Transcript Document

HEALTH AND HEALTHCARE
IN RUSSIA
TODAY AND TOMORROW
G.E. ULUMBEKOVA,
ASSOCIATION OF MEDICAL SOCIETIES
FOR QUALITY
© ASMOK
CONTENTS
1. Demography and Health Indices of Population
in Russian Federation
2. Key healthcare problems today
3. Future demographic, social and economic
challenges in healthcare
4. What should be done
5. About ASMOK and its strategy in medical education
PART 1
Demography
and Health Indices
of Population
in Russian Federation
LIFE EXPECTANCY AT BIRTH (YEARS)
Life expectancy at birth (LEB) has dropped from 70 years in
1985 to 68,7 years in 2009. It is 6,3 years smaller than in “new”
EU countries and 12 years smaller than in “old” EU countries
CRUDE DEATH RATE (PER 1000 PERSONS)
Crude death rate (CDR), the number of deaths of any reason,
increased from 10,5 in 1985 to 14,2 in 2009. It is 1,3- and 1,5 - fold
greater than that in the “new” and “old” EU countries,
correspondingly
CAUSE-SPECIFIC MORTALITY DISTRIBUTION
Major causes of fatal outcome:
 Circulation system diseases – 56,5%
 Neoplasm – 14,6%
 External causes – 11,2% (suicide, traffic accidents, alcohol
poisoning, homicides)
MORBIDITY (PER 100 000 PERSONS)
Morbidity of population has grown by 42% since 1985 from all
diseases. In the last years the circulatory diseases (44,5%) and
malignant neoplasm (17,6%) prevailed in the structure of morbidity
LEADING RISK FACTORS
Tobacco
consumption
The proportion
of daily smokers
among adults
is twice higher than
the average
in OECD countries
Alcohol
consumption
In liters per capita
for adult population
is twice higher than
the average
in OECD countries
DISPARITIES IN HEALTH INDICES
In mortality
In life
expectancy
Regions
(between the
extremes)
140%
3,5–4,5 years
Urban/rural
20%
2,7 years
Men/women
38%
12 years
CONCLUSIONS
 The most health care and demography indices in Russia are worse
than those in “new” and “old” EU countries
 The persistent elevation of the share of senior people necessitates
the sustainability of medical social service on the long-term care
 The predominant role among the factors aggravating health of
population in Russia was played by unhealthy lifestyle:

