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Problems and Trends of Russian Health Care Development
Available online at www.sciencedirect.com
ScienceDirect Procedia Economics and Finance 16 (2014) 34 – 39
21st International Economic Conference 2014, IECS 2014, 16-17 May 2014, Sibiu, Romania
Problems and Trends of Russian Health Care Development Julia Vertakovaa,*, Olga Vlasovab a Faculty of Economy/Department of Regional Economics and Management, Southwest State University, Kursk, Russia Faculty of Economy and Administration of Health Care / Department of Economics and Management, Kursk State Medical University, Kursk, Russia
b
Abstract The article is devoted to current problems of public health care development in the Russian Federation and the main trends of health policy. The role and the responsibility of the state and regional authority in the field of public health care are discussed; consideration is also given to public health priorities. Necessity of acceptance of the public health policy at the regional level to improve the efficiency of health care system, accessibility and quality of public medical care for the population is proved. The Authors. Published byThis Elsevier © 2014 2014Published © by Elsevier B.V. is an B.V. open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Selection and/or peer-review under responsibility of Scientific Committee of IECS 2014. Selection and/or peer-review under responsibility of Scientific Committe of IECS 2014 Keywords: development policy, health care, modernization, region
1. Introduction Currently, health care in the Russian Federation is in crisis and requires modernization. Due to the fact that the subjects of the Russian Federation were pretty much given free rein in decision making concerning health care development, issues of the development of the regional health care policy are real. Analysis of the current Russian situation in health care area has revealed that during the last 10 years governmental actions were mainly tactical, unsystematically and not strategic [Shilenko, 2012]. This is due to the lack of effective scientific public health care policy, taking into account not only the negative impact of the external environment on health care, but also the structure and features of its internal capacity. The development of the regional health care policy is necessary because of the following reasons.
* Corresponding author. E-mail address: [email protected] (J. Vertakova), [email protected] (O. Vlasova)
2212-5671 © 2014 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Selection and/or peer-review under responsibility of Scientific Committe of IECS 2014 doi:10.1016/S2212-5671(14)00771-0
Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39
To start with, the modern concept of sustainable development of socio-economic systems is based on the idea of wealth management and the quality of life of the population, which is mostly determined by the efficiency of proper functioning of the social sectors [Aujoulat, 2001, Genet, 2013, Molen, 2013, Vertakova, Plotnikov 2013]. Again, the current governmental actions in the sphere of socio - economic policy are refocused on health care, a lot of specialized national projects are being carried out presently. In this regard, the government has set the goals for the regions to develop and implement effective socio-economic policy of health care as soon as possible. Finally, since the Russian regions differ significantly in socio-economic, demographic and other parameters, there is a need to develop differentiated management approaches to the formation of socio-economic health care policy with the goals of increasing the internal capacity of the sector, the availability and quality of health care for the population, improving its health [Karanikolos, 2013, Tragakes, 2010]. 2. Current trends of health care development in different countries: comparative analysis A lot of scientific publications are devoted to studies of functioning and development of health care system. A number of researchers (Ifanti, 2013 ; Mur-Veeman, 2008 ; Aujoulat, 2001 ; Cabiedes, 2001; Sheiman, 2014, Shevski, 2014 etc . ) discussed issues of the health care system relationships and dynamics of socio-economic development of the state. Also, a number of authors (Karanikolos, 2013, Mladovsky, 2013,Cylus, 2013, Thomson, 2013 ; Siskou, 2013, Kaitelidou, 2008, Papakonstantinou, 2008, Ettelt, 2012, Mackenbach, 2013 ; White, 2013 ; Scott, 2014 ; Voncina, 2007 ; Kieke, 2013 etc.) reveal in detail in their works the essence of governance mechanisms of health care administration,, the priorities of the state policy in the field of health . In addition, such questions are being actively covered in the reports of the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). Key issues and conditions of health care development at various levels (national, regional, municipal) are deeply studied by Russian researchers. Particular attention is paid to the analysis of the resource potential of the field, features of