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VII Movement Against Cancer Forum: “Healthcare Regionalization” Will Significantly Reduce the Access to Cancer Care

10.02.2014

More than 73% of the Russian oncologists have concerns that “healthcare regionalization” will affect the conditions of medical care and the provision of medicines to patients.

Such results ¹ were announced at the press conference which was held in Moscow on the World Cancer Day as part of the VII Movement Against Cancer Forum, gathering the leading Russian and foreign oncologists, representatives of relevant governmental agencies and social and patient organizations, and leaders of pharmaceutical associations.
The key topic of the press conference was the “healthcare regionalization” (“budgetary maneuver”) which implies the decrease of federal healthcare financing through the increase of regional financing, while only 17 out of 83 constituent entities of the Russian Federation are assessed by experts as relatively problem-free in the terms of finance. Therefore, the regionalization threatens the Russian people who suffer from cancer with “discrimination” at the place of their residence. The deficit of cancer care budget is observed in most of constituent entities of the country, and in some regions the gap between the actual financing and the financing required is tenfold.
“Many regions are unable to find the sources of cost financing for purchase of the required medicines and treatment of severely ill patients. The refusal to provide the medicines timely on a free or reimbursement basis, especially those that are expensive, leads to the progression of diseases and the forced growth of treatment costs, premature disablement, and occasionally to untimely deaths of patients”, states the Appeal of Participants of the VII Movement against Cancer Forum to the President of the Russian Federation Vladimir Putin.
About 60 % of Russian oncologists had to refuse the issue of free prescriptions to the patients entitled to benefits, including reasons which lack any legal basis (for example, "due to insufficient budgetary financing" or “due to unavailability of the drug in the pharmacy”.
The possibility for each region to have its own list of free or reimbursable drugs deprives many Russian people of their equal right to the provision of medicines. Thus, for example, the section of the Federal Vital, Essential and Necessary Drug Listing “Anticancer Drugs and Immunomodulators” includes over 80 items while a similar 2014 listing under the Territorial Government Guarantee Program of the Krasnoyarsk Territory contains only 15 items. Oncological patients are not always provided with the necessary drugs even in relatively problem-free Moscow and Saint-Petersburg. Up to 50-60 % of patients with malignant tumors receive the adequate drug therapy in Saint-Petersburg – the fact recognized by more than a half of interviewed oncologists in the Northern capital. And more than a third of Moscow residents and 40 % of Moscow Region residents think that they have no or little access to the guaranteed volume of free health care ².
"All of us live in one state, under the same Constitution, and we must have equal civil and social rights, including those to treatment. Each Russian oncological patient must be financed according to the accepted standards of care. The regionalization and the standards are currently incompatible; the levels of financing and healthcare development vary significantly across different regions,” Georgy Manikhas, Saint-Petersburg Chief Oncologist, Medical Director of Saint-Petersburg City Cancer Clinic Center says. Thus, for example, RUB 43.5 thousand are allocated for treatment of each patient registered in Moscow, RUB 7 thousand – in Saint-Petersburg, and already from RUB 3 to 5 thousand - in other cities of the North-West Federal District. The issues on which the Forum focuses are whether the new budgetary policy solves the problem or aggravates the situation and what must be done so that the right to life becomes actually equal for all."
The experts emphasize: The main problems of the Russian healthcare are insufficient financing and managerial decisions rather than the unavailability of highly skilled physicians, equipment or advanced methods of treatment which the patients seek from abroad.
“If a person wants to receive treatment abroad and he has money for it - it is his right. But will this treatment be better?" Anatoly Makhson, Chief Oncology Specialist of the Moscow Department of Health Care, Medical Director of Moscow City Oncological Hospital No.62 comments. We often take patients who began receiving the therapy abroad, but then they ran out of money and came back to Russia for medical care. Many times we saw that not every western clinic provided the level of cancer care that was similar to or higher than that in the federal Russian cancer centers, while sometimes the patients paid a vast amount of money for screenings that did not influence the therapeutic approach. As a result, they received the same care and the same drugs which they would have in the specialized clinics at home.”
This position is also shared by Dmitry Borisov, Executive Director of noncommercial partnership “Equal Right to Life”, Deputy Chairman of the Board at the Association of Russian Oncologists: “Today cancer diagnosis is not a verdict. If detected early, and with the timely application of the advanced technologies and programs of treatment available to the Russian specialists, this disease can be overcome.”
However, the patients are required to continuously take expensive medicines in order to recover and maintain their quality of life. The healthcare regionalization can result not only in the deficit of free and reimbursable pharmaceutical products, but also in increased prices for these vital and essential drugs. Vasily Ignatjev, General Director of P-Pharm Group, says: “The pharmaceutical industry shows highly dynamic development during the recent years – Pharma 2020, the Domestic Pharmaceutical Industry Support Program functions actively, new plants are constructed, domestic and licensed medicines are put on the market, the standards of good manufacturing practice are implemented. However, some issues remain and require solution: it is desirable to tighten the control over the quality of circulating drugs, as well to provide stable and predictable financing of healthcare and drug provision, which can result in the reduction of prices by manufacturers and further enhance the availability of advanced methods of treatment."
Speaking about the effect of the new budgetary policy on the patients with cancer, the organizers of the VII Movement Against Cancer Forum expressed their concerns about potential worsening of the oncological situation in the country. “The reduction of total heath expenditure as % the GDP to 2.8 % by 2020 in Russia is dramatically low in comparison with the developed West European countries and the Big Eight members. The USA spends 15 times more on cancer care than Russia,” Dmitry Borisov, Executive Director of noncommercial partnership “Equal Right to Life”, Deputy Chairman of the Board at the Association of Russian Oncologists says.
“The governmental economic bloc plans include the reduction of financing for the governmental healthcare development program in part of the subsection "Specialized medical care" covering oncology, from RUB 161 billion in 2013 to RUB 72.7 billion in 2015. In such circumstances, it is impossible to comply with the commitments on the preservation of health of the nation and extension of the length and quality of life in the country. The targets set out by the President with respect to the governmental social and demographic policy are under threat," Nikolay Dronov, Executive Committee Chairman of IPM “Movement Against Cancer”, member of the Committee of Non-Governmental Organizations for Protection of Patients’ Rights at the Ministry of Healthcare of Russia expresses is concerned.
The participants of the event see the solution to the current situation in the strengthening of the government measures to enhance the access to diagnosis and treatment of cancer, increase financing of the Russian healthcare, both in absolute terms and as % of the GDP, as well as to finance treatment of cancer patients at all stages - from early diagnosis through palliative therapy - on the federal level including the effective public-private partnership mechanisms. These proposals were defined by the experts in their Appeal to the President of the Russian Federation Vladimir Putin.
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¹ The data given hereinafter are from the anonymous survey carried out by the Interregional Public Movement “Movement Against Cancer” with the assistance of the noncommercial partnership "Equal Right to Life" in September and November 2013 among 220 healthcare professionals from 49 regions of Russia (representing all federal districts of the country).
² The sociological studies as part of the program “Health Care Modernization and Situation with Cancer (Breast Cancer) Treatment in the Regions of Russia. Awareness and Satisfaction of Patients” were carried out in July and August 2013 in Moscow and Moscow Region. 500 respondents from each region were interviewed.