wide spread of alcoholism

tobacco smoking

drug abuse

poor working conditions
 lack of long term government strategy aimed to improve
population health
PART 2
Key healthcare
problems today
STRUCTURE OF PUBLIC HEALTHCARE IN RUSSIA
 Funding is based on a mixed budget-insurance model
 Organization of medical aid inherited some features of
N.A. Semashko healthcare model
POSITIVE FEATURES:
NEGATIVE FEATURES:
— Totally free
— Extensive type of development
— Budget finance
— Underfinanced
— Vertical integration
— Lack of quality control
— Governmental providers
— Administrative-command style
— Polyclinics
— Lack of high technologies
— Separate pediatric services
— Prophylactic approach
 Three administration levels: Federal, Regional, Municipal
 Three property forms of medical aid providers involved in SGP (State
Guarantees Program) realization: government (Federal and Regional),
municipal and private
POOR HEALTHCARE FINANCING
As a share of GDP Russia is spending on healthcare twice less
than OECD on average
Total and government spending for healthcare expressed in GDP
share in various countries
POOR HEALTHCARE FINANCING
Per capita government spending in Russia is 635 ($PPP) i.e.
3,4-fold smaller than the average spending in OECD nations
and 1,5 – 2 times smaller than in the EU countries
Total and government per capita spending on the healthcare in various countries
EXPENDITURE ON PHARMACEUTICALS FOR AMBULANT THERAPY
In the relative values (GDP share) the public expenditures on
pharmaceuticals in RF is only 0,23%, while the corresponding
figure in the developed countries is 4-fold greater (0,9%)
INTERDEPENDENCE BETWEEN HEALTHCARE FUNDING AND
POPULATION HEALTH INDICES
To achieve LEB of
73–75 years and
CDR of 11.0–10.0,
the government
per capita
spending on the
healthcare should
be no less than
1100–1200 $PPP
NOT EFFECTIVE MANAGEMENT
To attain CDR of 11,0, Local Guarantees Program (LGP) spending
should be doubled to the level of 15 thousand rubles which
corresponds to 1000 $PPP
Dependence of CDR on LGP (per capita) spending
SALARY OF MEDICAL PERSONNEL
The salary of doctors in 2009 was 10% lower than the average wage in RF (16,8
and 18,6, correspondently). At present, the salary of doctors in OECD countries is
higher by 3-5 times than the average wage in corresponding countries
COMPARISION OF INTEGRAL EFFICIENCY OF HEALTHCARE SYSTEM
IN RF AND OECD NATIONS
Index
Value in RF
Value in OECD
nations
Preventable death. It is assessed by
the number of potential years lost for
life (PYLL) per 100 thousand persons
Not measured
3700
Share of population satisfied with
quality and availability of medical aid
31%
70%
Treatment efficiency: mortality of the
patients with myocardial infarction
in a hospital (nonstandardized index)
20%
7.7%
Treatment efficiency: five-year
survival rate among the patients with
breast cancer
56%
85%
Treatment efficiency: lethality among
the patients with bronchial asthma
per 100 thousand adult population
(older than 18 years)
2.3
0.18
THE REASONS OF POOR PHYSICIANS PERFORMANCE
The reasons of poor performance:
 Continuous medical education — only 1 time in 5 years, 15%
doctors even didn’t match this indicator
 Educational programs not always up-to-date and taught
without using distant technologies (4 month out of work)
 Physicians lack evidence based literature at the point
of care
 Physicians don’t have access to electronic support systems
and electronic medical library
NOTE: the products are available on the market
CONCLUSIONS
The basic problems of healthcare in Russia are:
 Underfinancing and not equal distribution of healthcare resources
between various regions of RF
 Unclear directivity of the healthcare system on the patient’s needs
 Insufficient qualification of the medical personnel
 Inefficient management in the strategic development of the national
healthcare system
 Disproportions in healthcare supply in favor of specialists and hospital
care
 Lack of innovations coming from academia
 Lack of coordination with Russian pharmaceutical industry and medical
device industry
To solve these problems we need the systemic, targeted, and
coordinated long-term Strategy of National Healthcare - 2020
PART 3
Future demographic,
social and economic
challenges in healthcare
DEMOGRAPHIC CHALLENGES
The medium variant of projection toward 2025
(Federal Agency for Statistics):
If mortality is 15,0 (no change), birth rates will be 9,6 per 1000 population
(decline) and migration will rise by 50%
In 2025:
 Total population will decline by 5 mln (from 142 mln to 137 mln);
 Working age population will decline by 14 mln, it’s proportion
will diminish from 63% to 55%;
 Over working age population will increase by 6 mln and it’s
proportion will rise from 21% to 27%;
 Life expectancy will be – 70 years
ECONOMIC CHALLENGES
If LEB of the men is elevated by 5 years to 2020, almost 60% men would reach
the age of 65 years (the minimal retirement age established in all developed
countries), which corresponds to the curve (II). In contrast, the present variant
(I) shows that merely 48,6% men will reach retirement age
EXPECTATIONS OF PLAYERS INVOLVED
Population
Shorter waiting lists
Polite doctors
Lower charges (copayments)
Medical
personnel
Salaries increase 2-3 fold
Opportunities for continuous medical education and
professional growth
Less paper work
Government
Improve population health
Satisfy population
Decrease disparities
Pharmaceutical
industry
Higher sales
Less regulation
More transparency in government decisions
More influence on opinion leaders and physicians
Private providers
Access to public finance
Less regulation
Revenue growth
NATIONAL PRIORITY PROJECT “ZDOROVIE”
830 thousand additional lives of Russian citizens were saved
(0,6% population of RF)
PART 4
What should be done
THE AIMS ARE OUTLINED
DEMOGRAPHIC STRATEGY
«On Adoption of the Conception of Demographic Policy in
Russian Federation toward 2025”
Decree of RF President № 1351 of 9 November 2007
President of RF
Dmitry Medvedev
Prime-minister
Vladimir Putin
LONG-TERM SOCIAL ECONOMIC STRATEGY
OF RUSSIAN FEDERATION
“ Conception of the Long-term Socioeconomic Development
of RF toward 2020”
Instruction of RF Government № 1662-r of 17 November 2008
THE PRINCIPLES OF HEALTHCARE
STRATEGY
 Solidarity
 Total coverage
 Equity: payments + health status + access
 Fair resources distribution
 Transparent and evidence-based decisions
 Honesty of managers and no place for corruption
 Strategic and managerial approach in stewardship
 Open reports on results to government and public
 Share of responsibilities on health improvement
between government, business and population
KEY TASKS
FINANCE
