“Optimizing” Russian Healthcare to Death

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Given the dismal state of Russian healthcare, many people practice folk medicine. Photo by TRR

Experts Predict Reduction in Number of Hospitals to 1913 Levels
Polina Zvezdina
RBC
April 7, 2017

The optimization of healthcare has led to massive hospital closures and a decrease in the quality of medicine in Russia, experts say. By 2021–2022, the number of hospitals in the country might drop to the level of the Russian Empire.

Hospitals of the Russian Empire
Between 2000 and 2015, the number of hospitals in Russia halved, dropping from 10,700 to 5,400, according to calculations made by analysts from the Center for Economic and Political Reform (CEPR), based on data from Rosstat. In a report entitled “Burying Healthcare: Optimization of the Russian Healthcare System in Action,”  CEPR analysts note that if the authorities continue to shutter hospitals at the current pace (353 a year), the number of hospitals nationwide will have dropped to 3,000 by 2021–2022, which was the number of hospitals in the Russian Empire in 1913. (RBC has obtained a copy of the report.)

Healthcare reform kicked off in 2010, when the law on compulsory health insurance was adopted, David Melik-Guseinov, director of the Moscow Health Department’s Healthcare Organization Research Institute reminded our correspondent. It consisted in optimizing costs by closing inefficient hospitals and expanding the use of high-tech health facilities. The authors of the CEPR’s report explained that they examined a fifteen-year period when Vladimir Putin was in power, including his tenure as prime minister. In addition, the vigorous reform and optimization of healthcare kicked off between 2003 and 2005, as is evident from the statistics on the numbers of hospitals and outpatient clinics.

Hot on the heels of the hospitals, the number of hospital beds also decreased during the fifteen-year period: on average by 27.5%, down to 1.2 million, according to the CEPR’s calculations. In the countryside, the reduction of hospital beds has been more blatant: the numbers there have been reduced by nearly 40%. These data have been confirmed by Eduard Gavrilov, director of the Health Independent Monitoring Foundation. According to Gavrilov, the number of hospital beds has been reduced by 100,000 since 2013 alone.

Melik-Guseinov agrees the numbers of hospitals and beds have been decreasing, but argues these figures cannot be correlated with the quality of medical service and patient care. The primary indicator is the number of hospitalizations, and that number has been growing, he claims. For example, 96,000 more people were discharged in Moscow in 2016 than in 2015. This means that, although hospital bed numbers have gone done, hospital beds have been used more efficiently. Each hospital bed should be occupied 85–90% of the time, Melik-Guseinov stresses. If beds stand empty, they need to removed.

Outmaneuvering Outpatient Clinics
As the CEPR’s report indicates, the trend towards a decrease in hospitals and hospital beds could be justified were resources redistributed to outpatient clinics, but they too are being closed in Russia. During the period from 2000 to 2015, their numbers decreased by 12.7%, down to 18,600 facilities, while their workload increased from 166 patients a day to 208 patients.

“The planned maneuver for shifting the workload and resources from hospitals to outpatient clinics did not actually take place. The situation became more complex both in the fields of inpatient and outpatient care,” conclude the authors of the report.

In its report, CEPR also cites the outcome of an audit of healthcare optimization performed by the Federal Audit Chamber. The audit led the analysts to conclude that the reforms had reduced the availability of services. As the CEPR notes, the incidence of disease increased among the population by 39.1% during the period 2000–2015. Detected neoplasms increased by 35.7%, and circulatory diseases, by 82.5%. The analysts personally checked the accessibility of medical care in the regions. The report’s authors tried to get an appointment with a GP in a small Russian city, for example, Rybinsk, in Yaroslavl Region. If they had been real patients, they would have waited 21 days to see a doctor. In addition, write the analysts, hospitals do not have a number of drugs, such as dipyrone, phenazepam, and ascorbic acid.

