Issues of the industry’s development, including arrangements for rendering medical assistance, personnel training, computerisation of medical activities as well as scientific research in medicine, were discussed at the board meeting.
Dmitry Medvedev: Good afternoon. I’m pleased to see you. A year has passed since we have restored the Ministry of Healthcare as an independent department. I think this was the right decision. We supported the proposals of the medical community. On the whole, despite problems that exist in every department, the Ministry is doing a good job. At this meeting, we’ll sum up what has been done and determine our plans for the near future.
We all started working more actively when we began to carry out the national health project. Later on other important documents were adopted, including presidential executive orders, Government papers and a state programme. The goal remains the same – to make medicine modern and high quality and keep it accessible.
Dmitry Medvedev: "The ministry has adopted almost 800 new standards and 60 procedures for rendering medical assistance that have become mandatory for all medical institutions since January 1, 2013. <...> It is important to see all the advantages and shortages and consider them in drafting a programme of state guarantees for free medical aid in 2014."
The resolution of these ambitious tasks will require serious organisational and financial planning. The past year was devoted to the drafting and adoption of strategically important programmes. The Government endorsed a state programme for the development of healthcare, a strategy for pharmaceutical supplies for the population to 2025 and a roadmap for an effective system of medical aid, including outpatient and hospital treatment and high-tech centres for the most complicated cases.
The ministry has adopted almost 800 new standards and 60 procedures for rendering medical assistance that have become mandatory for all medical institutions since January 1, 2013. I’d like to ask all those present, especially the top managers of the ministry, to analyse their practical application. It is important to see all the advantages and shortages and consider them in drafting a programme of state guarantees for free medical aid in 2014.
I think it is important to establish a special Government commission on public health protection headed by the Prime Minister. It should focus on creating mechanisms for interdepartmental coordination with a view to conducting uniform state healthcare policy. In particular, it should promote a healthy lifestyle, including preventive care.
Dmitry Medvedev: "I’d like to emphasise the need to encourage specialists to work in rural areas. We know this issue and we’ve allotted money for it. In 2013 we’ll spend two billion to attract more than 4,000 doctors. Last year about eight billion roubles were spent on about 8,000 doctors."
Now a few words about specific areas of work. Programmes for upgrading regional healthcare should be completed in 2013. Much has been done to consolidate its material and technical foundation. In 2012, 71 medical institutions were built and almost 2,500 underwent major repairs. So, modernisation has been proceeding at a good pace. The target for purchases of medical equipment was even exceeded owing to efficient spending. First-aid stations continue to be upgraded in rural areas (I have seen one recently myself) and opportunities for remote consultations and diagnostics are being expanded. Today people can book an appointment online in all regions, though it is not always very easy. The equipment of on-duty stations with GLONASS should allow ambulances to get to their patients quicker and make this service more effective.
I’d like to emphasise the need to encourage specialists to work in rural areas. We know this issue and we’ve allotted money for it. In 2013 we’ll spend two billion to attract more than 4,000 doctors. Last year about eight billion roubles were spent on about 8,000 doctors. I must say that this work has been sluggish since the start of this year – only 50 doctors received these incentives. Let me repeat that we were looking for ways to find this money and introduced these payments for this purpose. All plans should be completed on time. Please pay attention to this.
Dmitry Medvedev: "Last year the Government adopted a strategy for the development of medical research to 2025. I think we should make the most of our research centres and major federal medical institutions. They should become the main source of innovations in healthcare."
The second point is about access to high-tech medical treatment provided by 120 federal and 222 regional medical institutions. Five federal centres were put into operation last year. They specialise in the areas with the greatest demand, such as cardio-vascular surgery, neurosurgery, trauma surgery, orthopaedics and prosthetics.
All institutions should spare no effort to provide prompt treatment to people. To make this possible it is necessary to provide them with funds on time. This applies, in part, to regional medical institutions. I’d like you to pay utmost attention to this issue. It takes so much time to sign agreements on high-tech aid with the regions that actual funding starts only in the second quarter. This is not good.
Third, modern medicine is inseparable from a foundation of serious research. This country has good potential in this respect – the development of medical technology and mew medicines is part of the plan for the technological modernisation of our economy. Last year the Government adopted a strategy for the development of medical research to 2025. I think we should make the most of our research centres and major federal medical institutions. They should become the main source of innovations in healthcare. I’d like to hear your proposals on this score as well.
Fourth, the quality of medical aid directly depends on the qualification of doctors and nurses, who must continuously upgrade their skills. In April we endorsed a programme of measures to eliminate the personnel shortage and improve qualifications. To resolve this task it is necessary to upgrade the programme of additional professional education that provides, in part, for the formation of training centres with simulation equipment. It is necessary to make broader use of distance and online education. In general, it is essential to use all modern capabilities and, of course, to develop employer-sponsored education.