 Increase the spending on state healthcare system at least
2-fold toward 2014
 Create conditions for fair distribution of the spending burden
on medical services for rich and poor strata of the society
 Adopt the system of predominantly single payer and single
fund manager for spending on the medical aid under SSP –
the law is already passed
 Create the conditions for leveling of the financial provision
for SGP in various RF subjects - the law is already passed
 Enhance efficiency of procurement of medical services
from the suppliers
 Update the norms of SGP on free medical aid to RF citizens
 Eliminate unofficial payments in patient care institutions
KEY TASKS
IMPROVEMENT OF ORGANIZATION OF MEDICAL SYSTEM
 Ensure availability and quality of medical drugs to RF
population — 3-fold
 Enhance the salary of doctors — 2-fold
 Restore the medical aid system inherited from the Soviet Union and
adapt it to modern conditions – industrial and school medicine
 Ensure availability of medical aid to rural population
 Reform the hospital-based medical aid
 Improve the medical aid system for the patients with social-motivated
disease (AIDS, tuberculosis, etc.)
 Create the control system over the quality of medical aid
KEY TASKS
RESOURCES
 Enhance qualification of medical staff through Continuous Medical
Education (CME)
 Enhance motivation of medical personnel to qualitative work
 Ensure the optimal structure of medical personnel (the over-all
number and available specialties)
 Elaborate the long-term program of sustainability of infrastructure
and re-equipment of the patient care institutions
 Actualize the standards for the number of hospital beds
 Enhance innovation character and the quality of the research work
in medicine and health care
 Develop the combined cooperative plan of the healthcare system,
pharmaceutical and medical industry – already started
KEY TASKS
CONTROL OF HEALTHCARE SYSTEM
 Introduce the strategic approach to realization of the state policy
 Restore partially the vertical control over the healthcare system
 Strengthen the state control over Medical Care Quality (MCQ) and
the medical aid tariffs
 Extend autonomy of the state and municipal Medical Prevention Institution
(MPI) and organize competition among the suppliers of medical services
of all property forms
 Adopt the economically efficient (market) methods of control healthcare
 Enhance professional skills of the management personnel
 Diminish the corruption risks and strengthen transparency and justification
of the adopted decisions
 Actualize the normative legal instruments in the healthcare system
KEY TASKS
ACTUALIZATION OF THE PROGRAMS ON HEALTHCARE PROTECTION
 Promote motivation in population of RF to the healthy life-style
 Enhance responsibility of population and the employers for maintenance
and strengthening the health
 Expand conditions for healthy life-style in RF
 Actualize the struggle program against tobacco smoking
 Actualize the struggle program against alcohol overconsumption
 Actualize the struggle program against drug addiction
 Extend prevention and prophylaxis programs
 Improve the sanitary-epidemiological surveillance in RF
 Ensure integration and coordination in the control over the programs on
health protection
PART 5
About ASMOK
and its strategy
in medical education
ABOUT ASMOK
ASMOK was founded in May 2005 in order improve quality in
medical education and services provision
The way how we work:
 methodology development
 analytical documents
 educational products initiation and coordination
MEMBERS
The outcomes of ASMOK activities
Coordination of work
Evidence based guidelines ~ 340
Modern and constantly upgrading sources of information, providing medical doctors with vital
materials on prevention, diagnostics and management of different diseases.
“National guides” ~ 60
Developed for continuous medical education. The series covers all major specialties. Each title is
accompanied with a CD based on Physician’s Consult platform. The leading Russian experts and
key opinion leaders participated in the development of the series.
The outcomes of ASMOK activities
Web-based medical decision support systems
Independent evidence based information
Powerful built-in search engine for finding
relevant information within seconds
Independent drug information,
free from the biases
introduced by marketing
Patients information
EBM Guidelines
CME Textbooks
CME Online and Portfolio
management, etc…
The outcomes of ASMOK activities
Web-based library for medical students
More than 300 textbooks
Multimedia clinical skills
Built-in eLearning tools
Built-in eLearning tools
The outcomes of ASMOK activities
Health promotion and patient education
Materials for healthy people and for all groups of
society: pregnant women, children from 0 to 14,
adolescents, young and middle age, elderly people,
women’s health. The materials were highly evaluated in 7
test regions. 1–1,5% of the regions needs were supplied
“Healthy Living Schools”. Either for those suffering from
non-infectious chronic diseases or for those having risk factors
for their progression.
2007-2008: the information materials on healthy lifestyle, delivered by ASMOK,
were expanded within the framework of the political project “Zdorovoye
serdtse” (Healthy heart) under guidance of the Chairman of the Supreme Council
of the party “Edinaya Rossiya” (United Russia) Boris Grizlov. This project was
highly evaluated all over Russia.
The outcomes of ASMOK activities
EBM Drug Reference Guide
Independent drug information,
free from the biases introduced by
marketing
Online version has a powerful built-in
search engine for finding relevant
information within seconds
Journal and website on problems and development of
Medical education and professional development.
Evidence
based
educational
content
New
technologies
in medical
education
CME and CPD
WWW.MEDOBR.RU
41
International conference “Medical Education in Russia
and the World: Traditions and Innovations”
WWW.MEDOBR.RU
The outcomes of ASMOK activities
Analytical documents developed by ASMOK :
Healthcare in Russia. How to cope with current
challenges
The conception for advancement of CME in
Russia
Clinical guidelines and standards of care
The program of state guarantees for Russia
Public-Private Partnership in Healthcare
Association of Medical Societies for Quality
ASMOK works closely with over 100 higher
medical schools throughout Russia and CIS.
ASMOK is founding member of Russian
National Chamber of Physicians.
ASMOK is Premium member of AMEE
(Association for Medical Education in Europe)
ASMOK is your RELIABLE
partner in Russia
WWW.ASMOK.RU
THANK YOU FOR
ATTENTION!!!