OREANDA-NEWS. April 28, 2012. “We may have different approaches to problems, but our common goal is to improve the quality of life in Russia, to make it more decent, comfortable and prosperous, to create conditions for resolving demographic problems so that we can have more children and more happy children, and to help people in trouble, people with special needs.”

Transcript of the meeting: Vladimir Putin: Good afternoon, colleagues. Today we will continue discussing how to implement the priority goals outlined during the recent political campaign. I suggest focusing on social policy, which certainly plays the key role in everyone’s life, as we know. I won’t offer any platitudes now. We often discuss these issues at various levels. I would like us to focus on some practical approaches.

First, salary is the simplest and most important thing for nearly everyone. Let’s talk about the salaries in the social sector – doctors, teachers and other social employees. When skilled professionals take on several jobs and work overtime and the government has to somehow legalise this situation – although we know that this affects work quality – this is not the best way to resolve social issues for either the provider or the recipient of a service. I will not speak in detail about this, [because] we will address this issue later today.

The second issue I’d like to suggest for our discussion is support for large families. It is a fact that demographics is a serious problem in this country and, in fact, many other countries, especially our European neighbours.

Russia is not an exception in this respect, and if we want to resolve this issue, it is not enough– although it is very important – to support women and couples who decide to have a child, and then a second and a third child, by issuing them certificates, vitamins and so on. We have many ways to assist at this stage, but what happens when the children are born? The number of openings at kindergartens and a families’ income – this is what we need to consider

I wrote in one of my articles that at this stage we should support the families who have decided to have a third child. Of course, this should be direct support granted to those who need it, as we’ve said more than once. This is a good approach and absolutely justified socially. Assistance should go first to families in regions with negative population growth and to low-income families that need our support.

This is what we’ll discuss today, along with what we decided before, to allocate land plots [to large families]. We have allocated 7,763 land plots and plan to issue another 31,000 plots in 2012. But this is not enough, and we know it. We should motivate the regions to help provide infrastructure for these plots, because otherwise using them will be impossible and people will start selling them and at least get some money. The value of such land plots may vary from region to region, but selling them is not a long-term solution anyway, as we see it.

The third issue I would like to highlight today concerns employment for people with disabilities. This is a very important issue. You know that we have millions of disabled people and the overwhelming majority of them want to and can work, which is important. For example, nearly 4.5 million of the more than 13 million Russians with disabilities are people of employable age, yet only slightly more than one million of them have jobs. As I have said, this is not because they don’t want to work – they do. Last year, 272,000 people with special needs sought the assistance of employment services, but only 85,000 of them were offered jobs.

Of course, employers should change their attitude towards this issue, but shifting the responsibility for finding employment for the disabled entirely to business would be the wrong approach. The cost of one special workplace varies from 30,000 to 430,000 roubles. We should consider and discuss ways and steps to support those businesses and employers who really want to join our efforts to help people with special needs, to offer them employment, especially because these people – I know this for myself having been to such facilities – these people work not only willingly but also efficiently.

These are the issues I would like us to discuss today. Of course, we will address any other issue you consider important in this sphere.

Let’s get down to work. Please, Ms Golikova (Tatyana Golikova, Minister of Health and Social Development).

Tatyana Golikova: Mr Prime Minister, colleagues. We have prepared a small presentation; it consists of three aspects that Mr Putin has outlined as key issues for our meeting today. It would be logical to start with the first issue – salaries.

I will begin with the salaries of doctors, nurses and low-grade medical personnel. Before talking about the details, I’d like to say the following: the adoption of the laws on mandatory medical insurance and on healthcare has divided the system into two levels – the state level in the regions, and the federal level, with healthcare facilities subordinated accordingly to regional or federal authorities.

I would like to say that the bulk of medical services in the regions are provided within the medical insurance system, which also have social facilities that provide medical assistance to patients with tuberculosis and AIDS and to drug addicts. The system is the same at the federal level, where the healthcare system has one more element – the provision of high-tech medical assistance.

With our legislation in mind, we are to gradually increase funding and to step up structural changes in healthcare within the next four years, by 2015.

In this connection, I would like to begin with the first slide that deals with the provision of personnel in the Russian healthcare system. I would like you to remember several figures on this slide, because I will also speak about them later.

We have nearly 523,000 doctors of various specialties – I will also speak about this later, including doctors working in sanitary and epidemiological inspection facilities and pharmacists, including those with a higher education. But there are also other medical personnel, to which I’d like to draw your attention. If you look [at the slide], you’ll see that this medical staff is considerably larger than the number of doctors, by almost 100,000. This is important to our discussion.

But clinical doctors, the doctors who directly help the patients, are the key medical personnel as regards the provision of quality and affordable medical assistance. Here is the situation – look at the second part of the slide.

In fact, we need 152,000 more clinical doctors. There is a shortage of doctors in outpatient clinics and too many doctors in hospitals.

As for nurses, the situation is complicated in both outpatient clinics and hospitals. We are still below the 1to 3 ratio, that is, one doctor for every three nurses. Our current ratio is 1 to 2.1.