ongoing modernization of health care in Russia, political and legal aspects of its provision. Currently, health care in the Russian Federation is in crisis. The main problems of its development, in our opinion, are the following: 1. Lack of financial resources in the health care system, which in turn, generates a number of negative consequences: the low salaries of medical personnel, problems of providing the population with free medicines, absence of the possibility of compliance with treatment standards and providing hospitals with modern equipment and consumables [WHO, 2011, Voncina, 2007]. Thus, in the Russian Federation in 2012, public expenditures on health care (including expenses on the program of state guarantees, education, investment in infrastructure and sanitary-epidemiological safety) were $48,9 billion dollars, or about 4% of GDP, that is at least two times lower than the average in the EU countries and the USA [Gusmano,2014, Mackenbach, 2013, Vertakova,Vlasova, 2013] (Table 1). Table 1: List some of countries of the world sorted by their total expenditure on health at purchasing power parity (PPP) per capita, and their total expenditure on health as a percentage of GDP, 2011 Source: OECD Health Data, 2012; WHO World Health Statistics, 2012 [OECD, 2013]. Country United States Norway Switzerland Netherlands Austria Canada Germany Denmark Luxembourg France Belgium Sweden
Total health expenditure per capita PPP Int.$ 8,508 5,669 5,643 5,099 4,546 4,522 4,495 4,448 4,246 4,118 4,061 3,925
Total health expenditure % of GDP 17,7 9,3 11,0 11,9 10,8 11,2 11,3 10,9 6,6 11,6 10,5 9,5
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Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39 Ireland United Kingdom Finland Spain Italy Portugal Greece Russian Federation
3,700 3,405 3,374 3,072 3,012 2,619 2,361 1,277
8,9 9,4 9,0 9,3 9,2 10,2 9,1 3,7
The U.S. spent $8,508 on health per person in 2011. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person. The U.S. devotes far more of its economy — 17.7 percent of GDP in 2011 — to health than any other country. The Netherlands is the next highest, at 12 percent of GDP, and the average among OECD countries was almost half that of the U.S., at 9.5 percent of GDP [ane, 2012]. 2. Deficit and suboptimal quality of medical personnel. A shortage of medical personnel, first of all, is associated with low payment for their work, it is 22% lower than the average salary in the Russian Federation and almost 10 times lower than in developed countries [OECD, 2009, Ettelt, 2012, Ifanti, 2013]. While, for example, in Europe the profession of doctor is one of the highly paid professions (doctor’s income is from 1,5 to 2,5 times more than the average salary in the country) (Figure 1). In the Netherlands doctors earn the most at $253,000, while specialists in the U.S. earn an average of $230,000. Averages vary from country to country, from $150,000 in the United Kingdom to $91,000 in Denmark, to $67,000 in Greece, to only $25,000 in Mexico and $12000 in Russia. In some cases (Finland, France, Germany, Italy, Poland) the minimum doctors’ salaries is equivalent to the average national salary; in Belgium, Denmark, Italy, the Netherland and Slovakia the minimum doctors’ salary is higher than the average national salary [OECD, 2013]. In Russia average doctors’ salary usually is equivalent to the minimum national salary. However, in the Russian Federation the number of doctors per 10,000 population is 44,1, which is 1,5 times higher than in European countries (in average 36 doctors per 10,000 population).
Figure 1: Comparative Analysis of Medical Doctors’ Incomes Across Countries, U.S. Dollars, 2011 Source: Compiled with data of Physician Compensation Worldwide, 2011
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Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39
This is connected, primarily, with a high level of incidence and morbidity of the population (40-50% higher than in Europe) [Vlasova, 2013] (table 2). Table 2: List of some countries of the world sorted by the number of physicians and nursing and midwifery personnel per 10000 population, 2005-2012 Source: compiled using data of World Health Statistics, 2013 [WHS, 2013]. Country United States Norway Switzerland Canada Germany Denmark Luxembourg France Belgium United Kingdom Finland Russian Federation
Physicians 24,2 41,6 40,8 20,7 36,9 34,2 27,8 33,8 37,8 27,7 29,1 44,1
Nursing and midwifery personnel 98,2 319,3 174,9 104,3 113,8 160,9 171,0 93,0 222,1 94,7 239,6 94,3
Nurse-to-doctor ratio 4,1 7,8 4,3 5,0 3,1 4,7 6,1 2,8 5,9 3,4 8,2 2,1
