It is an issue of maintenance of all equipment that was purchased under the program of modernization of health. It’s been almost 10 years.
The government hopes to import substitution. It is not noticeable?
We have the technological base is improving, but still weak. We have import substitution was started only when we were put in an impossible position.
I understand that the leadership of the country faces many challenges in addition to health and have to choose which to resolve first. But human capital is the most important factor, and it is necessary to invest. There are studies proving that one ruble invested in health care, brings 3-5 rubles of profit. But for this it is necessary to maintain health.
I openly opposed the position of the Ministry of Finance and Siluanov: this question has some misunderstanding. He believes that the less expenditure the better. In the structure of the Ministry of Finance has a research Institute that analyzes the costs, their position is that we must continue to reduce costs and direct the health to 3.6% of GDP to 2.8 percent. I said, if you do, you people just on the forks will make.
But Vladimir Putin may decree set the task to increase government funding for healthcare to 5% of GDP. In the EU they account for 7.2% of GDP in OECD 6.5% of GDP, from Russia according to this indicator, behind only China and India.
Putin knows how to listen. He was at the meeting in St. Petersburg in December, said Roshal him already ass on health financing.
So he heard you. We have the same in the economy plays a big role manual control.
I will say it again: I do not envy Putin. I would not be able to work in his place, because it is necessary to solve a lot of problems. And on defense including.
The country needs to spend more money on defense or health care?
Today, statistically, on defense, Russia spends less than on health.
But part of the defense spending is a restricted article.
We would have bent the horn very quickly, if we had no army. In the global economy is a tough fight, without any smiles and sentimentality.
All of us have on hearing an example of your friend Mark Kurtser, who created a medical company, standing now hundreds of millions of dollars. In an interview with Forbes, he admitted that medicine is very hard and very difficult business. In Russia, medicine will not be long business, unlike the U.S., said another billionaire Pyotr Aven. However, in 2017, about the desire to have large medical projects, said several billionaires. What is the interest of big business to medicine and can make money?
I suck at relationships, because I’m not a merchant, a doctor and a statesman. I like the Soviet system: the medicine was available and of good quality. Still some of the built in Soviet times clinics are among the best. These include the Institute of cardiology, Institute of cardiovascular diseases, Cancer Institute, and it was all done on public money.
Here you Kurtser called, but it’s a rare diamond. I always admire him: he built a successful commercial center. There are other successful examples of private medicine — JSC “Medicine” and the Center of endosurgery and lithotripsy. These centers are developing and, therefore, there is a need. For example, the rich have 5-10% of the population, some of them going abroad, and part is treated in Russia.
Reserve growth of private hospitals has not been exhausted. But competition between private and public medicine should not be. Patients should have a choice: someone who has the ability to pay, can be treated for money. That’s capitalism. And those who can’t pay that kind of money, should be treated in a good public hospitals. For example, at the University of Los Angeles in the same area are two hospitals — private and public: one beds wider and better nutrition, in the other chamber is smaller and the decor is simpler, but the level of medical care provided is the same, since in both cases work the same doctors.
Doctors are paid the same money for the reception of patients in public and private clinics?
There it is prestigious to work in a public hospital. There the doctor has no obligation to work eight hours in one place, and there is scope of work. To oppose public and private medicine is impossible.
Private medicine can complement public clinics, but to replace it they can never.
This is because the standard of living of the population of the lowest in Russia?
It’s not only for Russia. But also for rich countries such as America and Germany.
The number of private clinics is increasing. What is their potential?
Yes, in percentage terms the number is growing. But it is interesting to compare how the number of patients served by private and public clinics. The difference is huge!
More than 90% of patients served in public institutions.
The proportion of those who can pay for their health care, small.
Private hospitals should exist, but people should be a choice. If a person wants to be treated in a public hospital and believes that private clinics will cure better, let uses the services of private medicine.
Where do you go to?
I, in my opinion, never attached, because in the clinic I do not go. Most of my doctor friends. But once happened to me a problem and needed to put a shunt in the heart. This is not a simple procedure as it seems. In Russia there are exciting new medical centers, a shift in this area is huge. I could fly to Germany? Could. Could fly to America or Israel? Could. I could go to an academic institution? Could. But I went to do a bypass surgery in a Moscow hospital, where a centre for vascular surgery.
In a simple hospital went?
Yes, in a regular hospital.
You why? Went to the 23rd hospital.
I can’t believe Roshal went to the usual city hospital.
Or you went to a particular doctor?
Of course, the doctor went, not to the nurse.
