Russian doctor is acquitted of drug trafficking charges for providing opioid to a dying manBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7097 (Published 21 November 2014) Cite this as: BMJ 2014;349:g7097
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On the face of it, recent developments in the health care system in Russia  are similar to those in the eastern part of Germany after the reunification in 1990: quantitative reduction of governmental doctors' positions with a concomitant workload increase on remaining physicians. However, during my practice abroad (1989-2002 with interruptions), the workload was never excessive: I cannot recollect a single case when it was not enough time to come clear or to consult with colleagues.
There is however substantial difference between both countries. In Germany, medical insurance covered all necessary costs of a high-quality treatment. In Russia, the insurance does not cover all costs. There are so-called medico-economical standards listing the services that must be covered by the compulsory medical insurance. Such services are not always easily rendered, especially at the governmental polyclinics (health care centers). For example, there can be an alternative: long waiting or a paid service. Some personnel have become mercantile, bribes are taken and awaited in some institutions , nepotism is regarded largely as a norm. Foreign professional literature is used insufficiently while many domestic books are suboptimal . Postgraduate medical education is short and generally incomplete .
There is a need for competent and integer managers: some head physicians (who are at the same time senior managers of hospitals) have participated in construction, funeral and other business. There is no national medical association comparable to those in other countries, which is one of the reasons, why the status of medical profession and medical ethics are often disregarded. However, it would hardly be reasonable to recommend establishing a medical association in Russia today, as it would probably turn into another manger for managers being at the same time not independent, competent, and merciful enough. Obviously, Russia needs foreign help for a proper organization of health care. However, there are misgivings that foreign experts might be honest in their own countries but here they would be embroiled in corruption, that good specialists are needed in their own countries, and those coming here would be unemployed adventurers etc. Besides, self-complacency is strong here. Indeed, why should we care about life expectancy, survival rates etc.: it mainly pertains to pensioners; they have not much to do with economy and defense unless they are war veterans. There is a suspicion however that veteran status, which gives considerable advantages in everyday life and health care, has sometimes been awarded gratuitously.
Finally, everything depends on priorities, and priorities partly depend on external factors such as international conflicts. It should be mentioned here that military hospitals enjoy higher esteem today. Indeed, there can be more order in a military institution but not necessarily more professional competence or less corruption (for example, surgical treatment of non-authorized civil persons). In particular, superior specialists can be selected not always according to their professional competence. Coupled with the discipline and hampered criticism, it can have negative consequences . Some recent innovations are obviously unreasonable: for example, a patient in a polyclinic cannot go directly to a medical specialist today, but has first to visit a general practitioner, which can cause loss of time and additional sitting in queues. The ordinance about elevation of the doctors' salaries is certainly welcome, but it seems to be counteracted by civil servants cutting down necessary medical personnel .
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Competing interests: No competing interests