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16 May, 2009 11:10

Tackling cardiovascular mortality essential for nation’s health – Medvedev

In an interview to the Rossiya TV channel President Dmitry Medvedev spoke about the state of healthcare in Russia and its problems.

Sergey Brilev: Hello, Dmitry Anatolyevich.

Dmitry Medvedev: Hello, Sergey.

SB: It’s the fourth time that we are meeting in this format here in the Kremlin, so there are some traditions. I think our Saturday programs on the Rossiya and Vesti Channels will hardly avoid the issues of politics and economics, but there is a topic that we already outlined during our previous talk, and that’s the topic of medicines. Maybe it needs broader consideration, that is, in the form of discussion on health and healthcare. Allow me the following word play: how, in your opinion, is our healthcare feeling, has it been affected by the crisis and what are the consequences?

DM: You have, by all means, touched upon a topic of key importance to all the people of our country, because any person in any situation, whatever his or her financial status and age, has it on their minds. Any ordinary person cares about his or her health. As for the health of our healthcare, I’ll say that, of course, there are problems that have to do with our legacy and with what is going on with our economics in toto. In other words, Russia’s past problems and the current economic situation both affect our healthcare. Nevertheless, and I’d like to especially emphasize it at the very beginning of our conversation, none of the priorities defined at the start of the National Healthcare Project Zdorovye, have either been cancelled, or even had their budgets cut. In this sense, everything remains the way it was designed initially. However, we might need to adjust the rate of advance on certain trends. Still, we are planning to boost high-tech medical assistance, supply of medicines and the work of the top-priority healthcare programs, such as cancer treatment, tuberculosis, heart disease, that is, we’ll continue working on our earlier projects.

SB: Let us be, maybe, a little more specific here, especially since these national projects were started by your administration and have led to important changes, no doubt. But what awaits many of these major undertakings? What is going on there now?

DM: You know, I think we have managed to give it a good push and now everything’s moving on pretty well. Not without problems, but pretty well. Talking about high-tech medical assistance, we have decided to create 15 special centers. At the moment, some of them are not quite ready, but actually functioning. Last year we opened one in Penza. This year it’s going to be Cheboksary and Astrakhan. But, basically, they are already providing medical assistance, as well. These centers focus on cardiovascular diseases, traumatology and orthopedics. Of course, we’ll continue working on that by opening a number of new centers. And they’ll provide high-tech medical assistance based on the so-called module technologies when such a centre is quickly assembled and, so to say, stuffed with modern equipment to be able start operating practically in no time. Of course, as life is constantly changing, so do the technologies and treatment methods. With the necessary funding it will be possible to renew part of the equipment eventually. That’s the point of such module medical centers. But even apart from them, 82 regional cardiovascular centers are being created today.

SB: Across the country?

DM: Yes, across the country. And this may be especially important since we know that the cardiovascular mortality rate is the highest. Besides, 240 new vascular departments are underway. That adds up to some 300 specialized departments on a national level that are aimed at combating heart disease. Such priorities remain unchanged. Another issue, from a different medical area, is the so-called maternity certificates. I’ll say that it may be one of the most successful parts of the National Healthcare Project Zdorovye. It happens that more than 90% of future and new moms have already received the certificate. What are the results? First of all, it has resulted in an increased funding of healthcare, specifically prenatal centers, corresponding clinics and maternity wards, which allowed a pay-rise for the medical personnel involved. But the most important thing, so awaited by ordinary Russian women, is that it allowed quality growth in medical assistance. And that is one pretty good result. Last year’s total birth-rate in Russia rose by almost 7%. Despite a very difficult demographic situation, despite the fact that our demographic trend leaves much to be desired, 6-7-percent growth are very good figures that, hopefully, we’ll manage to maintain. At the same time, we have seen a decrease in general mortality and newborn mortality rates that is, in fact, very important for us because newborn mortality used to be a very complex issue in Russia. It remains complex today, but at least in some regions we are catching up with the European indices.

SB: New centers, sounds great. But, after all, you yourself have grown up in an ordinary neighborhood in the former Leningrad (St. Petersburg) and must very well know that locally people go to ordinary clinics and health centers where you get long queues and the condition of the buildings themselves leaves much to be desired. How can the situation be improved on the ground?