Obviously, only decent salaries can attract competent and conscientious people to healthcare. Decisions on this issue have been made and must be carried out. There are some positive results, but there are problems as well. In the first quarter of this year the salary fund of district doctors and village first-aid stations was reduced in almost one third of all regions because regulatory acts were not adopted on time. I’m addressing heads of regional healthcare organisations – it is necessary to put things in order and pay what is due before the end of May. Those who fail to do so will be held to account.
Dmitry Medvedev: "The quality of medical aid directly depends on the qualification of doctors and nurses, who must continuously upgrade their skills. In April we endorsed a programme of measures to eliminate the personnel shortage and improve qualifications. To resolve this task it is necessary to upgrade the programme of additional professional education."
Ladies and gentlemen, one of the main goals is to increase lifespan. Last year the rate of some diseases went down compared to 2011– by 12% for TB and by almost three per cent for cardio-vascular diseases. These are good figures and it is necessary to consolidate this trend.
It is no less important to focus on preventive care and early diagnostics. This year almost all restrictions on annual medical exams – by category of person, age and health status – have been lifted. Now we can call this exam universal.
Today we can speak about the comprehensive nature of this work, about the comprehensive nature of preventive medical check-ups. This calls for both the right organisation of the work and special attention from heads of healthcare administrative bodies.
I would like to reiterate such a significant achievement of the past years as the growing birth rate. It is in part a result of improvements in reproductive medicine. Although the number of reproductive age women has decreased, 100,000 more children were born than in 2011. As a result we have managed to stabilise the population size, which is a tremendous achievement.
Our unquestionable priority for the coming years is further progress in medical assistance to women. Experience shows that the situation in the regions changes dramatically with the appearance of perinatal centres, which shows that the policy we began implementing five to seven years ago was the right one. We will continue that programme, and its funding has already been earmarked.
It is clear that the work in all the areas I mentioned and didn’t mention (since these are just introductory remarks) should be coordinated by the authorities of all levels, and not only by the authorities but also through a close cooperation with experts, the civil society, the Council of Public Organisations on Patients Rights Protection, the Open Government and other expert venues.
I have outlined just a few issues. I don’t want to take the Minister’s share. Ms Skvortsova, go on, please.
Veronika Skvortsova: Mr Medvedev, colleagues,
The Ministry of Healthcare of the Russian Federation was re-established a year ago after almost ten years. The decision to come back to a specialised Ministry of Healthcare by separating it from the larger social protection body was enthusiastically welcomed by the medical community, healthcare officials, university and scientific communities, and fostered new expectations and hope among the population. Such a credit of confidence has laid an enormous responsibility on the Ministry and directed all our efforts towards focused systemic activities combining strategic planning and addressing everyday tactical problems.
The basic directions of the pending transformations in healthcare were determined by the executive orders of the Russian President of 7 May 2012 and instructions issued in developing these orders to the Government. In accordance with the executive orders, the Ministry was to draft, submit to the Government and approve several basic strategic documents in the course of the first year. I am happy to report that owing to our joint efforts all the above documents have been drafted, discussed and approved by the deadline.
The key systemic document specifying the targets, objectives and ways of developing the national healthcare system up to 2020 is the state federal programme of healthcare development based on the adopted federal law On the Principles of Health Protection of the Russian Federation’s Citizens. The programme has eleven sub-programmes on all major areas.
Veronika Skvortsova: A persistent positive trend towards decreasing mortality was achieved in all the major disease groups: mortality from cardiovascular diseases fell by about 3%, tuberculosis – by 12.2%, external causes – 4.9%, accidental poisoning – 14.6%, cancer – 0.7%.
Measures aimed at increasing the quality and accessibility of all kinds of medical assistance are generally implemented at regional healthcare facilities in accordance with each region’s conditions and needs. This is the reason the Ministry’s employees visited over 60 regions from September to December 2012, carefully studied the healthcare facilities networks, the way of life in rural areas and in cities, the transport infrastructure and the time it takes to deliver patients to the healthcare facilities, and where there was sufficient personnel and equipment. This became a basis for working out, together with regional healthcare officials, of regional segments in the state programme for healthcare development, as well as regional programmes on improving staffing policies and development road maps.
