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Dronov: Everywhere cancer patients have to listen tales from government officials

04.09.2013

In most cases cancer can be cured, as global practice proves. The Russian story is quite different: those who contracted cancer have to fight for themselves. Nikolay Dronov, chairman of the executive committee of “Movement Against Cancer”, is talking about the protection of rights of cancer patients.

In most cases cancer can be cured, as global practice proves. The Russian story is quite different: those who contracted cancer have to fight for themselves, to defend the right to diagnosis and treatment which is state-guaranteed for every citizen, including the right to drug provision and care. Chairman of the executive committee of “Movement Against Cancer” and member of the Council of public organizations for the protection of patients' rights under the Russian Ministry of Health Nikolay Dronov was interviewed by Irina Zubkova (RIA Novosti) and told about protection of the rights of cancer patients and how to beat cancer.

— Nikolay Petrovich, what rights of cancer patients need protection?

— Most disputes arise due to denials or delays in provision of drugs. People with cancer are entitled to free prescriptions. But our government declares a lot of things. Citizens have to understand that nothing is free, in every case someone pays for.

In particular, care for cancer patients is financed from the budget of the region, territory or republic in which they live, with the exception of federal cancer centers, where high-tech medical care is provided. In these centers the treatment is covered by the federal budget.

The biggest problem of our health care system is a lack of resources. A lot more money than we have now is needed to treat all patients. What will happen if your budget for the treatment of cancer patients is, let's say, a hundred thousand rubles, and it allows you to treat twenty people taking into account the current prices, while you need to treat two hundred? Twenty patients will receive the necessary quality treatment. It is not hard to guess what kind of people will make the lucky cohort. The rest of patients will either be treated with cheaper drugs and using the most simple, trivial therapies, or they will be told something like this: “Wait for a while, the drugs will arrive soon…” or “Your disease stage is not so serious, you can wait”. Patients hear this kind of comments from healthcare organizers everywhere, with the exception of some relatively prosperous regions.

— Why these regions are prosperous?

— First of all, it is good management. Second, the availability of resources. For example, in the Moscow region there are enough funds for medicines, but from the point of view of drug provision to cancer patients' it is the most problematic region. There is no other region from where we would receive so many complaints as from Moscow suburbs. Apparently, there are difficulties with coordination of competent procurement, logistics, monitoring of bringing drugs to patients.

In Moscow City, Krasnoyarsk and Samara regions, Khanty-Mansi Autonomous District enough funds are allocated for drugs and the situation is more or less normal there. But in most regions funds are physically insufficient, so drugs are not prescribed to all eligible patients. It is “unprofitable” to treat children and elderly people; they are not the source generating the added value or "labor resources". This is what we call economic cynicism. It turns out that the government cannot provide for all people all that it guarantees.

— What are the other problems?

— There are a lot of complaints due to the non-transparency of the system of medical and social assessment. For example, one patient with some cancer is assessed as disabled, while another one with exactly the same diagnosis is not, and they cannot clearly explain the reason, though they must do this. The latter patient is trying to complain, writes to all instances, requesting reasoning. However, the problem is that we have no clear expert criteria for assignment of disability status, the activity is not transparent and there is no clarity.

In fact, not every cancer patient should be considered disabled, unless the disease is in an advanced state. Cancer is no longer a death sentence; it is successfully treated in the last 15-20 years, most patients then returned to a normal life, to work. But nobody explains it to people. Moreover, the financing system is such that in the regions it is better to assign the disability status to patients: in this case money for his or her treatment can be taken from the federal budget — through the Pension Fund. So the more is the number of disabled, the better it is for the regional budget. Therefore the “effective strategy” is not to treat people well, but to bring them to disability.

— Are cancer patients rehabilitated in health resorts?

— Doctors do not have a consensus on this. Sunny southern resorts are not recommended for cancer patients, but pine forests can be good for them, and there are many treatments recommended for recovering patients. In addition, they need not only medical, but also medical and social rehabilitation, psychological support, assistance in returning to normal life. The system of cancer care needs medical and clinical psychologists, psychotherapists.

