According to an age-old proverb, it is better to be rich and healthy than poor and sick - a saying made all the more true in a country where some say the public health care system is nearly as ill as its patients. Russian health care has not been seriously reformed since the collapse of the former Soviet Union in 1991. But earlier this year, the Russian government launched a so-called national projects plan that aims to improve four sectors of Russian life, including health care.
In the last decade, the health of the average Russian has grown significantly worse. Overall life expectancy has fallen from 70 years to 65, with Russian men at particular risk. On average, a Russian man lives 13 years less than his female contemporaries the widest gender gap in the world.
The three major causes of illness among Russians are respiratory disease, circulatory disorders, and alcohol-related injury and poisoning. Russia also has sky-rocketing HIV/AIDS infection rates and growing problems with multi-resistant strains of tuberculosis.
Yet, despite these alarming trends, public health has not been high on the governments agenda. For years, only about three percent of Russias Gross Domestic Product was spent on health care. But according to the Kremlin that will soon change.
That is because beginning this year, the government has approved an additional $3.2 billion in spending on health care as part of its so-called national priority projects. The funds, mostly drawn from Russias oil revenues, are expected to cover salary hikes for doctors and nurses, the purchase of new equipment for clinics, and the construction of eight high-tech medical centers in Russias vast, outlying regions.
Addressing reporters at his annual press conference in Moscow earlier this year, President Vladimir Putin said his government views the reforms as a vital first step.
Mr. Putin says national projects are not a panacea (or quick fix) for all the problems that Russia faces. But he says they are a signal of the areas his government considers crucial at this stage of the countrys development.
One of the more controversial elements of the health reform plan calls for a major shift in emphasis on quality of treatment, rather than Soviet-style obsession with the number of people treated.
The plan also reportedly calls for doing away with tens of thousands of specialists - the idea being to encourage more doctors to become general practitioners or front-line, first responders.
Russian media say that means about 300,000 doctors and health care workers or about half the nation's total could be laid off, and scores of hospitals shut down in the next few years.
This promotion of general practitioners over specialists has many in the medical field worried, including Dr. Olga Golubkova. She is the head of a private clinic in Moscow called Spectra. She told VOA that, in her view, the plan will see Russian health care slide backwards by about twenty years.
Golubkova says a general practitioner, by nature, is not supposed to be curing all kinds of illness. She says there is a limited number of routine medical problems that a general practitioner is competent to treat. She says a general practitioner's job should be to identify and classify an illness and then send the patient to the appropriate specialist.
Now, she says, we will see GPs being forced to be all things to all people, including surgeons, with results one can only imagine.
Russias Deputy Health Minister downplays these concerns. Victor Starodubov told a recent health conference in Moscow that the shift in focus will lead to increased prestige for general practitioners. Starodubov says physicians will soon face less specialist competition, greater wages, and more opportunity to practice streamlined care. He says the result for patients will also be better.
The minister says many of Russias doctors appeared inadequately prepared or not interested enough in their work to deliver the necessary care. All our efforts must be placed on first-line doctors, he says, because, for any patient, they are often the first and only doctor a patient will see.
Sergei Smirnov says the reforms sound good on the surface. But, as the head of Russias Institute of Social Policies and Social-Economic programs, he says there are few plans he has not heard or seen tried.
Smirnov also told VOA he has serious concerns about how this major overhaul of Russias health care system will turn out. How is it possible, he asks, that a national health care project is managed not by the health ministry, but by the presidential administration?
Criticism aside, most agree reform of Russias health care system is urgently needed. But the question on the minds of many is whether this is really the plan to improve things, or will the Russian people be forced to pay the highest price with their health?