Dmitry Medvedev’s speech at the conference:
It's nice that everyone here in this hall of the Kremlin Palace of Congresses is a doctor. This is the first time that I'm addressing such an audience.
Dear friends and conference participants, I am glad to be able to talk to you. There are doctors present here from all Russian regions. It may sound trite, but it is a fact that people entrust to you their health and their very lives, their future, their children and their closest loved ones. Today we will discuss a large number of very complicated and pressing issues, and will formulate practical proposals on the development of our healthcare system.
Opinions may differ, but our healthcare system was in a state of systemic crisis for a long time. That crisis has recently ended, and the situation has changed. But this does not mean that we are satisfied with the current state of affairs in healthcare. I think that if doctors and ordinary people were asked, all of them would have complaints about the current rules and the healthcare system as a whole. However, it is clear that the Government has moved the focus to social development: increasing life expectancy and improving the quality of people’s life and health are among the key priorities of our social policy, and will certainly be a priority goal of the Government.
This is why I have decided to personally head the Government commission on public health. The commission has been set the task of modernising the national healthcare system, making it more effective and ensuring that people, no matter whether they live in a large city, a small provincial town or a village, have access to quality medical care. This is what people expect from us – from the state and the medical community.
A few words about a difficult and very important issue – figures, that is, money. I’d like to remind you that healthcare allocations have increased by more than 150% over the past five years. A total of 630 billion roubles have been allocated from the mandatory medical insurance fund in 2011-2012 for the implementation of regional healthcare programmes. In 2013, consolidated allocations for healthcare from the regions and the federal budget, notably from the Federal Mandatory Medical Insurance Fund and regional funds, will exceed 2.5 trillion roubles. These are considerable allocations. In 2015, we will provide 3 trillion roubles for these purposes, and allocations will further increase in subsequent years. In other words, there are enough funds in the healthcare system, and what we need to do is use them rationally. We have done a lot over the past few years. I am not embarrassed to say so, with regard to the Health priority national programme and regional healthcare modernisation programmes. We have created conditions for major improvements at the outpatient level.
The accessibility of high-tech medical assistance has definitely and considerably increased. Modern technologies are being introduced in various medical spheres. Achievements have been made in many spheres, but the most prominent and pleasing concern medical assistance for children, who not only need to be treated with particular care but also with top medical skills and complex medical equipment. The birth rate and life expectancy have increased for the first time in many years. This is a positive result however you look at it. This is the result of our work.
But there are also major problems, in particular major differences in the quality of healthcare services at the regional level. There are objective reasons for this, because Russia is a very large country with different traditions and potential, but it is nevertheless unacceptable for such differences to exist within a single state. For example, the life expectancy in St Petersburg and the Belgorod Region is seven years higher than in the Novgorod and Pskov Regions, although the distance between St Petersburg, Pskov and Novgorod is not very large. They are located in the North-Western Federal District, yet the difference in life expectancy is dramatic. The difference between Ingushetia and Chukotka is 20 years: the life expectancy in Ingushetia is 78 years (although healthcare standards are far from ideal there) and only 58 years in the Chukotka Autonomous Area. Of course, life expectancy depends on local customs and medical standards, yet the difference is alarming.
People continue to complain about the quality of healthcare services. They have to stand in long queues in outpatient clinics and pay for services that should be provided free of charge. On the other hand, doctors are not satisfied with their work conditions – their workload is too much – and, of course, salaries are too modest. Their concerns are understandable. Experts point to declining professional standards in many groups of medical personnel, a lack of incentives for efficient work and an inability to influence decisions in the healthcare system. This is cause for concern for the Government and the ministry; it means that quality change is overdue.
A state programme of healthcare development until 2020 will be submitted to the Government soon. Many of you participated in the relevant discussions. The following are the key goals of this programme.
First, additional allocations from the mandatory medical insurance fund will be provided in January 2013. Russian citizens, the whole of society hope that this will help improve the quality and accessibility of medical services. The Ministry of Healthcare should take measures to introduce common modern standards of medical services across the country. I’d like to repeat that one of our priorities is to reduce the gap between regions, between the urban population and rural residents, including resolving the issue of the shortage of doctors and nurses in small towns and villages. We pointed out this problem long ago, and have been working to resolve it, at least in the past few years, starting with the Health national programme, yet the issue remains pressing. People in small towns and villages sometimes are forced to wait years to receive qualified medical assistance, in particular at outpatient facilities, and these people go on living with advanced chronic diseases.
