HEALTH AND HEALTHCAREIN RUSSIATODAY AND TOMORROW

G.E. ULUMBEKOVA, ASSOCIATION OF MEDICAL SOCIETIES

FOR QUALITY

© ASMOK

CONTENTS

1. Demography and Health Indices of Population in Russian Federation

2. Key healthcare problems today

3. Future demographic, social and economic challenges in healthcare

4. What should be done

5. About ASMOK and its strategy in medical education

PART 1

Demography and Health Indices of Population in Russian Federation

LIFE EXPECTANCY AT BIRTH (YEARS)

Life expectancy at birth (LEB) has dropped from 70 years in 1985 to 68,7 years in 2009. It is 6,3 years smaller than in “new” EU countries and 12 years smaller than in “old” EU countries

Crude death rate (CDR), the number of deaths of any reason, increased from 10,5 in 1985 to 14,2 in 2009. It is 1,3- and 1,5 - fold greater than that in the “new” and “old” EU countries, correspondingly

CRUDE DEATH RATE (PER 1000 PERSONS)

Major causes of fatal outcome: Circulation system diseases – 56,5% Neoplasm – 14,6% External causes – 11,2% (suicide, traffic accidents, alcohol poisoning, homicides)

CAUSE-SPECIFIC MORTALITY DISTRIBUTION

MORBIDITY (PER 100 000 PERSONS)

Morbidity of population has grown by 42% since 1985 from all diseases. In the last years the circulatory diseases (44,5%) and malignant neoplasm (17,6%) prevailed in the structure of morbidity

LEADING RISK FACTORS

Tobacco consumption

The proportion of daily smokers among adults is twice higher than the average in OECD countries

Alcohol consumption

In liters per capita for adult population is twice higher than the average in OECD countries

DISPARITIES IN HEALTH INDICES

In mortalityIn mortality In life In life expectancyexpectancy

Regions Regions (between the (between the extremes)extremes)

140% 3,5–4,5 years

UrbanUrban//ruralrural 20% 2,7 years

Men/womenMen/women 38% 12 years

CONCLUSIONS

The most health care and demography indices in Russia are worse

than those in “new” and “old” EU countries

The persistent elevation of the share of senior people necessitates

the sustainability of medical social service on the long-term care

The predominant role among the factors aggravating health of

population in Russia was played by unhealthy lifestyle:

wide spread of alcoholism

tobacco smoking

drug abuse

poor working conditions

lack of long term government strategy aimed to improve

population health

PART 2

Key healthcare problems today

STRUCTURE OF PUBLIC HEALTHCARE IN RUSSIA

Funding is based on a mixed budget-insurance model

Organization of medical aid inherited some features of

N.A. Semashko healthcare model

POSITIVE FEATURES:

— Totally free

— Budget finance

— Vertical integration

— Governmental providers

— Polyclinics

— Separate pediatric services

— Prophylactic approach

NEGATIVE FEATURES:

— Extensive type of development

— Underfinanced

— Lack of quality control

— Administrative-command style

— Lack of high technologies

Three administration levels: Federal, Regional, Municipal

Three property forms of medical aid providers involved in SGP (State

Guarantees Program) realization: government (Federal and Regional),

municipal and private

POOR HEALTHCARE FINANCING

As a share of GDP Russia is spending on healthcare twice less than OECD on average

Total and government spending for healthcare expressed in GDP share in various countries

POOR HEALTHCARE FINANCING

Per capita government spending in Russia is 635 ($PPP) i.e. 3,4-fold smaller than the average spending in OECD nations and 1,5 – 2 times smaller than in the EU countries

Total and government per capita spending on the healthcare in various countries

EXPENDITURE ON PHARMACEUTICALS FOR AMBULANT THERAPY

In the relative values (GDP share) the public expenditures on pharmaceuticals in RF is only 0,23%, while the corresponding figure in the developed countries is 4-fold greater (0,9%)

INTERDEPENDENCE BETWEEN HEALTHCARE FUNDING AND POPULATION HEALTH INDICES

To achieve LEB of 73–75 years and

CDR of 11.0–10.0, the government

per capita spending on the

healthcare should be no less than

1100–1200 $PPP

NOT EFFECTIVE MANAGEMENT

To attain CDR of 11,0, Local Guarantees Program (LGP) spending should be doubled to the level of 15 thousand rubles which corresponds to 1000 $PPP

Dependence of CDR on LGP (per capita) spending

SALARY OF MEDICAL PERSONNEL

The salary of doctors in 2009 was 10% lower than the average wage in RF (16,8 and 18,6, correspondently). At present, the salary of doctors in OECD countries is higher by 3-5 times than the average wage in corresponding countries

COMPARISION OF INTEGRAL EFFICIENCY OF HEALTHCARE SYSTEMIN RF AND OECD NATIONS

Index Value in RF Value in OECD nations

Preventable death. It is assessed by the number of potential years lost for life (PYLL) per 100 thousand persons

