Positive changes

Alexei Khripun, Minister of the Moscow Government and head of the Department of health of the city of Moscow, answered our questions in an exclusive interview with “Capital Ideas”

Mr. Khripun, how would you assess the quality of healthcare in the city?

I think that the quality of healthcare should be assessed by Muscovites, not by officials. And they do this all the time - not just by giving feedback to the Moscow Department of Health and other government bodies, but also through the “Active Citizen” platform, the media and other channels.

Considering the fact that Moscow is the only city that currently has such an open and transparent system for exchanging information between residents and the city government, it is fair to say that the opinions of Muscovites regarding specific aspects of the healthcare system are relatively objective. Here is what these opinions are: about 90% of residents gave positive reviews of the city’s clinics. And we must take into account that, overall, people are generally more motivated to leave negative reviews than positive ones.

There is another telling moment. Recently, there was an award ceremony for doctors who were mentioned by Muscovites within the scope of the “Thank you, Doctor!” initiative. Tens of thousands of people voted. I think that if people had overwhelmingly negative feelings about the healthcare system, we wouldn’t have received this much positive feedback.

On the other hand, I, as head of the Department of Health, can only rely on objective facts and figures. These facts and figures strongly suggest that, over the past five years, the material and technical supplies to medical institutions in Moscow, the qualification of personnel, the accessibility and the quality of medical services have all improved significantly for Muscovites.

Over five years, over 100,000 units of modern equipment were purchased for the capital’s medical institutions: CT scanners, X-ray scanners, endoscopy equipment and much more. A lot of institutions were renovated, almost two dozen clinics have been erected, along with new hospital wings, emergency stations and much more. Some of these facilities are truly unique. For example, we are finishing construction on the largest perinatal center in Europe at the Vorokhobov Hospital and a wing of the Morozov Children's Hospital.

This large-scale program of positive transformations with a simultaneous increase in the efficiency of medical institutions in Moscow and the integration of new management principles allowed us to achieve significant improvements across health and demographic indicators.

For example, in Moscow, the mortality rates for deaths related to cardiovascular disease dropped by 18% over the course of four years, infant mortality decreased by almost a quarter, and average life expectancy increased by almost three years, climbing to 6 years above the national average.

Compared to Russia as a whole, Moscow definitely has better health and demographic indicators. Could you tell us what the essence of the healthcare modernization program that was launched several years ago is? Why is it necessary?

Let’s clarify something again. Because this is not the first time we have focused on this. Modernization, reforms, optimization - all of these terms, which we usually employ in conversations about the changes in the healthcare system, aren’t limited to the healthcare system in Moscow. These innovations in the healthcare system are not a private initiative of some individual subject of the Russian Federation. The process began with the adoption of the 2010 Federal Law No. 326-F3 “On Mandatory Health Insurance in the Russian Federation,” which entailed the transition to single-channel healthcare funding through the Compulsory Health Insurance Fund.

Moscow had it tougher than other cities, since before the law came into force the capital had one of the biggest shares of budget financing for healthcare.

After the law changed, allocating financing to hospitals based on the number of beds was no longer made sense. Now, funding “follows the patient,” so to speak, much like “funds follow the student” when it comes to funding schools. Clinics, for example, have switched over to per capita funding because they are interested in improving the quality of their services, not  in increasing the quantity.

The volume of high-tech medical care funded by the budget doubled compared to 2015, which helps a lot of people get qualified medical care (Moscow clinics are providing more patients from other cities with high-tech medical care funded by Compulsory Health Insurance).

A three-tier healthcare system, which combines the capabilities of clinics, multi-specialty hospitals and early treatment centers, has been steadily operating in Moscow.

In other words, we are not talking about an experiment that we can evaluate from a binary perspective of failure vs. success, but rather about the need to meet the requirements of current legislation. It obliges us to optimize the operations of medical institutions within the scope of the existing funding structure while catering to the needs of the public. I think we have managed to do this.

So far as hospitals are concerned, it used to be that a person would go to the hospital for an operation and ended up spending an average of 2-3 weeks there. That is, if there were 20 beds, an average of about 30 people per month would be accommodated. Now, the same procedure, thanks to new approaches that include the use of new technologies, takes 3-4 days (including the recovery period), and the same space can accommodate 60-80 patients per month. Today, hospitals are operating at full capacity and a lot more patience get quality medical care.