Another priority is the introduction of information technologies. They should ensure new standards in the medical profession and create more comfortable conditions for their work with patients and colleagues, which is important. The Ministry of Healthcare and local medical facilities must do their best to achieve this goal in full and within the approved timeframe.
Second, we have made a lot of efforts, and as part of them we updated the legislation that gives patients the right to choose their doctor, clinic, hospital and insurance company. But I would like you to discuss the current state of affairs in practical terms. In addition, we should improve the mechanisms of public-private partnership, and encourage investors to put money into healthcare. The Ministry of Economic Development has drawn up the relevant draft law, and I am calling on the medical community to join in its discussion.
Third, high-tech healthcare services, as well as the development and the subsequent introduction of innovative products is of special significance, we are well aware of that. Modern medical technologies, simulation centres and telemedicine healthcare services offer opportunities for the treatment of very complicated pathologies, for the production of drugs and for extending life expectancy.
Fourth, the positive changes that are now taking place in the Russian educational system should also cover institutions of higher medical education; the situation with them is not quite satisfactory, to put in mildly. We should improve the level of education and increase the number of medical research universities, bolster their integration with the leading research centres on the basis of research, educational and bio-medical clusters. And of course, we should pay due attention to training nurses, paramedics and midwives. I know that the medical community is highly concerned about this problem.
Fifth, there is the simple truth that it is easier to prevent a disease than to treat it. This usually depends not only on the physician’s abilities, but also on the patient’s attitude toward his or her health. This is again trite, but we should urge people to protect their health and to undergo timely standard medical examinations, for themselves and their children. Disease prevention remains one of the most important functions of the medical and healthcare system; we should not spare money and efforts to achieve this goal. Creating decent living and work conditions for healthcare professionals remains a priority for our state. Over the course of the next two years, the wage fund of healthcare professionals will increase by a third, and by 2018 the average salary of a doctor will be two times higher than the average salary for the given region. We have already agreed on this issue.
It is crucial that we implement all this on time, and make it a common practice for all of the regions. Our country is large, the conditions vary widely from region to region, but we should secure the implementation of these standards everywhere – in Moscow, Chukotka, the Caucasus and all other parts of our country. Both the Federation and the regions should play their part in implementing this task. I would like for all of the regional officials present it this hall, as well as those who are responsible for healthcare services in our country, to pay due attention to my words.
Friends, I believe that your discussions today will be frank, interesting and productive. But before you start them and before we listen to the minister’s report, let me carry out a pleasant mission and present state awards to the best doctors in our country. Renowned Russian medical scientist Vladimir Bekhterev once said that if a conversation with a doctor has not eased the patient’s pain, that person is not a real doctor. Russian doctors have always distinguished themselves not only by their professionalism, but also by their enthusiasm and humanistic approach to their work, and their commitment to the rules of professional ethics.
I would like to express my gratitude to all of you – doctors, nurses, paramedics and all other healthcare professionals – for the work you do every day. I wish you success in your very difficult work, and I hope for the work of the convention to be productive. Thank you.
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After addressing the Conference of Doctors, Prime Minister Dmitry Medvedev presented state awards to medical specialists.
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Healthcare Minister Veronika Skvortsova’s Speech at the conference:
Mr Medvedev, ladies and gentlemen, colleagues,
The Kremlin has become the venue for representatives of Russia’s healthcare system today – the best representatives of the medical community from around the country. This National Conference of Doctors is the first in modern Russia, and the third in the entire history of our country. It was convened because it became absolutely indispensable due to the enormous goals the President and the Government have set for the national healthcare system. The grand scale of the work, combined with tight deadlines, will require effective teamwork and professionalism on the part of the medical community, and also great commitment and dedication. In fact people’s health will depend on how effective we are, and consequently, the nation’s socio-economic development as well. Health is the key to alleviating economic crises; it also defines the horizon of social progress.
