1. 1 THE AVAILIABILITY OF HEALTH CARE. REGIONAL ASPECT 10 November, 2008 Athens

2. The structure of state and municipal health care service in the Pskov Region State system 28 public health institutions  The number of hospital beds - 2778, including twenty-four-hour beds – 2673. Municipal system 44 municipal health institutions, including 24 central district hospitals  There are 18 offices of general practitioners in central district hospitals  434 first-aid stations  The number of hospital beds - 4979, including twenty-four- hour beds – 4196. 2

3. The availability of health care is an inalienable constitutional right of the Russian Federation citizens Social access to health care is based on the following principles:  universality, accessibility, targeting;  the quality of medical care;  effectiveness. 3

4. Targeting of medical care is defined by the Program of Government Guarantees of Free Medical Care for Citizens The achieved level of public health funding does not fully meet the requirements for funding according to the territorial program of state guarantees of free medical care provision for the residents of the Region 4 The conformity percentage of used funds for protection of the Region residents health from all sources to the estimated demand (on a program of state guarantees)

5. Implementation of the national project «Health» in 2006-2008 made it possible to  increase the availability of primary outpatient - polyclinic aid by 6% (number of visits per inhabitant 1 to 6.9 to 7.6 per year)  improve the accessibility of high-tech medical care by 76% compared with 2005 5

6. Improvement of high tech medical care availability through its partial funding from the regional budget in regional specialized medical institutions (endoscopic and rentgen-surgical interventions, computed tomography, etc.) 6

7. Regional program on development of general practitioners offices (GPO) In 2007 14 municipalities took part in it, the amount of funding - 30.0 million rubles. By the end of 2008, the number of GPO will be brought up to 35. In 2009, 11 GPO are planed to be established in 11 areas of the Region, and then, up to 2010, it is scheduled to bring its number up to 50, almost in all parts of the Region 7

8. The program allowed to purchase sets of medical equipment for each General Practitioner Office, designed with a regard to the responsibilities of general practitioner (family doctor) by 50 positions, computer equipment, cars («Niva-Chevrolet»)

9. Key indicators of demographic and health status of population in the Pskov Region (1) Indicators 200520062007 The birth rate (per 1000 people) 8,88,99,7 The overall mortality rate (per 1000 people) 24,523,320,7 Natural population growth - 15,7- 14,4- 11,0 Infant mortality rate (per 1000 live births) 12,913,28,4 Maternal mortality rate (per 100,000 people) 15,6-14,5 Mortality of working-age population (per 100000 people) 1318,51236,2979,6 Including deaths from cardiovascular diseases 538,9475,5359,2 Including number of deaths from oncological diseases 105,3110,4109,4 Including deaths from external causes 402,3364,0319,3 Including deaths in road accidents 32,031,733,1 9

10. The key health care problems of the Region remain unsolved Disparities in access to health care (depending on domicile, etc.)  Staff shortage: indicators of doctors and paramedical workers in the Pskov Region (per 10.000 people) - 27.7 and 91.2, respectively, the need for medical personnel now - 373 individuals.  Inadequate funding.  Low efficiency of the health system to prevent the spread of several diseases.  According to opinion polls, satisfaction of population by the quality of medical care is rather low and does not exceed 60%.

11. Key indicators of demographic and health status of population in the Pskov Region (2) Indicators200520062007 The primary prevalence per 100 thousand people 5882,96060,16176,8 General disease incidence per 100 thousand people 12204,212747,413267,9 The incidence of major classes and groups of diseases (per 10 thousand people) 1.Tumors 72,069,068,1 2. Endocrinological diseases 70,575,493,0 2.1. Including diabetes mellitus 15,021,026,7 3. Diseases of the nervous system 159,1164,7188,2 4. Diseases of the circulatory system 149,8174,8179,4 4.1. Including myocardial infarction 14,516,114,6 5. Diseases of the respiratory apparatus 2632,92643,92616,0 6. Diseases of the musculoskeletal system 234,4254,2244,2 7. injuries and intoxication 676,1751,4825,7 11

12. The availability of modern means of pharmacotherapy in health care is a critical factor of its quality and efficiency The availability of modern means of pharmacotherapy in health care is a critical factor of its quality and efficiency However, currently in Russia:  as in all countries around the world, needs of population in drug provision face the problem of funds failure to cover the cost of treatment;  there is no any drug provision for citizens in outpatient departments and polyclinics, if they do not fall in any of the preferential categories;  there is an inadequate situation because of the federal law # 94 «About placing orders for goods, works, services for state and municipal needs». Buying medicine at the minimum price by auction, without regard to its quality, proven clinical efficacy and safety, is unacceptable both in terms of the doctors’ and the patients' position. When buying medicines in accordance with the law # 94, patients compliance to certain drugs, the need in a long-term adjustment (titration) of drug dosage using expensive methods are not taken into account. 12

13. Drug provision for federal and regional benefit recipients of the Pskov Region in 2008 Drug provision for federal and regional benefit recipients of the Pskov Region in 2008 30 154 people - regional benefit recipients, the total amount of funding in 2008 - 55 million rubles. The average price of prescription - 541 rubles (medicines for citizens are available from commercial inventory pharmacists agencies)  150 patients with haemophilia, cystic fibrosis, hypophyseal nanism, Gaucher disease, Myeloid leukemia, Multiple sclerosis, condition after organ or tissue transplantation. Total funding in 2008 - more than 136 million rubles. The average price of prescription - 80 thousand rubles.  24,598 people in the regional segment of the federal register of citizens, who eligible to receive a set of social services. In 2008, grants from the federal budget for the Pskov Region amounts to 125.5 million rubles, Additional funding in accordance with the decree # 722 - 41, 7 million rubles. The average price of prescription - 387 rubles.

14. Potential way s to optimize the system of benefit drug provision  Upholding the insurance principle for programs of benefit drug provision.  Involvement of all insured citizens of Russia in the program of guaranteed drug provision.  Creating Federal Target Programs “Bronchial asthma”,”Psychoneurology”, “Programmed hemodialysis”, “Oncology” and “Diabetes mellitus “.  Introduction of drugs co-financing mechanism by people, i.e. reimbursement of difference in the cost of imported drugs to its domestic analogues by citizens (within the International generic names).  Government support and funding for the creation of domestic original drugs and substances, public encouragement of research in development of new drugs.  Formation of a positive attitude to domestic drug producers in mass media, the supply of objective information on the quality of medicines  The creation of public corporations of drug producers.  Adoption of standards of treatment in the PEDP, equal to every citizen, regardless of his residence.  The purchase of medicines within the program of preferential drug provision for certain categories of citizens according to its trade names, taking into account not only the price aspect, but also the results of clinical and economic (pharmacoeconomic) analysis of alternative proposals (cost / effectiveness, cost / benefit).

15. Healthcare is seen by most people as the sphere of human life, in which all factors for differentiating accessibility are unjust … 15

16. ! Thank you for your attention!