during the recent congress of the Association of Peasants’ (Private) Farms in Tambov that more attention should be paid to developing the rural health service, especially considering that the situation there, unfortunately, is deteriorating rather than improving.

That is an alarming and intolerable trend, and it should be reversed. In the coming two years we should reorganise at least 2,000 primary medical and obstetric centres and open 300 more, in addition to organising more than 1,000 general practitioner offices in rural areas.

I have to say that there has been some positive experience of rural precinct services being switched to the general practitioner principle, for example, in the Astrakhan and Penza regions, in the Republic of Chuvashia, and in Tatarstan, where medical assistance has been brought as close as possible to the rural population.

And needless to say, we must create conditions in which specialists, especially young graduates, have an incentive to work in the rural healthcare system. If you look at what is happening in some regions – for example, in Smolensk, just 150 km away from Moscow – in the city itself, there are 50 doctors per 10,000 people, but in the surrounding rural communities, that figure drops to 15.

As part of these modernisation programmes, modern standards of medical treatment must be introduced, and the system of state guarantees must be effective. Regardless of where a person lives, he or she must have access to free and high-quality medical service.

The new law “On Medical Insurance” should kick in. It will give citizens the right to chose their own doctors, medical institutions, and insurance companies and use those facilities where they can get the best medical treatment.

We noted what massive resources were needed to modernise healthcare, and we have spoken about the supply of modern equipment and the repair of premises and buildings. But we will never achieve success if we fail to change the attitudes of medical workers about themselves and their work.

The Russian philosopher Ivan Ilyin once asked his doctor for the secret of his skill. He replied that it was the love of his patient, without which there is no first mover of the heart or the soul.

Unfortunately, let's face it, that first mover is sometimes not performing well in our healthcare services. Many people visit the government site and the public reception offices to complain about medical workers who are rude, unethical, and occasionally extort money. I hate to have to say it, but this is a fact. It is better to say it aloud and then consider how to go about solving it. Ultimately, what is taking place at this or that institution and what relations exist between the people who come to the institution and its staff depends on us. Many problems are not being solved not because of a lack of money but because nobody addresses them.

Take the much-maligned queues. Some people have to spend days in stuffy corridors, as was mentioned, incidentally, at a recent meeting in Ryazan. Those who had ears listened to this plea and took the necessary measures to mend the situation. For example, the cancer polyclinic in the Chelyabinsk Region promptly made changes. At once. The reception desk started to open at 7.30 am, they opened five additional windows for making appointments with specialists, and increased the number of offices for doctors at the expense of administrative space. But some regions have not reacted to the call and are apparently waiting for somebody from the top to conduct a post mortem for them.

I believe that we need to put in place a clear-cut, understandable, and effective system of medical quality assurance. People often complain about derelictions on the part of medical personnel who sometimes do harm to the patient’s health.

I suggest that we annually publish the ratings of medical institutions and insurance companies taking into account the opinion of patients. We should start with state healthcare institutions, major insurance companies, and private healthcare organisations.

I think that information on the real state of affairs at medical institutions and their reactions to citizens’ complaints must be absolutely open. It is absolutely inadmissible both for patients and the medical community to conceal unseemly occurrences and cover mistakes. I am sure that the more complete and accurate the information is, the faster the process of positive change in the healthcare system will proceed.

Dear friends,

We have spoken about the attitude of doctors to their patients and the quality of their work. Of course, complaints should evince a reaction. But medical workers deserve to be heard and to be understood. Many doctors and nurses are quite candid about it; when you earn pittance, it is hard to smile and be cheerful.

It is no secret that after getting their degrees, doctors come to work at a hospital or polyclinic at a salary of 5,000-7,000 roubles a month and have to hold several jobs, do night shifts, and sometimes work two shifts in a row in order to feed their families.

It is obvious that medical professionals should have decent pay…