Medical equipment in the era of sanctions: what doctors and patients hope for

Irina Mishina

After vain attempts to sign up for an x-ray for a month, I found out that in all three branches of the Moscow clinic to which I was attached, these devices were out of order, and there was a problem with spare parts. An even greater shock awaited me when I took a general blood test. It turned out that laboratory diagnostics in Russia depends on imports by 90%.

We have our own, but not very much, and imports will rise in price

We purchased not only reagents and test systems, but even most of the test tubes and reagents abroad. Needles - too, in Russia, as it turned out, medical needles are not produced at all. Tumor markers, hormones, tests for infections, in particular, necessary for the diagnosis of covid - all this on imported materials and reagents.

However, as commercial laboratories explained to us, there are also domestic test systems for oncomarkers, hormones, and infection detection. The problem is that they are not automated, and you have to enter data into the computer manually. And thus the risk of error or inaccuracy increases. The diagnosis made by eye with the flu is not so terrible. But when determining covid or during a heart transplant, this can lead to a tragic ending. In any case, even if the problem with imports is resolved, prices will rise. The reason is that suppliers and logisticians raise prices, and laboratories are forced to focus on them.

X-ray, CT, MRI, ultrasound - all these diagnostic methods are also likely to experience a crisis.

“Our equipment is there, but it does not work very well. At one time I worked in an X-ray room, on devices that Russia produced jointly with Ukraine. It was extremely difficult to work for them. We reported that we manufacture our X-ray machines and ECG machines in Rostov. But they do not have microcircuits that are produced abroad. Now we are waiting for China to offer them. By the way, almost all the ultrasound machines we work on are China, so you don’t have to worry in this regard”, - Dmitry Epshtein, vice president of the Regional Organization of Nurses in Moscow, told NI.

“Sanctions did not formally affect the supply of medical equipment. But Siemens and Phillips, for example, left the Russian market themselves. And these are the main suppliers of sophisticated diagnostic equipment and endoscopes for operations. Obviously, new expensive purchases are coming. As for drugs, we seem to produce generics ourselves, but the raw materials for them are imported. Now in clinics, the budget for reagents and consumables is small, you need to somehow fit into all this. And here a lot of problems arise. Indeed, we ourselves do not manufacture test tubes, needles, or tumor markers. Especially difficult times are coming for oncological patients”, - doctor of medical sciences, head. Department of Oncology, Tver Medical University Maxim Rykov told NI.

Cancer tragedy

Oncology is a field of medicine with a high demand for high-tech materials and equipment. And technological chains are most often multinational. This applies to equipment, and maintenance, and consumables, and medicines. So it is difficult to fully predict the consequences of sanctions for oncology.

“Not so long ago I was at a congress of oncologists. In the speech of the chief oncologist of Russia Andrey Kaprin, a new term was mentioned: the 3rd and 4th stages of oncological diseases were called "advanced" instead of the traditional term "common". Perhaps this was done to cover up problems. After all, good equipment is needed to diagnose cancer. And we in Russia, in fact, do not produce anything for the diagnosis of cancer. The basis of cancer diagnostics is microscopy, and there is no own production of microscopes in Russia. There are no endoprostheses in Russia either, we also order bone screws, and here difficulties with logistics will lead to their rise in price. Now there is such a trend: high-quality endoprostheses with good strong screws are placed for young and active, and for the elderly - domestic designs of low quality. In my opinion, prioritizing patients on some basis is not right”, - says Doctor of Medical Sciences, oncologist Maxim Rykov.

If in Moscow and St. Petersburg there are both finances and opportunities for the purchase of high-quality imported equipment, everything is rather sad in the regions.

“As a person who has worked in regional medicine for a long time, I can say that there is panic on the ground. There is no money for equipment and consumables that have risen in price in the regional budgets, and no one really knows how to make purchases according to the new rules. At the same time, some distributors leave. It would be wrong to say that we produce absolutely nothing ourselves. But few people try to understand the real possibilities of regional medicine. I was a witness when the commission of the Ministry of Health came to the Tula region. Instead of 20 days, she worked for 3 hours, fixed some little things like a shortage of gloves for nurses, but nothing was recorded in the final act, because everyone understands that the plight in the region will be a minus for the Ministry of Health itself”, - the vice president of the Regional Organization of Nurses of Moscow Dmitry Epshtein told NI.