Let me dwell on some of the results of the first ear of our joint activities. The number of deaths in 2012 fell by 26,200, the general mortality quotient went down by 1.5% compared to 2011 to reach 13.3 people per 1,000. A persistent positive trend towards decreasing mortality was achieved in all the major disease groups: mortality from cardiovascular diseases fell by about 3%, tuberculosis – by 12.2%, external causes – 4.9%, accidental poisoning – 14.6%, cancer – 0.7%.
However, despite the positive changes in road accident statistics (hospital mortality reached 4.4%, which corresponds exactly to the world’s best clinics, the average time for delivering injured people to trauma units has also decreased), road accident mortality went up by 2.3% compared to 2011. The analysis revealed that the mortality increased due to the greater severity of the accidents and the number of people who were badly injured in them. The problem of traumas caused by road accidents undoubtedly requires a comprehensive solution.
The year 2012 was also marked by a 5.6% increase in the birth rate, from 12.6 to 13.3 per 1,000 people. Apart from social incentives to families for childbearing , the positive effect was also achieved due to overall measures of mother and child protection including setting up a psychological counselling service for pregnant women, including those who found themselves in dire straits. This helped to decrease the number of terminations by 53,900, or 5.5% in just one year. High-tech reproductive technology was used 20% more often in treating infertility, which resulted in over 3,000 more babies born. Thus, in 2012 the mortality and birth rate curves criss-crossed, and the population decline in the country has practically been reversed.
Veronika Skvortsova: In 2012 the federal law On the Protection of Citizens’ Health from the Impact of Tobacco Smoke and the Consequences of Tobacco Consumption was drafted, discussed and adopted. The law contains the most efficient anti-tobacco measures.
The Ministry of Healthcare made unprecedented efforts in 2012 on the prevention of non-infectious diseases, which are a major reason for deaths in our country as well as in the world. Cutting alcohol and tobacco consumption, healthy diets, physical activity and regular medical check-ups are the measures that keep one healthy. To coordinate those measures, the Ministry proposed setting up a Government Commission on Health Protection headed by Prime Minister Dmitry Medvedev. The Commission’s members include most federal ministers and heads of federal agencies as well as civil society representative. For the first time ever foundations were laid for the principle “Every Minister Should Be a Healthcare Minister.”
In 2012 the federal law On the Protection of Citizens’ Health from the Impact of Tobacco Smoke and the Consequences of Tobacco Consumption was drafted, discussed and adopted. The law contains the most efficient anti-tobacco measures.
As part of implementing the state policy on reducing alcohol abuse and alcoholism prevention, alcohol sale was banned in 2012 in some organisations and public places, and also from 11 pm to 8 am.
Veronika Skvortsova: Health centres considerably intensified their activities in 2012: 502 centres for adults and 204 for children. They have examined 4.5 million people, 15% up on last year.
A plan was designed and approved on measures to implement the basics of the state policy on promoting healthy food for the period up to 2020. A draft federal law has been prepared on healthy hot food for children at schools and healthcare facilities and for some other groups of the population.
Health centres considerably intensified their activities in 2012: 502 centres for adults and 204 for children. They have examined 4.5 million people, 15% up on last year.
Measure continued in 2012 within the framework of the priority national healthcare project on additional preventive medical check-us of working individuals, teenagers and children in tough situations.
The experience of implementing the afore-mentioned projects has allowed the Ministry to develop a programme of large-scale preventive medical examinations for the entire Russian population, which was launched in January 2013. It should be stressed that all-out preventive medical examinations aim to diagnose existing and early exposed health disorders and diseases and to highlight and correct their development risk factors. A differentiated approach was applied during the development of the new programme to determine the volume and nature of preventive medical examinations for various gender and age categories, with due account for differences and thedevelopmental probability of various health disorders and diseases, and also with due account for the medical and economic necessity of conducting specific types of tests and research.
Veronika Skvortsova: In 2012, global targets to combat the spread of contagious diseases up to 2025, as well as a system for monitoring the rates achieved, were formulated with the Ministry’s active cooperation, and were coordinated with countries, members of the World Health Organisation (WHO).
Two-stage preventive medical examinations were launched. If any changes are found during primary health screening, then patients’ diagnoses are followed up by modern endoscopic, tomographic and laboratory analysis and other methods of in-depth profiling. Therefore the informal nature of current preventive medical examinations should be its key feature. Only then will preventive health examinations make a real and substantial contribution to improving people’s health and reducing death rates. In implementing the programme of preventive health examinations, Russian regions had to create special programmes stipulating measures for providing preventive healthcare to residents in villages and remote areas. In all, 187 mobile preventive healthcare systems were purchased and started operating in 2012. This made it possible to hold preventive health examinations with visiting teams of specialists. There are plans to buy over 260 more mobile systems under regional healthcare development programmes. All projects in the programme of preventive health examinations are financed by the mandatory medical insurance system. In effect, preventive health examinations are absolutely free for all age categories, for both people who work and people who don’t work.
