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Vasily Vlassov - Erasmus Observatory on Health Law

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Expanding expensive
interventions while resources are
scarce
V. V. Vlassov, Higher School of
Economics, Moscow, Russia
Tajik “Gahvora”, Kyrgyz “Bishik”
Tajik, Uzbek
“Sumek”,
Kyrgyz “Smek”)
Kazah cradle
Advice
• To accept the WHO live birth criteria
• To set the resuscitation devices for very
low birth weight neonates
• To switch to Western type of infants’ care
• While hospital care is for $0.1/day
• 40% women are anemic at labor
• …
Access to health care
50-70% of the Russia’s
population has systematic
difficulties in access to health
care
Estimate from the report of the Society
for Evidence Based Medicine, January
2008)
Rural medicine
People living in rural areas
– suffer from no jobs
– can not access health care
facilities
– no drug stores
Health care expenses, billions, roubles (1R=$31)
Drugs
Paid health
care
services
расчеты по данным Росстата, С. Шишкин)
9
ДЛО
In regions, where expenses for health care from budgeet
are smaller, the out pocket expenses are bigger
Источник: расчеты по данным обследования НОБУС 43 субъекта РФ , 2003г Цит по С. Шишкин
11
….what 2005 did show (increase of drug
spending 37%)…
% receipts delayed in fulfilling
delayed <=10 days
delayed >10 days
Khabarovsk
The tricks
• The criteria for disability reviewed,
hundreds of thousands of disabled people
around the country were re-evaluated,
many lost their eligibility for free drugs
• Program re-designed:
– Provision of most drugs is delegated to
regions
– Provision of the most expensive drugs
remains the federal center responsibility
Dispanserization
• What it is: The system of the early detection
and personal health care management of
sick person in the continuous care
• Degenerated to the idea of the screening by
‘physicals’ based on the idea:
early diagnosis = better treatment
• Enriched by expensive tests (prostate ca
screening, breast ca screening, ovarian ca
screening)
Another prevention
• All polyclinics now have the ‘health center’
– the small unit where physician is
available every day to advise visitors on
the healthу life styles and simple testing
• The expensive web portal for free
information on the healthy life styles was
build (useless by content, but cost a lot)
High-tech care
• New centers of high-tech medicine, mostly
surgical, build around the country (from
scratch, block design, simplified staff
training program)
• Program of financing the “high-tech”
interventions from federal budget was
opened
National project HEALTH
• Supervised by future President Medvedev
• Billions spent for equipment and cars,
mostly expensive diagnostic equipment
• Nowadays criminal investigation show that
about $100 billions are stolen
Expensive rare diseases
• Except program for disabled new
possibilities for purchasing expensive
treatments were opened:
– Biologicals for rare cancers
– Genzyme’s drugs Elaprase for Hunter’s
syndrome and Cerezyme for Type 1 Gaucher
Disease
Promise of the unlimited access
• This is what we inherited from Communist
state
• This is what Russian State continues to
promise
• State continue cheating instead of use of
the transparent language
• In crisis times State practice the
Orwellianism: declarinng the increase of
funding healthcare while reducing it
Decision making
• “Managerial vertical” built by V. Putin
makes impossible the public input
• No guidelines are funded by Government
and nor accepted from professional
societies to support the decision making
• No entity is providing the HTA
Perspective
• Because rising oil prices the Government
can afford to fiddle the same way
• Now the spendings for health care are
reduced, but $$ are enough to build the
Olympic infrastructure in Sochi and
football stadiums for the next Mondial.
• Health care funding will be insufficient
AND further poured to the inefficient
programs
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