As a social organization, we advise patients and their relatives, help them to cope with difficult psychological situations that arise in connection with the disease, organize various events in order to provide moral support, talk about what is currently available for the citizens, about recent advances in medical science. We have many examples of successful control of the disease, people share their life stories. But there is no institution of civil society that could replace the government institutions. Our functions are different.

The same applies to palliative care. Terminally ill patients need help: ease pain, relieve suffering, and organize a decent endowment. The shaping of this kind of medical care has started relatively recently in our legislation, and there are still many problems. In particular, for unknown reasons, hospices were not included in the palliative care system.

— What to do if diagnosis is in place, but patient’s efforts to receive treatment failed?
 
— In such a situation one needs without delay address to the head of the medical institution, to the regional department or ministry of health, to offices of Federal Service on Surveillance in Healthcare. In particularly difficult cases appeals to prosecutor or investigating authorities can help in order to initiate a criminal case. Recently we received an appeal from a young thirty years old woman who was diagnosed with "malignant neoplasm of the breast" of third stage. She asked a gynecologist four times for a referral to oncologist, but the doctor did not do that. It's not just the height of incompetence, but also an act containing signs of criminal offense: failure to provide care to a patient, omission to act.

The main problem is when the treatment is started. For example, a patient is diagnosed in March, but the region's health care budget is approved in September of the previous year, there is no money in it allocated for the treatment of this new patient. It is hard to understand why do we have such planning. A patient cannot receive treatment and lose time until the system "see" him or her and take into account. One can only write to all authorities and persevere admission to hospital.

— Is our health care system capable to help everyone who needs treatment, so that patients would not have to appeal to charities?

— Yes. It’s sure that at least children can be cured, the state has enough money for that and if it does not happen, then it's the same problem of inefficient management of funds. I have always been strongly against raising money to help the sick. It is state guarantees that must come with money, so that people need not collect funds for their treatment. However, some people say: “I do not want to be treated here, I want to go to Germany”. So, if the patient can be cured in Russia, but he wants it to be done abroad – it’s another case. The therapeutic result does not depend on doctors’ smiles, the availability of the TV or refrigerator in the ward. Our country has necessary medical technologies; if someone wants additional service in an Israeli hospital, then he or she has to pay for this. It makes sense to consider voluntary health insurance, in order to do not allow the diagnosis to catch you off guard and you would not have to sell all your property to pay for treatment.

Charitable foundations are doing great and important work, but they could not replace the state.

— What government measures will help to control cancer?

— In order to shift at earlier stages at diagnosis, one needs to upgrade the skills and level of education of primary care physicians: internists, general practitioners, gynecologists, dentists. But the main thing – we have to form a responsible attitude of citizens to their health. And, I think, material incentives are needed. People must pay for unhealthy lifestyle. Our system of compulsory health insurance is not connected with an individual, contributions are paid by employers. Let’s suppose that a smoker, or a hard drinker pays a contribution from salary twice as much as the average person who does not drink or smoke, then the former would have probably start to think about this.

Why our public health authorities do not popularize a healthy lifestyle? Why sports facilities are not easily accessible? Sports activities are available only for money and not everyone can afford to pay. Why TV and other media do nothing for the formation of intolerant attitude in the society to risk factors for health? We have a huge consumption of tobacco in the country, the excessive consumption of alcohol. Tobacco smoke is a recognized carcinogen. For already many years we offer not just to increase the excise tax on tobacco and alcohol, but to direct the collected funds to cancer care. We did not succeed yet, but it seems that the issues moved off the dead center.

We must understand that nobody will solve our problems for us. In Tatarstan, Krasnoyarsk Territory and in some other regions, incentive bonuses were paid to doctors who revealed malignancy at an early stage. It is a good example, because too many people in our country worry about nothing but money. Hence, the right attitude to health has to be formed using economic measures, through the development of well-weighed economic stimuli encouraging good attitude to health, which is invaluable in principle.