You should pay attention to the very low nurse-to-doctor ratio in Russia (2,1), indicating a shortage of nurses, which has a tendency of growth in recent years. In addition, the level of salary of teachers of medical schools is quite low (official salary is no more than $450 per month). It naturally leads to a decrease in motivation of their work and contributes to low level of education of students - future doctors. Hence the third important problem [Quaglio, 2013, Siskou 2008]. 3. Poor qualifications of medical personnel and, as a consequence, the low quality of medical care. For example, the survival rate of breast cancer patients, the ratio of intra-hospital mortality, the proportion of patients who had infectious complications in hospitals in the Russian Federation in 2 times above, than on the average in developed countries [Okma, 2013, Vlasova, 2013]. 4. The backlog of standards of medical care on the Program of state guaranteed benefit package (SGBP) free medical care to the real needs of the population of the Russian Federation. For example, from 1999 to 2010, standards of medical care for the SGBP haven’t been changed, and some types of medical services even have been declined, however, the incidence of the population (which identifies the need for medical care) in the period from 1990 to 2010 has increased by 1,5 times[Vertakova, Vlasova, 2013]. Our population is also insufficiently provided with free medicines on a doctor's prescription in polyclinics. So, in the Russian Federation in 2010 expenditure per capita on drugs from public sources were 5.6 times lower than in the countries of Europe, considering that drug prices are almost the same[Mackenbach, 2013, Mur-Veeman,2008]. 5. Very low volumes of high technology medical aid. For example, the number of heart revascularizing surgeries (i.e. restoration of patency of the heart vessels), which constitute 25% in the volumes of quotas on hi-tech medical aid in the Russian Federation is done 5 times less than in EU countries, average procedures of hemodialysis - 4 times less, the number of operations of knee and hip joints – 6,5 times less [Ifanti,2013, Kringos, 2013, WHO, 2009]. 6. Ineffective management of the health care system at all levels. For example, in the Russian Federation there is no strategic planning and responsibility of managers of all levels for the achievement of results (including annual reports) on indicators accepted in developed countries, e.g. on indicators of quality and safety of the medical aid, economic effectiveness. Ineffective management is manifested in the irrational allocation of public funds. So, the focus of government programs is on poorly controlled, having a high risk of corruption payments investment costs (construction and purchase of expensive equipment) instead of development of preventive ways and human resource capacity. Inefficient use of equipment and hospital beds also takes place. Cost-effective management tools, such as competition on the criterion of quality in the purchase of medical assistance for health care providers, ranking of medical institutions, the application of economic incentives for achievement of planned results are insufficiently used [Cabiedes, 2001, Groenewegen, 2013].
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Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39
7. The demographic problem is still urgent due to the projected reduction in the number of women of active reproductive age and growth of the elderly population. Many specialists in the field of health care believe that large budget funds are spent inefficiently: over the past 50 years, life expectancy in the world increased by 11 years, and in India -21 years. In Russia it has remained the same, although its catastrophic decline of the past decades has been overcome. But tasks set to the socio-economic system do not always accurately reflect the real needs of society [WHO, 2011, White, 2013]. 8. Untimately, poor use and maintenance of equipment purchased in hospitals due to lack of specially refurbished premises, well-trained staff, etc. 9. Low level of information technologies in health care. 10. The problem of choice, forming regional target programs should be prioritized. It is impossible to form the strategy of health for the population in general, it can be efficient only when targeted at specific age groups and diseases. For example, the tasks to reduce the death rate, set by the President, refer mostly to older age groups. 11. Low level of culture of the doctor-patient relationship that causes discontenting of the population. Such number of unsolved problems clearly indicates a lack of consistency of the reforms of the healthcare sector in Russia and its regions. Activities on modernization of the health system, conducted in the regions, often do not lead to increase of efficiency of health care system and do not contribute to its development at the pace required. In most cases the measures are «one-sided» (do not take into account all the problems of the field) and are not subject to a single system of values, ideas, visions and goals for the development of health. 