As well as our domestic policies, we have made considerable progress in charting the strategy and tactics of efforts to combat non-contagious diseases worldwide. In 2012, global targets to combat the spread of contagious diseases up to 2025, as well as a system for monitoring the rates achieved, were formulated with the Ministry’s active cooperation, and were coordinated with countries, members of the World Health Organisation (WHO). A global WHO action plan dealing with non-contagious diseases and comprising political obligations of member-states and specific procedures for their implementation at national level has been drafted for 2013-2020. We have prepared a WHO resolution in cooperation with our US and European partners on establishing a specialised UN group as part of the UN Economic and Social Council, where Russia is expected to preside.
Veronika Skvortsova: As part of these modernisation programmes, we have built 71 healthcare institutions, we have renovated almost 2,500 institutions, and we have re-equipped almost 5,000 institutions. Over 288,000 units of medical equipment were purchased for this purpose. Therefore the technical-equipment levels of state healthcare institutions rose by 60% on 2011.
While working on the development of preventive healthcare, the Ministry paid a great deal of attention to improving all types of medical assistance connected with patients’ treatment and rehabilitation. In 2012, we continued to implement the healthcare modernisation programmes which were launched in 2011 and which have received over 664 billion roubles’ worth of state funding. As part of these modernisation programmes, we have built 71 healthcare institutions, we have renovated almost 2,500 institutions, and we have re-equipped almost 5,000 institutions. Over 288,000 units of medical equipment were purchased for this purpose. Therefore the technical-equipment levels of state healthcare institutions rose by 60% on 2011, that is, from 7,700 roubles per square metre to 12,900 roubles.
Apart from upgrading infrastructure, we also focused on improving the planning of medical-assistance volumes, providing financial support for medical assistance, improving organisational logistics and developing our human resources potential.
In 2012, a three-year programme of state guarantees for the provision of free healthcare was drafted for the first time and, in so doing, we were able to set an appropriate time period for executing the plans.
For the first time, this programme included financing standards as regards preventive healthcare, preventive medical checkups, emergency and palliative assistance. This made it possible to concentrate financial resources on these important high-priority areas. In July-December 2012, the Ministry, in cooperation with the staff of chief part-time specialists and their renewed commissions (over 7,000 leading professors nationwide), drafted and approved 60 medical assistance protocols and 797 medical assistance standards for all classes of diseases and health disorders and types of medical assistance. All these protocols and standards were posted on the official website.
Russian clinical-statistical groups were drafted for the first time, in cooperation with World Bank experts. A Government resolution stipulates possible alternative payment options for medical assistance in any complete medical case or in line with specific clinical-statistical groups. Currently, this is the most effective payment option. This has made it possible to eliminate obsolete forms of payment completely, in line with gross indicators, including the number of patient days and visits, which lead to extensive and ineffective financial expenditures on healthcare.
What’s also important is that we have started introducing mandatory medical insurance policies nationwide, regardless of the region of their issue.
Veronika Skvortsova: Since January 2013, and due to modernisation programmes, residents in villages were able to get medical assistance at 4,534 revamped outpatient clinics, 3769 general practitioners’ offices and at almost 40,000 feldsher-midwife stations.
Under regional healthcare development programmes, every Russian region has drafted the relevant medical assistance logistics on its territory under a three-level system and medical assistance protocols. This approach ensures affordable medical assistance, no matter how complicated, in every category for every regional resident in accordance with specific deadlines.
I would like to once again focus on the absolute priority of providing convenient primary zmedical-sanitary assistance and neighbourhood healthcare. Since January 2013, and due to modernisation programmes, residents in villages were able to get medical assistance at 4,534 revamped outpatient clinics, 3769 general practitioners’ offices and at almost 40,000 feldsher-midwife stations. We will have to continue this work over the next few years under regional healthcare development programmes. The establishment of inter-municipal centres, the second level of medical assistance, is needed to accomplish a strategic long-term objective of providing emergency medical assistance in life-threatening situations and during those diseases and health disorders, which determine the structure of national mortality rates. In 2012, we have increased the number of inter-municipal centres more than two-fold, that is, from 571 to 1,169, but, of course, this work is not yet complete. Only 50-60% of second-level institutions have been established in some regions to date.
