Speech at Meeting on Healthcare Development 2008-07-14 21:47:40 Klin, Moscow Region Dmitry Medvedev: Good afternoon, colleagues. I am happy to see the members of the Russian Federation Government here in an ordinary Russian hospital, and not because we have not seen each other for a long time, but because the subjects we are going to discuss are of such exceptional importance for the vast majority of our citizens. Today we will continue examining a number of issues related to modernising and developing our country’s healthcare system. This year marks 90 years since the first decree on establishing the Russian People’s Commissariat for Health was issued, and this event took place in fact on July 11, 1918. In essence, these days should be something of a celebration for Tatyana Alexeyevna [Minister of Health and Social Development Golikova]. In this context, I especially want to note that we must not forget the traditions of past years or the unique experience accumulated by several generations of professionals. Time does not stand still and the healthcare system today has new goals and objectives. We are laying the foundations of a modern healthcare system. This is a great responsibility and a great challenge for everyone present. This is all the more so now that we are in the final stage of work on the country’s development concept for the period through to 2020, which devotes a big section to healthcare. We therefore need to set our priorities, formulate them and provide the necessary financial justification so that all of the priorities we agree on can be included in the budget drafts. I call on the Finance Ministry and the other members of the Government here because we have had sufficient time and we now need to make decisions. The level and quality of our healthcare system should serve the main purpose of making our population genuinely healthier. This means increasing life expectancy, reducing the disability and death rates, including for the most dangerous diseases our country faces, namely cardiovascular disease and cancer. We therefore have a number of important tasks. I will name them, though they are all well known. First is the provision of timely and professional medical care. I think this is one of our priorities. Second is prevention work, and third is routine checkups and regular medical supervision of patients. We need to formulate concrete targets and the steps to take to achieve them within the planned period. Above all, we need to make the necessary decisions on improving the medical insurance system. We said on several occasions last year and at the start of this year during work on a number of important decisions that it is time to give our insurance system new substance and make it work effectively. But this will be possible only if the medical insurance organisations take on genuine responsibility for the insurance risks they are obliged to guarantee, for the illnesses the people they insure develop and for the quality of medical treatment they receive. At the moment, as the doctors present here can confirm, people go with their complaints to the head doctor or the local authorities and do not always understand the need for insurance companies and policies. Most of our population sees insurance policies as simply pieces of paper with no real connection to the healthcare system, and this is a situation we must change. We must oblige the insurance companies to comply strictly with the law and work for the good of patients in order to make their right to choose their medical centre and insurance company truly effective. As we discussed on past occasions, if amendments to the laws are required, then let us make them. If work can go ahead without changing the current laws, then we can keep the laws as they are. But there can be no more delay. I will sign instructions after the meeting today. We also need to develop the mechanisms for making citizens more responsible for their own health and for rational use of the public good that is the healthcare system. In this area too there is plenty to discuss. An issue that requires our most serious attention is that of competition in the healthcare sector. Speaking frankly, at the moment competition is virtually absent or is practically not making itself felt. The reasons for this situation are well known. Above all there are the restrictions on private medical establishments’ participation in state guarantee programmes and the administrative mechanism for placing state procurement orders in the healthcare sector. But we must develop competition in the healthcare sector or else we will never achieve the quality we want, and we need competition at every level, what’s more, at federal, regional, and municipal level. Organisations should be allowed to take part in tenders regardless of their organisational and ownership forms. Some regions have already gained experience in this area and we need to spread this experience. Another problem is healthcare sector wages. The plan is to considerably increase wages in the sector and reform the wage payment system. This is something we have been working on for several years now. Pilot programmes have been carried out and targeted solutions have been applied within the framework of the national healthcare project. Some good regional programmes, including in Moscow region among the colleagues present today, have emerged. But these are all areas we need to continue working on. I remind you that the Government made a decision on introducing a new wage payment system for public sector workers last September. At the same time, the objective was set of raising labour productivity in the public sector, and this goes for the healthcare sector too. Quality work should be paid many times better than it is now. But quality evaluation is something that requires separate attention as incentive payments need to be made wisely and go exactly to the right people. The transition from a common wage payment scale will be difficult both organisationally and psychologically. We spoke about this and even within the Government there are differing views on this issue, but we must begin thorough work on organising this process today. This is something that the medical establishments themselves, the regions, and the municipalities all need to be involved in. We need to be bolder in freeing up doctors from functions they should not have to perform, transferring them to nurses instead. In this respect we need to ensure an optimum balance between the number of doctors and the number of nurses. At the moment the ratio is approximately one to two, but the optimum ratio today is at least one to three. Now, on the transition to new standards for medical care. This will require a two- to three-fold increase in funding taking into account the transition to a full tariff. The state is ready to undertake this spending. But we need to achieve a genuinely new quality of medical standards – genuinely irreproachable quality. Federal standards currently still leave much to be desired and often play into the hands of this or that producer of medicines or medical equipment. I propose taking rapid measures to ensure open and transparent mechanisms for developing and approving the new standards. Another very important subject is that of introducing modern medical technology, and I mean technology rather than equipment here. That is, methods for working with and usingnew technology that encompasses equipment, medicines and organisational methods and also the skills of the doctors themselves. I ask the Health and Social Development Ministry to draw up a list of the technology for practical introduction. Everything that I have just mentioned requires solid funding and the state will increase expenditure in this area. Our drafts provide for a several-fold increase in the healthcare budget over the period through to 2020. This obliges all of us to make wise and productive use of the money invested in this sector of such great importance for people’s lives. To say a few words more in conclusion, it is not chance that our meeting is taking place in an ordinary district hospital. You will recall that we began our national healthcare project by concentrating on the primary healthcare sector. Now we have seen that our efforts, together with funding and the right priorities can bring change for the better. We have had a chance to look over this hospital. It is a perfectly modern establishment, but it was built on the foundations of a project begun in the Soviet period and long left incomplete. There are many such hospitals around the country. It is good that this particular project, here in Moscow Region, was able to be completed, but there are many other projects that have simply been abandoned. We need to decide what direction to move in: some facilities can be developed and completed along the same lines as this one, while elsewhere projects will have to be abandoned and new facilities built instead. But overall, this work must continue. We have seen that much of what is in place here makes use of modern methods, and that there are interesting solutions in the area of blood donation, for example, which is something we are starting to work on actively now as part of blood-related programmes, and there are good rehabilitation programmes here. All of this shows that given the will, even an ordinary district hospital can obtain very decent results. I think that our colleagues present here, the medical workers here, will add their own words, and I would like to hear your views and not just the views of my Government colleagues. This is indeed a very important subject and this is why we are here, so as to discuss all of these issues on the front line, so to speak. Now let’s begin our discussion. I give the floor to Tatyana Alexeyevna Golikova for her report. Of course, as I already said, I will issue instructions following on from the results of our discussions today.