3. Conclusions Here we are faced with the current unsolved problems of health care system in Russia. Nowadays, the Government of the Russian Federation sets the goal to improve the socio-economic policy of the health care system development in regions. All regions differ by their socio-economic development, demographic parameters. Thus, there is a need to develop a socio-economic policy for every region separately. The policy should take into account the interests of the population of a particular region, weakness and strength of its internal potential. The main goal of the policy must be improving the level of health and well-being of the population of the region and the country as a whole. References Aujoulat, I., Le Faou, A., Sandrin-Berthon, B., Martin, F., Deccache, A. (2001) Implementing health promotion in health care settings: conceptual coherence and policy support. Patient Education and Counseling,45(4), p. 245-254. Cabiedes, L., Guillén, A. (2001) Adopting and adapting managed competition: health care reform in Southern Europe. Social Science & Medicine, 52 ( 8), p. 1205-1217. Determinants of Health Outcomes in Industrialized Countries: a Pooled Cross-Country Time-Series Analysis (2009) OECD Economic Studies, 30, p. 34-38. Ettelt, S., Fazekas, M., Mays, N., Nolte, E. (2012) Assessing health care planning – A framework-led comparison of Germany and New Zealand. Health Policy, 106 (1), p. 50-59 Genet, N., Kroneman, M., Boerma, W. G.W. (2013) Explaining governmental involvement in home care across Europe: An international comparative study. Health Policy, 110 (1), p. 84-93. Groenewegen, P. P., Dourgnon, P., Greß, S., Jurgutis, A., Willems, S. (2013) Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries. Health Policy, 113 (1–2), p.170-179. Gusmano, M. K., Weisz, D., Rodwin, V. G., Lang, J., Qian, M., Bocquier, A., Moysan, V., Verger P. (2014) Disparities in access to health care in three French regions. Health Policy, V. 114, I. 1, p . 31-40 Ifanti, A. A. , Argyriou, A. A. , Kalofonou, F. H. , Kalofonos, H. P. (2013). Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care. Health Policy. 113 (1–2), p. 8–12. ane, J. Health Costs: How the U.S. Compares With Other Countries. Available at http://www.pbs.org/newshour/rundown/health-costs-how-theus-compares-with-other-countries/ Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., Mackenbach, J. P., McKee, M. (2013) Financial crisis, austerity, and health in Europe. The Lancet, p. 1323-1331. Kringos, D. S., Boerma, W. G.W., Van der Zee, J., Groenewegen, P. P. (2013) Political, cultural and economic foundations of primary care in Europe. Social Science, p. 323-331.
Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39 Mackenbach, J. P, Karanikolos, M., McKee, M. (2013) The unequal health of Europeans: successes and failures of policies. The Lancet, p. 11251134. Macroeconomics and Health: Innovations in Health for Economic Development (2009). Report of the Commission on Macroeconomic and Health. Geneva: WHO. Mur-Veeman, I., Van Raak, A., Paulus, A. (2008) Comparing integrated care policy in Europe: Does policy matter? Health Policy, 85 (2), p. 172183. OECD Health Data 2013. How Does the United States Compare. Available at http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf Okma, K.G.H., Crivelli, L. (2013) Swiss and Dutch “consumer-driven health care”: Ideal model or reality? Health Policy, 109 (2), p. 105-112 Quaglio, G., Karapiperis, T., Van Woensel, L., Arnold, E., McDaid, D. (2013) Austerity and health in Europe. Health Policy, 113 (1–2), p. 13-19 Shilen, Y.V., Raizberg, B.A., Vyalkov, A.I. (2012) Administration and economy of health care.- ., p.45-49. Siskou, O., Kaitelidou, D., Papakonstantinou, V., Liaropoulos, L. (2008) Private health expenditure in the Greek health care system: Where truth ends and the myth begins. Health Policy, 88 (2–3), p. 282-293. The World Health Report 2011. Health Systems: Improving Performance (2011)- Geneva: WHO. They pay less for Hungarian doctors than other workers – Medical salaries in Europe. Available at http://medlines.org/ they-pay-less-for-ahungarian-doctors-than-other-workers-medical-salaries-europe Tragakes, E. and Lessof, S. In: Tragakes E., ed. (2010) Health care systems in transition: Russian Federation. Copenhagen, European Observatory on Health Care Systems, p.107. Van der Molen, I.N., Commers, M.J. (2013) Unresolved legal questions in cross-border health care in Europe: liability and data protection. Public Health, 127 (11), p. 987-993. Vertakova, Yu.V., Vlasova, O.V. (2013) Methodical approach to the assessment of the strategic potential of regional healthcare. Saint Petersburg University of Economy and Finance Bulletin, 6, p. 24-28. Vertakova, Yu; Plotnikov, V. (2013) Russian and Foreign Experience of Interaction Between Government and Business. World Applied Sciences Journal, 28 (3): 411-415. Vlasova, O.V. (2013) The investigation of human resources of the regional healthcare (by the example of Kursk region). Economic systems management,11 (59). Available at http://www.uecs.ru Voncina, L., Dzakula, A., Mastilica, M. (2007) Health care funding reforms in Croatia: A case of mistaken priorities. Health Policy, 80 (1), p. 144157. White, J. (2013) Budget-makers and health care systems. Health Policy, 112 (3) p. 163-171 World Health Statistics. Available at http://www.who.int/gho/publications/world_health_statistics/