Colleagues, during our meetings, conferences and meetings of our activists, we have frequently noted that infrastructure and logistics transformations being implemented in the healthcare systems of all regions must be well thought-out and most convenient for the population, the main recipient of healthcare services. Nevertheless, some mistakes could not be avoided when feldsher-midwife stations and subsidiaries of central district hospitals were shut down without any reason. In some cases, the population was not informed about the advantages of current transformations. Our task is to prevent all this in the future. The experience of Chuvashia, Tatarstan, the Sakhalin Region and many other regions shows that it is possible to convert to more advanced and more effective forms of medical assistance quite seamlessly and with active popular support. In these regions, this system evolved without abolishing the old system. People were able to choose between old and new systems during the transitional period, and they opted for the best one.
Veronika Skvortsova: Five federal high-tech centres, including two cardiovascular surgery centres in Perm and Kaliningrad, a neurosurgery centre in Novosibirsk, as well as two injury-treatment, orthopaedic and endoprosthesis replacement centres in Smolensk and Barnaul, increase the amount of affordable high-tech medical assistance available.
In 2012, the provision of high-tech medical assistance in Russia increased by 40.7% on 2011. This is largely linked to a substantial increase in the volume of high-tech medical assistance provided by regional medical institutions. In fact, the volume of this assistance has increased more than three-fold duringone year, that is, from 35,000 to 120,000 patients. In 2012, over 40% of kidney transplantation operations were conducted at regional healthcare level.
Five federal high-tech centres, including two cardiovascular surgery centres in Perm and Kaliningrad, a neurosurgery centre in Novosibirsk, as well as two injury-treatment, orthopaedic and endoprosthesis replacement centres in Smolensk and Barnaul, increase the amount of affordable high-tech medical assistance available. In 2012, these centres treated almost 9,000 patients and achieved good results.
A top priority of the Russian healthcare system is the improvement of medical care for mothers and children. According to the WHO, infant mortality and maternal death rates reflect the development level and effectiveness of the national healthcare system. At the end of 2011, we achieved the lowest infant mortality rate in the history of Russia: 7.4 deaths of infants under one year old per 1,000 live births relevant to our national criteria. This has allowed us to start following the international IMR standards as of 2012. Such a transfer is a challenge for any country. According to WHO experts, who used Petros Dellaportas’s mortality data representation, the IMR in Russia was supposed to increase to 14.5, i.e. by almost 100%. However, due to the implementation of a series of measures, the IMR only grew by 19%, to 8.7 deaths per 1,000 live births in 2012.
I’d like to note that the results of the first months of 2013 are very promising and show a gradual decrease in the IMR: as low as 8.3 in the first quarter of the year.
It is important to note that the infant mortality rate has continued to decrease in the regions with a developed three-level system of obstetric aid and neonatology, and which have operating perinatal centres, despite the new registration criteria. The rate stood at 4.3 - 6.5 in these regions, while in other regions it grew to 12-21. Thus, the gap between regions absolutely justifies the need to introduce an up-to-date perinatal service across the country, and we are grateful to the Government for supporting this activity.
According to a preliminary data analysis, 2012 witnessed an unprecedented decrease in the maternal death rate, by 18.5%: from 16.2 to 13.2 deaths per 100,000 births. Twenty-five regions have achieved the level of developed European countries, of less than 10 deaths per 100,000 births. We need to preserve this result and eliminate the gap between the regions.
Another important direction of the healthcare system's activity, including relieving intensive care departments of non-core activities, is the development of rehabilitation care, which should be customised as much as possible. The treatment for the acute stage of an illness must be conducted in specialised departments in hospitals and continued in specialised rehabilitation departments, day patient departments and outpatient facilities. In 2012, the Healthcare Ministry and the experts’ association developed and approved regulations for the medical rehabilitation of patients. The regions opened 2,704 rehabilitation beds, 227 beds at day patient facilities, and began training teams of interdisciplinary rehabilitation personnel.
We must not forget about those who cannot be cured but who need help nevertheless and whose pain and suffering we can ease. The Ministry has approved regulations for providing palliative medical care, covering all important issues. To date, we lack palliative care facilities, twice as few as in European countries, and we must increase the number in the upcoming years.
Veronika Skvortsova: Information system development in healthcare plays a crucial role in integrating all levels of healthcare. More than 286,000 units of computer hardware were supplied to medical organisations in 2012. The number of local medical networks rose by 250%. A new server, Making an E-Appointment at the Doctor’s, was installed at 4,000 medical organisations
Colleagues, the total number of hospital beds in the country has decreased by 60% since 1990: from 137,400 to 84,100 per 10,000 people. The need to increase this number, to create palliative care services, medical rehabilitation and medical attention, and the expected growth in the number of seniors, makes the further reduction of the number of beds counterproductive, for it may affect the accessibility of free medical care.
