Sunday, January 19, 2020

In ‘Hybrid’ Move, Moscow City Wants to Shift Funds Away from Hospitals Not to Provide Better Care but to Save Money

Paul Goble

            Staunton, January 16 – Health “optimization,” Putin’s plan to save money being spent for health care, has now come to the Russian capital where Aleksey Khripun, head of the Moscow city healthcare department, says that 20 to 30 percent of those now hospitalized could and should have been treated as outpatients at clinics.

            The shift is being portrayed as a way to cope with the rising number of Muscovites needing medical treatment, with Khripun arguing that they want to shift funds from hospitals to clinics in order to improve the care residents of the capital receive (

            Finding the right balance between hospital and ambulatory care is a challenge for all medical systems, but it seems clear that in the Russian case, such a shift of resources is designed in the first instance to save money because putting patients in hospitals is much more expensive than treating them elsewhere. 

            That this plan is about saving money rather than improving patient care is suggested not only by the track record of “optimization” ( but also by another recent set of Russian government moves that in the name of improving health care are actually making it worse.

            In hospitals in St. Petersburg and across Russia, medical personnel who are classified as invalids for one reason or another and who have been working to provide care to others are losing their jobs. This is being done in the name of protecting their health but in fact it is part of the cutback in the number of hospital employees (

            What these developments highlight is that Vladimir Putin’s much vaunted strategy of “hybrid” war is being extended into other sectors of Russian life, with the government taking nominally for one set of reasons even though they are being taken for an entirely different set of ones.

            In the military sphere, that continues to confuse many in Russia and the West. Perhaps not surprisingly, other Russian officials have taken notice and are adopting the same stragegy.

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