Interview by Vladimir Nesterov. Exclusively to Vestnik Kavkaza
The healthcare reform in Russia caused a broad discussion among experts and people. Hospitals, maternity houses are eliminated; the number of beds in hospitals is reduced; medical staff is dismissing, especially nurses. People fears that reduction of the state financed sector in healthcare will lead to a growth of expenditures for healthcare. Senator of the Smolensk region, Deputy Chairwoman of the Federation Council Committee on Social Policy, Lyudmila Kozlova, told Vestnik Kavkaza about goals and methods of the reform.
- Speaking about the healthcare reform, a large number of comments on this reform comes from the Russians. People are not used to change the established way of life, usually these comments are not positive. How far are these fears justified?
- The healthcare reform is necessary, there is no doubt in it. But the goal of any reform is to improve the quality of care and increase its availability. What do reformers offer as a result of this reform? It seems to be a good purpose - to make treatment of patients a little less expensive, and therefore transfer many types of treatments in patient care, which are much more expensive in outpatient care. You know, I cannot say anything against. And it would be wrong, if I could. It should be done, but with what methods and how. On the example of that reform, which was held in Moscow, which caused a negative reaction from the medical community, especially of doctors, you know, happened so it went beyond the metropolis of Moscow.
First, whenever there is no transparency, no extensive discussion, you begin to realize that people will understand that not everything is going smoothly, so everything is hidden, nothing is discussed. We must start not with the destruction of hospital care, but with the preparation of outpatient care. When it is prepared to take on the provision of quality care to the population, and its availability would not be reduced, then it is possible to reduce the quantity of beds. Have we done that? We have reduced the quantity of beds, but were not prepared for outpatient care. This, I believe, is the global error.
During all the years of my work this was the first such a large-scale action. Doctors used to tolerate and work for meager compensation. Salaries in fact always have been low. But doctors have never had such a low social status, which they have now.
- When it comes to just about any health care reform, people always refer to it cautiously and always with some certain degree of anxiety. Especially now, since we touched on the Moscow issue, when the medical staff and specialists have been reduced in large numbers, fears appeared that there would be not enough doctors to so many patients which we currently have, say, in Moscow . How to keep a balance?
- You know what makes me sad? It is the reducing of the availability and reducing of the quality of care. Let's think about why this is happening. We are told that we have a redundancy of doctors. In relation to what criteria is redundancy? It is referred to the Western countries. But it angers me extremely. After all, the number of physicians, and indeed the number of health professionals - physicians and mid-level health workers is determined, first of all, with the health condition of people. And if we refer to the Western countries, if there is a better state of health, and life expectancy there has been much higher than ours until recently. We have the task of maintaining and strengthening public health. I believe that it can be estimated as a criteria of national security.
- Absolutely.
- For any reduction, before to cut, I have to estimate the pros and cons and to see if there is enough possibility for this number of doctors to provide high level of health care, or at least keeping it on existing level at least, but not impairment, which is recorded over the last time. This is the first question. The second question is about the payment for the service. There is a good Russian proverb: measure seven times before you cut once. This was not applied, when I spoke about the reforms. And it was not done when it was offered to reform Russian system of health insurance. We had to really weigh the "pros" and "cons" and understand that Russia, with its vast territory, low population density in most areas – this is whole territory of Far East, Altai, Siberia, with bad roads, it will initially be less available and expensive.
And there are Americans. They work in conditions of health insurance. So what? Everyone knows this amount of money that Americans spend on health care, no one spends. That means, it is very extravagant. Same is in UK, Canada, where there is government funding, and the effectiveness of their systems is higher than efficiency of Americans with the big costs of the system.
So, to conclude what I said, it is better to wait, wait with moving to insurance medicine. And now the cuts of staff, and the elimination of hospitals, I believe it is wrong, in general, now it is erroneous actions, further increase in payment for medical services are the consequences of the transition to insurance medicine, we are reaping the fruits of its . And, of course, in these circumstances, I want to say, there are a lot of complaints to our Ministry of Health, but they are living hard times. In this case, I believe we must not make claims, but participate in and help the Ministry to solve many problems.
I always say that any mayor, head of administration, if you we talk about municipalities, prime ministers, presidents must have a good team, professional one, which not only justifies and says, "Here it is, we think so." We think so and expect. And immediately gives a forecast. That's when only the minimization of errors and minimizing the negative consequences can work if they are provided. It's similar to disease. The disease is easier to prevent than to treat. Then it could be possible, of course, to avoid some of these negative consequences that are so expensive first of all for patients, second, for the state and in general do not solve the problem.
- What is your overall evaluation of the current state of modern young doctors? And another problem I would like to touch upon is questions of distribution. It is well-known that everyone wants to work in the city.
- Concerning the deficit of staff, you know, wherever I went, whatever level I spoke at, when I hear that a question is dedicated to improvement of the quality of medical aid and its accessibility, I always say: “How can we speak about this in the situation of staff deficit?” Look, people make claims to medics, they have a very negative sentiment, there is negative reaction, lines in polyclinics. Let’s sort out why. If there are not enough doctors, a deficit of medical staff, and one doctor works for one and a half, or even two shifts, then tell me, please, would there not be lines? A reception is planned for only one. There will be lines. The quality of examination. Give me a chance to check, let’s say, one patient in 12-15 minutes, or I should check two using the same amount of time. What quality would there be? And if he has a side job because the salaries are low (I will now speak about this too), he comes after a night shift and needs to work at double output, tell me, please, how is this quality? Of course, improvement of service quality is out of the question. Another issue is accessibility. Ok, you need a specialist, you need a reception. What is accessibility? When I can see any specialist when I need to. But if there are no cardiologists, if there is only one per two-three polyclinics, would accessibility be higher? That is staff for you. And the main issue, of course, is the staff. So, I want to say that the president started the address, especially the address of 2013 and of 2014, he noted that a lot was done in healthcare, a lot has been done indeed.