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ScienceDirect Procedia Economics and Finance 16 (2014) 34 – 39
21st International Economic Conference 2014, IECS 2014, 16-17 May 2014, Sibiu, Romania
Problems and Trends of Russian Health Care Development Julia Vertakovaa,*, Olga Vlasovab a Faculty of Economy/Department of Regional Economics and Management, Southwest State University, Kursk, Russia Faculty of Economy and Administration of Health Care / Department of Economics and Management, Kursk State Medical University, Kursk, Russia
b
Abstract The article is devoted to current problems of public health care development in the Russian Federation and the main trends of health policy. The role and the responsibility of the state and regional authority in the field of public health care are discussed; consideration is also given to public health priorities. Necessity of acceptance of the public health policy at the regional level to improve the efficiency of health care system, accessibility and quality of public medical care for the population is proved. The Authors. Published byThis Elsevier © 2014 2014Published © by Elsevier B.V. is an B.V. open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Selection and/or peer-review under responsibility of Scientific Committee of IECS 2014. Selection and/or peer-review under responsibility of Scientific Committe of IECS 2014 Keywords: development policy, health care, modernization, region
1. Introduction Currently, health care in the Russian Federation is in crisis and requires modernization. Due to the fact that the subjects of the Russian Federation were pretty much given free rein in decision making concerning health care development, issues of the development of the regional health care policy are real. Analysis of the current Russian situation in health care area has revealed that during the last 10 years governmental actions were mainly tactical, unsystematically and not strategic [Shilenko, 2012]. This is due to the lack of effective scientific public health care policy, taking into account not only the negative impact of the external environment on health care, but also the structure and features of its internal capacity. The development of the regional health care policy is necessary because of the following reasons.
* Corresponding author. E-mail address: [email protected] (J. Vertakova), [email protected] (O. Vlasova)
2212-5671 © 2014 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Selection and/or peer-review under responsibility of Scientific Committe of IECS 2014 doi:10.1016/S2212-5671(14)00771-0
Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39
To start with, the modern concept of sustainable development of socio-economic systems is based on the idea of wealth management and the quality of life of the population, which is mostly determined by the efficiency of proper functioning of the social sectors [Aujoulat, 2001, Genet, 2013, Molen, 2013, Vertakova, Plotnikov 2013]. Again, the current governmental actions in the sphere of socio - economic policy are refocused on health care, a lot of specialized national projects are being carried out presently. In this regard, the government has set the goals for the regions to develop and implement effective socio-economic policy of health care as soon as possible. Finally, since the Russian regions differ significantly in socio-economic, demographic and other parameters, there is a need to develop differentiated management approaches to the formation of socio-economic health care policy with the goals of increasing the internal capacity of the sector, the availability and quality of health care for the population, improving its health [Karanikolos, 2013, Tragakes, 2010]. 2. Current trends of health care development in different countries: comparative analysis A lot of scientific publications are devoted to studies of functioning and development of health care system. A number of researchers (Ifanti, 2013 ; Mur-Veeman, 2008 ; Aujoulat, 2001 ; Cabiedes, 2001; Sheiman, 2014, Shevski, 2014 etc . ) discussed issues of the health care system relationships and dynamics of socio-economic development of the state. Also, a number of authors (Karanikolos, 2013, Mladovsky, 2013,Cylus, 2013, Thomson, 2013 ; Siskou, 2013, Kaitelidou, 2008, Papakonstantinou, 2008, Ettelt, 2012, Mackenbach, 2013 ; White, 2013 ; Scott, 2014 ; Voncina, 2007 ; Kieke, 2013 etc.) reveal in detail in their works the essence of governance mechanisms of health care administration,, the priorities of the state policy in the field of health . In addition, such questions are being actively covered in the reports of the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). Key issues and conditions of health care development at various levels (national, regional, municipal) are deeply studied by Russian researchers. Particular attention is paid to the analysis of the resource potential of the field, features of ongoing modernization of health care in Russia, political and legal aspects of its