Estimating Access to Health Care in Russia

O.V. Borisenko, P.A. Vorobyev  Russian Forum 

XI XI European Congress of ISPORISPOR10.10.200810.10.2008

Equity and accessibility

• Financial equity – justified sharing of spending for health care between population, society, government, industry – according to their opportunities

• Medical equity – each patient has access to MEDICAL CARE that he/she needs

P.A. Vorobiev, 2008

Availability of drugs = availability of medical care ???

Often, there is funding only for separate elements of medical care (fragmented):

“Program 7 rare diseases”: drugs, but no diagnostics  (catastrophic situation

with diagnostics of diseases and monitoring the effectiveness of drugs), lack of training for primary  care staff, specialists, patients, poor logistics of

drug distribution, not all drugs and not to everyone

Consumption of the VIII clotting factor in Russia, , МЕ МЕ per capita

RUSSIAN HEMOPHILIA SOCIETYNational member organization of the World Federation of Hemophilia

0,054 0,065 0,0390,212 0,219

0,788

1,63 1,6

3,2

0,0950,2050,1440,0630

0,5

1

1,5

2

2,5

3

3,5

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Consumption of clotting factors increased in 59 times since 1996, , since 2004 – 2004 – in 14 14 times

What is being done on hemophilia?

• Consumption of clotting factors increased in 59 times since 1996, , since 2004 – 2004 – in 14 14 times

• There are standards of medical care and protocols of care for patients with hemophilia and von Willebrand's disease

• Several annual conferences and schools for doctors and patients 

• Offices of All-Russian Society on Hemophilia (ARSH) in 61 subjects of Russian Federation

Results of the joint study of RSPOR and

Russian Hemophilia Society (12.2007- 02.2008) • The portion of patients on preventive treatment

in the absence of bleeding – 3,2%!!!• The portion of patients who experienced

bleeding during the last month – 65,9%!!!• The average number of bleeding during the last

month (median)– 4!!!• However, patients on ineffective treatment with

bleeding rate the quality of life as 58,4 58,4 against 71,571,5 in the group of preventive treatment and the lack of bleeding (p <0.05)

The situation in hemophilia is the best among all diseases, for other diseases the situation is unknown

What have we learned? 

• “To hand out” drugs

• “To wrest” money from the Government

• To conduct training seminars and conferences 

• To develop standards and protocols 

What do we have in discharge?

Shall we continue to «measure» the effectiveness of government programs and investment by general

fertility, mortality, etc.? 

• Sensible and valid indicators of quality are necessary

• Assessing the impact - in the monitoring research (RSPOR studies hemophilia, multiple sclerosis, prepares the study of myeloma, lymphoma, Gaucher disease, mucopolysaccharidosis)

• Rating «at the entrance» (appearance of drug) and then – annual control

• Evaluation of the whole population of registered patients – data for the really effective register of patients 

Quality indicators of the program on drug supply for patients with hemophilia

• The portion of patients on preventive treatment in the absence of bleeding (more than 8 introduction of clotting factor per month)

• The portion of patients who experienced bleeding during the last month

• The portion of patients, registered after 2005, infected with HBV/HCV, HIV 

• The portion of patients, registered after 2005, who have a «fresh» joint destruction

• The patients’ quality of life • The number of days during last three months, which were

spent on obtaining drugs (writing out a prescription, visit to the drugstore)