There were advantages in the pandemic – Newspaper Kommersant No. 217 (7418) dated 11/23/2022

In 2022, the Russians unexpectedly discovered positive changes in the healthcare system. This follows from a survey of the All-Russian Union of Patients, whom Kommersant met. The proportion of study participants who reported a worsening situation almost halved, from 68.6% in 2021 to 38.9% in 2022. And the number of those who positively assessed the changes increased from 8.7% to 11.1%. Sociologist Aleksey Firsov explains the change in sentiment as the “relaxation of the clamps” of the pandemic and the “besieged fortress syndrome.” In his opinion, people criticize the healthcare system less because they see the situation as “we are all in the same boat.”

The study of urgent problems of Russian healthcare in 2022 was held from October 20 to November 15 in an online format. The All-Russian Union of Patients (VSP), with the support of the Social Mechanics Center for Humanitarian Technologies and Research, posted questionnaires on the Yandex Forms platform. As a result, 2559 patients from 80 regions of the Russian Federation took part in the survey (last year there were 1452 patients from 76 regions). Among the participants in the study, women (81.5%) and middle-aged people (65%) traditionally predominate. The most widely represented diseases of the nervous system and neurological diseases (28.3%), diseases of the endocrine system, eating disorders and metabolic disorders (21.9%), orphan diseases (16.1%), disorders of the musculoskeletal system (15 .2%), diseases of the musculoskeletal system and connective tissue (14.7%), as well as diseases of the blood and hematopoietic organs (14.3%).

The authors of the survey note that the structure of the sample by sex, age and disease profile of the study participants is close to last year. This makes it possible to track the dynamics for two years. In 2022, the opinion of those surveyed on health care trends “changed markedly,” the WSP points out. The share of respondents who reported a deterioration in the situation with medical care almost halved: from 68.6% in 2021 to 38.9% in 2022. And the proportion of those who positively assessed the changes increased from 8.7% to 11.1%. At the same time, the majority of patients (44.9%) believe that the situation has not changed over the year.

Against this background, the number of those satisfied with medical care has doubled – from 10% in 2021 to 21% in 2022. In particular, citizens began to point out the poor performance of the ambulance service less often: in 2021, 36.4% of respondents complained about this problem, in 2022 — 18%. The low availability and quality of outpatient care was noted by 53.2% of respondents this year against 66.2% last year; inpatient treatment – 27.5% and 38.5%, respectively.

Participants in the study were also asked what exactly had improved in health care delivery over the past year. The authors emphasize that for all the proposed options, there is a “dynamics of positive changes”. “Significant” was the gap between estimates of the availability of subsidized medicines (8.1% called them affordable in 2021 and 13.5% in 2022) and electronic prescriptions (growth from 4.3% to 9.9%), the relationship medical staff to patients (5.1% last year and 9.1% now), patient routing in the clinic (4.6% and 8.5%), availability of remote medical consultation (5.4% and 8.9% ). 39.6% of respondents in 2022, when asked about positive changes in the provision of medical care, stressed that “nothing has gotten better.” However, the percentage of such answers is significantly lower than in 2021 (61.2%).

Co-chairman of the All-Russian Union of Patients Yuri Zhulev believes that positive changes in the assessments of the healthcare system are due to the fact that the coronavirus pandemic has begun to decline. “During the pandemic, medical institutions were repurposed, access to doctors was limited,” he recalls. At the same time, the expert emphasizes that the fight against the pandemic “spurred on many positive initiatives” – for example, the development of digitalization of the healthcare system and telemedicine services, and remote delivery of medicines. The GSP hopes that “positive trends will continue.”

Aleksey Firsov, a sociologist and founder of the Platforma social design center, agrees that this year there has been a “clearing of the clamps” that arose during the pandemic. However, the positive dynamics in the assessments of the health care system, in his opinion, can also be explained by the “besieged fortress syndrome”. “We see it in other areas as well. For example, the social reputation of business has greatly increased. Nothing seems to have happened either, but everyone knows that business suffered from the sanctions, and against this background, the strength of the social brand of Russian entrepreneurship as a whole has almost doubled,” explains Mr. Firsov. “Now is the time: people criticize less, because there is an awareness that we are all in the same boat.”

The survey also recorded that large-scale problems persist in healthcare. The most significant of them, according to patients, is the low quality of outpatient care in polyclinics (53.2 percent think so). Evaluations of the work of the polyclinic at the place of residence are quite critical. “Extremely low” it was rated by 15% of respondents, “deuce” by another 20%. 40% gave “satisfactory” ratings, while only a quarter of the interviewed patients gave ratings of “4” and “5” (20.1% and 4.8%). 69.8% of respondents faced the lack of the necessary specialist in the polyclinic. 63% of the interviewed patients indicated an appointment with a doctor for more than 14 days, and 54.1% complained about the need to buy drugs free of charge by law. 51% of the respondents pointed to the lack of a discounted drug in the pharmacy, and 45.3% spoke about the queues for diagnostics and tests, as well as the inability to undergo diagnostics on time. In 2022, 84% of the surveyed patients applied to paid medical services.

Andrey Konoval, co-chairman of the Deystviye medical trade union, notes that the number of medical workers in Russia has been declining since 2013. So, back in 2019, Deputy Prime Minister Tatyana Golikova reported to Vladimir Putin about a shortage of 25,000 doctors and 130,000 nurses due to low wages and low base salaries. “The shortage of staff leads to huge workloads. Doctors do not have time for personal life, for rest, not to mention time for advanced training,” says Mr. Konoval. “As a result, a burnt-out doctor will not even smile at the patient.” He recalls that primary care physicians see 30-70 patients a day, with an average of 12 minutes per appointment. At the same time, the diagnostic capabilities of polyclinics are limited: according to Andrei Konoval, physicians are often given a limit on the issuance of referrals for research. There is also a shortage of narrow specialists to whom it is necessary to refer citizens according to the profile of the disease.

The introduction of quarantine measures in connection with the pandemic has significantly stimulated patients to turn to the Internet and electronic services to receive medical services. However, the only remote service that was used by about 60% of patients a year ago and is now used is online doctor appointments (61.1% in 2021, 64.9% in 2022). The number of patients using online access to a medical record is growing (from 15.1% to 18.3% per year).

Ekaterina Kuzina, Medical Director of MK Doctor Nearby, points out that telemedicine is “just beginning its journey” in Russia, and therefore is not yet publicly available. At the same time, many familiar offline services are moving to digital, which increases their availability and popularity. “A striking example is remote monitoring of diabetes mellitus and cardiovascular diseases. Further development of this trend, the introduction of a number of changes to the current legislation will help improve the development of telemedicine,” concludes Ms. Kuzina.

Natalya Kostarnova