Socio-economical impact of telemedicine in Russian Federation.

• Author: Khasanshina, Elena V.
• Position: Report

Abstract

Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status general and specific for health education, health care, diagnosis, monitoring, management, and research. During the last ten years, telemedicine in Russian Federation (RF) has become more common, despite the fact that all publications are developmental reports without studies of outcomes evaluation and effectiveness. Information on social-economic impact is lacking. Although telemedicine in Russia can be expected to have social and economic implications for communities, healthcare providers, patients and others, most available publications to this date focused on its feasibility, estimation of cost saving, and some reference to social benefits. Russian and English language literature searches were used to encompass telemedicine evidence in terms of the social aspects, and economic performance for populations and individuals. The main benefits we looked for are access to healthcare services, cost resources, cost-effectiveness, education, social isolation, health outcomes, quality of care, and quality of life. For better understanding of telemedicine's place in society, we also present an overview of both the Russian healthcare system and telemedicine.

1. Healthcare system in Russia

   With the establishment of the Soviet Union its healthcare system developed based on healthcare principles articulated by Nikolay Semashko [1]: (1) governmental responsibility for health, (2) a close relationship between medical practice and the findings of science, (3) highly trained professionals and high quality professional care, (4) coordination of health promotion, medical treatment, and rehabilitation, (5) universal and free access to services, and (6) a preventive approach to "social diseases". The results of this approach led to the assertion that the Soviet health care system was one of the USSR's greatest achievements [2].

   Using these principles, health care was provided by personnel who were employees of, paid by, and who received their medical supplies from the state which centralized control of the healthcare system. Thus, the system which was financed by government revenues could be an asset in the pursuit of economic and social development plans. The focus was on increasing the numbers of both hospital beds and medical personnel, improving community prevention, urban sanitation, hygiene, and promoting routine medical check-ups. Beginning in the 1920s, a network of facilities was built in order to reach even remote settlements and provide basic health coverage to the entire population [3]. Quality of care varied, was better in urban than in rural areas, but was a significant improvement over what had existed previously [4].

   Unfortunately, with time there was deterioration of it adherence to these principles. That resulted in less effective healthcare, and were diverging of the health status of the Russian and Western populations [1, 5]. Specifically, the paternalism inherent in Soviet philosophy allowed the failed development and/or atrophy of individual responsibility for crucial life-style issues recognized in the West such as diet, obesity, and use of alcohol and tobacco [5]. Officials relied on growth of heath care facilities, resources, supplies and manpower, but neglected quality or effectiveness of care. Individuals saw themselves embraced in State medical facilities that shouldered the entire responsibility for an individual's health, reducing or absolving them of individual responsibility and encouraging their consumption of health care services without regard to cost.

   Further, political separation between the West and the Soviet Union, abetted by the arms race, isolated Soviet medical science from Western advances in medical technology, knowledge and treatments, including new pharmaceuticals. With a stagnating economy in 1980s, the system could not afford the treatments that were coming on line in the West [6]. In Russia, access to quality care increasingly depended on whether you were "connected".

   Health care and the health status of the Russian population fared poorly as a consequence of the collapse of the Soviet Union in 1991, in part because government revenues were no longer able to sustain the inherited system [7].

   Government leaders recognized the problems and identified areas of focus that include encouraging family practice-based primary care of high quality, promotion of healthy lifestyles, prevention, and de-emphasis of a dependency and excessive use of secondary and tertiary care [1]. However, according to Rozenfeld [5], while Russia is searching to improve public health care and health promotion, current uneven development of the healthcare system, together with an ineffectively organized health care delivery system hampered by a lack of funds, equipment, and supplies is generating popular dissatisfaction with medical personnel and the services they provide. An essential difficulty is that Russia has still not completed the "first epidemiological transition" (the eradication of infectious diseases and epidemics), so that manpower and financial resources can be focused on issues of life-span elongation and other goals of the "second epidemiologic transition [5]. In other words, diseases typical of previous periods of lower socio-economic development are still present and it is difficult to move into the realm of managing chronic disease.

   Since perestroika in the Russian Federation, health care and other systems, are attempting to deal with the process of decentralization. There are 89 regions with varying degrees of autonomy. Initially, each was trying to balance the responsibility for funding and delivering health care while trying to design and put into place a new system of health insurance [7] and then reversing the process in parallel with more recent efforts at central government reform [8]. Economic and social status of the population are priority task for RF government. The new models must face the reality of finding new ways to work. Current model of management and finance in Russia presented on figure 1.

   In the current Russian healthcare system, a portion of the total medical organizational structure is federal [10]. Each of the federal health care organizations carries out all activities in the sphere of health care, the property for doing which is federal--including buildings, medical equipment, and staff. Each of these organizations report to and are subordinate to a specific federal department. There are 17 federal ministries and/or organizations which have their own health care service components. Of these, the three largest are: Ministry of Railroads -782 healthcare organizations; P resident's cabinet--56 healthcare organizations; Russian Academy of Science--36 healthcare organizations. Federal healthcare organizations connected with regional and government for referrals, and policies what work on this territory.

   Regions are having portion of healthcare system what independent from the center (Federal Government) in finances, and almost in policies. Regional, local, and private healthcare providers are responsible for following federal and regional policies. Insurance divided into mandatory/obligatory, and voluntary. Obligatory required having by each individual, voluntary is optional and depends on diseases base or program of healthcare services.

   [FIGURE 1 OMITTED]

   Current reorganization in RF healthcare system is oriented to investment in the acquisition of technology and its integration into the healthcare system. Organizational changes are in direction to increase effectiveness of use existing potential without monetary investment [11]. Telemedicine is addressing both these aspects.

2. Telemedicine in the Russian Federation

   There are some characteristics of RF and its health care system that demonstrate the potential value of telemedicine/telehealth:

   * There is a large difference in the level of available diagnostic and treatment options between federal (Moscow, St. Petersburg), regional, and rural medical facilities.

   * Huge distances separate population and there is a general lack of affordable transportation for patient and healthcare specialist travel to get or deliver specialized medical care.

   * "Strong need to raise corporatism of physicians and their expertise level instead of this (to overcome these) difficulties." [12]

   * The current aggressive development of broadband telecommunication access in the RF is allowing the potential of providing telemedicine/telehealth services to remote communities

   * Knowledge of information technology by potential end users is not something new and there is widespread use of computers on a day-to-day basis.

   * "Com puters and digital communication channels become cheaper and transportation/living costs tends to rise." [12]

   * There is an aggressive existing market for telecommunications, video-conferencing, telemedicine/ telehealth equipment, and software.

   * "The new economic structure in Russia has influenced every segment of Russian society. While the shift to freemarket enterprise has created many opportunities for businesses and industry, it has also provided many challenges for health-care facilities, which are trying...