provision. Currently, health care in the Russian Federation is in crisis. The main problems of its development, in our opinion, are the following: 1. Lack of financial resources in the health care system, which in turn, generates a number of negative consequences: the low salaries of medical personnel, problems of providing the population with free medicines, absence of the possibility of compliance with treatment standards and providing hospitals with modern equipment and consumables [WHO, 2011, Voncina, 2007]. Thus, in the Russian Federation in 2012, public expenditures on health care (including expenses on the program of state guarantees, education, investment in infrastructure and sanitary-epidemiological safety) were $48,9 billion dollars, or about 4% of GDP, that is at least two times lower than the average in the EU countries and the USA [Gusmano,2014, Mackenbach, 2013, Vertakova,Vlasova, 2013] (Table 1). Table 1: List some of countries of the world sorted by their total expenditure on health at purchasing power parity (PPP) per capita, and their total expenditure on health as a percentage of GDP, 2011 Source: OECD Health Data, 2012; WHO World Health Statistics, 2012 [OECD, 2013]. Country United States Norway Switzerland Netherlands Austria Canada Germany Denmark Luxembourg France Belgium Sweden
Total health expenditure per capita PPP Int.$ 8,508 5,669 5,643 5,099 4,546 4,522 4,495 4,448 4,246 4,118 4,061 3,925
Total health expenditure % of GDP 17,7 9,3 11,0 11,9 10,8 11,2 11,3 10,9 6,6 11,6 10,5 9,5
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Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39 Ireland United Kingdom Finland Spain Italy Portugal Greece Russian Federation
3,700 3,405 3,374 3,072 3,012 2,619 2,361 1,277
8,9 9,4 9,0 9,3 9,2 10,2 9,1 3,7
The U.S. spent $8,508 on health per person in 2011. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person. The U.S. devotes far more of its economy — 17.7 percent of GDP in 2011 — to health than any other country. The Netherlands is the next highest, at 12 percent of GDP, and the average among OECD countries was almost half that of the U.S., at 9.5 percent of GDP [ane, 2012]. 2. Deficit and suboptimal quality of medical personnel. A shortage of medical personnel, first of all, is associated with low payment for their work, it is 22% lower than the average salary in the Russian Federation and almost 10 times lower than in developed countries [OECD, 2009, Ettelt, 2012, Ifanti, 2013]. While, for example, in Europe the profession of doctor is one of the highly paid professions (doctor’s income is from 1,5 to 2,5 times more than the average salary in the country) (Figure 1). In the Netherlands doctors earn the most at $253,000, while specialists in the U.S. earn an average of $230,000. Averages vary from country to country, from $150,000 in the United Kingdom to $91,000 in Denmark, to $67,000 in Greece, to only $25,000 in Mexico and $12000 in Russia. In some cases (Finland, France, Germany, Italy, Poland) the minimum doctors’ salaries is equivalent to the average national salary; in Belgium, Denmark, Italy, the Netherland and Slovakia the minimum doctors’ salary is higher than the average national salary [OECD, 2013]. In Russia average doctors’ salary usually is equivalent to the minimum national salary. However, in the Russian Federation the number of doctors per 10,000 population is 44,1, which is 1,5 times higher than in European countries (in average 36 doctors per 10,000 population).
Figure 1: Comparative Analysis of Medical Doctors’ Incomes Across Countries, U.S. Dollars, 2011 Source: Compiled with data of Physician Compensation Worldwide, 2011
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Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39
This is connected, primarily, with a high level of incidence and morbidity of the population (40-50% higher than in Europe) [Vlasova, 2013] (table 2). Table 2: List of some countries of the world sorted by the number of physicians and nursing and midwifery personnel per 10000 population, 2005-2012 Source: compiled using data of World Health Statistics, 2013 [WHS, 2013]. Country United States Norway Switzerland Canada Germany Denmark Luxembourg France Belgium United Kingdom Finland Russian Federation
Physicians 24,2 41,6 40,8 20,7 36,9 34,2 27,8 33,8 37,8 27,7 29,1 44,1
Nursing and midwifery personnel 98,2 319,3 174,9 104,3 113,8 160,9 171,0 93,0 222,1 94,7 239,6 94,3
Nurse-to-doctor ratio 4,1 7,8 4,3 5,0 3,1 4,7 6,1 2,8 5,9 3,4 8,2 2,1
