ПОЛИТИКА, ЭКОНОМИКА И ИННОВАЦИИ № 5 (52), 2023 УДК 614.2(470)
Джуванита Адрин, студент международного медицинского института Курского государственного медицинского университета
Email: j uvanitaadrin@gmail. com
СОСТОЯНИЕ СИСТЕМЫ ЗДРАВООХРАНЕНИЯ В РОССИИ
Аннотация: в данной статье рассматривается взаимосвязь между здравоохранением и экономическим развитием, состоянием здоровья населения России, а также финансированием системы здравоохранения. По сравнению со средним показателем в мире, который составляет 10% ВВП на здравоохранение, Россия тратит один из самых низких процентов своего ВВП — всего 5-6% — на систему здравоохранения. Население вынуждено обращаться в частные клиники, поскольку в государственных секторах, как правило, не хватает современного медицинского оборудования из-за недостаточного финансирования.
Ключевые слова: экономический рост, состояние здоровья, расходы на здравоохранение, медицинские технологии, общественное здравоохранение.
Juvanita Adrin, student of the International Medical Institute, Kursk State Medical University, Kursk, Russia.
Email: juvanitaadrin@gmail.com
STATE OF HEALTHCARE SYSTEM IN RUSSIA
Abstract: this paper examines the relationship between healthcare and economic development, the state of health of the Russian population, and the characteristics and financing of the healthcare system. In comparison with the worldwide average, which is
ПОЛИТИКА, ЭКОНОМИКА И ИННОВАЦИИ № 5 (52), 2023 10% of GDP on healthcare, Russia spends one of the lowest percentages of its GDP— only 5% to 6%—on the healthcare system. People are typically forced to use private hospitals since public sectors typically lack contemporary medical equipment and have poor infrastructure due to underfunding.
Keywords: economic growth, state of health, healthcare expenditures, medical technology, public healthcare.
Health is an essential determining factor of economic development of a country. The well-being of individuals affects economic growth directly by increasing labour productivity as they are more efficient economically, which means higher income per person [5]. The nation's economic growth encourages the increase of health expenditures, which can be described in a circle-like relationship. To start with, the size of public health expenditures caused by the development of the medical system will grow annually as the country's economy expands. People start paying more attention to their health problems as a result of the advancement of the medical system because life quality is then assured. The improvement of public health encourages an increase in labour force efficiency and working hours, which will promote economic expansion [6]. It is impossible to overstate the contribution of human capital to economic growth because it progresses the development of the economy. As a result, productivity is negatively impacted when people are in poor health and this could explain why different parts of the world have had varying levels of development. According to several studies, economic expansion improves public health since it allows individuals to live longer and healthier lives. Public health is often assessed by health expenditures [5].
In Russia, the number of deaths has recently exceeded the number of births, with the gap reaching almost one million in 2021. The mortality rate, or the number of deaths per 1,000 people, rose from 14.6 in 2020 to 16.7 in 2021 [9]. The majority of these fatalities happened during the Covid-19 epidemic, which is the main cause of this rise in mortality rates. Around the end of 2021, Russia reported more than 115,000 deaths.
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During this time, the nation was charged with downplaying the seriousness of the epidemic since the response to it had been reduced due to public outrage [10].
Figure 1 shows that circulatory illnesses were the leading cause of death, accounting for 640 deaths per 100,000 people in the nation. The Covid-19 pandemic, which resulted in 319 deaths per 100,000 people, was the second leading cause of fatalities. Neoplasms are the third most frequent type, with 194 fatalities per 100,000 persons [9].
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MAJOR CAUSES OF DEATHS
Figure 1 - Major causes of death in 2021 per 100,000 population.