As for shortages or redundancies, outpatient clinics primarily lack the specialists shown in part one of the second slide. I won’t read out the figures, but you can see that the shortages are substantial. As a rule, outpatient clinics lack specialists in narrow fields.

At the same time, hospitals employ too many of the specialists mentioned in the middle of the slide. But hospitals also lack specialists in such areas as anesthesiology, critical care medicine, oncology and phthisiology. Several Russian territories mentioned here face substantial disproportions in terms of human resource shortages or redundancies.

In this connection, when we don’t have enough doctors and medium-level medical personnel, then we must certainly assess our opportunities in the context of the possible retraining of those extra specialists working at hospitals. At the same time, we activate our available resource, namely, the students at higher medical education institutions.

That situation is as follows. In all, 23,600 future medical specialists are studying at higher medical education institutions at the expense of various sources, including budgetary and extra-budgetary sources. However, the estimates for 2012 show that about 20% of them will not be working in the medical profession. Consequently, the healthcare sector is to receive an estimated 18,900 specialists. Nevertheless, we have monitored the situation, and it turns out that many aging medical specialists are quitting their jobs. As a rule, this problem is linked with inter-district and rural communities, which have few young specialists. Local elderly specialists already have to retire.

Instead of merely eliminating human resources shortages, we must also create incentives to motivate our students to work in rural areas. This issue is highly important. Here is what we are doing and plan to do in this respect.

Under newly adopted legislative changes, the Ministry of Education and Science and we have approved a new educational standard for medical students on September 1, 2011. This educational standard envisions far more intensive practical training courses for senior students, beginning with the fourth year. We have already signed the order, which allows medical students who have completed a three-year course, to work as junior and medium-level medical personnel in their home communities or at any clinic of their choice, provided the opportunities are available.

This will reduce the problem and the tensions linked with medium-level medical personnel to some extent. Nevertheless, it will not drastically solve the problem with doctors, and we will have to take action and stipulate persuasive measures, so that students will go and work in remote communities.

Various states use similar practices. If a high school graduate wants to enroll at a medical college or university but has failed to score enough points, then the administration might agree to accept him or her and even to train them free of charge on the condition that he or she promises to work for three or five years in the northern territories or other sparsely populated territories. This deal would allow the students to receive their medical degrees and to work for some time periods later on. I believe that we should consider a similar mechanism.

We don’t have enough doctors, and this is a major problem. At the same time, you have already decided to provide financial support for the mandatory medical insurance system. Consequently, we should keep in mind that there is enough funding to pay doctors and medium-level medical personnel up to 2015 under the mandatory medical insurance programme. This is a cautious estimate.

Why am I saying that the Ministry of Finance and our ministry have reached consensus on providing additional funding for the mandatory medical insurance programme? Such funding will make it possible to raise wages by 24% in 2013, by 13% in 2014 and by 17% in 2015. Why am I talking about 2015? Because we see the 2015 period as a certain criterion when equal mandatory medical insurance rates and prices for non-working people will be introduced all over Russia.

We might face some problems with financial support after 2015. This can be explained by the fact that we will also need additional financial resources then. Slide No. 4 shows the estimated calculations in this area. With what can these financial resources be linked? The thing is that the mandatory medical insurance system encompasses three population categories: the economically active, children and senior citizens. The non-working population comprises children and senior citizens. Employers pay for the economically active and the regions pay for the non-working population.

Both payment categories amount to insurance premiums under the law. But employers pay twice as much for economically active individuals than what is being done for the non-working population. The latter is more expensive in terms of medical costs. Regarding this, many experts and analysts, including those affiliated with employers, have raised the issue of increasing payments for the non-working population, so they would be similar to those being made by employers for economically active individuals. But, considering the extremely high financial-support differentiation levels among the regions, we are in no position to accomplish such an objective quickly.

Nevertheless, we will have to re-examine the indexation of payments for the non-working population, I repeat, the non-working population, after 2015. This should be done either in 2014 or, better still, in late 2013 in order to facilitate the functioning of the mandatory medical insurance system. Frankly speaking, this is what the law says. We are not discussing the possibility of compelling employers to pay higher insurance premiums. This will allow us to solve the problem with salary increases for junior-level and medium-level medical personnel employed within the mandatory medical insurance system.

And now I would like to say just a few words about federal medical agencies. This situation seems to be more complicated, but in a sense it’s simpler.  The federal system of medical agencies is rather multi-faceted. This system comprises federal agencies and R&D institutes, which apart from treating patients  conduct research. Moreover, they provide high-tech medical assistance. Under the law, high-tech medical assistance remains an independent branch until 2015. After that, it will become part of the mandatory medical insurance system and will be covered by the appropriate rates and prices.

On the other hand, we have quite a few departmental agencies, which are primarily affiliated with law enforcement agencies and 27 federal executive agencies. All of them control medical agencies to a varying extent. This includes federal agencies and various academies, such as the Russian Academy of Sciences, the Russian Academy of Medical Sciences and their branches, etc.