Melik-Guseinov is certain that one cannot rely on data on the incidence of disease among the population as an indicator of deteriorating healthcare in Russia. He points out that what is at stake is not the incidence of disease per se, but diagnosis. The fact that the more illnesses are detected is a good thing.

Fastfood Wages
The CEPR’s analysts write that the lack of medicines in hospitals reflects another problems in Russian healthcare: its underfunding. The government constantly claims expenditures on healthcare have been increasing, but, taking inflation into account, on the contrary, they have been falling. The CEPR refers to an analysis of the Federal Mandatory Medical Insurance Fund. Their analysts calculated that its actual expenditures would fall by 6% in 2017 terms of 2015 prices.

The report’s authors also drew attention to medical personel’s salaries. Taking into account all overtime pay, physicians make 140 rubles [approx. 2.30 euros] an hour, while mid-level and lower-level medical staff make 82 and 72 rubles [approx. 1.36 euros and 1.18 euros] an hour, respectively.

“A physician’s hourly salary is comparable, for example, to the hourly pay of a rank-and-file worker at the McDonald’s fastfood chain (approx. 138 rubles an hour). A store manager in the chain makes around 160 rubles an hour, meaning more than a credentialed, highly educated doctor,” note the analysts in the CEPR’s report.

According to a survey of 7,500 physicians in 84 regions of Russia, done in February 2017 by the Health Independent Monitoring Foundation, around half of the doctors earn less than 20,000 rubles [approx. 330 euros] a month per position, the Foundation’s Eduard Gavrilov told RBC.

Compulsory medical insurance rates do not cover actual medical care costs, argue the CEPR’s analysts. For example, a basic blood test costs around 300 rubles, whereas outpatient clinics are paid 70 to 100 rubles on average for the tests under compulsory medical insurance. Hence the growing number of paid services. Thus, the amount paid for such services grew between 2005 and 2014 from 109.8 billion rubles to 474.4 billion rubles.

The authors of the report conclude that insurance-based medicine is ineffective in Russia. Given the country’s vast, underpopulated territory, one should not correlate money with the number of patients. This leads to underfunding and the “inevitable deterioration of medical care in small towns and rural areas.”

“It is necessary to raise the issue of reforming insurance-based medicine and partly returning to the principles of organizing and financing the medical network that existed in the Soviet Union,” the analysts conclude.

RBC expects a response from the Health Ministry.

Translated by the Russian Reader. Thanks to Comrade AT for the heads-up

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Farewell to Matyora

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Experts Predict the Closure of All Rural Hospitals by 2023 
Ilya Nemchenko
RBC
December 9, 2016

If the number of social welfare institutions continues to decrease at the same pace, there will be no hospitals in rural areas within seven years. Experts argue that all rural schools and medical clinics could be closed within seventeen to twenty years.

Due to “optimization” processes, over the past twenty years, rural areas have lost much of their social infrastucture, experts at the Center for Economic and Political Reform (CEPR) have concluded. In report entitled “Russia, Land of Dying Villages,” they note the numbers of hospitals, schools, and clinics in rural areas will continue to decline in the coming years. RCB has a copy of the report.

Based on Rosstat’s data, the CEPR has calculated that, over the past fifteen to twenty years, the number of rural schools had shrunk by nearly 1.7 times (from 45,100 in 2000 to 25,900 in 2014), the number of rural hospitals by four times (from 4,300 to 1,060), and the number of rural clinics by 2.7 times (from 8,400 to 3,060).

The upshot is that all rural hospitals could close in seven years, while all rural schools and clinics could close in seventeen to twenty years, claims the report.

“It is clear that this is not possible and that all ‘optimizations’ have their limits. However, there are fears that social welfare institutions will continue to close in the countryside in the coming years, albeit at a much less impressive pace,” write the report’s authors.

The optimization of schools and hospitals is often justified by decreases in population, although it is socio-economic problems that facilitate flight to the cities. The experts argue the government has deliberately pursued a policy of depopulating rural areas and has deprived the countryside of its “last hope for the future.” They call the current circumstances a vicious circle. Optimization of social welfare facilities has proceeded at a much faster rate than rural depopulation and the abandonment of villages.