While the Gross Domestic Product (GDP) of certain regions in Russia was equivalent to that of high-income nations, the growth in health was less obvious, with disparities in life expectancy by gender as a result of unequal progress driven by social variables [8]. According to a study, the difference in life expectancy between men and women can be attributed to behavioural variables, such as dangerous alcohol usage in association with violent behaviours, stress variables in society due to economic and political changes, resulting in a high male mortality rate especially in employed groups of
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ПОЛИТИКА, ЭКОНОМИКА И ИННОВАЦИИ № 5 (52), 2023 individuals [7]. According to the 2017 OECD Health at a Glance study, Russia has one of the greatest life expectancy gender differences, with women generally anticipated to outlive males by roughly 10 years. Men lived 68.18 years and women 78 years in 2019, despite a new socioeconomic environment that increased life expectancy. On average, residents in 2019 were expected to live 73 years [8,9]. Due to a national project called "Health" that was started in 2006 and equipped with modern medical tools and technology, the medical care system improved in the mid 2000s, as the socioeconomic condition improved. With this, the then-occurring rising mortality rate could be reversed [2].
Despite having formerly been regarded as having one of the best healthcare systems in the world, Russia now only qualifies as offering a reasonable grade of treatment. A Bloomberg survey that examined 55 developed countries depending on how efficient their healthcare systems were, Russia ranked the last. The country which was once considered as the most scientifically advanced nation, came in at number 58 out of 89 for its healthcare system by the 2021 Health Care Index, also highlighting a very poor rating for infrastructure quality. The public health care system is under criticism, which may be due to its weak organisational design, lack of government financing, obsolete medical technology, and underpaid staff. In Russia, 17,500 towns and villages have no medical infrastructure at all, which has forced people in need to seek the help of various practitioners, including faith healers, who are now more prevalent than physicians [1].
The primary factor contributing to Russia's inferiority to other modern nations is the underfunding of the healthcare system. The nation spends 5% to 6% of its annual GDP on healthcare, which is less than the worldwide average of 10% and places it in the bottom of all European nations. The country needs to introduce more advanced medical technology and infrastructure as well as more personnel working in hospitals and pharmacies. Costs associated with healthcare rise as a result of these requirements. Unfortunately, when estimates were made, GDP expenditure on public health remained unaltered [1,2]. Due to a lack of finance, access to high-quality healthcare and modern medical technology has been limited, along with low wages in healthcare. The average
ПОЛИТИКА, ЭКОНОМИКА И ИННОВАЦИИ № 5 (52), 2023 income in the healthcare industry was one-fourth less than the average for the national economy, despite the fact that hospital staff members were highly qualified and had strong educational backgrounds [2].
In recent years, it can be seen from the Figure 2 that the % of GDP spent on healthcare is rising with the GDP at 5.65% in 2019, it is lower in 2018 and 2017 at 5.36%. Russia spent $653 (per capita, in US dollars) on healthcare in 2019, a 7.29% rise from $609 in 2018, and a 5.06% increase from 2017. $580 was spent on healthcare in 2017, a 24.69% increase over 2016 [4]. While other countries spend 10% of their GDP on healthcare, Russia spends only about 5% of its GDP on healthcare, placing it below many developed nations despite the steady increases in healthcare spending.
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Figure 2 - Healthcare spending in Russia from 2006 to 2019.
Low funding caused the public healthcare system to collapse, which helped the private healthcare industry expand. When compared to public hospitals, private hospitals typically offer the greatest quality of care and services, including staff that speak English and lower waiting times in contrast to the long waiting times in public sectors. Even in private clinics, they can only handle straightforward cases; if the patient had a serious
ПОЛИТИКА, ЭКОНОМИКА И ИННОВАЦИИ № 5 (52), 2023 illness, they would need to be sent to a different hospital with more advanced medical technologies. Things began to improve gradually in 2013, and the number of people using public healthcare increased tenfold. Sadly, this was only temporary, and the financial crisis of 2014 led to yet another round of significant public sector budget cuts [1].
