Modernization on the march

by Moskovskiye Novosti & The Moscow News at 05/12/2012

The numbers for health care funding in Moscow look better than ever - but the real challenge is improving the quality of care as practiced by actual doctors.

At a RIA Novosti press conference dedicated to summarizing the state of social services in Moscow in 2012, deputy mayor and head of Moscow's social development department Leonid Pechatnikov pointed out that state-funded health services in Moscow are enjoying a boom as far as money is concerned.

"For the past two years, around 105 billion rubles have been pumped into the Moscow health care modernization program," he said. "Neither in Moscow nor elsewhere in Russia have we ever spent that kind of money before. "

Pechatnikov also pointed out that City Hall actually saved money on purchasing costly diagnostic devices for local clinics - due to increased transparency. "It so happens that if you hold tender in a normal, competitive atmosphere, you can save twice as much - sometimes, even four times as much," he said. "And for some devices, we were able to get a price ten times lower than previously expected."

Better standards, more honesty

The bigger problem, as far as City Hall is concerned, is the lack of qualified personnel in Moscow - with 300 million rubles now being set aside for sending young doctors to train abroad.

City Hall also plans to introduce a single diagnostics center - where computer data on patient diagnoses will be processed and looked at by additional specialists, in order to slash the numbers of misdiagnosed patients in the capital.

"There will be a team of people offering second opinions," Pechatnikov said. "They can serve as a kind of second line of defense, helping those [doctors] who deal with patients directly."

Irina, an infectious diseases specialist at a Moscow hospital who did not wish to give her last name for fear of reprisal from her bosses, said that City Hall has its work cut out for it as far as improving standards of care is concerned.  "You're dealing with a system where many hospital administrators have been corrupt," she said. "These people actually benefit from the health care system being in chaos, and from patients not knowing their rights. Changing their habits will not be easy."

Irina cited the recent scandal that Bolshoi Gorod magazine exposed at a testing lab in the famous Botkinsky hospital, where a former staff member, Fyodor Baranov, accused his colleagues of not maintaining basic sanitary norms and his bosses of forcing staff to process test results more quickly for certain "elite" patients.

"Right away, Baranov was accused of stealing a video camera from the lab," Irina said. "His bosses were trying to intimidate him - they try to intimidate anyone who calls attention to major problems with our work."

Coordination and private investment

A much more basic problem, which is the lack of coordination among outpatient clinics and hospitals in Moscow, will also have to be addressed.

Pechatnikov in particular cited the appalling problem of cooperation between clinics for expectant mothers and actual hospitals where women go to give birth. "A woman is being looked after by one doctor in her clinic - and where she may end up giving birth may not be clear right away," he said. "So then she is hospitalized around her due date, and the medical history of her pregnancy is either completely shrouded in mystery, or almost completely shrouded in mystery."

Though pregnant women in Moscow usually arrive to give birth with a hefty amount of paperwork and analysis data from their primary OB/GYNs, the paperwork itself often resembles useless bureaucratic documents, and does not always reflect the most important information on the health of the expectant mother and the baby.

Outpatient clinics are also suffering from a lack of specialists in narrow fields, whereas inpatient programs often have an excess of them, resulting in hospitalization requirements that can turn out to be costly for both the patient and the state. "As we hospitalize people less, we can create more and more combined centers with both outpatient and inpatient treatment programs," Pechatnikov said. "So local medical specialists can see all of their patients in one spot, instead of having to trek across Moscow to different hospitals as they often do now."

Another aspect of modernization is giving patients free rein to choose their doctors and treatment centers, banning the use of so-called tickets to see a doctor only at one's local clinics. This practice is particularly useful for many patients who arrive to Moscow from elsewhere in Russia and have not gone through the cumbersome process of establishing official residency in the capital.

City Hall also admits that some "problem" hospitals can be aided via private investment - pointing out the story of Moscow Hospital 63, long considered one of the most run-down medical establishments in the capital. The city found a long-term investor for the hospital who put up four billion rubles. "For a project like this, the investor expects to get his money back within 15 to 17 years," Pechatnikov said.

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