According to the report, the rural population has been in constant decline over the past twenty years. This has happened due both to migration outflows and the fact that the death rate has exceeded the birth rate. The number of deserted villages increased by more than six thousand from 2002 to 2010, to 19,500. Moreover, less than one hundred people live in more than half of all rural settlements.

The experts note that while the number of depopulated villages has continued to grow in Central Russia and the north, rural areas have been developing vigorously in the south. In 2016, the North Caucasus Federal District had the largest population in terms of percentages (50.9%), while the Northwest Federal District had the lowest (15.8%).

The study underscores that the main causes of depopulation in the countryside are social and economic problems. The standard of living is low in rural areas, while unemployment is relatively high, and this has spurred a growth in the crime rate. The experts note that prices in rural areas are high, so country dwellers spend more money on food than city dwellers do.

Population outflow has also been due to the poor quality of utilities and housing. According to the CEPR, only 57% of rural housing stock is supplied with running water, while only 33% of houses have hot water. The condition of the water mains in the countrsyide has constantly grown worse: only 54.7% of residents are supplied with safe drinking water. The experts note that only 5% of villagers have sewers. (This figure has not changed since 1995.) However, the provision of natural gas is relatively better. According to Rosstat, approximately 75% of the rural housing stock is supplied with pipeline or liquefied gas.

The CEPR’s researchers write that the government policy has concentrated capital, jobs, and people in the large cities, while attempts to maintain the rural population have failed, because there are no conditions for developing the villages. The experts believe that comprehensive socio-economic reforms are needed to solve the problem. Otherwise, the number of deserted villages will have increased by the time of the next census.

Translation and photo by the Russian Reader

See some of my previous posts on life in the Russian countryside:

The Stability Pit, or, Bend Them like Gandhi

Screenshot of a photograph on the website of the Debt Collection Development Center. The photograph was taken during a conference on debt collection. Source: Tsentr razvitiia kollektorstva
Screenshot of a photograph found on the website of the Debt Collection Development Center. The photograph was taken during a conference on debt collection. The man in glasses displayed on the screen is identified as “M. Gandhi.” Source: Tsentr razvitiia kollektorstva

Russia in the Pit of Stability
The state has disclaimed all liability for the country’s future
Elizaveta Alexandrova-Zorina
Moskovsky Komsomolets
June 22, 2016

The country has been handed the bill for Crimea, Donbass, and “stability.” The bill includes unemployment, poverty, and hopelessness. The petrodollar dolce vita is over. The only things growing now in Russia are prices, taxes, and utility bills, while incomes, purchasing power, and the standard of living are falling. Nineteen million Russians live below the poverty line. Yet the minimum monthly cost of living in Moscow is 14,413 rubles [approx. 200 euros], and 9,452 rubles nationwide, meaning that a huge number of people who are not officially poor are barely making ends meet. Thirty-nine percent of families do not have spare cash; they spend their entire incomes on groceries. The worst thing is that these people cannot afford to buy not only things but also medicines. Almost fifty percent of the population suffers from structural hunger. And that is not is the limit: the crisis is not over yet.

On the other hand, no one in the government has been sacked, there has not been a single bankruptcy on the Forbes list of the world’s billionaires, and the number of dollar millionaires in Russia has not changed. “We picked the sweet berries together, but the bitter berries I pick alone”?

“Berries Are Sweet,” a song from the film Earthly Love (Yevgeny Matveev, dir., 1974)

The propagandists have, of course, been trying to powder the ugly picture with “poll results” claiming that eighty percent of Russians consider themselves happy, ninety-four percent look to the future with optimism, and eighty-two percent support the president’s policies. Not even the most desperately optimistic patriots believe in this anymore, however. Universal jingoistic boldness has given way to a heavy hangover, and instead of talk about Russia getting up from its knees, you more often hear the saying, “It won’t be worse than the nineties.”