We need to focus on optimising the bed capacity, boosting the activity of hospital beds that treat acute illnesses and converting them into beds for the further treatment and rehabilitation. This will lead to significant cost saving. I’d like to emphasise that, in accordance with international Russian regulations, when optimising the bed space capacity we need to pay attention to population density, the size of a region and transport accessibility. Reducing the number of beds in small-capacity medical facilities located in some regions on the Far East, the North, Yakutia and some other areas is impossible due to poor transport accessibility and difficult climatic and geographical conditions.
One of the key priorities of the healthcare industry is to protect the constitutional right of any citizen to free medical aid at state and municipal medical facilities. The lack of funding, which we witnessed in the 1990s and 2000s, has led to widespread chargeable services provided at state facilities, including their main official activities, which has caused an increase in illegal co-payments. The backbone federal law On the Basic Principles of the Protection of the Health of Citizens defines the cases in which certain medical services can be provided on a paid basis. A Government resolution, adopted in 2012, supplied the Law with more details.
In 2013, the funding for the programme for state guarantees is enough to implement it for all types of diseases, using insurance payments and budget means, without using the patients’ money. In the case of the most expensive medical conditions, cooperating with charity foundations is allowed, which should be ready, together with the Ministry, to justify the need for the treatment and ensure that no money can be provided from the Government.
We should consolidate our efforts to eliminate the old habits and the stereotypical behavior of medical workers, with the help of positive changes that are taking place due to an increase in medical workers’ salaries and the introduction of additional measures of social support and special working conditions in the regions. In the meantime, the revival of ethical norms needs constant attention, including toughening of state and departmental control.
Veronika Skvortsova: The Health Ministry’s 46 higher educational institutions, which turn out 32,000 doctors and pharmacists a year, including 26,000 whose training is subsidised by the state, form the core of the medical education system. The annual turnout of interns and hospital physicians comes to 22,000. <...> The Ministry of Education and Science recognised all of the Health Ministry’s educational institutions as effective.
In 2012, the rules for conducting inspections by the Federal Service for Supervision of Healthсare were reviewed, and new inspection types were introduced, as well as regulations for medical care. The changes include the implementation of the state guarantees programme, adherence to the principles of providing free medical care, and the preparation of amendments to the Administrative Offences Code, which broaden the powers of the service responding to the violations.
The introduction of information technologies to the healthcare system plays a strategic role in the integration of all levels of medical care.
Information system development in healthcare plays a crucial role in integrating all levels of healthcare. More than 286,000 units of computer hardware were supplied to medical organisations in 2012. The number of local medical networks rose by 250%. A new server, Making an E-Appointment at the Doctor’s, was installed at 4,000 medical organisations and launched on December 1, 2012, and has been used by 7 million patients since then. Of course, this is a drop in the ocean compared to the total number of applications. We hope to bridge the gap in 2013. Almost 2,500 medical organisations were provided with e-record capability, with over 36 million electronic medical records, which covers 26% of the population, fed into the federal server. Record exchange capacity was made available to 2,803 medical organisations. GLONASS satellite navigation equipment was installed in 19,000 medical vehicles and over 2,500 ambulance stations and posts. An e-catalogue, Russian Medicine, with over 500,000 bibliographic entries, was developed. A teaching e-library in 36 health professions was developed and put into operation, with over 3,000 full-text documents and 600 books converted into electronic format. These are our first steps in IT penetration. Jointly with the Ministry of Communications and Mass Media and the expert community, we are speeding up the implementation of all projects. We hope to achieve qualitative changes by late 2013, including a stage-by-stage introduction of computerised workstations for doctors with a capacity for continuous remote training, TV consultations with colleagues, assistance in decision-making and a reduction in paperwork.
No healthcare system can function unless it has enough trained medical personnel. Improving medical training and personnel policy is one of the most important areas of our work. The Health Ministry’s 46 higher educational institutions, which turn out 32,000 doctors and pharmacists a year, including 26,000 whose training is subsidised by the state, form the core of the medical education system. The annual turnout of interns and hospital physicians comes to 22,000. An independent analysis has put the Health Ministry’s higher educational institutions in the lead in general ratings compiled for the education system as a whole. We were in first place in terms of the USE (Unified State Exam) grade point average for 2012 entrants. The Ministry of Education and Science recognised all of the Health Ministry’s educational institutions as effective.
During the autumn term of 2012, my Ministry, jointly with the Educational and Methodological Association and the Council of Rectors of Medical and Pharmaceutical Institutions, updated the standard working curricula in the main fundamental biomedical and therapeutic disciplines, taking account of the same curricula used in the best medical schools around the world. We also optimised the logistics of the teaching process. Between October and December 2012, the staff of all the institutions I have mentioned underwent advanced training in the fundamental areas of biomedicine.
