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HEALTHCARE SYSTEM IN NORTHWEST RUSSIA.


1. General Information of the Region.

Northwest region of Russian Federation consists of 11 districts and covers the 1 677 900 square km in total. The population is 14 515 000 (appr. 9,8% of the total population in Russia).

The main information about the districts you may find below:

Regions

Capital of the region/republic

Total area
(x1000, sq. km)

Population
(x1000)

Arkhangelsk region

Arkhangelsk

587,4

1 491,9

Vologda region

Vologda

145,7

1 333,7

Kaliningrad region

Kaliningrad

15,1

943,3

Leningrad region

Saint-Petersburg

83,8

6389,9

Murmansk region

Murmansk

144,9

988,5

Nenetsk region

Narjan Mar

176,7

45,7

Novgorod region

Novgorod

55,3

736,9

Pskov region

Pskov

55,3

689

Karelian republic

Petrozavodsk

172,2

775,2

Komi republic

Syktyvkar

415,9

1 162,9

Tourist industry in the NorthWest Russia is constantly developing. In 2001 some 3 088 000 foreign tourists visited NW Region, in 2002 increased to 3 500 000. Saint-Petersburg holds one of the leading positions in cruising more than 173 000 guests and 70 000 crew members entered Russia via these sea gates. The industry growth dynamics is 6-8 % per year.

Germans are around 10% of the total visitors of NW Russia, holding the second place after Scandinavian tourists. Others are of USA origin (6%), Italy and Great Britain (both 4%). Speaking in terms of whole Russia, NW Region is the major place of attraction 300 thousand Germans out of 500 thousand visiting Russia per year come to NW Region. The main places of interest for German citizens are, no doubt, Saint-Petersburg with suburbs, ancient Russian cities Novgorod and Pskov, they often visit big port in the north of Russia Murmansk, beautiful Karelian capital Petrozavodsk. Less tourist flow is reported in distant regions such as Nenetsk Region and Komi Republic. We should also mention that the above figures do not include people who crossed the border in other regions and traveled to NW Region inside the country e.g. approximately 600000 tourists have Saint-Petersburg and NW Russia included in their trips to Russia starting from Moscow.

 

2. Contemporary Issues of Russian Healthcare System.

State healthcare system in Russia has been formed in Soviet Union times and was oriented to provide high quality free medical care. The main accent was made on developing of technical side and medical staff training; paramedical services were very poorly developed.

Geographically:

The general system of emergency hospital service is the following: every area has the biggest and well-equipped Regional hospital, and distant districts are medically covered by small District hospitals with lack of equipment and qualified staff. Large cities have also several additional hospitals; some of them are equipped even better than Regional ones.

Financing:

According to the Russian laws emergency medical services for the Russian citizens are to be rendered free of charge through mandatory medical insurance. The main financial sources for the hospitals are:

  • State or regional budget
  • Mandatory medical insurance
  • Paid services (commercial departments etc.)

The percentage of any of these sources in the particular hospital's budget differs, but the part of paid services is never more than 10-15% from the total amount.

Mandatory and Complementary Medical Insurance:

Due to the old budgeting system of financing has showed its low effectiveness, some 10 years ago a new system of mandatory medical insurance for Russian citizens has been started. The common fees for the medical services have been established throughout Russia. Unfortunately it also proved to be insufficient because of extremely low tariffs and usually covers less than 40% of the medical facility expenses.

During last several years the system of complementary medical insurance has been forming and today has grown up to the important and, in some hospitals of Saint Petersburg, to the key source of financial support.

Drug coverage:

Medications except narcotics are sold without doctor's prescription in the drug stores. In outpatient practice physician only recommends preferable medications and suggests his patient to buy them in the nearest drug store. Hospital has to provide patients with necessary medications, but actually patients pay money under table to nurses and doctors to get the drugs they need.

Medical services for non-residents:

Medical services for non-residents are rendered on the commercial basis. In the majority of the areas ambulance admits non-resident patients to the Regional hospitals according to the local laws dated 1970-75. In case Regional hospital appears to be too far, patients are delivered to the closest available medical facility. Due to the new economical conditions medical providers are looking for the new ways of increasing their revenue. Therefore they use to apply multiplication coefficients to the regular prices when dealing with non-resident patients. Generally they vary from 5 to 8-10. Russian medical facilities regularly don't provide any assistance services to their clients and relatives and don't accept direct payments from foreign insurance companies. English or German speaking staff is rarely available, in the majority of cases only under the special request. Ambulance services are usually available round-the-clock, but in the distant regions delay up to several hours may occur.

Difficulties:

The main problems of the Russian healthcare are:

  • Quality of medical services differs in central and distant hospitals
  • Low professional level of medical staff in hospitals located in distant and under populated areas
  • Lack of medical supply materials and disposable items (sometimes usage of very expensive hi-tech equipment is impossible due to the absence of relatively cheap disposable items)
  • Poor management in the hospitals leading to delays and miscommunication

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