But they knew that it was going Roshal. All must toe the line stood, once such a high-ranking patient.
In the face learned that I had arrived. Here I have about a finger there is a small artery; it entered, passed and then walked into the vessels of the heart, did research, put everything that you want to insert. Well, I lay for a moment, and all. And such operations are made in Russia. Opportunities of Russian public medicine I have tried.
Maybe because you Roshal, any urban hospital can do the surgery at the level of space technology.
No. To make this operation, you need good equipment, qualified doctors. And we have these opportunities. Professionals in this public hospital is good.
Your family did not insist on treatment in foreign clinic?
With me is difficult because I’m not very flexible.
It is not necessary to extol Western medicine as the ideal. Here is an example. There was a composer Schnittke. He had a stroke, and it so happened that I was doing them, because we were friends. He was sent to Germany for treatment, and then his plea was taken and treatment was done here. And in the end, he finished the Symphony, and it was restored by Russian doctors. Or take Robert Rozhdestvensky: when he was diagnosed with the tumor, he went through friends to France for the operation. And it relieved him we’re already here, in Russia — hardly took away from France. After that, he wrote wonderful poems. There are plenty of other examples. Iosif Kobzon, first drank there.
He was held in Germany treatment?
Yeah, but then took it and was relieved here. The main specialists that treated him, were Russians. Several times he traveled abroad for consultations. There is some technique that’s not in Russia, and is, for example, in Italy. Almost 20 years it dragged, and the Russian doctors from the oncological center Blokhin, which was headed by Mikhail Ivanovich Davydov, neurosurgeons, chemiotherapeutic and others.
Made by Russian medicine leap in recent years is very noticeable. And the fact that people can’t see that, I was very concerned.
Let’s get back to business. Entrepreneurs complain that without government intervention the clinic to be build. They need to provide assistance?
If private hospitals are built, then it can be done. If you have a mind, money, you can make a successful clinic. Of course, private medicine has its problems, and we have ours. For example, we are not competitive compared to private clinics with medical specialists. In private clinics better conditions and more opportunities, and the load is smaller and easier to work than in a public hospital, where you have to answer for the attached contingent.
What is the model develops and should develop the Russian health care system? Should be like the ratio of the sectors of OMS and DMS? I wonder if the business will operate on the compulsory health insurance system taking into account the accepted billing services and level of costs for equipment?
Business running on the OMS. For example, private hospitals are actively working on such policies, operations on coronary artery bypass surgery, where you pay more money, but when the government says the clinics: take CHI attached the plot as a whole and work with the people, it is interesting to them. You read all the responsibilities at the local doctor — you will go mad: a huge number of responsibilities and incredible moral burden.
There is a brilliant example — the city of Kovrov of the Vladimir under businessman Vladimir Sedov, which produces sleeping bags, built a cool private clinic, her envy of the Moscow hospitals: there are MLA and coronary artery bypass graft and any endoscopic studies do. This is an example of a socially-oriented business.
He has the opportunity — he was invited from Moscow professors, gave them good conditions for life: it gave the apartment a good salary. He is not a doctor and does not dictate to doctors what to do, he just trusts a good specialist, whom he invited to work. And, by the way, the managers he employs the doctors.
For example, private hospitals can tell who’s better at medical business to the doctors, who decided to go into business or entrepreneurs who decide to practice medicine?
Good doctors are able to create a successful business. But history has many examples of entrepreneurs who developed the Russian medicine. Remember Ludvig Nobel — the socially oriented capitalist, who built schools and hospitals. Or, for example, a merchant Morozov, who built a children’s hospital that bears his name. The role of philanthropy in health care has always been great.
For the population it would be better if private hospitals will take part of the work of the state clinics.
Many patients complain that in state clinics the crowds, and at a private clinic, all shiny, no queues, nice to be and all smiles.
You know what they say about doctors who worked in the “Kremlin hospital”: “parquet floors, personal physicians”.
The doctors of the city hospital more practice. In our case, one pediatrician had 700 or 800 people, now the ceiling is up to 2000 people a year.
If private hospitals have the ability to pay higher salaries to doctors, and qualified doctors, can be higher?
Not so, because the number of complaints and troubles to the total number of patients of private clinics lose state. But this can be partly explained by the fact that when a person pays money, he is more demanding.
You and the Chairman of the RCDS Alexander Bastrykin recently discussed complaints on medical criminal cases. This is a very loud and painful subject. As written media, the meeting lasted 10 hours. What’s so captivating?