To promote the system of continuous medical and pharmaceutical training, the Health Ministry has established a specialised interagency coordinating council. The Educational and Methodological Association, jointly with the Council of Rectors, the Presidium of the Russian Academy of Medical Sciences and the Medical National Chamber, has developed and submitted for consideration a continuous medical training strategy which, among other things, makes provision for the use of remote training and advanced educational technologies.
As of January 1, 2013, Russian medical organisations employed 2,162,000 medical staff, of which 639,300 doctors and 1,300,000 employees with a secondary medical education were employed in the public sector.
Veronika Skvortsova: In accordance with a Presidential Executive Order, doctors' salaries should be increased in stages until 2018, by which time they should be double that of the average regional wage, while the salaries of junior and mid-level medical staff should be equal to the average regional wage.
Calculations performed in each region of Russia on the basis of population density figures and other specific indicators demonstrated that the overall shortage of doctors has declined in recent years to 40,000, while the shortage of nurses has increased to 270,000. In the absence of staff imbalances, we would have removed the shortage of doctors within the next four years. But gross personnel disproportions have taken shape during the last few decades, including a shortage of certain types of specialists and a surplus of others, an imbalance in doctor-patient ratios in rural and urban areas, a disproportion between outpatient clinics and hospitals, and in-patient facilities at different levels.
Under these circumstances, we will not be able to harmonise the composition of doctors before 2018, given the same amounts of training at universities and an increase in the percentage of internship and residency training. A new form of targeted contract-based training is of particular importance for removing staff imbalances in each specific region. In 2012, we increased the number of targeted student positions at federal universities to 38.5%. The Country Doctor programme helped to ease the problem by channeling nearly 8,000 young specialists to rural areas. We have also drafted amendments to the Labour Code, which would make it possible for country doctors to carry out their duties at home.
The education system trains about 63,000 specialists with a secondary medical education a year. Between 90% and 95% of college graduates take jobs in their line, but only 20% of them keep the jobs towards the end of the first year. It will take between five and seven years to deal with the shortage of nurses if the constituent entities of the Russian Federation, which control medical schools and colleges, increase the key enrolment figures by 50% to 90,000 a year, as it was 20 years ago. Targeted enrolment in this context must constitute 50% of the total, but the main thing is that the constituent entities should implement social support measures designed to keep nurses in the profession. In 2012, my Ministry developed a set of measures intended to provide the healthcare system with healthcare staff in strategic areas. Based on them, health administrations in the constituent entities of the Russian Federation drew up regional personnel programmes. Their examination and streamlining enabled my Ministry to coordinate 52 out of 83 programmes and recommend their approval by the authorities in the relevant constituent entities. We are continuing to work on the other regional personnel programmes.
Colleagues, we must not forget that by protecting people’s health, healthcare workers perform a strategically important function. This work should be remunerated accordingly. In accordance with a Presidential Executive Order, doctors' salaries should be increased in stages until 2018, by which time they should be double that of the average regional wage, while the salaries of junior and mid-level medical staff should be equal to the average regional wage. The Ministry has drafted the relevant roadmaps, on the basis of which the state authorities have drafted regional programmes to improve the salaries of workers, which have been approved in consultation with the Ministry of Healthcare.
I would like to note that in the first quarter of 2013 the total funding from the Federal Mandatory Medical Insurance Fund allocated to the regions for healthcare purposes rose by 61%, including money for salaries. All incentive payments, worth 119.4 billion roubles, have been preserved. Nevertheless, some regions and medical institutions temporarily reduced salaries at the beginning of 2013 as a result of the delayed adoption of the relevant regulatory documents and because of insufficiently well thought-out decisions by regional tariff commissions. The Ministry set up a telephone hotline to collect information about these facts. We receive numerous complaints and we check all of them. Colleagues, it is impossible to solve all these problems from the federal Ministry. We are calling on you to pay the utmost attention to implementing the Presidential Executive Order and to respond promptly to all complaints regarding reductions of salaries of healthcare workers.
The Strategy for the Provision of Medicines to the Public up to 2025, which was drafted in 2012, aims to systematise current elements of the pharmaceutical market regulation system in order to fully meet the public demand for medicines. The first stage of the implementation of the Strategy, which has already been launched, focuses primarily on harmonising the regulatory framework and creating a system for the rational use of medicines. In 2012, the Ministry of Healthcare, in cooperation with the Federal Tariff Service, amended the Methodology to Set the Maximum Prices of Medications Included in the List of Essential and Most Important Medications. This was done in order to create an effective mechanism to prevent unjustified price increases for medicines and to ensure there is no reduction in the range and assortment of medications available in pharmacies.