Another issue is dentistry. How will the sanctions affect it? After all, this is a high-tech branch of medicine, which is absolutely dependent on imports. Dentists warn: after the stock of materials and instruments from suppliers runs out, which is 3-5 months, we will mainly put fillings from silicin and silydont. About aesthetic dentistry, apparently, will have to be forgotten. There are no Russian analogues, and this is not even about medical equipment, but about filling material, ceramic masses, impression material - absolutely all of this is imported. Suppliers are not terminating contracts yet, but they are raising prices by 30-50%. So the prices for dental services, it is possible, will also grow.

“Compulsory medical insurance tariffs for dentistry do not apply entirely. Good fillings, dentures - all these are imports. That is why most dental services are provided in private clinics. And there is also a deficit. As well as in plastic surgery. In these areas, a serious crisis should be expected. I want to say that private clinics are now generally sagging in terms of clients, many are closing: there are no clients, there is no demand. It’s just that people don’t have money”, - says Maxim Rykov, the doctor of medical sciences, the head of the Department of Oncology in Tver Medical University.

New providers and new CHI tariffs

Where is the exit? After all, Crimea survived after the introduction of Western sanctions. We addressed this question to a general practitioner Dmitry Epshtein, who worked in the Crimea for a long time after its annexation to Russia.

“In Crimea, after the imposition of sanctions, starting literally from 2014, there were no direct deliveries, but at the same time, there was absolutely all the necessary equipment and consumables. And now, if you debug the general scheme, everything will work. Delivery from China, through India is possible. All laboratory equipment, consumables, analyzers - all this is quite realistic to receive, however, taking into account the increased cost of logistics. From experience I can say that business does not tolerate empty spaces. China responds very promptly to emerging demand, works well and dynamically, adapting to any situation. But we need to develop other markets, for example, the Indian one”, - says Dmitry Epshtein, Vice President of the Regional Organization of Nurses.

“Of course, Siemens equipment cannot be compared with Chinese equipment, but now China dominates at medical equipment exhibitions and presents all types of equipment - CT, MRI, ultrasound, PET CT. The question of the supply of Chinese components may be raised. It would be nice to rebuild military factories, for example, for the assembly of tomographs. But all the restrictions, the increased cost of logistics - all this will inevitably fall on the shoulders of patients”, - says oncologist Maxim Rykov.

Indeed, even if it is possible to agree on the supply of diagnostic equipment, test systems for analyzes and other consumables, due to changes in logistics, all this will rise in price, and this will inevitably affect the rise in the cost of compulsory medical insurance services. Doctors are already sounding the alarm: an increase in the cost of medical equipment, test systems, analyzers and consumables may lead to a reduction in the list of compulsory health insurance services. What should be prepared for? We sent a request to the Russian Ministry of Health, however, at the time of publication, no response was received. If he still comes, we will certainly publish it.

“We are waiting for the adoption of a decision to increase tariffs for CHI. The government commission that deals with this plans to increase the cost of spending and allocate subsidies. A special interdepartmental commission has been created. Reducing state subsidies for health care is impossible, based on the Constitution of Russia. In addition, there are revenues in the state from the sale of oil and gas, they must cover the new logistics. Transportation through China, Turkey, India is possible. The problem should be solved by our trade representatives in these countries, and urgently, this is their job. Everything is there, you just need, as they say, to work hard to pick it up from the floor”, - a member of the Public Council for the Protection of Patients’ Rights under Roszdravnadzor, Doctor of Medical Sciences, Professor Alexey Starchenko told Novye Izvestia.

There was a hope that the own production of diagnostic equipment in Russia will begin in the near future. The way for this was opened by a bill submitted by the government on March 3 to the State Duma. It allows you to approve a group of products that will not be subject to patent protection legislation. In fact, this means that you have to take someone else's, because they could not do their own.