In the Criminal code, doctors can judge by the various articles — for 109, 218, 238 and others. In the 109th and 118th articles of the deadline for filing claims in court are limited and therefore, many cases transferred to the 238 th article of the criminal code, which envisages imprisonment. But this approach, as it was in the high-profile case of a doctor Misurina, half the country can go to jail. She is not to blame in this death. Complications can occur always, they happened in my work, but I’m not intentionally doing that.
It turns out, the doctor has the right to be wrong?
If the doctor intentionally harmed the patient, this shall be punished by imprisonment, otherwise each of us can plant. And another question: prison is will make the doctor better? No, I will not do it. Sometimes a good doctor working for 40-50 years, has a wealth of experience to save thousands of lives, and suddenly an accident, which negates all previous achievements, and a physician sent to prison. Is it possible?
Mr Putin said: “All is not jail”.
We’re just now struggling with the fact that not all of the jail and to criminal penalties expected only for intentional acts. I am grateful to the Investigative Committee and its Chairman for what they are beginning to understand our position. And we begin to understand them. It would be possible not to contact with the Investigative Committee and to take a different position. But we have taken this contact to understand each other and understand.
It was your initiative?
Of course. I understand the Investigation Committee: the number of complaints increases, and the need to respond. But we need to understand what is happening.
There’s also the problem with how the media react to criminal cases against doctors. For example, there is a trial, this case, nothing has been proven, but the media immediately give such titles: doctor arrested for murder. All the doctors, it turns out, murderers.
And as the Chairman of the RCDS responds to these things?
Bastrykin is a very powerful and principled man. He listens to not only the victim, but causes in the TFR and representatives from the region, which recorded the generals stand at attention, and he’s very demanding of him. But there is still the problem that the solutions are tightened. I sometimes stand on the side of the investigators, because it is difficult to determine the fault of the doctor or not because they are not doctors. The case is sent on is judicial-medical examination. For example, if the number of cases has doubled, and the number of investigators has not increased the workload of investigators has increased, and they don’t have the time. Or it happens that the documents detained by the police. In short, a lot of subjective factors.
Bastrykin accusatory towards the investigators: why didn’t they do this or that.
People can make mistakes, they do not iron. But there are cases where I do not agree with the charges, so I always say. We actually stand up for investigators. For admission to Bastrykin break not the ordinary people, they have come with the documents prepared by the lawyers. I am against intimidation of investigators, they require that they necessarily found guilty of a doctor.
Look at the statistics, of the 6,000 complaints against doctors filed for the year, before the court brought 140 cases and convicted fewer people, and in most cases they were put on probation. I would have carried out the analysis and applied to the court to journalists, who spread unverified facts. There must be responsibility.
Why a growing number of complaints?
We tried to understand, watching the statistics, not only in Russia but also in the world. It turned out that in many developed countries — in America, European countries, in England the number of complaints increases. In Germany, for example, twice over the past eight years. There are several reasons. First, the increased requirements of patients. Second, it helped the development of media and electronic systems. If now we is not satisfied, he can easily write a letter and complain to the President, Prime Minister, Minister of health, Prosecutor, etc. In the end there is a shaft of complaints. Now the doctors live and work under such a magnifying glass as never before. And highlight the issues to help the media. Help and lawyers: sometimes they call up the relatives of the victims and offer them assistance on submitting documents to the court as the opportunity to earn some money.
The amounts of claims to reach tens of millions of rubles. The money is going, usually to pay for the services of lawyers, part of the family. This is a very bad situation.
We compared the ratio of complaints to total number of patients of hospitals and clinics and received a hundredth of a percent.
Health is now supervised by Deputy Prime Minister Tatiana Golikova, which you publicly criticized in the presence of Putin, when she was in charge of the health Ministry. This assignment will affect how to reform the Russian medicine?
I set to constructive cooperation. If professionally everything will go fine, no doubt. While steps against the National medical chamber and me personally no. Golikova surrounded by people whom I opened in the presence of Putin was criticized.
Who, in your opinion, should control the medicine?
I have no doubt that the development of medicine should be run by a doctor. Health Economics is important, but where it leads is unclear. I approve of the modernisation of healthcare and believe that it should continue, but for optimization of health, I’m very cautious, because to tighten the economic screws — cut doctors and cut technological base if health is poor, very difficult. Around Tatyana Alekseevny there are people who think we are bitter enemies.
I do not know.
In 2011, at a meeting with Vladimir Putin, you said that in health care a lot of “sawing”.
And now sawing.
Not considered. But it’s a different story.