It will be worse. In the nineties, it was only the free hand of the market that suffocated ordinary folk, but now the market will be reinforced by the strong arm of the state. More and more new taxes will be introduced: on property, land, vehicles, securities, and anything that moves. More and more bureaucratic dodges will be devised so the state can get its share, but from everyone and for nothing. There will be more and more new construction projects whose price tags will be doubled or trebled so the “elite” can maintain their prosperity. Phrases like “Crimea tax,” “payment for an extractive economy and decades of incompetent sloth,” and “money for officials and security forces” will be inscribed in invisible ink on each new levy, requisition, and massive construction project.

Sensitive to change, since they have something to lose, and quick off the mark, because they are able to leave, the middle class has quickly realized that hard times are coming. Since the introduction of sanctions, its ranks have thinned: some have been ruined, while others have fled. Even before the crisis, the regime did everything it could to make doing business more or less honestly in Russia unprofitable. Even the sanctions and promises to support domestic producers have changed nothing. Those who steal have it good, those who work have it bad, and the smaller the business, the more it gets fleeced. Due to the government’s anti-western rhetoric, many entrepreneurs who do business with other countries also got scared they would be targeted with everything from travel bans to confiscations of money and property. Hedging their bets, they have taken refuge in the Baltic countries, where it is easy to get a residence permit, as well as in Europe, Asia, and even Latin America. So many economic emigrants have left the country in recent years that we could speak of “economic steamships” bearing them out of the country. Many have purchased citizenships in other countries, and many of those people plan to renounce their Russian citizenships due to the passage of new laws. (The question of whether Russia needs such citizens and whether we should mourn their departure is beyond the scope of the article.)

But what will happen to those people who stay here? Will the nineties seem like a piece of cake to them?

People had no money in the nineties, but neither they did have any debt. Today, around thirty-eight million people have outstanding bank loans. This is fifty-nine percent of the working population, and it excludes people in debt to semi-underground micro lenders. Moreover, eight million people have at least three outstanding loans, and every sixth person has no way to pay back his or her debts. More than half the loans taken out in 2016 were used to pay off outstanding loans. In addition, people raised on the ideology of consumption cannot kick the credit habit even in hard time. Impoverished and unemployed, they mechanically keep on acquiring debt, using the money they have left to buy appliances or a trip to a resort, thus getting bogged down ever deeper in debt. The laws are written in the interests of the banks, and the inaction of the police and the connivance of the authorities favor the debt collectors. Banks get away with things mere mortals could not get away with. Billions are spirited out of the country annually using crooked banking schemes, and these crimes go to trial only in exceptional cases. It is one thing, however, to move capital abroad and not returns millions in loans to the treasury. It is almost a safe thing to do.

It is another matter not to give back a bank 100,000 rubles on time. True, a law regulating the work of debt collectors has finally been passe. As of 2017, absolutely criminal methods of forcing people to pay their debts will be prohibited. The law is quite timely, but you can count on laws only in countries where they are obeyed. Debt collection will thus shift from the legal realm to the semi-legal realm. Instead of official bank employees, debtors will now be getting visits from shaven-headed wise guys who supposedly have no connection to the banks.

By the way, bailiffs have recently been permitted to garnish the bank accounts of debtors. No one could care less whether you need the money for a life-or-death operation or you have a whole house of children to feed. The bank needs the money more than you do. The more the debt burden of the population increases, the more such measures will be adopted to help banks get their money back.

In the nineties, after the collapse of the Soviet Union, utility rates had not yet skyrocketed, and people could put off paying bills for years on end, until better times. There were no methods of debt collection, and besides, the housing and utilities sector had not yet been divvied up among contractors, many of whom are now in the hands of officials and their “subsidiaries,” only minus any government liability.

