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09.10.2007

Health Care is a Right, Not a Privilege

The authorities have been talking a lot about raising the country's birthrate to deal with the population decline. A special federal benefit program was set up this year to allocate about $10,000 for women who give birth to a second child. In addition, prenatal programs have been expanded on a national level.

These are laudable undertakings that have brought some positive results. In the first half of 2007, 753,000 children were born, which is more than in the same period of 2006 (715,400) and all of the preceding years since 1999.

These measures are not nearly enough, however, to stop the population decline. Birthrates need to rise by 50 percent from current levels in the next decade to reverse this demographic trend.

It is clear that in order to halt the population decline, more serious attention needs to be paid to the staggering high death rates in the country. Russia is the only developed country in the world that has experienced a decline in life span in the last 40 years, while death rates in certain working age groups have doubled.

In 2005, the government introduced the four national projects. One of these projects is devoted to significantly boosting healthcare spending. This was an important step in addressing the high mortality rates. In 2006 and the first half of 2007, the nation's population decline slowed down. From a peak of 2003, when the number of deaths exceeded the number of births by almost 800,000, the decline in population slowed down significantly to 532,600 in 2006, and it is projected to be around 500,000 in 2007.

Deaths in 2006 decreased by 138,000. It was the first year in a long time when death rates actually fell. The trend continued in the first quarter of 2007, when the death rate fell by another 9 percent or 47,500 deaths.

Much of that improvement in death rates has been due the introduction of the Federal Free Drug Benefit Program in 2005. It gave thousands of people access to expensive, new medicines that save lives. The most significant impact the program has had on decreasing death rates occurred in oncology care. Thousands of cancer patients' lives were saved simply by improving access to cancer drugs.

Cancer is the third largest killer in Russia after heart disease and alcohol poisoning. Every year more than 300,000 people die of cancer. Another 150,000 go on disability. Cancer survival rates in Russia are the worst in Europe. The five-year survival rate from all types of cancer in Russia is at a dismal 43 percent. In France or Austria it is 61 percent, and it is 62 percent in Sweden.

One of the main reasons for this is that there is not enough financing for oncology care and cancer drugs. In 2006, Russia spent about $803 million, or $5.60 per capita, on cancer drugs. By comparison, per capita spending on cancer drugs in the United States in 2006 was $53, in Canada $39, in France $31, in Italy $27 and in Poland $13.

Since 1971, the global arsenal of cancer drugs has tripled. Improving access for cancer patients to innovative cancer drugs has become a standard policy in most developed nations. Better access to new drugs helped reduce overall cancer death rates by 30 percent in the United States and in the European Union from 1995 to 2003.

Many countries have introduced special government-sponsored reimbursement programs for innovative drugs to reduce the financial burden on cancer patients. The spending on these programs range from $30,000 to $70,000 per patient per year. Croatia, a country with a population of only 4.3 million people -- roughly the size of Tatarstan -- allocated $40 million for innovative oncology drugs in 2007; this amount is more than the entire 2007 free drug program budget for Tatarstan of $26.7 million.

It was a clear mistake not to delegate cancer drugs into a special subprogram within the free drug program. As a result, funding is thinly spread to cover all types of medicines, including the cheapest ones. This has the effect of draining funding away from costly, but effective, drugs. Another mistake was to allow program participants to opt out of the system with a corresponding reduction in the program's budget.

The free drug program's budget in 2007 of $1.4 billion is 50 percent less than what was actually spent under the program in 2006. As a result, purchases of cancer drugs under the program in 2007 have decreased by 50 percent as well.

Moreover, the program does not cover all cancer patients in Russia -- only those who are narrowly classified as disabled In addition, people are often forced to wait months for treatment. By the time the patient ultimately enters the free drug program, he might no longer have a chance of surviving the disease.

The government has a chance to rapidly decrease cancer mortality rates by improving funding for new cancer drugs. Perhaps, a special federal program to cover the cost of those drugs is needed to address this serious issue.

It should not be a privilege but a right of all Russians to have access to modern and effective medicines and medical treatment.


Source:  themoscowtimes.com

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