Budget - 2021: how the government cuts spending on medicine

Before its adoption, the Higher School of Health Organization and Management sent an appeal with criticism to the government, the State Duma, the Federation Council and the governors of Russia.

Irina Mishina

What caused the experts' criticism? After all, the draft budget provides that next year government spending on healthcare will increase by 15% (by 600 billion rubles) compared to 2019. These are additional costs due to the pandemic (payments to medical workers, for the purchase of drugs and equipment), as well as the national project "Health". In 2021-2023 Also, expenses are provided for the national project "Healthcare" (about 240 billion rubles per year). An amendment was approved on the annual allocation of 90 billion rubles for primary health care. Budget allocations for the “Healthcare” section will amount to 150 million rubles in 2021, 154 million rubles in 2022, and 158,559.8 million rubles in 2023. It is expected that these funds will be used, among other things, for the treatment of children with severe, rare diseases, for the purchase of expensive drugs, rehabilitation means, as well as for high-tech operations.

As you know, the health care budget consists of three "pockets": these are funds that come from the federal budget, from the Federal Health Insurance Fund (FFOMS) and from regional budgets. “Planned government spending on health care at current prices in 2021 will remain at the level of 2020, and by 2023 will grow according to the plan by only 7-8%. But...

Adjusted for inflation, health care spending in 2021 will decrease by 3% compared to 2020, and by 4% by 2023. This will happen mainly due to the federal budget, whose expenses in prices adjusted for inflation in 2021 will decrease by 14% compared to 2020, and by 23% by 2023.

"We are told that in 2021 expenses from the FFOMS for health care will grow by 7-8%. But the funds of the FFOMS largely consist of contributions to the CHI system. And these contributions, in turn, directly depend on the wage fund. However, in the context of a protracted pandemic and economic crisis, the reality is a decline in wages and an increase in unemployment. Where does the growth of CHI expenditures on health care come from in these conditions? The 7% figure was set in the summer, when no one expected such consequences of the second wave of coronavirus. Accordingly, in 2021, in relation to 2020, the budgetary system's expenditures on health care will be completely reduced", - Rector of the Higher School of Health Organization and Management Guzel Ulumbekova told Novye Izvestia.

In her address to the chairman of the State Duma Committee on Budget and Taxes Andrey Makarov, she says: “Unfortunately, this budget does not provide for the necessary increase in health care costs. This will not make it possible to increase the availability of medical care to the population of Russia and to fulfill the national goals - “preserving the population, health and well-being of people”. The rector of the Higher School of Economics also sent appeals on the need to increase the budget for health care to Prime Minister M. Mishustin, Chairman of the Council of Federations V. Matviyenko, Chairman of the State Duma V. Volodin, as well as Russian governors. However, there was no reaction. It seems that state institutions and their leaders agree on only one thing: to go with the flow, repeating the mantra: "The state has no money".

The budget adopted in its current form means that free medical care will become even less accessible, less free medicines will be received by “beneficiaries”, less money will be allocated to pay medical workers, less money will be spent on consumables, and additional personnel will not be able to be attracted to medicine. And all this - against the backdrop of a pandemic that is not declining. As you know, the Chief Sanitary Doctor of Russia and the head of Rospotrebnadzor Anna Popova extended the validity of her decree "On the approval of sanitary and epidemiological rules "Prevention of coronavirus infection" until January 1, 2022.

According to calculations provided to Novye Izvestia by the experts from the Higher School of Health Organization and Management, the share of public funding for health care in GDP will also decrease next year - from 4.1% in 2020 to 3.6% in 2023. At the same time, government spending in the Russian Federation today, and so it is almost one and a half times lower than in most countries of Eastern Europe - in particular, in Hungary, Latvia, Lithuania, Poland, Slovakia, Slovenia, the Czech Republic and Estonia.

By the way, in these countries already today the indicator of life expectancy, which is a key characteristic of the health of the population, is almost 78 years, while in the Russian Federation it is only 73.3 years. Experts expect a further decrease in this indicator next year. “The expected increase in mortality in Russia with the continuation of the pandemic will be 130-140 thousand people a year. Half of them will die from the coronavirus, the rest - from the fact that they were not provided with the necessary medical care on time”, - sums up Guzel Ulumbekova.

Experts cite other alarming indicators. So, since 2017, the population in the Russian Federation has been decreasing and in 2020, according to forecasts, the number of deaths will exceed the number of births by 353 thousand people. This is due to high mortality and low birth rates.

Over the past 30 years, the number of disabled children has grown 4.4 times. And at the same time, as the rector of the Higher School of Economics said, from 2000 to 2019. the provision of pediatric beds decreased by 54%, by 21% by pediatricians and by 11% by district pediatricians

How much money is needed to ensure that healthcare in Russia at least justifies its name? According to economists, in order to solve the problems of Russian healthcare, it is necessary to find additional funds from the federal budget in 2021 - 512 billion rubles, and by 2024 - 2,212 billion rubles. This calculation was made on the basis that government spending on health care should gradually increase to 5% of GDP by 2024, as in the Eastern European countries of the EU, which are close to our country in terms of economic development.

If this does not happen, Russia may suffer the most irreparable losses - human losses. After all, health care, as well as defense, is the basis of the security of our country.