Medicine is infected with corruption
The Russian healthcare system is short more than half a trillion rubles, the Accounts Chamber has stated. The largest amount of money – 379 billion rubles – is needed to bring the salaries of medical personnel to the level set by the president’s May decrees. The ambulance service is short another 22.9 billion.
What is noteworthy is that the calculations were made without adjusting for the shortage of doctors. If we assume that the personnel deficit could be overcome, then already this year the system would need an additional 133.2 billion rubles, and in 2025 – another 139.7 billion rubles.
Such gigantic volumes of underfunding are not always connected with a lack of funds. It turned out that local officials sometimes simply do not delve into the needs of the healthcare system. For example, standards for providing medical care in the regions are set lower than those stipulated at the federal level.
It is clear why – according to reports, regional authorities are fulfilling their obligations, but Moscow does not know that it is almost impossible for local residents to get to a doctor.
At the same time, the Accounts Chamber has been talking about the problems of underfunding the healthcare system year after year. Thus, in 2021, auditors warned that in the event of a sharp increase in the incidence rate, the regions would physically not be able to increase the volume of medical care. And in 2020, figures were made public on the record budget deficit of territorial compulsory medical insurance programs: in 56 regions it then amounted to 51.3 billion rubles. It would seem that what should the Ministry of Health do in such a situation? At the very least, take on the problem. However, the department Mikhail Murashko They seem to be looking at the situation with Olympian calm.
Recently, Mikhail Murashko presented a report to the State Duma on violations in the financing of emergency medical services. It turned out that 9.5 billion rubles were “diverted to other purposes,” and another 16 billion rubles were supposed to come from regional budgets, but did not. At the same time, for some reason, the minister limited himself to stating these facts, without saying anything about the measures that will be taken. And this despite the fact that the topic of underfunding of emergency medical services has become relevant in connection with the mass protests of doctors who are dissatisfied with the fact that their service is not mentioned in the government decree on the appointment of increased social benefits.
Rosstat, which recently presented a report on the average salary of medical workers, was apparently tasked with sorting out the situation. According to official data, on average, Russian doctors earn about 116 thousand rubles a month, nurses – 58 thousand, and orderlies – just over 50 thousand. It is easy to guess that in reality, things are somewhat different. According to a survey conducted by RNC Pharma jointly with the industry resource Medvestnik, the salary of every sixth medical worker in the country not only did not increase by 7%, as state statistics claimed, but even decreased. The difference in calculations is easily explained. In February, the president ordered that the share of medical workers’ salaries in the payment structure be increased to 50%. In pursuance of the order, the Ministry of Health issued recommendations according to which medical institutions were allowed to “review the list of incentive payments and the conditions for their appointment.” It was also said that it was possible to “replace payments as a percentage of the salary with fixed amounts.” That is, in fact, the salary has increased, which was confirmed by Rosstat. But the total amount of income received by doctors in hand has decreased.
No hospital – no debt
Hospital administrations have their own truth. Due to a lack of funding, some hospitals are now on the verge of bankruptcy. For example, this situation has developed in medical institutions in the Magadan Region. In the spring, the accounts payable of medical organizations in the region exceeded 2.5 billion rubles, and bailiffs even initiated enforcement proceedings against the regional hospital to collect debts on taxes and fees in the amount of more than 1 billion. The hospital also owes 17 million to its employees.
At the same time, the situation in the Magadan Region is not unique. The overdue accounts payable of medical organizations this year amount to about 17 billion rubles, the Ministry of Health calculated. Not forgetting to boast: supposedly, last year the debt was as much as 20 billion. As a result, the department assessed the situation as stable.
Since it is prohibited by law to bankrupt state hospitals, optimization came to the rescue. “Nasha Versiya” has already reported how in the same Magadan Region they took the path of quantitative reduction of medical institutions. As they say, fewer hospitals – less debt. As a result, an oncology dispensary and district hospitals were added to the regional hospital, and psychiatric and drug dispensaries, adult and children’s dentistry were combined. Apparently, this experience was considered successful, which is why it quickly spread to other regions. Thus, in Khabarovsk, the local Ministry of Health decided to merge all three existing maternity hospitals.
Bribe virus
However, looking at what is happening in the territorial ministries of health, you are not at all surprised by what is happening. The news coming from the relevant ministries of the regions has long resembled a crime chronicle. Here are just a small part of the events that happened in August. In Ingushetia, the Investigative Committee opened a criminal case against the former deputy minister of health of the republic. According to the investigation, using a commercial firm under his control, the official purchased medical equipment at inflated prices. In the Irkutsk region, a court is hearing a case against the former minister of health Yakova Sandakova. He is accused of bribery, money laundering and abuse of office. Notably, Mr. Sandakov replaced Natalia Ledyaevawho also ended her career after becoming a defendant in a criminal case of fraud. The Sandakov case involves episodes related to the supply of equipment to regional hospitals at inflated prices. It is quite natural that in such a situation, medical institutions find themselves on the verge of bankruptcy and cannot pay salaries to employees.
The Khabarovsk Krai Ministry of Healthcare has also been plagued by personnel failures. In 2023, two assistants to the head of the department were accused of fraudulent purchases of medical equipment. Moreover, as Nasha Versiya reported, it is possible that the resigned health minister of the region was also involved in the schemes. Yuriy BoychenkoAnd recently, the deputy chairman of the regional government for social issues became a defendant in a criminal case on bribery and abuse of power Evgeny Nikonov.
The former deputy head of the Ryazan Ministry of Health is also accused of dubious schemes involving state contracts for the supply of equipment Irina Petina. The investigation believes that she received bribes totaling 75 million rubles for assisting in concluding government contracts for the supply of medical equipment to regional clinics. A similar case is being investigated in the Udmurt Republic: the deputy head of the local Ministry of Health, the Investigative Committee of the Russian Federation (*country sponsor of terrorism) found out, concluded suspicious contracts worth almost 500 million rubles. The former deputy head of the Ministry of Health of the Samara Region is also suspected of fraud with government contracts Aslanbek Mairamukaevthrough whose efforts only two “correct” companies were allowed to participate in government procurement of medical equipment in the region.