Making Health Care Healthier for All in Russia

The premature death rate in Russia's Kirov region, especially for working men, is 15% higher than the already high rates in the rest of Russia.

One of the ways the Kirov region is tackling the problem is by strengthening the primary health care system and pruning the old, bloated health structures of the past.

One of the ways the authorities are doing that is by taking medicine to the people. Instead of taking her 8 month old son Kiril to the hospital for his cold, Elena Afzalutdinova is bringing him to a primary care office on the outskirts of Sloboda, a city 1,000 kilometers northeast of Moscow, in the First of May neighborhood.

She says it is just easier to come here. "Here, there's a good attitude toward patients, we can always get in to see a doctor."

The doctor's office in First of May sees about 35 patients a day, and it is part of a larger plan to make basic and preventive health care accessible and available to everyone, especially in the countryside, which often suffers from too few doctors. With support from the World Bank, the number of family clinics here has almost quadrupled in two years.

And the focus has shifted. Now, doctors focus on better living and disease prevention. The idea is to keep people healthier longer. And the patients keep on coming, says Dr. Alexandr Maximovsky, a family doctor at a clinic. "Better health—anytime we can provide emergency care, that means we're important," he says.

The goal is keeping people out of the hospital.

Only the truly sick wind up there now. In the Kirov region, there are over ten hospital beds for every one thousand people. That's an extremely high hospitalization rate.

And it is expensive. Government officials in Kirov argue there are better ways to spend money on health.

Shorter hospital stays, stronger basic health care and a smaller bureaucracy are all parts of the new plan. "Now, we link expenditures and outcomes. We want to know how the money is spent, to increase life expectancy, raise birth rates, lower mortality rates," says Nikita Belykh, governor of Kirov region.

At the Sloboda Central City Hospital, administrators have cut the number of beds in half, to 265, over two years. The hospital serves about 200,000 people, and has about of 95% occupancy rate.

Before 2009, about 20% of the hospital's patients simply checked themselves in. Now, they come in only in emergencies, or with a doctor's referral, instead of just showing up for care. Patients say far fewer people crowd the halls now, and it is much easier to get the care they need.

"It is quiet, its better now, there used to be people everywhere in the wards," says Vera Mozhegova, who has had a hernia removed at the hospital. Iya Irshova, whose husband had a mild heart attack, agrees. "Things have changed for the better. There are fewer people in the hospital. I don't have to wait to see a doctor."

Hospitals are also consolidating. A network of 11 interregional hospitals will now offer high tech and specialized care. The government is closing old, inefficient hospitals and building local clinics in their place.

And new equipment is on the way. Workers at the Central City Hospital are building rooms for new MRI machines. And they're renovating the infectious disease wards. In 2003, the hospital owned no resuscitation equipment. Now it has nine emergency resuscitation beds and expects to have 15 next year.

This is a new emphasis for Russia. State-of-the-art technology combined with a more nimble health care system, which authorities hope will move from mostly treating the sick and dying to providing preventive care to a generally healthier population.