Average temperature by healthcare system

Russian Health Minister Mikhail Murashko announced a “colossal breakthrough” in the healthcare system: the level of patient satisfaction with medical care increased to 47% from the pre-pandemic 30%. However, experts interviewed by Kommersant criticize the method by which the agency receives feedback from citizens. They point out that the Ministry of Health has combined in one issue both the level of service and the quality of medical care itself, which confuses patients. Experts also consider the approach in which officials “evaluate themselves” to be incorrect.

Minister of Health Mikhail Murashko told students at the Pirogov Russian National Research Medical University that the level of patient satisfaction with medical care increased in June of this year to 47.1%. Mr. Murashko clarified that a year earlier the Ministry of Health estimated the figure at 41.4%, and in the “pre-pandemic period” – within 30%. Therefore, the minister called the “jump” that the Russian healthcare system has made “colossal.” Citizens, in his opinion, primarily appreciated the quality of work during the pandemic.

Let us recall that the formula for calculating the level of population satisfaction with medical care appeared only in June 2022. It was developed by the Research Institute of Organization and Informatization of Health Care (TsNIIOIZ) of the Russian Ministry of Health, the same structure is responsible for the calculation. Citizens are asked to fill out a questionnaire of 21 questions: about the availability of medical care, interaction with staff, compliance with expectations, and the ability of the system to solve their medical problem. But the final percentage of the satisfied population is derived from only one question in the survey: “Assess your overall satisfaction with medical care.” The remaining questions, clarified the head of TsNIIOIZ Olga Kobyakova, are used “to build an ordinal regression model” – to identify the factors that have the most and least impact on the overall level of satisfaction with medical care. According to them, the Ministry of Health promises to give individual recommendations to the regions.

It should be noted that until 2022 in Russia there was no single mechanism for assessing citizen satisfaction – and different departments, Ms. Kobyakova noted, used different methods, which ultimately showed different figures. Mikhail Murashko did not specify in his lecture exactly what methodology was used to calculate the satisfaction rate of 30% in the “pre-pandemic period.” Later, the Ministry of Health told Kommersant that this figure was taken “based on data from earlier sociological surveys.”

Director of the Institute of Health Economics at the Higher School of Economics Larisa Popovich believes that there is still work to be done with the survey methodology: “A person is asked for a long time whether he is satisfied. They bring up the concepts of quality, availability, which have many meanings. As a result, the overall assessment is based on one single general question. And it is completely unclear what a person understands by this “common.” Ms. Popovich believes that the satisfaction indicator should be more comprehensive. And he notes that for management decisions it is much more important to understand what exactly the consumer would like to improve in this system. “It’s good that general estimates are growing, but this is the average temperature for the hospital, which does not reflect the problem itself and does not detail it,” summarizes Larisa Popovich.

The founder of the social design center “Platform” Alexey Firsov draws attention to the fact that healthcare services are divided into two autonomous parts: organizational aspects (how the patient was received, whether there was a queue, how they were served) – and the quality of the treatment itself. Under such conditions, assessing the problem “as a whole” is quite difficult for the respondent, Mr. Firsov believes. “Methodologically, it would be more correct to separate these positions. But doing this for the Ministry of Health is risky in its own way. It may turn out that the position, which is easier to manage, has grown significantly. And it’s easier to manage the organizational process, by and large,” suggests Alexey Firsov. “Against the background of the washout of imported medicines and other possible problems, the treatment process itself might not have received such high marks. And perhaps it is easier to combine these two positions manipulatively. Then the stronger factors will pull out the weaker ones.”

Yan Vlasov, a member of the Human Rights Council under the President of the Russian Federation and co-chairman of the All-Russian Patients’ Union, agrees with him: “I can’t say that there are any serious changes in terms of increasing satisfaction with the quality of medical services. But there are positive trends related to the quality of service. If the situation has improved in these matters, this should be welcomed. However, these options do not directly relate to the medical service.” In general, Mr. Vlasov points out, there are no more specialists in the system and there is still a problem with the availability of some medications. Therefore, it is necessary to conduct a more in-depth study and validate the questions raised by the Ministry of Health. Alexey Firsov also calls the situation when the medical department “evaluates itself” incorrect. In his opinion, for this there should be a “relatively external audit.” Mr. Firsov calls for looking at the Ministry of Health data from the other side: it turns out that 53% of Russians are still not satisfied with medical care.

The head of the Higher School of Organization and Management of Healthcare, Guzel Ulumbekova, calls the share of those satisfied with medical care at 40% a “satisfactory indicator” – with the caveat that the sample of respondents included small towns and rural areas. In France, Germany, Norway, the satisfaction rate, according to her, is 60–70%, but there they spend 2.5–3 times more on free healthcare than in Russia in comparable terms. The expert believes that there are no prerequisites for further increasing the availability of free medical care in our country, primarily because there remains a high staff shortage. “Additional government funding can solve this problem,” she points out. “Today, the share of healthcare in GDP is 3.9%. We need at least another 1%, or 1.5 trillion rubles, to solve both the personnel problem and implement a system of universal drug provision. Then the share of satisfied patients will increase to 60%.”

Natalya Kostarnova, Karina Sergeeva