You should pay attention to the very low nurse-to-doctor ratio in Russia (2,1), indicating a shortage of nurses, which has a tendency of growth in recent years. In addition, the level of salary of teachers of medical schools is quite low (official salary is no more than $450 per month). It naturally leads to a decrease in motivation of their work and contributes to low level of education of students - future doctors. Hence the third important problem [Quaglio, 2013, Siskou 2008]. 3. Poor qualifications of medical personnel and, as a consequence, the low quality of medical care. For example, the survival rate of breast cancer patients, the ratio of intra-hospital mortality, the proportion of patients who had infectious complications in hospitals in the Russian Federation in 2 times above, than on the average in developed countries [Okma, 2013, Vlasova, 2013]. 4. The backlog of standards of medical care on the Program of state guaranteed benefit package (SGBP) free medical care to the real needs of the population of the Russian Federation. For example, from 1999 to 2010, standards of medical care for the SGBP haven’t been changed, and some types of medical services even have been declined, however, the incidence of the population (which identifies the need for medical care) in the period from 1990 to 2010 has increased by 1,5 times[Vertakova, Vlasova, 2013]. Our population is also insufficiently provided with free medicines on a doctor's prescription in polyclinics. So, in the Russian Federation in 2010 expenditure per capita on drugs from public sources were 5.6 times lower than in the countries of Europe, considering that drug prices are almost the same[Mackenbach, 2013, Mur-Veeman,2008]. 5. Very low volumes of high technology medical aid. For example, the number of heart revascularizing surgeries (i.e. restoration of patency of the heart vessels), which constitute 25% in the volumes of quotas on hi-tech medical aid in the Russian Federation is done 5 times less than in EU countries, average procedures of hemodialysis - 4 times less, the number of operations of knee and hip joints – 6,5 times less [Ifanti,2013, Kringos, 2013, WHO, 2009]. 6. Ineffective management of the health care system at all levels. For example, in the Russian Federation there is no strategic planning and responsibility of managers of all levels for the achievement of results (including annual reports) on indicators accepted in developed countries, e.g. on indicators of quality and safety of the medical aid, economic effectiveness. Ineffective management is manifested in the irrational allocation of public funds. So, the focus of government programs is on poorly controlled, having a high risk of corruption payments investment costs (construction and purchase of expensive equipment) instead of development of preventive ways and human resource capacity. Inefficient use of equipment and hospital beds also takes place. Cost-effective management tools, such as competition on the criterion of quality in the purchase of medical assistance for health care providers, ranking of medical institutions, the application of economic incentives for achievement of planned results are insufficiently used [Cabiedes, 2001, Groenewegen, 2013].
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Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39
7. The demographic problem is still urgent due to the projected reduction in the number of women of active reproductive age and growth of the elderly population. Many specialists in the field of health care believe that large budget funds are spent inefficiently: over the past 50 years, life expectancy in the world increased by 11 years, and in India -21 years. In Russia it has remained the same, although its catastrophic decline of the past decades has been overcome. But tasks set to the socio-economic system do not always accurately reflect the real needs of society [WHO, 2011, White, 2013]. 8. Untimately, poor use and maintenance of equipment purchased in hospitals due to lack of specially refurbished premises, well-trained staff, etc. 9. Low level of information technologies in health care. 10. The problem of choice, forming regional target programs should be prioritized. It is impossible to form the strategy of health for the population in general, it can be efficient only when targeted at specific age groups and diseases. For example, the tasks to reduce the death rate, set by the President, refer mostly to older age groups. 11. Low level of culture of the doctor-patient relationship that causes discontenting of the population. Such number of unsolved problems clearly indicates a lack of consistency of the reforms of the healthcare sector in Russia and its regions. Activities on modernization of the health system, conducted in the regions, often do not lead to increase of efficiency of health care system and do not contribute to its development at the pace required. In most cases the measures are «one-sided» (do not take into account all the problems of the field) and are not subject to a single system of values, ideas, visions and goals for the development of health. 