- And what about distribution?
- The Soviet Union had a good distribution system. But the country was different. We live in a completely different country now. Distribution has suddenly become a violation of human rights. Some of my colleagues proposed the following solution: let’s impose distribution on tuition-free students. I considered that distribution should be compulsory for both tuition-free and tuition-paying students. Because those who pay for their education, the sum does not cover all the state expenses of education. But when they told me that it would not work because it is a violation of rights, then I see only one question: signing of purpose contracts. If some treatment center faraway, in one such district I talked about, needed certain specialists to arrive, I would send 2-3 people to study in the district, the people I need, the soon-to-be specialists, I add to the scholarship of the 2-3 people, even if it is an absolutely small sum, it is still an addition to the scholarship. Upon their return, I have got specialists. This would be right. And the person discusses how much he will earn there, the 3-5-10 years are already fixed in the contract. And, naturally, they will get housing. Naturally, there would be no housing in such a district, but it would not be worse than that of others at least, the housing he can live in, service housing. In the future, look here, some people work, make families, and stay, especially if they get housing there.
- Lyudmila Vyacheslavovna, you and I, we are on Vestnik Kavkaza. I cannot help asking you a personal question. What is your personal attitude to the Caucasus? I know you were born in Baku.
- You know, you don't have to ask my personal attitude. We had such a state, we were proud of it. We lived a very pleasant life, because we believed that a powerful state in which it was comfortable and which would never allow a war was the Soviet Union. And previously we didn't even understand that, you know, everything else, that it was someone else's, not ours, that we, as the Balts say, were occupied, absolutely not. After all, living in Smolensk, when I received my excellent marks (I was a good student) I suddenly decided to please myself. We still had a session, I thought, while my classmates were preparing for exams, I would go to Riga to listen to the Dome Cathedral organ. I packed up and went. Here it was the Soviet Union, it was a possibility. And we all thought that we were from one country. And the Caucasus, you know, for what was it always famous? It is its amazing people, very kind, welcoming, sometimes even very naive. And the education we had was so, you know, respectful, it is still preserved. Here it is, regardless of nationality, for all those who lived in the Caucasus. I was born in Azerbaijan, so there it was: whether you were Russian, Azerbaijani, Armenian, Georgian, etc, the nationality was one - from Baku. When asked about nationality, I said - i'm from Baku, a person of any nationality can say this, because it's so. And I say that it was this nation with respect for the elderly, and respect for women. Always on public transport if middle-aged people or even a woman or a young girl were travelling, all the men always stood up, always helped them get on. And it was very peaceful.
Today Baku is much prettier. I saw that again there are many nationalities living there, that they feel comfortable. I met with my classmates, and when asked, "How do you live here?" One replied: "When many began to leave the republic, I had nowhere to go, and I'm so happy that I had nowhere to go, because I live very well." I saw the familiar people of Armenian origin who live there. And I think that's right. I have a feeling that maybe that's revived what has always been famous for my city, which gave the world a very well-known people, and who until the end were proud that they were born in Baku and called themselves Bakintsi. \
I would very much like to have this revived, it was that good, and there was no such thing as "persons of Caucasian nationality", it was not heard. And I am glad that this is no longer heard here. It was heard quite recently, especially in the 90s, when this could be stopped, not now. Because when we understand what nationality we belong to, it does not matter, we are all one nation. And the main purpose of our being and work is to contribute to the strengthening of our state, for it to be strong and provide such assistance that is expected from all of us. But to do this we must also help the state to overcome these difficulties here, which it has now. We must be united and understand that any person of any nationality, first of all, is a human.
- How do you like the city externally, because it has changed significantly, I think, since the Soviet Union? I've been there several times, in my opinion, it varies from year to year. There are wonderful promenades, fantastic sports facilities, cultural centers.
- You know what else I liked there, not only liked it, but what also impressed the whole delegation of the Federation Council and the State Duma, who visited the Milli Majlis of the end of December, December 22? We arrived unexpectedly, and the Republic of Azerbaijan was celebrating on this day, celebrating on this day of the great Russian poet Lermontov's 200th anniversary. And the organizer was the granddaughter of Heydar Aliyev, Leyla. She herself made a speech. In general, the concert was incredible, it was at a great level, respect and love were felt there, you know, we were shocked.
Remembering the wonderful Heydar Aliyev, during whose rule in Azerbaijan I grew up and studied, in such a situation, about which I said, and the wisdom of the man in the future. Because if it were not fir his policies, Azerbaijan would not be a secular state but would be an Islamic state. And now it is a secular state. You know, they say, "Here there us a succession, a family, that his son is now president. How wonderful it is!" He is the president not because he is his father's son, but because he deserves it. He is a very educated man, a wise politician, too, he probably received such an education. And I think, therefore, the benefit is that Azerbaijan is now flourishing and all the staff along with all the people, first of all, happen because of Heydar Aliyev and Ilham Aliyev. I love my home and my second homeland, Russia, Smolensk as well, which became for me the same dear, place where I became a person. When I come to Baku, I feel a range of emotions, vibrant feelings. And when I go back to Smolensk - the same feelings I feel, no matter there or here. I would like all people to feel like that. It can be felt in a place where you are understood, where you are comfortable, where you are in harmony with yourself and with others.