DM: You know, all our hospitals, except for the rare privately-funded ones, are nothing but ordinary with all the consequences that may bring. And we are very well aware that their medical conditions are far from perfect. It’s a complex issue that, nevertheless, needs to be addressed in a very specific, target-oriented way. What do I mean by this? Not long ago I visited the city of Ryazan. And, by a coincidence, a person addressed me via the internet suggesting I check upon the infectious disease department of their local hospital. We checked on it and were appalled by its condition.

SB: Well, the photographs have been all over the web.

DM: All over the web and the media in general. So I had to give a direct order. As far as I understand from the reports, it is now being fulfilled and by September everything must be done. That’s one way of addressing a situation.

SB: Of course, there’s no resolving every issue directly through the President.

DM: Even though such things happen, to think that everything can be resolved through the President would probably give a wrong message to the whole nation. But a lot depends on each given situation and the executives in question, the situation in the region, in the City Hall. We once started working on feldsher-obstetrical centers. It’s a complex major problem, especially in rural areas where everything was in terrible decay.

SB: Many of us, city people, don’t even know what the abbreviation FOC stands for.

DM: Many don’t, while these very FOCs are, if fact, the places of primary medical assistance for rural residents. And, to tell you the truth, in the regions where this problem is dealt with in a serious way, the FOCs have gone through a considerable makeover: they now have new equipment, new buildings, the medical staff have been allocated special accommodation. It means that such problems must be addressed at the regional level and judging from the current situation, that’s the only way. Not some general approach, but the funding of concrete healthcare facilities.

SB: So, maybe, in this case it’s not all about the money?

DM: Absolutely. It depends on the attitude of the executives and even of the people working for a specific City Hall. If they make it a priority, then at least some peanuts can always be found. Otherwise, nothing happens.

SB: There’s this very special subject, donor blood. You know, at my office just recently someone hung a notice: Please help to find blood of a certain type. Those who have been there know that one has to start calling friends and acquaintances to find the necessary donor blood. Do you think it’s appropriate to discuss the possibility of creating some federal blood bank or even a centralized one? How can this problem be solved?

DM: Talking about a blood bank in general, that’s definitely a federal-level task. Such a bank is now being created, lost possibilities are being restored and even special blood plasma plants are being set up. By the way, one of these plants is situated in Kirov, and I believe it’s a good example of such work shaping up this way. This is a national task and it will be solved.

SB: Mr. President, there’s a specific issue which is, basically, the news of recent days, the so-called ‘swine flu’. Allow me a brief personal example. I was on my way back via Europe from a business trip to the U.S. When the plane landed in Moscow, the representatives of Russian sanitary services paid us an unexpected visit, very effectively checked the temperature of all the passengers coming from Mexico or the Americas. No medical checkups had accompanied my connection in Europe. In other words, this is a clear example of how uncoordinated are the actions of different states. Do you think the world and, of course, Russia will be able to cope with this new threat?

DM: Your example clearly shows how efficient our healthcare and sanitary and epidemiological services can be. In this case, it works to our advantage because all incoming passengers are under control. That’s precisely why the current situation in Russia concerning this virus is rather calm. I believe that, on the whole, this problem is quite solvable. All we need is to pay special attention to the corresponding research and creation of a monovalent vaccine since the whole world is busy with it right now. I think it will appear in the near future. As for the current situation, all in all, Russia has the necessary amount of medication in stock. If we are able to establish the production of the new vaccine, then our nation is absolutely safe. All in all, the situation is under control. And I’m sure that we are ready to resist this flu strain.

SB: So we have unwillingly come back to the topic we began with – medicines, their cost and especially that of imported ones which is a burning issue nowadays. Is it possible to control it somehow?

DM: Not only is it possible, but it’s a must because the state of the Russian drug market affects the lives and health of our people, both those who have a lot of money and those who, unfortunately, have very little.

SB: Absolutely.

DM: Thus, it’s a nationwide task. What can I say? All in all, we have taken rather efficient steps toward finding a solution here, although the economic crisis has affected the field very seriously as Russian drugs account for only 30% of our market, with the other 70% being imported.

SB: Unfortunately.

DM: Yes. Our pharmaceutical industry is not ready for it yet. Given the case, fluctuations in foreign currencies’ exchange rates make the corresponding medication more expensive.