In terms of numbers, the recent changes, which happened against the backdrop of a decline in the number of beds across state medical institutions in Moscow, have led to an increase in the number of people who received treatment. In 2015, the total number amounted to 1,965 thousand people (compared to 1,879 thousand in 2014 and 1,863 thousand in 2013).

There was once a time when Western journalists and diplomats working in Moscow would fly to Helsinki to get a simple filling done. There is no need for this today, right? Are there world-class medical centers in Moscow?

Of course, and they don’t exist only within the scope of private healthcare. Almost every Moscow clinic is on par with European medical institutions, both in terms of personnel and technical equipment. I wouldn’t point to any one clinic as an example. The number of foreigners who receive medical care (including specialized medical care) in Moscow continues to grow. We don’t have concrete numbers here because patients who don’t have Compulsory Health Insurance are provided medical care on a contractual basis. The same applies to Russian citizens if the medical services provided are not on the list of the service types or volumes guaranteed by the state.

Our doctors have started going abroad frequently to complete internships there. And foreign specialists come here as well, such as Indian ophthalmologists. Could you talk a little bit about these exchanges?

In 2012, at the initiative of the Moscow Department of Health, a program for the development of medical staff from the state healthcare system of the City of Moscow was launched. Education programs at foreign medical institutions are an integral part of this program. The program’s objective is timely training of medical personnel in accordance with trends in the medical industry in Moscow, current medical guidelines and international standards.

The first step toward in the development of international cooperation was the signing of the memorandum of mutual understanding between the Government of Moscow and the Department of Health in Basel (Switzerland). Then, there was a framework cooperation agreement between the Department of Regional Affairs, Economy and Health (DARES) of the Canton of Geneva (Switzerland), the University Hospital of Geneva and the Moscow Department of Health. There were also bilateral cooperation agreements signed with leading medical institutions in South Korea, germany, Italy, Belgium, Israel and Slovenia.

Experts from both sides developed unique programs for training medical personnel from the Moscow state healthcare system in accordance with the needs and trends of development of the industry in Moscow. There are currently international internship programs for doctors and nurses across various fields, as well as for policy-makers. The result of implementing international cooperation is a series of training programs and innovations in the operations of medical institutions that have proven to be efficient in Moscow public health practice.

A total of 975 Moscow healthcare professionals have received training abroad since 2012 - 605 doctors, 179 of which are department heads, and 370 nurses.

Is healthcare in the capital open to foreign investors? Do you have any examples?

Yes, there is a project that is being implemented within the scope of the Federal Law No. 160-F3 “On the International Medical Cluster and Amendments to Certain Legislative Acts of the Russian Federation." According to the bill, Russia is to have “world-class clinics that operate in accordance with the standards of medical care applicable in OECD countries, which includes the attraction of foreign doctors, the use of foreign medical equipment, technologies and medicine (certification for personnel is not required by Russian law in this case); scientific institutions that specialize in the development, manufacturing and implementation of medicines, medical technology and medical devices; educational institutions that provide training for Russian doctors and other medical staff with assistance from international experts in this sphere.”

The International Medical Cluster (IMC) is to be established on a 57.6 ha area at Skolkovo Innovation Center. Over the course of 10-15 years, up to 15 clinics that specialize in treating the most severe and widespread illnesses will be located on the territory: centers that specialize in cancer treatment, cardiology, orthopedics, traumatology and neurology. IMC projects participants will include leading medical centers from OECD countries. The first facility to be constructed at IMC will be a 13,000 sq.m. diagnostic building, which will house:

  • a diagnostic center (Check Up) for 375 visits per day with 49 outpatient rooms and a day patient facility with 4 beds
  • a simulation center for education and training
  • a conference hall that can accommodate 300 people, office spaces, a cafe for personnel, patients and visitors, and auxiliary facilities.

We plan on building two pilot buildings - one for diagnostics, and one for treatment - in 2017-2020.

Undoubtedly, this information serves as evidence of the fact that Moscow is an open city that is very appealing to foreign investment and partners. We are talking about a large-scale, international medical project. All of this requires us to work very hard and take into account the needs and wishes of people who live in our capital, which is really becoming a center for medical tourism.



Founder: Department for External Economic and International Relations of the Government of Moscow

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