Putin’s live phone-in: what did he say about health care?

I wrote this post in December 2011 but didn’t quite complete it and post it…

Today, Vladimir Putin, Russia’s Prime Minister and presidential hopeful hosted his annual televised phone-in. This was his ‘historic’ 10th consecutive year in the TV format, as either Prime Minister or President. It lasted a record-breaking 4 hours 32 minutes, with no breaks.  I followed the programme live using a combination of the livestream from the TV station; a version hosted by Russia Today with simultaneous translation into English; the Guardian’s live blog hosted by Luke Harding; and a Twitter feed. I did, however, allow my concentration to wane now and then: four-and-a-half hours is a lot of time to listen to someone.

Some of the comments  and discussion on Twitter in particular, were  amusing to follow, as the Russian word for ‘botox’ became a Twitter trend (and proxy for ‘Putin’).  Miriam Elder of the Guardian provides an excellent summary of the event. There was particular interest in the light Putin would shed on the recent protests about the parliamentary elections. In truth, he engaged with the subject in a shallow and inconsistent way. For the completists among you, the PM’s official website  has a full transcript of the Q & A; including an English translation (at the time of writing, this is not yet finished).

Here  is a brief analysis of what discussion there was about healthcare in Russia. This was limited to several minutes early on in the session, when Putin was questioned by one of the invited studio audience. Leonid Roshal is a prominent spokesperson on medicine and healthcare. He was introduced as  ‘well-known children’s doctor, head of the Research Institute on Emergency Paediatric Surgery  and President of the National Medical Council of Russia’.  The National Medical Council was established in 2010 and brings together a number of professional associations and other health  pressure groups /voluntary organisations.

Roshal began his questioning ‘off-topic’, returning Putin to the theme of the Bolotnaya rally and introducing the general subject of corruption and its impact on businesses. He also raised the subject of Takhchidi,  another prominent doctor who was recently fired from the directorship of an eye clinic. The implication is that his dismissal was politically motivated, due to his activities in the Medical Council of which Roshal is head.

Roshal then moved on to more directly healthcare-related issues (and Putin responded).  I entered the text of the discussion from this point to the end of Roshal’s contribution into a word cloud generator to facilitate a crude content analysis:

Wordcloud of Putin-Roshal discussion at Dec PM's Q&A

The questions and discussion that were healthcare related focused on two elements: the issue of paid versus free medical services; and under-staffing /under-resourcing leading to unacceptable wait times.

Payment for medical services: the word платность is fairly prominent in the word cloud – not easily translatable but something along the lines of ‘paid-for-ness’ – the official transcript uses ‘direct-pay’. Roshal asked for clarity on this. Putin does not answer directly, except to affirm that there will be a further shift towards mixing requirements for out of pocket payments with ‘subsidised’ provision.  In practice direct payments for basic health services have already been in evidence for many years, albeit ‘informally’ and with great variation. The discussion merely confirms that these arrangements will be formalised. Putin acknowledged that Roshal was well known as an opponent of fees for medical services and claimed that ‘basic’ health services should always be free.

Roshal particularly highlighted unacceptable wait times to see specialists, which he blamed on under-resourcing. Putin pointed out that the health reforms of the early 1990s which devolved budgetary responsibility to the regions were mainly to blame for chronic underinvestment, and wide variations in healthcare funding /investment between regions. He claimed that the new legislation would seek to balance some of these funding issues, with some centralised aspects of funding -although this will happen in ‘stages’. Putin also indicated that investments in the system over the past few years (‘Health’ national project) had started to reverse some of the problems with understaffing and resourcing.

To summarise, it was interesting to see Putin challenged on health care and the reform plans, albeit by someone who is  well known for such challenges. As might be expected, Putin’s answers were rather bland and uninformative. Critics of the new legislation (including Roshal) question how clear it is where statutory ‘free’ services end and payment begins – especially in a context where payment has become a normal expectation. Huge variations in quality, availability and accessibility of health services across the country, combined with long-standing lack of investment in infrastructure, will take a long time to turn around, however much money is invested in the name of ‘modernisation’.

About the word cloud:I place the cloud here purely for illustrative purposes. It would need to be utilised in a much more sophisticated way to overcome its limitations as an analytic tool. Tagxedo is the only word cloud platform I found that could easily cope with Cyrillic script. I had to manually edit out the ‘common words’ (this is usually automatic with English text), so there is a possibility that I edited out words of significance. Conversely, I can see now that I have left in certain common words such as ‘from’, ‘us’ and ‘them’ which could have been omitted. Another limitation is that in Russian, as in many other languages, almost all words decline in relation to grammatical position, tense, gender, etc. In a word cloud all these versions are generated as separate words. I am sure there is a workaround for this.