Russia has made significant progress in the field of healthcare over the past few years. In fact, policies in the field of healthcare and demography are among the Government’s priorities. The rapid progress of the Healthcare national priority project launched in 2006, as well as regional healthcare modernisation programmes adopted in 2011, has resulted in an overhaul of the national healthcare infrastructure and re-equipment of outpatient centres and hospitals across Russia. IT is being introduced in healthcare as well.
After a period of relative neglect, the Government has once again started focusing on primary and emergency healthcare, and the social standing and working conditions of community doctors and specialists working at local outpatient centres. The Childbirth Certificate, Neonatal and Audiological Screening and Prenatal Diagnostics programmes have been very helpful in improving the health of pregnant women, new mothers and children less than one year old. The Government has provided unprecedented support to patients requiring high-tech medical services. Russia has begun consistent efforts to fight the most common causes of death, such as vascular disorders, cancer, traffic accidents and TB. The massive efforts have yielded some positive results. Life expectancy grew by almost four years over the past six years, the death rate decreased 16%, the infant death rate by 33% and the maternal death rate by 36%. In fact, the death rate from all the main lethal diseases has declined.
These improvements would have never come about without greater healthcare financing, by 160% compared with the 2005 level. This increase was not only due to the Government’s social responsibility and humanistic policies. Financing healthcare can also be viewed as investment in human capital, and some return on this investment is expected in terms of greater production and a greater economic potential of the nation.
Colleagues, we all know that these successes are due to the hard work and dedication of doctors, paramedics, nurses and all those people who have devoted themselves to saving lives and restoring health. The professional community of doctors is probably the group that is best aware of the existing problems and flaws in this system. Healthcare workers know only too well that disease prevention is the best way to improve people’s health and increase life expectancy, as well as to save financial and material resources. While in the 20th century, heath risks mostly stemmed from infection, today we are obviously witnessing growing global epidemics of non-infectious diseases, which are the main causes of death and disability in Russia and the world. They lead to disastrous economic and social consequences. Vascular disorders, cancer, respiratory diseases and diabetes are responsible for nine in every ten deaths in people under 60 in Russia. Regardless of genetic factors, people develop many non-infectious conditions gradually, due to their lifestyle – diet, the quality of drinking water, the natural environment, physical activity, their emotional state and substance abuse – and well as social factors such as working conditions and recreation. The combined influence of behavioural factors alone accounts for 61% of vascular pathology and up to 35% of cancer cases. For instance, alcohol abuse is an issue in about 12% of deaths, smoking in 17% and unhealthy diet in nearly 13%.
I would like to remind you that Russia has proposed the concept of an integrated health promoting environment, which was approved by the international medical community. It was also the main achievement of the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control. Russia’s concept was reflected in the WHO resolutions and a political declaration of the UN General Assembly. This environment should include an infrastructure, information and educational institutions, a relevant legal framework, tax incentives and other conditions to promote and support healthy lifestyles and choices. It should also motivate people to preserve their health and extend their years, and foster everyone’s responsibility for their own heath and that of their family.
It is worth noting that creating an integrated health promoting environment will require commitment and contributions from all Government ministries and public agencies. Each of them will have to adopt some healthcare functions. This work will require strong political will, which is certainly present in Russia. I would like to thank you, Mr Medvedev, and the Government, on behalf of the entire medical community, for your support of the Healthcare Ministry’s initiative to set up a Government healthcare commission and for your willingness to head it. This commission will coordinate the work on the integrated environment promoting good health, by bringing together each industry’s healthcare aspects and civil society, achieving a shared understanding of priorities, and developing inter-agency and inter-industry contacts.
Dear colleagues. We must jointly restructure the established system of rendering medical aid from the habitual “doctor-patient” pattern into that of “doctor-healthy person.” We must create and introduce a system of health monitoring. Above all, this means the organisation of primary health care, and community , school, and occupational medical services. Preventive activities must account for no less than 30% of the time of primary care physicians. For that, new approaches for the organisation of activities of the medical community service, tariff policies, and new material motivations of assessing doctor’s work are required. This must be based not on the amount of doctors’ appointments and the number of prescriptions, but rather the final result –the state of the health of a community’s population, the percentage of diseases revealed at the earliest treatable stage. We are going to develop prenatal and neonatal screening, return to annual medical check ups among children and teenagers, regular preventive examinations and check ups for the adult population.
