Excerpts from the Opening Address at the State Council Presidium Session 2006-10-02 17:37:46 Kurgan Vladimir Putin: Dear colleagues! We are going to examine a range of issues related to modernising regional and local health services. You know that in the last few years we have paid a great deal of attention to the accessibility and quality of medical services. Among all the measures that have been taken I want to first and foremost emphasise the consistent implementation of the national project, Health. One of this project’s concrete and significant results is increasing the salaries for one third of all doctors and a quarter of all registered nurses and paramedical workers in Russia, including doctors and nurses in primary care, in emergency services and in various medical and midwifery stations. I shall add that doctors working in primary care have also started to receive extra money for carrying out preventive medical examinations. We started strengthening the material and technological base of local clinics and updated the vehicles of our emergency services. This work will proceed in 2007. <…> But let me repeat that significant improvements remain theoretical. We still have a lot to do in public health services and, first and foremost, at the regional and local levels. In connection with this I would like to draw your attention to the following moments, those I consider to be fundamental. First. In 2005 the programme of state guarantees designed to provide citizens with free medical help had a deficit of almost 130 billion rubles or 21,4 percent. Therefore in one out of every four regions state guarantees were receiving up to only 40 or 50 percent of their required financing. Just what this insufficient financing resulted in is well known. People were required to pay extra from their own pocket for this state-guaranteed free medical help. And according to the federal statistics service, Rosstat, in 2005 almost 110 billion rubles of private finances were spent for these purposes. <…> Each region should provide sufficient financing for this programme. As a matter of fact, I am referring to ensuring one of our citizens’ fundamental constitutional rights. Today in the context of the separation of powers the federal centre is to a large degree losing control. In any case, the centre is losing direct control over how this money is spent and how priorities are defined. And here we see a lot of disorder. Our citizens are suffering from this state of affairs and together we must think about how to extricate ourselves from this situation. Second. We must precisely differentiate between the powers and obligations various levels of authority have with respect to health care. And there should not be any overlap here or placing the responsibility on someone else. We must define the share of responsibility each level of authority has when implementing state guarantees of medical help. Third. According to decisions that have already been taken, newer and better systems of financing health care with the corresponding financial support from the federal level must be developed in the so-called pilot regions. And you know what I am referring to. At the end of the day this new system of paying wages amounts to the standardization of medical help. We must have a precise idea about what we must do for citizens in the sphere of health care and in which conditions. A concrete personalised account of the services patients receive. We must uncover all the best things that have been developed in various regions and approve new models for managing our material, personnel and financial resources. We must then implement the most effective of these models in other regions. At the same time this does not mean that increasing the effectiveness of health care management is limited to the regions participating in this experiment. This is a common task for all the regions of Russia. Financing for public health care services must be used not to maintain establishments – it must affect the treatment that real patients receive. And here an obvious issue is that of monitoring the effectiveness of the relationship between expenses paid and quality of treatment. It is also important to develop and introduce a new system for paying the salaries of medical workers. A system in which the volume and quality of services offered are its main criteria.