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"Equal Right to Life" and "Movement Against Cancer" are in the top of the trust rating of health care system participants

01.08.2014

NP Centre for Social Economy has recently published the results of this year's Trust and Cooperation Preferences Rating of the Health Care System Participants. In the "patient organizations" category with 33 nominees the following organizations were recognized as the most trustworthy: non-profit partnership "Equal Right to Life" (71%), interregional charity organization for assistance to children with rheumatic and other chronic diseases "Vozrozhdeniye" (68%) and interregional public movement "Movement Against Cancer" (67%).

 The annual rating is compiled from a survey of more than 300 representatives of health care industry; its purpose is to identify the overall level of confidence in the players of health care system as well as leaders in specific categories among public and private medical centers, distribution, pharmaceutical and insurance companies, non-profit organizations, government bodies – all those who influence the development of the industry, its policy and quality.
 "The aim is to demonstrate to all players the open-mindedness of these bodies and persons who heads these structures, identify the needs of the health system and determine how they can be solved by collective efforts, through a meaningful dialogue with all key stakeholders," commented David Melik-Guseinov, director of the Centre for Social Economy, member of the Public Council under the Russian Ministry of Health.
 The rating results were announced at the roundtable discussion "Cutting spending on health care: who is at risk and what to do?" which was held at the press center of AiF Publishing House. During the event, representatives of public health authorities, business, professional associations and patient organizations expressed their opinions on the pressing issues and the near-term outlook of the industry development. How is the program of state guarantees fulfilled under conditions of "budgetary maneuver", what are the criteria for quality of care, is it appropriate to abolish the system of mandatory health care insurance, how available the high-tech medical care and medicines are, where the balance between private and public sectors in healthcare is – these and others issues were discussed while participants were trying to find possible answers and solutions.
 Among the government bodies top of the rating looks as follows: Russian Ministry of Health (53%), Federal Service on Surveillance in Healthcare of the Russian Federation (48%) and Federal Antimonopoly Service (44%). Interestingly, in the last year the federal Ministry of Health was ranked only fifth in terms of trust level, behind regional health care authorities.
 
Financing health care
 Addressing to the leaders of rating, the moderator of this event David Melik-Guseinov asked them to give an opinion: how much funding will be adequate for the Russian health care and what are the prospects of increasing of funding?
 According to the head of Department for monitoring of social sphere and trade of the Federal Antimonopoly Service of Russia Timofey Nizhegorodtsev, the health care system has money, but they are used very inefficiently: "The main task is to reconfigure the health care system so that to take these reserves from the pockets of unscrupulous participants and send them to the needs of public health."
 The expert added that there are sufficient funds in the public drug supply system and "if we look at the results of tenders where necessary conditions for competition were created, the cost of drugs was often reduced as much as several fold. These funds are then returned to the system. It shows how much money it would be possible to save and return in the health care system provided that the following conditions are ensured: effective use of public procurement, coordinated work of the Ministry of Health, drug registration, and preparation of tender documentation by health authorities. It is possible that in case of proper organization of works the existing funding would be enough even to launch the reimbursement system."
 Talking about the quality of health services, Timofey Nizhegorodtsev noted the lack of competitiveness of the Russian health care system: "We see that patients who are capable of paying, run away from our health care system as soon as they have such an opportunity, they prefer to receive treatment abroad. This is also a kind of rating of our health system and its effectiveness."
 
Comments on the initiative of the Ministry of Finance to introduce partially paid mandatory health insurance (MHI) policies for non-working citizens
 In the course of the event, experts also commented on the recent initiative of the Russian Ministry of Finance regarding the introduction of 18% surcharge for MHI policies for non-working people or people who works unofficially, without records of employment (except for pensioners, children and the unemployed who are registered with the employment service)
Timofey Nizhegorodtsev noted that he supports the "budgetary maneuver" of the Russian Ministry of Finance in general but does not agree with the proposal for the introduction of co-payments. "The insurance system is designed so that employed pays for unemployed (non-working). If we remove this basic concept, then it becomes incomprehensible why shall we pay these taxes if we can pay directly to medical facilities. If we provide medical care for employed only than why do we need all these complicated superstructures? Well, let’s allows the employed go directly to a clinic and pay for all services there, let’s relieve them from funding all this superstructures in the regions."
 