Taking into account the latest deficit of primary care physicians, it is necessary to develop visiting check up practices in organised students’ and workers’ groups, in rural and remote areas.
Colleagues, it is no secret that the medical check ups we are conducting for children and adults is often no more than a formal procedure that does not always bring about the expected results. We must defeat these formalities and improve the professional level of preventive check ups and examinations. It is necessary not only to reveal the factors of risk and early signs of diseases, but to carry out active prevention of their development. Doctors must introduce advanced methods of creating a healthy lifestyle, not only in reports but in practice. To implement this programme, it is necessary to optimise doctors’ workloads, change the norms that have existed for years and that determine the extremely short amount of time that a doctor spends communicating with a patient, and to give doctors a chance to realise their knowledge and skills to the full, and to perform their duties in a high-quality manner.
At the All-Union Conference of Physicians held in 1988, a lot of critical remarks were expressed regarding the paperwork that replaces live doctor-patient communication. Unfortunately massive amounts of paperwork still take up most of a doctor’s time. Due to a lack of nursing staff, doctors have to perform duties they should not be responsible for. New approaches that are already laid out in the programme of state guarantees of rendering free medical aid in 2013 will change the situation. This includes reforming the time standards included in the orders of rendering medical assistance, which will be obligatory all across Russia starting in January, 2013. We hope the informatisation of healthcare, introduced as part of the modernisation programmes, will also improve the situation. Introducing electronic document circulation will not only improve quality and provide continuity of medical assistance, but will rid doctors of the excessive amount of paperwork. Online registration for medical appointments must be applied in all regions in December, 2012. Consequently, each doctor’s schedule will be made available online. This will guarantee maintaining standards of time and of the overall work loads.
Dear colleagues, another important objective for the Russian healthcare system is enhancing availability and the quality of medical aid.
International experience shows that to create a system for monitoring the quality of medical services we should first standardise these services and introduce rules and standards that would allow each Russian citizen, irrespective of their place of residence and employment, to receive the guaranteed amount of medical services identical in terms of patients’ conditions. Introducing common requirements, opening the system of mandatory medical insurance to medical facilities of all forms of ownership and giving patients the right to choose where to receive medical assistance will create conditions for the development of mechanisms of controlled competition and hence improving the standards of medical services.
It should be said that the introduction of common standards does not amount to depriving medical facilities of their identity. Standards are the goals set primarily for medical managers; they are necessary for creating comparable administrative, material, technical and personnel conditions of the provision of medical services in all regions.
Colleagues, taking into account major differences between the healthcare standards in the regions, we launched an unprecedentedly large and expensive project to modernise the national healthcare system in 2011. In fact, we launched 83 different regional modernisation programmes designed to meet the requirements of each given region. The main goal of all modernisation projects is to create a three-tier system of medical services that would be the best for each given region. It should be based on the development of the outpatient level of healthcare and broad introduction of day-care facilities and relevant technologies, telemedicine and visits of patients by staff of outpatient facilities. This development of outpatient healthcare services should be complemented with a substantiated reorganisation and partial conversion of in-patient facilities in each region based on a careful analysis of the patients’ routes, the provision of the necessary number of rehabilitation care, nursing and palliative care beds. In other words, we should ensure a full range of assistance from intensive care to recovery.
The development of emergency medical assistance is of vital importance. We are glad that the regions will complete the development of mobile telemedicine systems on the basis of ambulances equipped with the GLONASS technology by December 2012. At the same time, we should revive the system of medical aviation services. We are completing the drafting of a concept for its development for each region and also at the interregional and federal levels, which is crucial for the healthcare systems of the northern, eastern and some other regions of the country.
Special attention should be paid to the provision of medicines and medical goods, as well as special nutritional care products. All of us understand that quality medical assistance is impossible without effective and safe medicines. A lack of the necessary medicines is a tragedy for the doctor and his patients. We have defeated many diseases which we discussed at the convention in 1988 and dealt with the physical absence of medicines and the black market (unrecorded sale) of medicines. But we are now facing other problems such as a wide range of highly effective and predominantly foreign-made medicines which some groups of people cannot afford because of their price.
