Comment / From Russia with love

Undoubtedly one of the oddest assignments I have ever undertaken for HFMA was to join a trip to Russia along with chairman Chris Calkin and three other professional colleagues.  The trip was organised by HFMA US with the intention of analysing how far the Russian health system had modernised since the collapse of communism in 1991.

There will be more output from the trip in the form of comment and articles, but I wanted to use my column to talk about my observations.  As a veteran of study tours, this was the first country I had visited that was visibly behind what might be called the ‘Western standard’.  The tour provided us with a fascinating insight into how the system works and it would indeed be interesting to see how it develops over the next five years.

We started at the public health institute where a discussion with officials revealed some startling facts about the healthcare system.  The average life expectancy for women is 70 whereas for men it is down at a lowly 59.  Cardiovascular diseases were by far the highest cause of death with cancer coming in second.  The tell-tale signs of deprivation were there as it was reported that tuberculosis was a major killer and something that did not appear yet to be a major problem was diabetes (which can be evidence of a wealthy, excessive diet).

In terms of the financial picture only some 4.5% of Russian GDP is devoted to healthcare, although it is listed as one of four state priorities and is receiving significant extra resources. These resources are aimed at reducing preventable mortality by cardiovascular disease, decreasing deaths by 35% and increasing life expectancy to 70 for men and 80 for women.  The system is mainly state funded, however with the advent of the market this is gradually changing to an insurance-based system. 

This system is organised a bit like our national insurance system.  However while national insurance is collected by a nondescript organisation in Newcastle and handed to the Treasury, the Russian compulsory insurance scheme funds primary care directly.  There are big increases in expenditure taking place.  For example between 2005 and 2006 healthcare expenditure increased from 1trillion roubles (£25bn) to 1.5 trillion (£37.5bn).  Although inflation is running at about 12% it still indicates a seriousness to modernise healthcare.

Not surprisingly given the state is a former communist one, there is a major focus on the hospital.  Some 32 million people attend hospital each year with an average length of stay between 13 and 14 days.  In fact one in five Russians are likely to be inpatients in any given year. 

The response of the Russians to all these developments has been to move towards the development of a market-based insurance system.  However, in a land where the rich seem to be getting very rich and the poor seem to get poorer, I wonder what the average Russian thinks about capitalism?   The infrastructure is well planned but doesn’t look as if a kopek has been spent on it for many a year and I wonder if the market economy really is the dream for them?