Putin’s Health Care ‘Optimization’ Accelerating the Dying Out of Rural Russia

Paul Goble

            Staunton, June 27 – Because of Vladimir Putin’s health care “optimization” campaign – a euphemism for cutbacks – only 45,000 of 130,000 rural population centers in the Russian Federation have any medical services, and a combination of bad roads and poor transportation services means that many who don’t have them can’t go to where such services exist.

            As a result, as Anatoly Komrakov reports in “Nezavisimaya gazeta” today, “the level of mortality in rural areas is significantly higher than in the cities” and Tatyana Golikova, the head of the Accounting Chamber, is expressing concern that “there will be a rise in mortality in rural areas” when statistics are published next month (ng.ru/politics/2016-06-27/1_selo.html).

            Along with flight to the cities, increased mortality in rural areas, now 1.8 per thousand greater in rural areas than in urban ones, is pushing down the population in many parts of the countries. While the population of Russian cities grew last year by 93,400, that of the rural portions of the country fell by 61,400.

            The situation in some regions is especially dire, although no current statistics are available. Officials promise to release them in August, Komrakov says.  But despite their absence, data from some regions are available already – and they indicate that the collapse in health care in rural areas is behind the rise in mortality rates there.

            In Orel oblast, one of the most ethnically Russian regions of the country, health care has collapsed over the last 25 years. In 1990, there were 12,700 hospital beds for rural residents; in 2000, there were 10,500; now there are only 7500. The number of polyclinics has fallen over the same period from 133 to 85 and the number of nurses by 13 percent.

            As a result, the “Nezavisimaya gazeta” journalist reports, “if 25 years ago, morality in the oblast stood at 13 deaths per 1,000 residents; in 2015, the rate stood at 16.4 per 1,000, an increase of 26.4 percent.” The situation in Pskov oblast is even worse, and as a result, life expectancies there are five years less than for Russia as a whole.

            According to Eduard Gavrilov, director of a health monitoring foundation, there are today “three to four times” fewer doctors in rural areas than in cities and mortality rates in rural areas are “15 to 18 percent higher.”  And because there are fewer doctors, fewer people are able to visit them: the number of rural people seeing a doctor fell by 39 million between 2012 and 2015.

            Figures for infant mortality also vary widely between rural areas and the cities, according to government statistics, and mortality among women giving birth is much higher in rural areas than in urban ones: In Stavropol kray, 13.6 such women out of a thousand in rural areas are die in childbirth while in cities only 8.9 per thousand do.

            The real figures for rural Russia are almost certainly worse than what the government is reporting, Komrakov says, for two reasons. On the one hand, some officials have ordered hospitals not to report more than a certain number of deaths each month regardless of how many there actually are. (See permv.ru/2016/06/22/prikamskiy-minzdrav-vvel-kvoty-na-kol/.)

            And on the other, in an additional cost-saving measure, doctors rather than anyone else are responsible for reporting deaths to government statisticians. In the two-thirds of Russian villages where there are no doctors any more, there is no one left to report on deaths and so they are unlikely to be included in Russian government statistics.

             

Помимо заботы о здоровье у врачей теперь есть еще и обязанность отслеживать статистику. По данным пермского портала «В курсе.ру», по местным больницам прошла рассылка от подконтрольного краевому Минздраву Медицинского информационно-аналитического центра, в которой врачам региональных больниц напоминали, что «на одном терапевтическом участке не должно быть превышения рекомендованных МЗ РФ показателей, а именно – не более одного умершего и не более 11 вызовов скорой медицинской помощи в неделю».
Впрочем, по данным Татьяны Голиковой, в 85 тыс. населенных пунктах страны за подобной статистикой вообще никто не следит, так как там нет никаких форм оказания медицинской помощи.