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I have had to argue with colleagues, including those who have a direct relationship to decision-making about the role and place of health in Russia. My position is simple: in the whole system of social policy that is medical (and more broadly health) is priority No. 1. This should be expressed not only in ritual phrases, but in the concrete actions of the state. Don’t want to offend those who are engaged in education, but why it is the budget system allocates about 4.5% of GDP, and health care — only 3.5%? In response, I listened to a lot of arguments that boiled down to the fact that:

— when implementing the priority national project “Health” in 2006-2009 were spent almost a trillion rubles, which was then supplemented by special regional programmes;

— life expectancy at birth for the years 2005-2019 increased by 8 years;

— an emphasis on education stems from the challenges of the next technological revolution and the need for structural adjustment of the Russian economy.

In response I’m not diminishing the achievements of the last years of that allocated to the health sector public resources remains insufficient to provide universal access to quality basic health,

— we have lost this perspective of school, along with the significant part of children’s health;

— as a result of the so-called “optimization” disappeared municipal health care, which is vitally important, especially in rural and remote areas;

— the payment continuously for the past many years, it replaces the free provision of medical services;

we do not know the real state of health of the nation because of the lack of availability of health care services, and it is not possible to create public demand for an adequate situation model of the organization of medicine and the financing thereof;

preliminary estimates show that our health, if we take only budget (including JMS) sources, underfunded 1.5–2 times.

All of these disputes would continue indefinitely, despite the fact that sociology showed gradually increasing the level of mass public discontent with medical care, if not for coronavirus pandemic. As they say, there would be no happiness, Yes the misfortune has helped.

it became Clear that Russian health care is in need of an emergency measures and a very significant additional financial investments to fight the epidemic. But maybe when the coronavirus will retreat, everything will return to normal? I think not.

Humanity in recent decades has seriously relaxed against epidemics. Plague, cholera, smallpox and many things like managed if not overcome until the end, then at least to localize. Same as��e applies to the various newfangled flu (“swine”, “avian”), fevers… it Seemed that the global pandemics of type “Spanish flu” a hundred years ago is no more. But it’s not.

Despite the fact that the origin COVID-19 is not yet established, it is clear that humanity is entering a new medical era: mass infection (or high probability) we will have to live very long. And at least because of this to the current health care system will have to attach another great module that will require more money for a new building and is equipped with resuscitation equipment to beds, additional numbers of physicians, nurses, nurse’s aides and technical workers (and this is salaries with special bonuses, personal protective equipment). In General, it is still difficult to calculate, but apparently it is, if you become reconciled to our realities, about one hundred billion rubles a year.

But that’s not all. As a result of “optimization” of health, already officially recognized as a blunder, from access to health care was effectively cut off millions of people. This creates great risks even in a pure epidemiological sense. We have, as you know, an unacceptably high proportion of those who go to the doctor only when the disease — cardiovascular, cancer and others — adopted the running form. These people, as experience shows COVID-19, are at heightened risk not only of infection, but also to die.

Therefore, if confined to an Annex to our public health modern infectious module, the main objective — protection of the health of the population — may still not be achieved. You need to raise the quality of the whole system, and this, along with structural changes inside it, obviously, will require very significant additional resources.

And here comes the dramatic question: how to take an extra 2-3% of GDP (3-4 trillion) a year, which will take our health for early exit from its crisis? The drama of this question that the budget situation in Russia is now dramatically exacerbated because, first, a sharp drop in revenues from oil and gas exports, and secondly — a serious blow to the economy as a result of the coronavirus a pause.

Moreover, it should be borne in mind that the oil and gas situation on world markets has worsened for Russia at least for a few years, and the economy will emerge from crisis for at least 2-3 years at best. In such circumstances, the state budget and the national welfare Fund will be forced to spend money on all sorts of subsidies and benefits to business, the payment of aid to the population. How then to find a additional considerable resources on health care?

Apparently, in the narrow circle of those who shapes decisions in Russia seriously discussed a change in the financial policy. Instead of a budget surplus is the deficit, will begin attempts to increase the sovereign debt burden via the extension of public borrowing, will raskupaetsya the national welfare Fund. So that additional money will appear — and it will not be one trillion rubles. It is important that they were in priority order dedicated to health care reform, but not dispersed without a trace on the support of all friendly (“backbone”) projects.

I don’t use the word “reform” in relation to Russian health care. Put only two questions.

the First is the fate of obligatory medical insurance. The main, as I see it, the problem of the Institute — the low wages in our economy. Because OMS is living at the expense of contributions that employers pay from the wages Fund, and regions pay extra little money for the unemployed. The collected money is no longer provide decent affordable health care, which is more expensive. That is why we see low, despite the increase in recent years, salaries of medical personnel, Omnia meager rates of payment to medical institutions for services rendered. We need to shift to low-end models of health care which in one form or another, is functioning in the most advanced countries.

And the second. Now the health and social protection divided numerous departmental barriers. But COVID-19 showed that nursing homes and psycho-neurological boarding schools are very vulnerable to infections. The health component of their work is minimal. Probably, it is necessary to stimulate the resettlement of patients in families — their own and adopted, with the introduction of important care benefits. And those who are in a state that requires round-the-clock professional supervision, transfer to the health system, dispersing not crowded hospitals involved in this care.

And the last. All these and other reforms, the necessity of which coronavirus pandemic revealed for your success require the creation of a political Institute, which will identify and coordinate the interests of not only the state but also the whole society. Otherwise, no any meaningful lessons from the current system of the Russian crisis will not be fetched. And this casts doubt on the optimistic future of Russia.