Nowadays, people who are overdue paying their utility bills for a couple of months are threatened with having their gas, electricity, water, and heating turned off, sued in court (which in Russia is always on the side of the strong), and can legally be evicted from their apartments. The regime, of course, serves the interests of the property management companies by increasing fines and simplifying debt collection procedures. Trying to carve up a meager budget, people wonder whether to pay the utility bills or make their loan payments. They base their decision on whom they fear most: the extortionists from the utility companies or the gangsters from the banks. The water and the power will probably not be turned off nationwide, but targeted outages and evictions will definitely kick off, and the most defenseless will be at risk. In my landing, a pensioner living with her sick son has had her electricity shut off, and the widow of a man disabled during WWII has received a “polite” threat from the housing service.

For the time being, Russians are keeping on top of their bills, but according to experts, the numbers of overdue utility bills will skyrocket and grow exponentially. Already sensing the profits to be made, collection services have taken an interest in the matter. (The new law on debt collectors, by the way, does not extend to people in debt to utility companies.) Considering their methods, this is definitely frightening. The website of the Debt Collection Development Center features a special section on extorting utility bill debts that lists such methods of pressuring debtors as special notices in the media and leafletting, participation of debt collection specialists in general tenant meetings, legal threats, and unorthodox options [nestandartnye varianty].* The last point gives me the creeps. What exactly are these unorthodox options? A clothes iron? A soldering gun? Matchsticks under the fingernails?

Another sign of the times that did not exist in the nineties is that no one feels sorry for anybody nowadays. A young family with a child has no way of paying back its foreign currency mortgage? Parents cannot pay for their son’s eduction? People have to sell the TV, car or dacha to pay off the loan used to buy that selfsame TV, car or dacha? You shouldn’t have borrowed money from a bank! You have no money to pay your bills? Sell your flat and buy one you can afford! You cannot pay for medical treatment or pay your university fees? Get a job! There are no jobs? That is your fault!

People have no sympathy for others or sense of solidarity. Nor should we expect protests and rallies in support of these who have gone into debt, even when the whole country ends up in that pit. The police and judicial system insures our government against any disturbances.

In fact, the punitive apparatus (from the police and the courts to bank debt recovery departments) is a single sector in which the state is present in one way or other. But what does the state do for its own people? It squanders state funds, including the pension fund. It cuts spending on everything not associated with the military, abroad and domestically. It has been exiting the social sector, shutting down hospitals, schools, and kindergartens, eliminating further and supplemental educational programs, canceling benefits, and reducing welfare payments that as they were amounted to kopecks. 24,000 schools, 4,800 hospitals, and 4,800 medical clinics were closed in Russia from 2001 to 2013 alone. (There is no data on the Rosstat website after 201. Apparently, it was decided to classify the information.)

The state has disclaimed all liability for the country’s future, but it still costs a lot to its people. In the nineties, the regime attempted to spend the Soviet inheritance, which was so rich that part of it is still left over today. In the noughties, it cashed in on resource extraction.  Today, it has no choice but to shake down its own citizens for money. The entire state vertical, the entire system of power, from the government to the security forces, has focused on this. And since it often has to shake the last kopecks from people’s pockets, the process will be cruel and painful.

Translated by the Russian Reader

* In the interests of fairness, I should mention I could not find this exact wording on the Debt Collection Development Center’s website, although I did find the page where the other methods listed, above, were discussed. TRR

Thousands of Muscovites Protest Hospital Closures and Layoffs

Around 6,000 People Rally against “Collapse of Medicine” in Moscow
Farida Rustamova and Artyom Filipenok
November 2, 2014
rbc.ru

A rally against health care reform in Moscow brought together six times more protesters than originally announced, uniting medical and educational trade unions and people from entire spectrum of the political opposition. They protested against the city government’s plans to close twenty-eight medical facilities in the near future. The protesters demanded the resignation of Moscow deputy mayor Leonid Pechatnikov and the heads of the capital city’s health department. According to organizers, another protest, this time nationwide, has been planned for late November.

