EMS Around the World: Russian Government Ready to Spend

The Russian government has approved record investment in its domestic primary healthcare sector and the nation’s emergency medical services until 2026, according to recent statements from senior officials of the Ministry of Health and local healthcare analysts.

Tatyana Golikova, Russia’s deputy prime minister for health, told Russian media the overall investments will come to an estimated 550 billion rubles, or around U.S. $7.3 billion. Of this, about RUB 100 billion will be invested this year.

As part of the reform, the government plans to address shortages of personnel, medical equipment, and ambulances in the domestic EMS industry.

In contrast to previous reforms, particular attention will be paid to ensuring better access to EMS for citizens living throughout the vast Russian provinces as well as small cities and districts. The government hopes the reform will provide a better access to EMS for more than 40 million people.

The reform was initially scheduled to begin in July 2020 but was suspended due to the pandemic until this year.

Salaries and Facilities

A significant part of the funds will be invested in the construction and renovation of first aid stations, as well as raising the salaries of paramedics and improvement of the overall technical level of the industry.

Most of the interviewed analysts consider the reform an acute need for the EMS sector, as in the last 10 years the number of emergency hospitals and first aid stations in Russia has significantly declined. At the same time their level of use has increased, especially during the pandemic.

A shortage of hospitals in Russia occurred in recent years due to the policy of optimization implemented by the government during the 2010s in various spheres of the country, including the healthcare sector. That entailed state efforts to consolidate industries to concentrate needed resources and improve the quality of areas like domestic EMS.

So far the most difficult situation with emergency hospitals has been observed in sparsely populated or hard-to-reach areas of the country, where most were closed at the beginning of the 2000s. That led to massive protests by local residents, and waiting times for ambulances significantly increased.

Numerous polls in recent years show that even before the pandemic, state policy in the EMS and healthcare sectors was unpopular. Concerns include the quality, cost, and availability of services. The pandemic has only deepened the crisis.

Still, the government hopes the reform—to be jointly conducted by the federal government and regional authorities—will improve the situation.

Fleet Renewal

One major element of the reform in an almost-complete renewal of aging local EMS fleets. For this purpose up to 19,000 new ambulances will be delivered to the domestic EMS sector over the next five years. That will allow complete renewal of the industry’s fleet, the replacement of which, under Russian regulations, should take place every five years.

The shortage of ambulances in some regions has even forced local authorities to utilize private operators to move patients, although these plans sparked massive protests from both patients and doctors.

Not Enough?

Despite the state’s optimism, most independent Russian analysts believe the allocated funds will be insufficient to substantially improve the situation. According to Andriy Konoval, a cochair of the Russian trade union of medical workers, “At the first glance the planned investments look high. However, they are still insufficient to conduct a large-scale, successful reform in the industry.”

According to his data, as well as some open sources in Russia, at present the share of state spending on healthcare in the gross domestic product does not exceed 4%—a low figure even compared with emerging nations. This is also reflected by official statistics, according to which the average annual salary of a paramedic in Russia is in the range of RUB 480,000–600,000 (U.S. $6,500–$8,100).

As a result in recent years Russia has faced a shortage of paramedics. The pandemic led to a massive outflow of personnel from the industry, with many remaining employees working substantial overtime. The lack of funding also forced many Russian hospitals to conduct massive cuts of their EMS staff even during the pandemic.

According to experts with the Eurasianet, there is a need to increase the funding volume of the domestic primary care sector and EMS by at least five times to solve the majority of existing problems.

Part of the state plan also involves measures to reduce bureaucracy and raise the efficiency of provided services. Under current legislation the provision of emergency medical care should require voluntary consent of the patient or their representative. According to calculations by Ministry of Health analysts, the provision of such permission usually requires from 5–17 minutes. Often patients refuse to provide such permission, which sometimes leads to their death. Since the beginning of the pandemic, the number of such deaths has significantly increased, sparking serious concerns from the Russian government. To prevent further deaths a special order that lifts restrictions on the provision of emergency care without patients’ consent has been recently approved.

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at gerden.eug@gmail.com.