Doctors in Moscow rally against planned hospital closures
- Vasiliy Vlassov
Doctors and other healthcare workers took to the streets of Moscow on 2 November to protest against the planned closure of more hospitals and other healthcare facilities in the Russian capital.
The plans to close 28 healthcare facilities—including 15 hospitals—in Moscow, which were leaked and published on the internet, are expected to result in the loss of thousands of healthcare jobs.1
Since 2000 the number of healthcare facilities in Russia has more than halved—from 10 704 facilities in 2000 to 4398 in 2013. Small rural facilities and offices of doctors and nursing care providers were the first to close, and then the closures continued when responsibility for basic healthcare provision was transferred from municipal to regional administrations. Officials argued that the closures were necessary because the health service was costly and inefficient and needed to be reorganised.1
Reorganisation of healthcare funding began four years ago and included the channelling of money through the compulsory medical insurance fund, with an accompanying reduction in the federal budget for health. However, the insurance fund was not sufficient to cover all healthcare costs, and regional budgets do not have spare funds to make up the shortfall.
Adding to the pressure was an order, signed by President Vladimir Putin when he entered office for a third term in 2012, that doctors’ salaries were to be increased substantially to 200% of the regional mean wage. To fund this rise some doctors’ posts were cut, increasing the workload of those who remained. The Russian ministry of health reported that the income of doctors had risen since 2012, but the state accountant reported that the amount doctors are paid per hour had not increased.
Moscow’s vice mayor for social affairs, Leonid Pechatnikov, will be responsible for implementing the planned closure of health facilities in Moscow. He told radio station Ekho Moskvy on 28 October that the leaked document outlining the closures was not a finalised plan but a proposal from an unfinished study being conducted by a consulting company.2 The document included an economic evaluation of every hospital to be closed and a step by step description of the legal actions to be taken—from the first formal decision to the passing of the hospital complex from the medical administration to the city.
In apparent response to the anger of healthcare workers the state legislative body called for a public consultation to be held before any reorganisation of the healthcare system was implemented.
Cite this as: BMJ 2014;349:g6623