The Stop the Collapse of Moscow Medicine rally took place on Sunday [November 2, 2014] on Suvorov Square in Moscow. According to rally organizer Alla Frolova (leader of the civic movement Together for Decent Medicine) around six thousand people came out for the rally, despite the fact the announced number had been one thousand.

“We are grateful to the doctors who were not afraid of being laid off and came. Seventy percent of the speakers were doctors, and many people wanted to speak at the open mike we announced at the end of the rally,” Frolova commented.

She told RBC that the trade union Action planned to hold a nationwide protest against medical care reform on November 29, and Together for Decent Medicine would support it.

The speakers included representatives of Yabloko, the December 5th Party, and the CPRF, and Andrei Nechayev, leaders of the Civic Initiative party and former economics minister. The rally was also attended by activists from independent trade unions (Confederation of Labor of Russia, Action, Paramedic.ru, a trade union of ambulance workers, the trade union Teacher, and opponents of reforms at the Russian Academy of Sciences) and opposition movements, from far-rightists (the National Democratic Party) to anarchists.

The rally was attended by people of all ages, but the attendees were mainly middle-aged and elderly. Several protesters wore uniforms of doctors and orderlies. The slogan on the placards borne by protesters called for “bureaucrats to get a conscience shot,” “demolish old Soviet residential buildings, not maternity hospitals,” and so on. Many of the attendees were health care workers who had either been fired or threatened with layoffs. All the protesters with whom RBC spoke wished to remain anonymous, for fear of losing their job and not finding a new one.

ukraine

Protester at Sunday’s rally: “They screwed up with Ukraine, now they’ve moved to medicine. Let’s say a firm no to closures and layoffs. The people who busted the budget should be fired.” Photo courtesy of RBC

Psychiatrist Alexander still works at Psychiatric Hospital No. 14, but the hospital is among those slated for closure by 2017.

“We have slowly been cut back. Over the past two years, half of our 1,100 beds have been slashed. My salary has not been cut yet, but it has been kept afloat by layoffs of coworkers,” he said.

According to Alexander, the elimination of clinics will primarily affect the most disadvantaged people. He warned of a possible increase in the number of offenses and suicides committed by patients, who will be left to fend for themselves at inpatient facilities.

“Western Europe already went through this in the seventies, when psychiatric hospitals there were closed. Later, they had bring them all back,” said the psychiatrist.

The doctors, nurses, trade unionists, and party activists who gathered at Suvorov Square in Moscow demanded an end to layoffs of doctors and wage cuts, and a moratorium on the reorganization of medical facilities. Another demand was the dismissal of all the top managers of the Moscow health department involved in reorganizing the Moscow health care system. During the rally, doctors even promised to organize a Doctor at Hand protest rally where attendees would be able to get free medical advice. Organizers said that doctors who had been planning to attend the rally had been threatened with dismissal.

Marina, a nephrologist, received a layoff notice on Friday.

“I, a highly qualified nephrologist, will be unemployed as of January 1 of next year due to a downsizing of beds. Ten of sixty beds are left in our department at Izmailovo Municipal Children’s Hospital, which has been merged with the Morozovskaya Hospital. Since April, only a third of our five hundred employees are left. I have come here in the hope that we will be heard, because as these reforms continue it will only get worse,” said the fired doctor.

Elena, an anesthesiology nurse, expects to be fired after the New Year.

“Our hospital, Gynecological Hospital No. 5, was merged with Municipal Clinical Hospital No. 57: now we are Medical Diagnostic Unit No. 3. In the past two years, eighty beds have been slashed at our hospital. The remaining one hundred and ten beds will be cut to sixty, meaning only one of five wards will be left,” she said.

Despite the fact she has worked twenty-one years, she is the first to face redundancy, she says. Her salary is now 22,000 rubles a month [approx. 400 euros at the time of publication]. Over the past two years, it has been cut by forty percent.

“Who is now going to provide qualified gynecological assistance to women in our place? We are told that we aren’t wanted,” said Elena.

Ekaterina came to the rally instead of her relatives, who were threatened with dismissal if they went.