3. Conclusions Here we are faced with the current unsolved problems of health care system in Russia. Nowadays, the Government of the Russian Federation sets the goal to improve the socio-economic policy of the health care system development in regions. All regions differ by their socio-economic development, demographic parameters. Thus, there is a need to develop a socio-economic policy for every region separately. The policy should take into account the interests of the population of a particular region, weakness and strength of its internal potential. The main goal of the policy must be improving the level of health and well-being of the population of the region and the country as a whole. References Aujoulat, I., Le Faou, A., Sandrin-Berthon, B., Martin, F., Deccache, A. (2001) Implementing health promotion in health care settings: conceptual coherence and policy support. Patient Education and Counseling,45(4), p. 245-254. Cabiedes, L., Guillén, A. (2001) Adopting and adapting managed competition: health care reform in Southern Europe. Social Science & Medicine, 52 ( 8), p. 1205-1217. Determinants of Health Outcomes in Industrialized Countries: a Pooled Cross-Country Time-Series Analysis (2009) OECD Economic Studies, 30, p. 34-38. Ettelt, S., Fazekas, M., Mays, N., Nolte, E. (2012) Assessing health care planning – A framework-led comparison of Germany and New Zealand. Health Policy, 106 (1), p. 50-59 Genet, N., Kroneman, M., Boerma, W. G.W. (2013) Explaining governmental involvement in home care across Europe: An international comparative study. Health Policy, 110 (1), p. 84-93. Groenewegen, P. P., Dourgnon, P., Greß, S., Jurgutis, A., Willems, S. (2013) Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries. Health Policy, 113 (1–2), p.170-179. Gusmano, M. K., Weisz, D., Rodwin, V. G., Lang, J., Qian, M., Bocquier, A., Moysan, V., Verger P. (2014) Disparities in access to health care in three French regions. Health Policy, V. 114, I. 1, p . 31-40 Ifanti, A. A. , Argyriou, A. A. , Kalofonou, F. H. , Kalofonos, H. P. (2013). Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care. Health Policy. 113 (1–2), p. 8–12. ane, J. Health Costs: How the U.S. Compares With Other Countries. Available at http://www.pbs.org/newshour/rundown/health-costs-how-theus-compares-with-other-countries/ Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., Mackenbach, J. P., McKee, M. (2013) Financial crisis, austerity, and health in Europe. The Lancet, p. 1323-1331. Kringos, D. S., Boerma, W. G.W., Van der Zee, J., Groenewegen, P. P. (2013) Political, cultural and economic foundations of primary care in Europe. Social Science, p. 323-331.
Julia Vertakova and Olga Vlasova / Procedia Economics and Finance 16 (2014) 34 – 39 Mackenbach, J. P, Karanikolos, M., McKee, M. (2013) The unequal health of Europeans: successes and failures of policies. The Lancet, p. 11251134. Macroeconomics and Health: Innovations in Health for Economic Development (2009). Report of the Commission on Macroeconomic and Health. Geneva: WHO. Mur-Veeman, I., Van Raak, A., Paulus, A. (2008) Comparing integrated care policy in Europe: Does policy matter? Health Policy, 85 (2), p. 172183. OECD Health Data 2013. How Does the United States Compare. Available at http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf Okma, K.G.H., Crivelli, L. (2013) Swiss and Dutch “consumer-driven health care”: Ideal model or reality? Health Policy, 109 (2), p. 105-112 Quaglio, G., Karapiperis, T., Van Woensel, L., Arnold, E., McDaid, D. (2013) Austerity and health in Europe. Health Policy, 113 (1–2), p. 13-19 Shilen, Y.V., Raizberg, B.A., Vyalkov, A.I. (2012) Administration and economy of health care.- ., p.45-49. Siskou, O., Kaitelidou, D., Papakonstantinou, V., Liaropoulos, L. (2008) Private health expenditure in the Greek health care system: Where truth ends and the myth begins. Health Policy, 88 (2–3), p. 282-293. The World Health Report 2011. Health Systems: Improving Performance (2011)- Geneva: WHO. They pay less for Hungarian doctors than other workers – Medical salaries in Europe. Available at http://medlines.org/ they-pay-less-for-ahungarian-doctors-than-other-workers-medical-salaries-europe Tragakes, E. and Lessof, S. In: Tragakes E., ed. (2010) Health care systems in transition: Russian Federation. Copenhagen, European Observatory on Health Care Systems, p.107. Van der Molen, I.N., Commers, M.J. (2013) Unresolved legal questions in cross-border health care in Europe: liability and data protection. Public Health, 127 (11), p. 987-993. Vertakova, Yu.V., Vlasova, O.V. (2013) Methodical approach to the assessment of the strategic potential of regional healthcare. Saint Petersburg University of Economy and Finance Bulletin, 6, p. 24-28. Vertakova, Yu; Plotnikov, V. (2013) Russian and Foreign Experience of Interaction Between Government and Business. World Applied Sciences Journal, 28 (3): 411-415. Vlasova, O.V. (2013) The investigation of human resources of the regional healthcare (by the example of Kursk region). Economic systems management,11 (59). Available at http://www.uecs.ru Voncina, L., Dzakula, A., Mastilica, M. (2007) Health care funding reforms in Croatia: A case of mistaken priorities. Health Policy, 80 (1), p. 144157. White, J. (2013) Budget-makers and health care systems. Health Policy, 112 (3) p. 163-171 World Health Statistics. Available at http://www.who.int/gho/publications/world_health_statistics/
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