In accordance with a relevant executive order of the President, we are to submit for discussion a national strategy for the provision of medicines in the near term and to forward it to the Government by January 1, 2013. I’d like to point out that the proposed introduction of additional state guarantees, such as prescription drug insurance or partial compensation of the cost of medicines for outpatients, should be directly connected with reciprocal commitments on the part of the population. These commitments should include a healthy lifestyle, regular medical check-ups and strictly following medical prescriptions.
Ladies and gentlemen, the healthcare system is always a product of conditions unique to each particular country, its history, political life and national character. There is no one universal healthcare system that suits all countries. In all countries, the healthcare system is facing the problem of rising medical costs due to the introduction of new technologies and innovative medical goods and medicines. A distinctive feature of the Russian healthcare system is that it is rooted in the Soviet-era state monopoly, which ensured access to free medical services of the same quality for everyone. This explains the expectations of the majority of Russian population and especially the older generation.
A difficult challenge and a very important task for the national healthcare sector is creating conditions that will preserve the principles of social equality and solidarity, while constantly renewing standards of medical services and using the most efficient and advanced medical technologies. Such harmony can be achieved only through two processes proceeding in parallel: optimisation and increasing the internal efficiency of the healthcare system, as well as the active, innovative development of medicine. Experts estimate that within the next decade, countries with advanced economies will fully change their technological mode and will switch to using the latest developments in biomedicine, computer science and nanotechnology. Introducing modern, personalised and highly efficient medicine will make it possible to treat previously incurable deceases, extend life expectancy, and considerably change ideas about health characteristics and the capabilities of the human body. The healthcare sector will turn into an industrial branch that will produce intellectual product in high demand. Today, Russia has enormous scientific potential for developing biomedical technologies, yet there are organisational, personnel and infrastructure issues that prevent us from making a breakthrough to catch up with technologically advanced countries.
The draft state programme for the development of the healthcare sector to 2020 includes a special sub-programme on innovative development. Together with members of scientific, medical and expert communities, we have to define common national priorities in biomedicine and strengthen scientific schools by establishing scientific and educational clusters at the best universities and making the education process more creative.
Accelerating innovative development will require both simultaneous and advanced training of qualified personnel, scientific and medical workers, the carriers of technology. Within three years, starting in 2013, we plan to renew scientific infrastructure, set up a network of pre-clinical research centres which will create the conditions for modelling human diseases in animals, collecting various biological materials and cell cultures, and bringing together unique equipment and technological capabilities. It is vitally important to more actively introduce programme and targeted financing of biomedical projects, attract businesses in administrative activities and facilitating the introduction of new medical products.
In December, in accordance with the President’s executive order, the Ministry of Healthcare will submit to the Government the strategy for medical science. Detailing a strategy and specific tactical steps are implied in the draft state programme for the development of the healthcare sector to 2020, which was developed by the Ministry of Healthcare and other federal bodies together with leading experts in all major fields of medicine and healthcare. Currently, the draft state programme is actively discussed both in state agencies and at the Open Government, the Public Chamber and internet forums. All proposals and comments will be welcomed and considered to the maximum extent while improving the programme.
Organisational, scientific, methodological, material, technical and financial issues are certainly important – but the upgrading of the national healthcare sector will be implemented by our army of medical workers, which amount to some 3 million.
Training future doctors at educational institutions is of paramount importance. Even a cursory look at academic programmes at medical universities shows that the level of training at our universities and academies differs greatly. In many universities, educational programmes for basic biomedical subjects, which are essential for modern medicine, considerably lag behind today’s achievements. To change the situation, the Ministry of Healthcare has initiated the re-evaluation and renewal of educational programmes and curricula at medical universities under the third-generation state educational standards. The working group, which comprises leading specialists in medical education, researchers of the Russian Academy of Medical Science and the Russian Academy of Science, and Skolkovo experts, has finished analysing the best Russian and foreign practices and developed revised educational programmes in most essential fields, such as molecular biology, molecular physiology, bioinformatics, and others. On October 1, comprehensive work began on advanced training of academic teaching stuff at all medical institutions. The work will be implemented in full within the next two years. This is a complex task, and it involves both the best medical universities and traditional universities that boast strong medical faculties, such as Moscow and St Petersburg state universities, as well as the Skolkovo Open University. Bringing together higher medical education and modern scientific schools will be accomplished by setting up scientific and educational clusters at the best medical universities and actively attracting students in research activities. The work has already started and will be comprehensively expanded next year.
