Doctors, patients rebel against Moscow health care reform

On Sunday, thousands of doctors and their patients are set to march against the reform as part of the first mass social protest in Russia in nearly a decade

MOSCOW – Dr. Semyon Galperin spent a decade in medical research in Russia and as much time in the United States, working at top hospitals and research companies. Despite his expertise, Galperin was recently given a stark ultimatum from the Moscow hospital where he works: Leave or stay on as a lowly hospital attendant.

Galperin’s job is being eliminated as part of a sweeping reform in which at least 28 Moscow hospitals are to be closed and up to 10,000 medical staff fired, an overhaul that officials say is needed to modernize a decrepit Soviet-era health system. On Sunday, thousands of doctors and their patients are set to march against the reform as part of the first mass social protest in Russia in nearly a decade – a threat to President Vladimir Putin who faced down a wave of political protests launched in 2011 and is now struggling with a faltering economy.

The doctors’ rebellion started early this month, when thousands took to the streets to protest the layoffs and hospital closures. Last time a similar protest happened in 2005, Putin became so alarmed that within a week he overturned the scrapping of social benefits for millions of pensioners and the disabled, and in fact doubled pensions instead.

Aware of the potential fall-out of this protest, Putin last week asked the Moscow government to reconsider the reform as his human rights council hosted a round table discussion with prominent doctors and trade unions that were not consulted when the reform was launched.

At Moscow’s Hospital 11, Galperin is vowing to stay on even if that means working as an attendant: “I can’t leave work because we decided to fight till the end,” he said.

Moscow officials say they are only complying with a 2010 Russian law designed to help hospitals complete a transition from the Soviet-era economy and make them self-reliant by cutting budget subsidies to a minimum. Moscow Health Care Department spokeswoman Elina Nikolayeva defended the firings as inevitable: “Some of the doctors who are being fired are underqualified,” she said. “Some of them don’t have enough workload.”

The doctors’ unrest is particularly problematic for Putin because almost all of them are state employees – the core of his support base. Russia has enjoyed low unemployment of about 5 per cent in the last decade because of heavy subsidies to state enterprises, schools and hospitals. Following the political protests, Putin won his third term office in 2012 largely because state employees believed in his promise to increase their living standards.

Now, that very promise seems to be backfiring.

Moscow officials are carrying out the health care reform in order to make good on Putin’s election pledge to boost the livelihoods of public servants – including a vow to make doctors’ salaries twice that of the average employee by 2018. Moscow Deputy Mayor Leonid Pechatnikov says that had it not been for Putin’s pledge, the health reform would not be so fast or brutal.

Moscow’s health care system is a relic of the communist health care system under which every citizen was entitled to free medical services. In a bid to save funds, Moscow health care officials are focusing on promoting neighbourhood clinics that will provide comprehensive care and keep people out of hospital beds.

The reforms were not discussed with the medical community, however, and their details only became public in October following a leak in the press. Doctors and hospitals that found themselves in the vortex of the reform have not been told why they are being phased out or what is going to happen to their patients.

At Hospital 11 where Galperin works, 136 out of its 320 medical staff, mostly doctors, were given the notice and the hospital is to be shuttered by April.

Grilled about the hospital’s closing, Deputy Mayor Pechatnikov told a session of the presidential human rights council last week that the hospital “monopolized” the treatment of multiple sclerosis in Moscow, making it impossible to get treatment elsewhere in the city.

The health department’s Nikolayeva told The Associated Press that Hospital 11’s “doctors are abusing their position” and that the city does not need as many neurologists now that Moscow purchased high-tech MRI equipment making it easier to diagnose multiple sclerosis.

Galperin and his colleagues say they provide multiple sclerosis treatment that cannot be obtained elsewhere in Moscow. Their suggestion to set up a multiple sclerosis clinic on the grounds of the hospital in order to keep the expertise and equipment in one place has not received a response.

Galperin says he was probably targeted because of his union activities: He was given notice the day after he made a speech at a trade union committee, demanding a fairer pay scheme. But other doctors who kept a low profile were given the boot, too.

Meanwhile, Putin’s objection to the Moscow health reform appears to be making its mark. In a statement last week, the presidential human rights council called for a halt to the layoffs and insisted that in its current form, the reform violates a constitutional right to free health care. The Moscow health department held a number of roundtables with medical professionals, while Moscow Mayor Sergei Sobyanin offered additional severance pay of up to 500,000 rubles ($10,700) per doctor. But that has not yet translated into any concrete action.

Meanwhile, some patients fear that the reform will hurt them the most.

Ales Kochevnik, 29, was diagnosed with multiple sclerosis two years ago. Treatment allows her to live a more or less a normal life, albeit one interrupted by fits that can leave parts of her body temporarily paralyzed.

“They taught me to walk five times,” the young artist says of Hospital 11. “It’s a scary disease. It can strike at any moment. A couple of times I was sitting with friends drinking coffee, and within 15 minutes it would strike.”

On a recent afternoon, Kochevnik went to Red Square to lay down on its cobbled pavement in protest. Supporters stood by, each carrying an IV drip. One held a poster reading: “A hospital without doctors is a mortuary.”

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