Commenting the initiative on the surcharge for MHI policy, the Executive Director of the International Medical Device Manufacturers Association (IMEDA) Alexandra Tretyakova added that not all non-working citizens will be able to pay extra for mandatory health insurance policy in the case of the introduction of such a measure: "This argument seems very strange to me, because according to experts of, say, Higher School of Economics, about a quarter of the population lives in single-industry towns that are dependent on a single employer, or on the government, and it is hard to imagine that these people can easily choose between working or not working, or decide how much to earn. We then have to change the whole structure of employment. One has to understand that, just like it happens in America, he or she has to be engaged in everything, develop your business and pay for your health. But we have a completely different structure of the labour force and employment, our population is characterized by very low labour mobility, there are huge geographical distances – as a result, there is no freedom in the choice to work or not to work and how much to earn. Proposals of the Ministry of Finance are good only within Moscow Automobile Ring Road or Central Administrative District of Moscow."
 
The problem of balance between private and public medicine
 Experts discussed the problem of balance between private and public sectors in healthcare. "Asymmetric economic relations do not create conditions for the development of private medicine and demoralize the public one. Clinics are looking for opportunities to make a person pay for medical services; in the absence of clinical guidelines quality of care is not ensured, even if the services are paid for. This is one of the fundamental problems. Even if you pay, you cannot count on high-quality medical care," Timofey Nizhegorodtsev comments. "It seems to me that there should be two systems in the country. We are in favour to the existence of private sector. But it can develop only when the public health system performs its functions, namely provides medical care under the state programs and does not provide paid services. On the other hand, the private sector shall provide such services, with a broader range of drugs and medical interventions, not covered by the state program. Under these conditions, balanced development of the two systems is possible; each of them would meet its part of the demand."
 According to CEO of independent laboratory "INVITRO" Sergey Ambrosov, today private medicine fulfils supporting function; it reduces the total financial burden on the public sector and frees it from the portion of costs, which may be directed to the provision of services to those who are unable to pay for their treatment. "The main thing is to build a proper dialogue with the private sector and do not perceive us as antagonists of the public healthcare system, it’s necessary to find pluses in partnership with the private sector – we would like to make the national health care system better and more effective, so that people do not opt to have treatment in Germany, Turkey and so on."
 By the way, health care system participants trust most of all in such federal medical centers as P.A. Herzen Moscow Research Institute of Oncology (68%), N.N. Burdenko Institute of Neurosurgery (63%) and Moscow Research Institute of Pediatrics and Pediatric Surgery (61%).
 Federal medical centers are involved when it comes to high-tech medical care (HTMC). Describing the situation in this area, David Melik-Guseinov noted: "We know what is happening with HTMC – the government does not want to increase financing of this health sector too much. It is very expensive and risky sector in terms of management decisions. Today, the HTMC system "decays" – services partly migrate into specialized medical care. You may remember that this year a lot of medical procedures and services were re-classified as ordinary specialized medical care that means that payment will be through the system of mandatory health insurance, which is trying to "evenly spread" the available shoestring budget to all recipients. The second part of services, according to unofficial information, will be transferred to the system of innovative health care – at the intersection with R&D. It will be funded from the federal budget."
 "In Russia, the situation is that the federal centers play the role of what is called "university (or academic) hospitals" in other countries. In such hospitals they make real science, implement state-of-the-art methods, so you cannot take HTMC and "spread" to all other organizations," Alexandra Tretyakova commented." "Indeed, the insurance system is not very friendly to innovation in any country. This is normal, because insurers want predictable costs, while innovations are always expensive. But there are additional mechanisms that can improve this situation. For example, in Germany there are special "innovation rates" for innovative technologies which are still not at the stage of mass application. It is, of course, very difficult in our situation, but nothing is impossible. If we assume that there should be additional rate for innovations, additional funding, as well as understanding of how this rate and then this innovation will further be disseminated, than there is nothing wrong with it. But now, if we "pull out" the whole HTMC and impose on all regional municipal hospitals, I'm afraid that you can forget about innovations."
 During the discussion, experts noted that the quality of medicine consists not only of HTMC; it also includes the availability and safety of health care, the maximum possible effect of it, doctors' compliance with clinical guidelines, and proper system for monitoring the quality. All this contributes to the patients' satisfaction with medical services, and, therefore, allows patients to trust the national health system instead of going abroad for treatment; in this way their money instead of "draining" to foreign clinics will be directed to the development of Russian medical industry.
 
