The Russian Healthcare System

What is the contribution of the healthcare system in Russia with relation to cardiovascular disease prevention and treatment?

What is the contribution of the healthcare system in Russia with relation to cardiovascular disease prevention and treatment?

Even though effective treatments for heart disease have been available for decades, they don’t always reach those people who need them the most. While this is true in every country, it is a particular challenge in Russia. This is because of its widely dispersed population throughout a territory that spans eleven time zones, and reaches from the warm shores of the Black Sea to the Arctic.

In this part of the study, we want to understand the challenges that face patients with heart disease when they need treatment.

What constraints are imposed by geography of Russia on access to treatment?

The management of many acute conditions requires transporting the patient to appropriately skilled staff and equipped facilities within a short period of time. In case of myocardial infarction the preferred strategy for treatment is primary percutaneous coronary intervention (pPCI).

In 2015, the number of hospitals performing PCIs in Russia was 260 up from 144 in 2010. One can see substantial growth both in the number of PCI facilities and in the number of performed interventions. However it stands clear that people living in different parts of the country have unequal timely access to PCI facilities if needed.

We are particularly interested in quantification of the constraints imposed by geography on scaling up PCI services. We have done this by estimating driving times from each of the 2577 Census local areas to the nearest PCI hospital. This has shown an appreciable reduction in average travel times for the population of Russia as a whole between 2010 and 2015, although large geographic inequalities remain. This work will hopefully feed into policy development to further reduce these inequalities by appropriate location of new facilities and implementing other strategies of treatment in particularly remote and sparsely populated areas.

A set of maps showing access times by Russian region can be viewed here.

What happens if you have a heart attack in Russia?

The first component has recruited one thousand men and women aged 35 to 69 years who had a heart attack. Recruitment was done within 24 hours of being admitted to a clinic. This was done by colleagues in fifteen hospitals spanning thirteen of Russia’s regions in 2015-16. These hospitals are in Barnaul, Bryansk, Samara, Saratov, Kazan, Perm, Kchanty-Mansiysk, Kemerovo, Tuymen, Rostov-on-Don, Tver, Arkhangelsk and Belgorod.

In this component, we have investigated how patients who were admitted to these hospitals actually got there. In particular, whom did these patients call for help when they first felt ill? How long did it take to get help? How did they get to the hospital and how long did it take them? And after they got to the hospital, what was done for them?

We are particularly interested in any obstacles that these patients experienced in the course of getting the best possible care. We have already been able to describe the enormous progress in providing advanced treatment for heart attacks to many parts of Russia, due to increased investment in the field. Now we need to better understand the logistical and organisational challenges of ensuring that everybody benefits from this progress and investment.

We also wanted to know what happens after these patients leave hospital. New treatments that have been developed for people who have had heart attacks can now significantly reduce their chances of having another one. However, this means that these people must take medicines for the rest of their life. In addition, we know from research in many countries that people often struggle to adhere to such life-long treatment.

To find out what the situation is for patients in Russia we have followed up people in our study 6 months and one year after their heart attack to see what treatment they were on and what contact they had with cardiologists and other medical services.

The information that the study will provide will be very valuable. We are drawing on this information as we work with practitioners and policymakers in Russia to ensure that everyone with heart disease can obtain the best possible care.

Making a difference: how can we get the best possible results from Russian hospitals?

Hospitals play a vitally important part in the healthcare system. When they work well, they can make a real difference to people’s lives. However, experience from many countries shows that hospitals often fall short of expectations.

The main problem is that hospitals are extremely complex organisations, which makes them very difficult to manage. How do you make sure that everyone is working together as effectively as possible? How do you make sure that new ideas on the best ways to organise care are implemented?

There are no easy answers to these questions about hospitals. That said, in some countries, we have seen really impressive achievements from studies that have tried to understand how these complex organisations work.

What systems are in place to monitor quality and to bring about change when it is needed?

In this part of the study, we will be applying diagnostic tools that have been previously used elsewhere, in order to understand both the opportunities and the obstacles to getting the best possible results from Russian hospitals. We are looking at how doctors and managers work together, and what systems are in place to bring about change. We are also looking at how new systems might be adopted to bring about further improvements.

In another part of this component, we will be looking at the opportunities provided by the relevant legislation in Russia to bring about further improvements.

What systems are in place to monitor quality and to bring about change when it is needed?

In this part of the study, we will be applying diagnostic tools that have been previously used elsewhere, in order to understand both the opportunities and the obstacles to getting the best possible results from Russian hospitals. We are looking at how doctors and managers work together, and what systems are in place to bring about change. We are also looking at how new systems might be adopted to bring about further improvements.

In another part of this component, we will be looking at the opportunities provided by the relevant legislation in Russia to bring about further improvements.

Reducing the toll of avoidable mortality

Deaths from conditions that could be prevented with timely and effective care are still higher in Russia than in any comparable countries. Despite this, considerable progress has been made in the past few years. In this study, we will look at the progress that has been made in reducing these deaths across Russian regions. On this point, some Russian regions have done better than others. The question now is what lessons we can learn from the experiences of the better-performing regions that can help the ones still in need of improvement.