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65 % of health care expenses are associated with inpatient care vs. 45% on average for the OECD countries. Given the low funding for the Russian health sector, it means that polyclinics are paid on, a very weak, residual basis.
Of the total number of Russian physicians, only 20 to 25% provide primary care, while in modern health care systems this share is 40-50%, and 60% in Canada (In Russia, primary care is provided by area-serving internists and pediatricians, workplace-serving internists, and Ob/Gyn physicians on the staffs of policlinics).
Hospitalization rate is 21 per 100 enrollees vs. 12-17/100 typical for the OECD countries.
Average length of hospital stay (ALOS) is 17 days vs. 8-13 typical for the OECD countries.
More than 30% of primary visits result in patient referrals to specialists vs. usual Western 4-10%.
As patients cannot afford drugs because of their high sale prices, their health status deteriorates resulting in growing demand for high-cost hospital care.
Excessive hospital capacities build up financial pressure on health care systems (today, fixed costs share in health care facilities’ budget is up to 50%).
Today two issues of Russian health system development are being discussed nationwide by health care leadership: Can we get more money? and Who is to be in position to control money (health authorities or health insurance funds)? The problem of remodeling health care structures is hardly considered at all. At the same time, nothing indicates that the health sector budget would increase significantly. So, the main challenge of the day is to redesign health care system itself -- to find new ways for cost-containment that would not affect quality and accessibility of care.
Russia's hospitals and polyclinics are generally old (about 15 percent were built before 1940), and they lack basic amenities. Roughly 42 percent of the country's hospitals and 30 percent of its clinics lack hot water, and 12 percent and 7 percent, respectively, have no running water at all. About 18 percent of hospitals and 15 percent of clinics are not connected to a sewerage system, and only 12 percent in both categories have central heating. Even in the best hospitals, medical personnel do not regularly wash their hands, surgical instruments are not always properly sterilized, and rates of infection are abnormally high.