In 2014, the economic instability in Russia led to the fast devaluation of the ruble on the foreign exchange market. Capital left the U.S. and other rich nations as investors sought out higher pay-outs, with the rising interest rates. The capital outflow slowed down the economy, which led to the ruble's collapse. The debt was in dollars, and other businesses found it challenging to pay it back, which made the slump worse. Additionally, Russia's economy is reliant on its crude oil and natural gas, but in the middle of 2014, the price fell sharply from $107.95 per barrel to as little as $29.16. The main Russian source of income was likewise impacted by this price decline. Moreover, the United States and its allies imposed a series of sanctions on Russia after it decided to attack Ukraine in 2014. During the same year, these sanctions cost the nation $26.7 billion, and they may have increased to $80 billion in 2015. These sanctions cost the economy 1.2% of GDP, adjusted for inflation. This is not necessarily a modest percentage because it was very high, particularly at a period when the economy was struggling to avoid a recession. Due to the devaluation of the ruble, Russian businesses were essentially compelled to convert their rubles into U.S. dollars in order to fulfil their debt-interest payment obligations [3]. Since this economic crisis in 2014, neither a continuous period of growth nor any investments that may have enabled the public sector to grow have occurred. Additionally, the shortage of funds led to a sharp increase in private spending, which included household purchases of medical supplies and an increase in voluntary medical insurance contributions. When comparing the amount spent on buying pharmaceuticals between 1995 and 2018, it rose about 12 times, while the amount spent on paying for medical services increased nearly 7 times. Along with the advancement of private spending growth, its proportion of overall healthcare spending increased [2].
ПОЛИТИКА, ЭКОНОМИКА И ИННОВАЦИИ № 5 (52), 2023 For the lowest income portion of the population, several health services and medications could be categorised as luxury items, while their costs are inflexible with respect to income for the wealthy segment of the population [11]. The ageing population, deteriorating infrastructure, and complex political history are straining Russia's public healthcare system [1]. An article contends that the first step in resolving the Russian Federation's low budget crisis—and, ideally, increasing public expenditure on healthcare—should be the introduction of high income tax rates, comparable to those in other affluent nations. The fact that it shouldn't be a tax introduction with a multilayer scale of tax rates should be emphasized given the low income of the great majority of residents and how complicated it may be. The enhanced rate should be imposed in this case, taking into consideration the threshold income amount. It is suggested to not go over the established threshold, which is the income of the vast majority of the population [2]. Regarding the enhancement of the healthcare system, introducing medical insurance schemes, at least beginning with low-income groups, could be reasonable in order to advance public health [11]. It is clear from the evidence that more funds are required for healthcare expenditure in order to develop the medical infrastructure, purchase new medical technology, and pay medical staff who work for the public sector, greater wages.
References
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3. Kuepper, J. (2022). What Caused the Russian Financial Crisis of 2014 and 2015. [online] The Balance. https://www.thebalancemoney.com/what-caused-the-russian-financial-crisis-of-2014-and-2015-1979012
4. Macrotrends. (n.d.). Russia Healthcare Spending 2000-2020. [online] https://www.macrotrends.net/countries/RUS/russia/healthcare-spending
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5. Niu, X.-T., Yang, Y.-C. and Wang, Y.-C. (2021) Does the economic growth improve public health? A cross-regional heterogeneous study in China. Frontiers. https://www.frontiersin.org/articles/10.3389/fpubh.2021.704155/full
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7. Pietila, I. and Rytkonen, M. (2008). 'Health is not a man's domain': lay accounts of gender difference in life-expectancy in Russia. Sociology of Health & Illness, 30(7), pp.1070-1085. https://doi.org/10.1111/j.1467-9566.2008.01106.x
8. Shartova, N., Tikunov, V. and Chereshnya, O. (2021) Health Disparities in Russia at the regional and Global Scales - International Journal for Equity in health. BioMed Central. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01502-6
9. Statista Research Department (2022) Main causes of death in Russia 2021, Statista. https://www.statista.com/statistics/892363/main-causes-of-death-in-russia/
10. The Moscow Times (2021) Russia's excess death toll hits 930k, The Moscow Times. The Moscow Times. https://www.themoscowtimes.com/2021/12/30/russias-excess-death-toll-hits-930k-a75964
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