Wednesday, April 15, 2015

Moscow’s Medical ‘Optimization’ Program Pushing Up Russia’s Death Rate, Audit Finds

Paul Goble


            Staunton, April 15 – The Russian government’s plan to save money by consolidating hospitals and reducing staff has failed to meet almost all of its intended goals, but it has achieved one outcome few would consider a positive one: it has led to a 2.2 percent rise in death rates among Russians, according to a study by the Audit Chamber.


            In a report to the Chamber’s collegium, auditor Aleksandr Filipenko says that his investigation has shown that “the main goals of optimization … have not been achieved and the expected growth in effectiveness and access to medical help has not taken place” (


            Only five regions met the four goals Moscow had set, and many fell short on most of them, although just how severely is complicated by the fact that central guidance on many questions was anything but clear and questions about who was to finance what were left unanswered, he said.


            But one trend is clear: the number of medical facilities available to the population, and the number of doctors and other medical staff has fallen, decreasing public access to health care and increasing the amount of time people must spend to get to medical assistance and the number of people who die because it is not readily available.


            Especially hard hit are people in rural areas.  Medical assistance points in 14,900 villages with fewer than 300 residents each simply must be closed if budgetary goals are to be met, but that means that Russians living in those places either must travel long distances often over very bad roads or not get care at all.


            According to his investigation, Filipenko said, there are approximately 17,500 villges in Russia which no do not have any medical infrastructure or doctors at all. Of these, “more than 11,000 are located more than 20 kilometers from the closest medical organization where there is a doctor,” and 35 percent of these are not serviced by public transport.


            Moscow’s optimization plan has hit rural people in another way far harder than it has urban residents.  During 2014, hospitals across Russia reduced their number of beds by 33,757. The cuts were far deeper and more rapid in district hospitals than in oblast ones and in oblast ones more than in metropolitan centers.


            That in turn led to an increase in deaths in 61 regions, with the growth in 49 of those regions linked to the reduction in the number of those who were hospitalized, the direct result of the cutbacks in the number of hospital beds. Even those who were able to get some medical attention died at greater rates.


            In 2014, 17,900 more people admitted to hospitals died than in 2013, Filipenko said. And the number dying at hope shot up dramatically especially in areas where hospital access was reduced.


            But he argued that the most serious aspect of the situation is that “the optimization did not lead to a planned reduction in mortality.” Instead of a decline to 12.8 deaths per 1,000 the plan called for, there were 13.1 deaths. And “if one compares the indicators for January-February 2015 with the same period a year earlier, then the growth of mortality was 2.2 percent.”


            There were two areas of growth: the number of people using private medical services rose by almost a quarter in one year, a pattern fine for those who have money but not for pensioners and others, and the pay of those medical staff still employed also went up. Unfortunately, the latter increase came at the expensive of massive staff cuts.


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