Veronika Skvortsova: In the first quarter of 2013 the total funding from the Federal Mandatory Medical Insurance Fund allocated to the regions for healthcare purposes rose by 61%, including money for salaries. All incentive payments, worth 119.4 billion roubles, have been preserved.
In cooperation with the patient and pharmaceutical communities, we have drafted a federal law to amend the current federal law on the Sale and Purchase of Medicines. The draft law has already been submitted to the Government. While meeting current popular demand for medical assistance and provision of medicines, we should not forget about the development of biomedicine, the formulation of individual approaches towards preventive care and treatment, and the development and introduction of highly effective innovative technologies. The biomedical science of today is the medicine of tomorrow. The Ministry of Healthcare, in cooperation with the Russian Academy of Medical Sciences, leading experts from federal institutions, the Russian Academy of Sciences, the Lomonosov Moscow State University, the Kurchatov Centre and other research institutes have actively discussed and approved the Strategy for the Development of Medical Science in the Russian Federation up to 2025. The Strategy lists 14 scientific platforms dealing with the most important and promising areas of biomedicine. The detailed scientific platform measures, setting out various projects and products, form the basis for formulating state orders for federal institutions, as well as for financing targeted programmes. In 2012, the first research projects were implemented at affiliated ministerial institutions under a state order based on the above-mentioned strategic platforms. This yielded the first positive results. We have seen a big increase in the number of articles in peer-reviewed Russian and foreign publications, reflecting the quality, importance and demand for these projects.
To improve interdepartmental coordination when planning and implementing research projects a scientific council has been established at the Ministry. It includes leading experts from various areas of medical science. The work of the Ministry of Healthcare is based on cooperation with professional medical communities. In autumn 2012, there have been some staff changes among the chief part-time experts in 70 major medical areas as will as the composition of their expert commissions and permanent working groups. On the whole, this expert community now includes over 7,000 leading Russian professors from all 83 Russian regions.
The Ministry has permanents contacts with the Civic Chamber, non-profit healthcare organisations and physicians associations. On October 5, 2012, the first national conference of doctors was held after a 30 year break. You opened the conference, Mr Medvedev. It was attended by almost 6,000 deputies from all Russian regions. The serious discussions of all current problems in the sector that took place at the conference were reflected in the final resolution. The delegates of the conference called on the population to take greater responsibility for their own health. The conference adopted an ethical code for doctors.
The activities of the Open Government are making a large contribution to the development of the Ministry and to the formation of an open format for its activity. It is noteworthy that currently all legal regulatory acts of the Ministry are posted on the internet for extensive public discussion and for presenting proposals that are closely analysed and taken into consideration.
The Ministry has created a council of non-profit organisations on protecting patient’s rights. Cooperation with charity organisations is expanding.
Colleagues, the current Ministry of Healthcare board not only finalises the results of the first year of our joint performance, but also outlines all areas of planned activity of our department and sector in general for the future. In effect, we are holding a professional public discussion of future work. Importantly, the scale of infrastructure, personnel, financial and economic problems that have accumulated in our sector over the decades requires parallel development of all interconnected and mutually dependent areas of the healthcare sector. We are sure that by working together in harmony we will be able to attain all objectives that are demanded of the healthcare sector by the country’s leadership, the Government and life. Thank you.
Dmitry Medvedev: Colleagues, we have heard an informative report on what the Ministry has done and what it plans to do. Over the last 10 years, the healthcare system has seen considerable changes. All those present are aware of this. It is clear that a lot more remains to be done. I mean those numerousplans for healthcare modernisation and the problems that have accumulated over the past few decades. To cope with all these challenges, we have all capabilities at our disposal, including a sufficiently large healthcare budget. Of course, improvements can always be made. The Minister will always defend additional priorities, attend meetings and argue with the Ministry of Finance – this is the normal process. But truly, we have never had such enormous funds at our disposal in the healthcare system – I mean since the modern Russian healthcare system was formed – and this is a positive development. But we should use these funds wisely, and you have been informed on all programmes.
And our joint objective is to implement them – steadily and methodically, whatever the challenges, but we should respond to the nuances we encounter. You will encounter many nuances, because this activity is complicated and also very important – the lives and health of millions of people depend on it.
I propose that we wrap up the official part of our board meeting not simply by finalising the results (you will continue working with my participation, of course), but also by recognising those who have performed well in this period. I propose to move on to the ceremony.
* * *
After the first part of the meeting, Dmitry Medvedev presented state awards to healthcare workers.