Almost a year and a half after the start of the pandemic, the availability of medical services under compulsory health insurance (MHI) is still limited, according to a study by the All-Russian Union of Patients. Rosstat describes the situation in healthcare in a similar way. At the same time, according to the statistics department, against the background of reduced access to medicine, Russians paradoxically began to assess their own health condition more positively.
Despite the fact that almost a year and a half has passed since the beginning of the COVID-19 pandemic and the Russian healthcare system has had time to adapt to the additional burden, the previous availability of medical care, according to the Russians interviewed, has not recovered. This conclusion follows from a study conducted by the All-Russian Union of Patients in August this year. A survey was conducted of Russians who have applied for medical care over the past three years, and experts from specialized non-profit organizations. We also analyzed the complaints received by the hotline of the union.
Recall that since the beginning of 2020, due to the spread of COVID-19, some clinics and hospitals in the Russian Federation have been redesigned to treat only patients with coronavirus, and in some cases other patients could not receive treatment. The Compulsory Medical Insurance Fund claimed that the volume of reduction in planned medical care did not exceed 7-10% (see Kommersant dated August 12, 2020).
Now half of the respondents complained about the deterioration in the quality and availability of treatment under the compulsory medical insurance policy compared to the period before the pandemic (2018–2019). Among NPO experts, the share of those who gave such an assessment turned out to be higher (61%). The situation in primary health care looks worse than in hospital: while the proportion of those satisfied with treatment in hospitals was 42–45%, the proportion of those who were treated on an outpatient basis did not exceed 25%. Among the main problems when seeking help from polyclinics, the respondents named difficulties with access to both specialists and therapists, queues, and the inability to receive the entire volume of necessary treatment in one institution. During hospitalization, most often complaints were caused by the refusal to free hospitalization of the parents of patients under the age of 18, the need to buy prescribed drugs at their own expense, the incorrect behavior of health workers and referral to paid services.
The data of the All-Russian Union of Patients on the decrease in the availability of free medical care partially confirm the results of a comprehensive observation of the living conditions of the population, conducted by Rosstat in October-November 2020. So, in 2020, citizens applied for help a little less often (39.8% of respondents instead of 41.7% in 2018) and more often could not get it (4.8% complained about this after visiting a polyclinic against 2.9% in 2018 year). The share of those who received treatment in a hospital practically did not change and amounted to 7.4% (in 2018 – 7.6%), however, the waiting time for hospitalization increased: if in 2018 72.4% of patients were hospitalized on the day of treatment, then in 2020 this the share decreased to 43.1%.
According to Rosstat, paradoxically, despite the recorded difficulties with access to medical care, for the first time in several years, the proportion of Russians who positively assess their health has increased for the first time in several years. If in 2016 and 2018 the share of those who rated the state of the body as “very good” and “good” did not change and amounted to 4% and 38%, then in 2020 it increased to 5.8% and 40.7%, respectively. At the same time, the estimate of the prevalence of chronic diseases in the population, on the contrary, increased – from 26% in 2016–2018 to 27.2% in 2020.
Head of the Center for Health Policy at the Higher School of Economics (HSE) Sergey Shishkin notes that the reassessment of health status could be associated with the introduction of quarantine and the transition to remote work. “Many people had more time to take care of themselves, and this could feel like they were feeling better,” he says. According to Elena Selezneva, senior researcher at the HSE Institute for Social Policy, for many at the beginning of the pandemic, the risks of contracting certain diseases decreased – for example, the spread of infectious diseases (except COVID-19) and cardiovascular diseases decreased due to self-isolation. In addition, the impetus for revising the assessment could be a comparison of the state of one’s body with the state of health of those infected with the coronavirus, especially if the course of the disease turned out to be severe.
However, a slight increase in self-esteem of health could be caused precisely by the limitation of the ability to evaluate it more objectively at a doctor’s appointment. According to statistics, women, with more frequent visits to doctors and longer life expectancy, consider themselves to be more sick. Men who, on average, die ten years earlier, are less likely to complain about their health (see Kommersant, April 12). Perhaps because of the pandemic, women have also embraced this strategy of behavior, and it is likely that this will affect demographic indicators in the coming years.
Where do patients complain
According to the All-Russian Union of Patients, up to a quarter (24.3%) of all patients in the past three years have applied to various institutions with complaints about treatment under compulsory medical insurance. At the same time, only 29.4% of those who applied were able to achieve a solution to their problem. It was most effective to complain directly to the management of the medical organization in which the problem arose – it was resolved in half of the cases (52.1%). In second place in terms of the effectiveness of work with appeals were insurance companies – the problem was solved in a third of cases (35.2%), or at least the applicant received an explanation (40.2%). The prosecutor’s office turned out to be just as effective, with the help of which a third of the respondents also achieved the elimination of the problem. The respondents named appeals to the Federal Compulsory Health Insurance Fund and its territorial divisions the least useful in case of difficulties with treatment. In the case of FFOMS, only 21.3% of respondents managed to achieve a solution to the problem, for territorial funds this figure was 27.1%.