Attention should also be paid to practical aspects of training young doctors. The new educational standards imply increasing practice time starting from the earliest academic years. During the next few years, work will be done to develop university clinics and clinic centres, actively introduce new educational technologies and simulation and training classes, set up experimental surgery rooms for animals, create virtual situational software and launch interactive distance learning, electronic databases and libraries, and create systems for assisting young specialists in making decisions. It should be noted that while renewing academic programmes, particular attention is paid to making a medical university graduate’s skills and abilities correspond with clinical protocol, regulations and standards of healthcare services.
We all understand that being a doctor is a lifelong learning process. Introducing a system of continuous medical education is imperative and should be done in the most convenient manner, without taking a specialist away from his work for a long time and using mechanisms like saving credit points and distance learning.
The Healthcare Ministry calls on the medical community to take an active part in developing professional standards and dovetailing them with graduate and post-graduate programmes, and in improving the mechanisms of informal attestation of doctors. The introduction of attestation of medical professionals under the law On the Main Principles of Protecting the Health of the Citizens of the Russian Federation will enable us, beginning from 2016, to introduce a system that is new to our country of individual certificates allowing the holders to engage in certain types of medical activities, which will enhance doctors’ responsibility for the results of their work.
Providing personnel for the healthcare system is one of the main challenges we are facing. Our task is not just to provide the necessary number of medical workers, but to make sure that their training and qualifications meet the real needs of the three-tiered system of medical care. The share of healthcare workers under 45 dropped by 12% between 2000 and 2010. Not all the graduates of medical schools, colleges and so on work in their core field, and there is still an outflow of highly skilled specialists from the state healthcare system. The reason is low pay and inadequate social benefits of medical workers at state and municipal medical organisations. According to Rosstat (the Russian State Statistics Service), the average monthly salary of public-sector healthcare workers is less than 18,000 roubles, or 73.5% of the average pay in the country’s economy. The average monthly pay of municipal healthcare workers, who account for 45.7% of all medics, was a mere 14,600 roubles, i.e. 62.7% of the national average. Raising the social status of doctors and other medical professionals and improving their standard of living are among the most important factors motivating them for creative and dedicated work. Without meeting these conditions we will not be able to strengthen the human resources in the industry, enhance the prestige of the medical profession and stop the brain drain among medical personnel. An exceedingly important measure is raising, by 2018, the average pay of doctors to twice the average wage in the region, and the pay of middle-level and junior personnel to 100% of the average wage. It has to be stressed that the legislation on the development of the Mandatory Medical Insurance system in line with new healthcare standards ensures that the remuneration of medical workers will grow at the necessary pace until 2015, provided the regions pursue a sound tariff policy.
A necessary condition of the effectiveness of the whole healthcare system is retaining all the trained personnel in their work places, especially in remote parts of the country and in rural areas. The targeted training schemes that exist today do not guarantee that a specialist, after being trained, will return to the region that referred him or her for training. Nationwide, up to 35% of targeted undergraduate and postgraduate students do not make up for the cost of their training, and the figure in some regions reaches 70%. New forms of targeted contract training at a medical higher education institution, college or school, including targeted postgraduate and additional professional training, should provide real mechanisms for targeted employment of specialists. Such contract forms have been developed by the Ministry OF Healthcare jointly with the Ministry of Education and Science and have been sealed in the new draft law on education submitted to the State Duma. The terms of the contract will help determine legally sound obligations of the parties: social and financial support of the applicant, student and graduate on the part of the regional administration and an obligation to work for at least three years in a workplace specially reserved for him or her on the part of the graduate.
The introduction of a lump sum payment of 1 million roubles is an important and effective government initiative that encourages young graduates to work in rural healthcare centres. That initiative attracted 3,900 doctors to rural areas in 2012 alone. We believe it is practicable to extend this programme into 2013 and extend it to graduates who have started work at healthcare centres in industrial communities.