Drugs and their availability
 It is hard to imagine the high level of medical care without quality medicines and their availability. Commenting on the pricing in this area, executive director of the NP "Pharmacy Guild" Elena Nevolina noted: "We have a price controls on vital and essential medicines. It is regulated only to observe formalities or is it for consumers after all? When I am in the consumer's shoes, it is strange to me that I have to visit three pharmacies and compare the price of the same drug and make decision based on the results – the price is different everywhere, but it is nevertheless "controlled". It is even stranger to me as a specialist when the retail price is lower than the registered manufacturer's price. How can I be confident in this drug?"
 By the way, among the professional NGOs the "Pharmacy Guild" earned 68% in the trust rating, on a par with the Association of International Pharmaceutical Manufacturers (AIPM). Other leaders on this category are Association of Russian Pharmaceutical Manufacturers (67%) and Association of International Manufacturers of Medical Devices (IMEDA) (63%).
 Alexandra Tretyakova added that there is a problem of registration and access to the market of medical devices: "After the introduction of new registration rules the process has slowed down by four or five times, now the launch of a new product to market takes about one and a half to two years. For medical devices this is "fatal" because in about two years technologies are renovated. It means that when we register something, it is already out of date. According to the latest data published by the Russian Federal Service on Surveillance in Healthcare, in the past year only 73 new medical products have been registered. Earlier somewhere 4.5-5 thousand products were registered every year. This means that up-to-date medical devices are not launched on the market. What shall we use to treat patients if we are not able to register anything?"
 "Among all, patients need pharmaceutical preparations manufactured in pharmacies, thought in small amounts," Elena Nevolina adds an item into the list of urgent problems. "The Federal Law No. 61 unequivocally bans the manufacture of such preparations, regardless of their registration in the Russian Federation. Now imagine a situation: a doctor prescribes the dose "1/16 of tablet" to a baby. Then imagine a young mother who is trying to split the pill into sixteen parts. Who will be responsible in case she gives a large dose? Manufacturer? Mother? Therefore, today our priorities are those that are aimed at protection of our customers – patients."
 Commenting on the topic of patients' rights, the chairman of the Executive Committee of interregional public movement "Movement Against Cancer", member of the Public Council under the Russian Ministry of Health Nikolay Dronov noted: "The patient has the right to receive medical care or to refuse receiving it, but when someone exercise this right, he or she often acts not so much deliberately, as forced. Many of the issues that we discussed today are pushing some people to think as follows: "They will not help me, whether it is worth going there?"
 Nikolay Dronov also added that a well elaborate system is needed to motivate people's attentive attitude towards their health. "Does a person have the right to smoke? Probably, yes. But in this case it must be understood that in case of certain harmful consequences he or she will have to pay more. Relevant public opinion shall be formed. We have problems with healthy lifestyles in our country. Such problems exist everywhere in the world. There must be effective incentives for the formation of a culture of responsible attitude to health."
 
Insurance against cancer
 The system of insurance against cancer and other life-threatening diseases can become one of the most effective mechanisms to address this issue, according to Oleg Merkulov, the First Deputy General Director (Development and Sales) of VTB Insurance (63% in the trust rating).
 "Recently we, in cooperation with non-profit partnership Equal Right to Life, have brought to the market a new program for insurance against cancer and other critical diseases. When a person, God forbid, is diagnosed with cancer, stroke, heart attack or kidney failure – in coordination with our colleagues from Equal Right to Life we start to "lead the patient by the hand" from the very first moment. Because patients do not know how the health care system works, which quotas or high-tech interventions they are entitled for, how the budget available in the country is applicable to him or her specifically. Patient starts to learn it when it is most difficult for him to do that because severe diagnosis is always stressful. For us it is important that the patient would have an opportunity to receive assistance from a psychologist, a lawyer and a manager who will guide him and provide necessary services so that medical facility would be correctly selected, correct treatment plan assigned and necessary medicines provided, which are prescribed for the patient, and most importantly, that the medicines are of proper quality."