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Appeal to the President of the Russian Federation V.V. Putin

01.10.2013

Dear Vladimir Vladimirovich!
We are writing to you on behalf of millions of Russian citizens – current and potential patients, whose interests we represent.
We are extremely concerned by the plans to reform the health care financing, the so called "budget maneuver". Our many years of experience in protecting the constitutional rights of Russian citizens on health care and drug provision convinces us that if the responsibility for public health is delegated largely to the regions then for many regions of Russia a long period of sharp worsening of the situation is inevitable. We would expect a significant increase in morbidity and mortality of the population, for whom the access to health care and medication on free and reimbursed basis – which lags behind the guarantees even today – will become even more limited.
The first and the main argument against "budget maneuver" is that it does not guarantee that the administrative units of the Russian Federation will have sufficient funds even to maintain the health care system at least at its current level. The rosy forecasts for the growth rates of budgets of territorial compulsory medical insurance funds were revised downward, attempts to find additional sources to fill these budgets were blocked. So far, there are no signs of improvement in this area.
Already today, the inequality in terms of regional incomes poses serious problems. According to the Russian Ministry of Health, territorial programs for provision of free medical care are non-deficient in 17 regions only. As a result, territorial programs in most Russian regions are not fully implemented, that infringes the rights of a large part of Russian citizens.
Access to treatment under compulsory health insurance program is limited even in Moscow. According to sociological studies, in other regions patients do not expect to receive reimbursed drugs at all, or receive in the minimal amounts, insufficient for adequate treatment.
The lack of due attention to the health care system over the years has given rise to a number of serious problems. Some of them are being partially solved in the framework of regional healthcare modernization programs, but most of them still waiting for solutions. Under conditions of "budget maneuver" they will have to be solved the regions of Russia. Given that certain costs, a substantial increase in medical staff wages in particular, are absolutely necessary, considering limited resources, they are possible only at the expense of other costs, which are equally necessary (for prevention and early detection of diseases, drug provision, rehabilitation, etc.).
Reliance on compensation of the shortfall through federal subsidies is also unreliable, especially taking into account the proposed "uniform reduction of all costs" of the federal budget by 5%.
The situation is additionally complicated by creation of a universal federal subvention, which does not include breaking down of findings by authorities delegated to the regions of Russia – regional powers may change the proportion of spending on education, health care, protection of forests and on other needs at their own discretion. Is it a "flexible financial instrument"? Under conditions of lobbying and corruption, it is difficult to expect that it will take into account the real needs of the population. At the federal level, it is sometimes possible to counteract such an evil, but at the regional level the authoritarian nature of management and control systems, the embryonic state of civil society and the controlled media leave no hope for this.
Dear Vladimir Vladimirovich! It seems that today the "budget maneuver", at least in health care, is an unjustified social experiment on the most valuable thing in our country - the health and lives of citizens of Russia. We insist on the fact that this highest value must remain an absolute priority for leaders at all levels. We are convinced that the main part of health care and drug provision costs – above the minimum which even the most subsidized regions are able to afford at their own expense – should be funded from the federal budget as before. A different decision will lead to irreparable demographic and social consequences that would trigger political upheaval.
Dear Vladimir Vladimirovich! We ask that you, together with the Government of the Russian Federation and the Federal Assembly of the Russian Federation, in the process of discussion of the federal budget for 2014 and the planning period of 2015-2016, exclude the cost of health care from the scope of "budget maneuver" and keep them mostly in the federal jurisdiction.

We ask you to send your response to our appeal to the following address: 125040 Moscow, ul. Verkhniaya 34, build.1, Russian Union of Patients, Tel./Fax (499) 426 06 42

The list of organizations supporting the collective appeal:
A. A. Bocharov, vice-chairman of the Board of interregional public organization "Assistance to sarcoma patients";   

N.A. Bulgakova, president of the All-Russian public organization of disabled people Russian Rheumatology Association "Nadezhda";

Ya. V. Vlasov, co-chairman of the All-Russian union of patients, president of the All-Russian public organization of disabled people - patients with multiple sclerosis;

M.Yu. Gavrikov, chairman of the All-Russian public organization of nephrology and transplant patients "Right to Life";

N.L. Gerasimova, president of Interregional public organization "Association of aid funds for patients with neuromuscular diseases "Nadezhda";

V.O. Grigoriev, president of Interregional charitable public organization for assistance to children with rheumatic and other chronic diseases "Vozrozhdenie";

E. V. Gustova, co-president of the All-Russian Union "Russian Diabetes Federation - RDF", president of interregional public organization of disabled people "Moscow Diabetes Association of diabetes patients - MDA";

N. P. Dronov, chairman of the executive committee of interregional public movement "Movement Against Cancer";

Yu.A. Zhulyov, co-chairman of the All-Russian union of patients, president of the All-Russian hemophilia society;

E.Yu. Zakharova, chairman of the Board of All-Russian organization of rare (orphan) diseases;

V.V. Kozhereva, vice-chairman of the interregional public charity organization of disabled people "Society of patients with primary immunodeficiency", president of Charitable Foundation to help children with congenital disorders of immunity "Podsolnukh";

L.M. Kondrashova, chairman of the interregional public organization of kidney patients "NEPHRO-LEAGUE";

N.B. Levina, chairman of the Board the All-Russian public organization of people disabled due to mental disorders and their families "New opportunities"

L.F. Matveeva, president of the All-Russian society of onco-hematology "Co-operate";

E.A. Meshcheryakova, vice-president of interregional public charity organization "Union of patients with rare diseases and patient organizations for rare diseases", president of regional public organization to assist patients with imperfect osteogenesis "Fragile children";

I.V. Miasnikova, chairman of the of the Board of interregional public organization "Assistance to patients with cystic fibrosis", executive director of the All-Russian organization of rare (orphan) diseases;

I.V. Pchelin, executive director of the All-Russian public organization "Association of People Living with HIV";

A.V. Saversky, president of the All-Russian public organization "League of advocates for patients";

E.V. Sorokina, Coordinator of the working group on oncology and onco-hematology of the All-Russian union of patients;

V.G. Sukhanov, president of regional public organization of disabled people – ostomy patients "ASTOM";

T.A. Tarasova, president of non-commercial partnership "Society of parents of children with ulcerative colitis and Crohn's disease"

M.D. Terekhova, chairman of the interregional public organization "Assistance to lifelong disabled persons suffering from Gaucher's disease, and their families", vice-chairman of the Board of All-Russian organization of rare (orphan) diseases;

E.A. Khvostikova, Director of the Center for social rehabilitation of people with rare and genetic diseases of St. Petersburg Association of public unions of parents of children - disabled people;

E.K. Chistyakova, director of the Charity Fund for children with oncohaematological and other diseases "Gift of Life".