SB: But the way prices are recalculated, the percentage…

DM: The way prices are recalculated sometimes is a crying shame. The problem is that they grow out of proportion to the fluctuations of certain currency rates. I already mentioned it before in one of my interviews, which made our colleagues in the regions work on this. And not just them, but prosecutors as well. What needs to be done? We need to closely follow the situation locally, because our drug market consists of several segments. The first part has to do with the costly medication for the seven diseases that medical people refer to as the ‘seven nosologies’. The second part is the so-called additional medication funded from various sources, including the federal budget that is the responsibility of the regions. We are also talking about tens of billions of roubles here. Altogether, this year’s total volume of medication funding amounts to 80 billion roubles. In this case, the task of the regions is to make sure the drugs are purchased at regular prices, because, according to the reports I get, the purchases are often made with extra charges or the so-called bonus to the factory price which can sometimes be 80% or 100%.

SB: The kickback, so to speak.

DM: It’s the kickbacks and just an actual rise in the factory price, which is unacceptable as such bonuses are not possible. These are the issues the Antimonopoly Service, prosecutors and other law-enforcement agencies must deal with. And we are talking about such ordinary medication groups as the anti-fever and anti-virus ones, which is definitely unacceptable. Those responsible must be severely punished. And, finally, there’s the third group of drugs sold on the free market, meaning pharmacies, which is impossible to control. Here we are to guarantee the prices declared by the manufacturers, and the implementation of this system is underway. Its aim is to make sure that prices are not only formed, but also published in the correct way, so that we can understand where they come from. These are the three segments of the drug market: expensive medications, then those medicines given for free as part of special assistance to healthcare beneficiaries (there are over 5 million such beneficiaries in Russia), and, finally, this free pharmacy market. If we manage to regulate the situation in all the three parts, we’ll have a correctly functioning modern drug market.

SB: Will we manage?

DM: I’m sure we will, but people should be involved in it at all levels – the federal, regional and even the local.

SB: There’s also a fourth segment that has to do with self-treatment. The Russians like to play this age-old game, and not just us. The problem exists everywhere in the world. But on top of it there are all kinds of fraudsters who always try to convince you that their special treatment will work.

DM: Magical treatment.

SB: Exactly, magical treatment. Only that it leads to opposite results, just like self-treatment does, although the medicines are well-known to us we say: Why not, I’ll give it a shot. What is your attitude to this problem?

DM: I guess my attitude coincides with that of the medical community, and I consider it absolutely unacceptable. There is no miracle solution, whatever the press may say about it again and again. Anyway, one needs to remember that, in the end, or at least according to the World Health Organization, two thirds of our health depends on our lifestyle: how we live, what we eat, what water we drink, etc. And only 10-15% depends on the condition of healthcare. It may sound a platitude, but our health considerably depends on ourselves.

SB: One of the most accessible ways of staying fit for the Russian people is going to the country. Now that it’s May, the season has begun. But, taking into consideration the current economic situation, for many people their dacha or country-house is not only about physical exercise or laying in the sun, but it is, actually, a way of feeding themselves. According to recent statistics, various fruit and vegetable seeds are being sold much more than before. But that’s just the crisis. And what about the Countryside Amnesty? Isn’t it time to finally legalize the rights of people for the land where they spend their leisure time and work on the dachas?

DM: It’s high time. That’s precisely why the Law on Countryside Amnesty was passed. What do we actually have today? There are about 20 million people in Russia who possess garden patches, vegetable gardens and belong to different societies. We are talking about a very considerable part of our population. Since the Law came into force, about two and a half million people have legalized their rights. It concerns those who had their land before the Land Code was passed and, basically, had no rights or legal property documents. Now the situation is changing. Of course, there are some bureaucracy-related difficulties, and many people wish the system worked faster. Still, about 15% of additional landowners of this kind have already legalized their rights. It’s extremely important. However, it’s also important that this process doesn’t stop at some point. That’s why, judging from the current situation and the remaining interest of our citizens, not all of them have managed to do it in time, so, for objective and subjective reasons, I shall put forward a proposal to prolong the expiry date of the so-called Countryside Amnesty, so that it could be used by as many people, as possible.

SB: That’s good news. Thank you, Mr. President.

DM: Thank you. Good-bye.