At the same time, regional administrations have a big share of responsibility for organising and providing social support for medical workers. It is worth repeating that under the President’s executive order every constituent entity of the Russian Federation must design its own medical personnel programme envisaging mechanisms for attracting graduates and retaining the existing personnel.
Esteemed delegates,
The distinguishing features of the medical professional, along with competence, are a sense of responsibility, kindness and compassion. The fact that one of the main complaints against medical workers recently has been their violation of professional obligations and medical ethics gives great cause for concern. Undoubtedly, the majority of doctors are dedicated to their profession and uphold the Hippocratic oath; however, rudeness, callousness and neglect on the part of some medical workers and soliciting of bribes tarnish the reputation not only of individuals, but of the whole medical profession. We hope that through common effort we will be able to restore confidence in the medical profession, in the doctor. What needs to be done above all is to improve the organisation of medical community itself. A doctor who behaves in an inadmissible way towards a patient must be censured by his or her colleagues and denounced by the medical community. There is a pressing need to develop non-governmental organisations of medical professionals capable of coordinating all the main areas of modern medicine, uniting doctors on the basis of corporate responsibility and corporate ethics. The legislative and regulatory framework that has been created makes it possible to actively and consistently shape the professional philosophy and self-regulation of the medical community. Consolidation on the basis of professionalism, responsibility, integrity and equality alone will enable us to meet the challenges of the time and enhance our main national treasure: the health and lives of Russian citizens.
Colleagues, I would like to wish successful and fruitful work to all the delegates of the First National Congress of Doctors of the Russian Federation. Thank you.
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Dmitry Medvedev’s closing words:
Allow me to say a few words before I leave this big hall. I have a proposal. It is quite rare for so many representatives of the medical community to gather at one place. I am addressing everyone present here – the minister, the leadership of the Academy of Medical Sciences and all those present: try to discuss the most urgent issues that the medical community is really concerned about. I believe there are many such issues, we have already discussed several of them, and there are others that were not discussed. But I noticed that the issue of increased workloads stemming from the need to do a huge amount of paperwork has resounded among you. Let’s think out how to facilitate the work of doctors. This is very important and absolutely achievable under modern conditions.
I also hope that you will engage in such fundamental issues as the quality of medical assistance and the quality of medical education. I am not going to explain to you issues that you know about better than I. It is obvious that there are big problems in these areas, and we should think about how to reorganise the entire system of education so that the medical sphere remains competitive and we attract new specialists, and not only doctors, of course. I believe that the issue of education is crucial.
I would also like you to pay attention to the state programme, which I talked about and Veronika Skvortsova mentioned in her report. This is a pivotal document that will define the development of the healthcare system until 2020. The organisational forms of work, and of course, the financial basis for it, the balance between different priorities of the programme and the key standards it will use, should be reviewed. Try to make a detailed review of this programme so that we later do not have to make last-minute amendments on the fly. I have a question that concerns all healthcare professionals, and I just want to say that the Government recognises its responsibility. Jointly with the regions, we will be sure to engage in improving the living conditions of doctors and increasing their salaries. We have the control figures, they are quite complicated, I won’t hide this, but the federal budget, the Compulsory Medical Insurance Fund and the regional budgets are capable of this, so we will implement this task.
Another issue mentioned here that I want to comment on quickly is the programme concerning rural doctors and doctors who could work in worker settlements. We reviewed this, and established that the programme could be extended at least through next year. I believe that this decision will be useful and I will take it.
School healthcare services, which were addressed by Olga Kovtun (Head of the Urals Research Centre of Children’s Health), represent another important topic. I hope that you will also discuss this, as well as all other significant issues that were addressed today.
And the last. I look at this hall, where 5,700 people are present, the hall is really huge, I have never seen so many doctors in one place, and you too, perhaps. Why am I saying this? The last time such an event was held was in 1988 – let’s meet more frequently than once every 25 years. Until next time!
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Prime Minister Dmitry Medvedev attended the First National Convention of Russian Doctors and visited a Healthcare Ministry exhibition on the introduction of a comprehensive information system in healthcare.