Not measured 3700

Share of population satisfied with quality and availability of medical aid 31% 70%

Treatment efficiency: mortality of the patients with myocardial infarction

in a hospital (nonstandardized index)20% 7.7%

Treatment efficiency: five-year survival rate among the patients with

breast cancer56% 85%

Treatment efficiency: lethality among the patients with bronchial asthma per 100 thousand adult population

(older than 18 years)

2.3 0.18

THE REASONS OF POOR PHYSICIANS PERFORMANCE

The reasons of poor performance: Continuous medical education — only 1 time in 5 years, 15% doctors even didn’t match this indicator

Educational programs not always up-to-date and taught without using distant technologies (4 month out of work)

Physicians lack evidence based literature at the point of care

Physicians don’t have access to electronic support systems and electronic medical library

NOTE: the products are available on the market

To solve these problems we need the systemic, targeted, and coordinated long-term Strategy of National Healthcare - 2020

CONCLUSIONS

The basic problems of healthcare in Russia are: Underfinancing and not equal distribution of healthcare resources between various regions of RF

Unclear directivity of the healthcare system on the patient’s needs

Insufficient qualification of the medical personnel

Inefficient management in the strategic development of the national healthcare system

Disproportions in healthcare supply in favor of specialists and hospital care

Lack of innovations coming from academia

Lack of coordination with Russian pharmaceutical industry and medical device industry

PART 3

Future demographic, social and economic challenges in healthcare

DEMOGRAPHIC CHALLENGES

The medium variant of projection toward 2025

(Federal Agency for Statistics):

If mortality is 15,0 (no change), birth rates will be 9,6 per 1000 population (decline) and migration will rise by 50%

In 2025:

Total population will decline by 5 mln (from 142 mln to 137 mln);

Working age population will decline by 14 mln, it’s proportion will diminish from 63% to 55%;

Over working age population will increase by 6 mln and it’s proportion will rise from 21% to 27%;

Life expectancy will be – 70 years

ECONOMIC CHALLENGES

If LEB of the men is elevated by 5 years to 2020, almost 60% men would reach the age of 65 years (the minimal retirement age established in all developed countries), which corresponds to the curve (II). In contrast, the present variant (I) shows that merely 48,6% men will reach retirement age

EXPECTATIONS OF PLAYERS INVOLVED

Population Shorter waiting lists

Polite doctors

Lower charges (copayments)

Medical personnel

Salaries increase 2-3 fold

Opportunities for continuous medical education and professional growth

Less paper work

Government Improve population health

Satisfy population

Decrease disparities

Pharmaceutical

industry

Higher sales

Less regulation

More transparency in government decisions

More influence on opinion leaders and physicians

Private providers Access to public finance

Less regulation

Revenue growth

NATIONAL PRIORITY PROJECT “ZDOROVIE”

830 thousand additional lives of Russian citizens were saved(0,6% population of RF)

PART 4

What should be done

President of RFDmitry Medvedev

Prime-minister Vladimir Putin

«On Adoption of the Conception of Demographic Policy in Russian Federation toward 2025”

Decree of RF President № 1351 of 9 November 2007

“ Conception of the Long-term Socioeconomic Development of RF toward 2020”

Instruction of RF Government № 1662-r of 17 November 2008

THE AIMS ARE OUTLINED

DEMOGRAPHIC STRATEGY

LONG-TERM SOCIAL ECONOMIC STRATEGY OF RUSSIAN FEDERATION

THE PRINCIPLES OF HEALTHCARE STRATEGY

Solidarity

Total coverage

Equity: payments + health status + access

Fair resources distribution

Transparent and evidence-based decisions

Honesty of managers and no place for corruption

Strategic and managerial approach in stewardship

Open reports on results to government and public

Share of responsibilities on health improvement between government, business and population

KEY TASKS

FINANCEFINANCE

Increase the spending on state healthcare system at least 2-fold toward 2014

Create conditions for fair distribution of the spending burden on medical services for rich and poor strata of the society

Adopt the system of predominantly single payer and single fund manager for spending on the medical aid under SSP – the law is already passed

Create the conditions for leveling of the financial provision for SGP in various RF subjects - the law is already passed

Enhance efficiency of procurement of medical services from the suppliers

Update the norms of SGP on free medical aid to RF citizens

Eliminate unofficial payments in patient care institutions

KEY TASKS

IMPROVEMENT OF ORGANIZATION OF MEDICAL SYSTEMIMPROVEMENT OF ORGANIZATION OF MEDICAL SYSTEM

Ensure availability and quality of medical drugs to RF population — 3-fold

Enhance the salary of doctors — 2-fold

Restore the medical aid system inherited from the Soviet Union and adapt it to modern conditions – industrial and school medicine

Ensure availability of medical aid to rural population

Reform the hospital-based medical aid

Improve the medical aid system for the patients with social-motivated disease (AIDS, tuberculosis, etc.)

