In Putin’s Russia, Universal Health Care Is for All Who Pay

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RUSSIA HEALTH PROTEST

Russian medical personnel and patients march in Moscow protesting against healthcare system reforms in this Nov. 30, 2014 file photo.

Photographer: Dimitry Serebryakov/AFP via Getty Images

Expectant mothers in Moscow must wait as long as six weeks for ultra-sound scans, up from three days last year. Hospital outpatients pay for blood tests and X-rays that were free 12 months ago. And Marif Alekberov, a 27-year-old fireman with leukemia, is being told to find $23,000 to help fund a bone marrow transplant.

“His kidneys are about to fail,” said Tatiana Filyeva, Alekberov’s mother, who was turned away repeatedly by officials in the southern Rostov region as she appealed for the state to help cover costs for the operation, even writing to President Vladimir Putin in March. “This is his last hope.”

Such experiences are increasingly common as Russia slashes health-care services to plug budget gaps left by lower oil prices. That has provoked labor unrest by medical workers -- some have even staged hunger strikes -- and alarm among patients and their families as one government agency said the cuts were responsible for thousands of extra deaths in Russian hospitals last year.

“It’s become unbearable,” said family practitioner Albina Strelchenko, 35, one of dozens of Moscow doctors who have protested by refusing to work overtime. “We want to provide quality treatment, but that’s impossible.”

Technically Free

With the memory of Putin’s annexation of Crimea starting to fade, more prosaic concerns such as health, education and pensions are taking center stage -- threatening growing dissatisfaction with the government. A poll last August by Moscow researcher Levada Center found that just 19 percent of respondents were satisfied with the state medical system.

“The population is far from happy about these health care problems,” said Alexei Grazhdankin, deputy head of Levada. “Ukraine isn’t as important for the public now, and these issues are increasingly in the spotlight.”

After the Soviet era of universal care, Russia today has a mix of public hospitals and clinics, where most treatment is technically free, and much pricier private facilities with better care. The public system improved rapidly over the past decade as health spending rose from $96 per person in 2000 to $957 in 2013, according to the World Health Organization.

This year, though, Russian health spending is 9 percent lower than two years ago after adjusting for inflation, according to Guzel Ulumbekova, a public health expert who advises Russia’s Chamber of Commerce and Industry.

Closing Clinics

“This makes it impossible to implement the president’s promises of raising doctors’ pay and improving the nation’s health,” she said.

The government in 2014 initiated what it calls an “optimization” of the medical system. The Health Ministry says the plan is to eliminate waste by concentrating resources in major hospitals and closing many smaller facilities.

“The overall level of medical care isn’t being reduced, but rather increased by a more effective distribution of resources,” according to a ministry statement.

So far, that has mostly meant job cuts and extra work for those who remain, some doctors say. Strelchenko, the family practitioner, says her workload jumped from eight hours to 12 hours a day plus as many as three weekend shifts a month last year -- without any increase in her 60,000 ruble ($1,200) monthly salary.

‘Cry for Help’

In Ufa, a city in the Russian Urals, a dozen paramedics demanding an end to dismissals staged a hunger strike, ultimately winning mediation with local authorities to settle their demands.

“This is a cry for help,” said Irina Tishina, a 42-year-old paramedic who didn’t eat for five weeks in the strike. “They just weren’t listening to us.”

RBC newspaper, citing leaked official documents, in March reported that almost 10,000 medical workers in Moscow lost their jobs last year as 28 clinics and hospitals shut down. By 2017, the paper said, the city plans to dismiss an additional 14,000 people -- a reduction of almost one-third from the beginning of last year. The Moscow health department didn’t respond to requests for comment.

The Audit Chamber, a government agency that monitors the budget, in April said state medical care has become far less accessible for a large part of the population, especially in rural areas. The chamber said budget cuts played a role in a 3.7 percent increase in-hospital deaths from 2013 to 2014, or almost 18,000 additional deaths.

Restricting Coverage

At the same time, Russians are paying more out of pocket. Last year they paid $8.7 billion for private care or for superior care at state facilities, a quarter more than in 2013, the Audit Chamber says.

The government’s aim is to reduce to a minimum free health care, says Andrei Konoval, head of the medical workers’ trade union Destviye, or Action.

“They want to restrict 100 percent coverage under the state medical system to the poorest people and top bureaucrats and make everyone else pay something,” Konoval says.

At a sprawling Soviet-era hospital in northeastern Moscow, outpatients now have to pay for all medical tests under a policy introduced over the past year, according to a doctor there. The rule restricts the tests to walk-in clinics -- where facilities are typically less sophisticated -- said the doctor, who didn’t want to be identified for fear of losing his job.

‘Two Choices’

In a cramped waiting area downstairs from the doctor’s second-floor office, patients seeking appointments crowd around a reception window. To be seen by a specialist, they must be referred by a general practitioner. Appointments, though, are only for a given day, not a specific time, so patients often end up waiting for hours. Those willing to hand over a bribe of about 1,000 rubles can be seen immediately, says the doctor.

Ekaterina Chatskaya, a Moscow gynecologist, is protesting the budget cuts by “working to rule” -- following every detail of her contract and refusing extra hours. She says she has been ordered to spend no more than 15 minutes with each patient, down from a half-hour last year.

“A doctor has two choices -- either you work like a machine when your patient comes and you just tick off the boxes without helping them, or you stay at work from morning to night and sacrifice your personal life and health,” she said.

The wait for an ultrasound now stretches to a month or six weeks, up from a few days last year. That spurs many pregnant women to pay for the tests because it can be dangerous to wait, Chatskaya says.

Toxic Spill

Cancer treatment has become particularly problematic, according to Podari Zhizn (Give Life), a charity that helps fund care for children with severe illnesses. Health authorities this year said the state will no longer pay for many procedures such as radiation therapy for transplant patients, Podari Zhizn says. And the situation for people needing bone marrow transplants is “catastrophic,” said Elena Gratcheva, head of Advita, another charity fund.

Tatyana Chemagina, the mother of a boy with leukemia, raised 270,000 euros ($303,000) in an online appeal to pay for a bone marrow transplant and follow-up care in Germany.

“We’re really lucky that we can afford to pay for drugs and treatment,” she said.

Even if patients can schedule a bone marrow transplant in Russia, which is free, they almost always are asked to pay for various costs -- typically more than $20,000 -- associated with organizing the donation.

The fireman Alekberov, who is married and has a three-year-old daughter, can barely get out of his hospital bed, said his mother, who has only managed to raise about half the money needed. Doctors refused to give him costly imported cancer drugs when he first got the disease a year ago after exposure to a toxic spill on the job.

Officials tell her there’s no money available for a donor to enable him to have the transplant as scheduled in May, said Filyeva. In an April 7 letter, the regional Labor and Social Development Ministry declined a request for funding, noting that Alekberov had already gotten a state donation of 9,000 rubles.

“He’s all that I have,” Filyeva said. “We’ve tried everything.”

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