“My relatives work in Moscow’s oldest eye clinic, on Mamonovsky Alley. In December, the clinic will turn a hundred and ninety years old. Now it is Branch No. 1 of the Botkin Hospital. This clinic is being vacated. It is on the timetable of hospitals slated for downsizing, and by 2017 there will not be any doctors or patients there,” said Ekaterina.

Not everyone could make it to the rally. As an ob-gyn doctor from Medical Unit No. 33 who identified himself as Dmitry told RBC, a shift prevented him from going to Suvorov Square. According to him, layoffs have also been made in his unit, which is attached to Hospital No. 40.

“Many of my colleagues no longer believe the situation can change,” he said, expressing hope that the rally would have some impact.

In a number of Moscow hospitals, Sunday had been declared “Health Day,” which, people in the crowd claimed, had been done specially to prevent doctors from taking part in the rally. Rain TV reported this, in particular, citing a source in Clinical Diagnostic Center No. 1.

In the resolution adopted by the rally, protesters demanded an immediate halt to “pseudo-reforms to health care in Moscow.” Organizers were also interested in the fate of the real estate vacated after the closure of the health care facilities. There were also demands for the immediate resignations of Moscow deputy mayor Leonid Pechatnikov and the top managers of the Moscow city health department, who had been “discredited by their involvement in the destruction of Moscow’s health care system.” As Frolova told RBC, rally organizers had invited Pechatnikov and health department chief Alexei Khripun, but the deputy mayor’s office only promised to pass the invitation on to him, while Khripun was represented at the rally by an aide, who “remained incognito.”

Protesters called for a public debate on the present state and future of the Moscow health care system involving members of the medical community, the Pirogov Doctors Movement, Together for Decent Medicine, and other public organizations. They demanded that all discussions be public, and the proceedings be published in the media.

“The demands in this resolution will be sent to municipal and federal authorities,” the conclusion of the resolution states.

Cuts to medical institutions in Moscow have been underway since late last years. According to the working version of the timetable for closing Moscow clinics and maternity hospitals, employees at twenty-eight facilities, including fifteen hospitals, will be fired and their premises vacated. Employees have already been laid off at several hospitals listed in the timetable. The bulk of the closures will take place by April of next year.

hospital closures infographic

Plan for eliminating medical facilities in Moscow. Courtesy of RBC

“We did not want to publish [the timetable] because we were crying softly in our offices. But since it has already gone public, we can now all cry together,” said Pechatnikov, commenting on the document.

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Read more about the planned hospital closures in Moscow and the public outcry:

  • Andrei Kozenko, “‘You closed a hospital, open a cemetery’: doctors rally against health care reforms,” Meduza, November 2, 2014 (in Russian)
  • Alison Quinn, “Moscow’s Deputy Mayor Attempts to Allay Panic over Health Care Reforms,” Moscow Times, October 29, 2014 (in English)
  • Lyudmila Alexandrova, “Russia’s fast-tracked health service reform sparks protests,” Tass, October 21, 2014 (in English)
  • Ilya Matveev, “Who built them?” OpenLeft.ru, October 17, 2014 (a list of facilities scheduled for closure, in Russian)
  • “We were crying softly in our offices,” Navalny.com, October 17, 2014 (in Russian)
  • Dina Yusupova and Konstantin Gaaze, “Why hospitals are being closed in Moscow,” Bolshoi Gorod, October 17, 2014 (in Russian)

__________

Meanwhile…

Moscow, October 16, 2014, Interfax. On Thursday, Admiral Vladimir Komoyedov told Interfax that, according to the draft budget, a record sum of 3,286,800,000,000 rubles [approx. sixty billion euros] which amounts to 4.2% of GDP, would be spent on the national defense in 2015. This exceeds 2014 spending by 812,160,000,000 rubles.

In 2016, the government plans to spend 3,113,240,000,000 rubles on defense; in 2017, 3,237,820,000,000 rubles.