Create the control system over the quality of medical aid

KEY TASKS

RESOURCESRESOURCES

Enhance qualification of medical staff through Continuous Medical Education (CME)

Enhance motivation of medical personnel to qualitative work

Ensure the optimal structure of medical personnel (the over-all number and available specialties)

Elaborate the long-term program of sustainability of infrastructure and re-equipment of the patient care institutions

Actualize the standards for the number of hospital beds

Enhance innovation character and the quality of the research work in medicine and health care

Develop the combined cooperative plan of the healthcare system, pharmaceutical and medical industry – already started

KEY TASKS

CONTROL OF HEALTHCARE SYSTEMCONTROL OF HEALTHCARE SYSTEM

Introduce the strategic approach to realization of the state policy

Restore partially the vertical control over the healthcare system

Strengthen the state control over Medical Care Quality (MCQ) and the medical aid tariffs

Extend autonomy of the state and municipal Medical Prevention Institution (MPI) and organize competition among the suppliers of medical services of all property forms

Adopt the economically efficient (market) methods of control healthcare

Enhance professional skills of the management personnel

Diminish the corruption risks and strengthen transparency and justification of the adopted decisions

Actualize the normative legal instruments in the healthcare system

KEY TASKS

ACTUALIZATION OF THE PROGRAMS ON HEALTHCARE PROTECTIONACTUALIZATION OF THE PROGRAMS ON HEALTHCARE PROTECTION

Promote motivation in population of RF to the healthy life-style

Enhance responsibility of population and the employers for maintenance and strengthening the health

Expand conditions for healthy life-style in RF

Actualize the struggle program against tobacco smoking

Actualize the struggle program against alcohol overconsumption

Actualize the struggle program against drug addiction

Extend prevention and prophylaxis programs

Improve the sanitary-epidemiological surveillance in RF

Ensure integration and coordination in the control over the programs on health protection

PART 5

About ASMOK and its strategy in medical education

ABOUT ASMOK

ASMOK was founded in May 2005 in order improve quality in medical education and services provision

The way how we work: methodology development analytical documents educational products initiation and coordination

MEMBERS

The outcomes of ASMOK activitiesThe outcomes of ASMOK activities

Coordination of workCoordination of work

Evidence based guidelines ~ 340

“National guides” ~ 60

Modern and constantly upgrading sources of information, providing medical doctors with vital materials on prevention, diagnostics and management of different diseases.

Developed for continuous medical education. The series covers all major specialties. Each title is accompanied with a CD based on Physician’s Consult platform. The leading Russian experts and key opinion leaders participated in the development of the series.

Web-based medical decision support systems

The outcomes of ASMOK activitiesThe outcomes of ASMOK activities

Independent evidence based information

Powerful built-in search engine for finding relevant information within seconds

Independent drug information, free from the biases introduced by marketingPatients information

EBM Guidelines

CME Textbooks

CME Online and Portfolio management, etc…

Web-based library for medical students

The outcomes of ASMOK activitiesThe outcomes of ASMOK activities

More than 300 textbooks

Built-in eLearning tools

Multimedia clinical skills

Built-in eLearning tools

“Healthy Living Schools”. Either for those suffering from non-infectious chronic diseases or for those having risk factors for their progression.

Health promotion and patient education

Materials for healthy people and for all groups of society: pregnant women, children from 0 to 14, adolescents, young and middle age, elderly people, women’s health. The materials were highly evaluated in 7 test regions. 1–1,5% of the regions needs were supplied

2007-2008: the information materials on healthy lifestyle, delivered by ASMOK, were expanded within the framework of the political project “Zdorovoye serdtse” (Healthy heart) under guidance of the Chairman of the Supreme Council of the party “Edinaya Rossiya” (United Russia) Boris Grizlov. This project was highly evaluated all over Russia.

The outcomes of ASMOK activitiesThe outcomes of ASMOK activities

Independent drug information, free from the biases introduced by marketing

EBM Drug Reference Guide

Online version has a powerful built-in search engine for finding relevant information within seconds

The outcomes of ASMOK activitiesThe outcomes of ASMOK activities

4141

Journal and website on problems and development of Medical education and professional development.

WWW.MEDOBR.RU

International conference “Medical Education in Russia and the World: Traditions and Innovations”

WWW.MEDOBR.RU

Analytical documents Analytical documents developed developed by by ASMOK ASMOK ::

Healthcare in Russia. How to cope with current challenges

The conception for advancement of CME in Russia

Clinical guidelines and standards of care

The program of state guarantees for Russia

Public-Private Partnership in Healthcare

The outcomes of ASMOK activitiesThe outcomes of ASMOK activities

Association of Medical Societies for QualityAssociation of Medical Societies for Quality

ASMOK works closely with over 100 higher medical schools throughout Russia and CIS.

ASMOK is founding member of Russian National Chamber of Physicians.

ASMOK is Premium member of AMEE (Association for Medical Education in Europe)

ASMOK is your RELIABLE partner in Russia

WWW.ASMOK.RUWWW.ASMOK.RU

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