Perspectives on quality from Russia's first JCI accredited hospital
Within 25 years Medicina has grown to become to Russia’s only JCI accredited hospital. That gives Professor Roytberg something of a unique perspective when it comes to quality. We talk JCI, rouble depreciation and grey sector.
How widespread is quality within the Russian healthcare system?
It is upsetting that Russia still has no effective system for the assessment of medical services. The ministry of health produces reports that conflict directly with the conclusions of independent experts. As a professor of medicine, I know many people across the system and they don’t trust the official data.
But even with the official data, the picture is not bright. Take oncology patients: life expectancy after diagnosis is less than three years compared to 12.5-14 years in other European countries. It is a similar picture across most conditions.
Why is there only one JCI accredited hospital in the country?
We chose JCI because it is the most common and the most comprehensive quality standard. It provides us with good benchmarks on how to improve. With regards to others, I know that many have tried to get JCI, but have failed. Others will try and some of them will, no doubt, succeed.
However, it is very difficult to get JCI and the pay-off can be meagre for some. In the public system patients will go to the hospital because they have no other option so there is no advantage to be gained through JCI.
Most private hospital groups are focused on immediate profits and it takes time to develop quality. Even more to become JCI accredited. Then there is no benefit when it comes to tendering for public contracts. Normally, the public hospital will get the contract even if the private hospital is much better.
Sadly, the only incentive that Russian doctors have to perform well is the medical oath! But I believe that this will change and more hospitals and their doctors will begin to target quality.
What impact has the crisis had on your business?
Let me first say that I am enjoying this period. I remember the crisis back in 1998 when the exchange rate jumped five times. Two is nothing! Everything passes in time and this will pass as well.
We are becoming more concentrated and more focused on the actual complaints of the patients. We actually have to foresee the problems now.
So far we have seen no decrease in the patient flow, although that will probably change over time. There has definitely been a movement away from areas like cosmetic surgery and dentistry, but you can’t exactly wait until the end of the crisis to fix your acute heart condition.
The currency depreciation is a problem, which is very difficult to get around. For example: If you have bought a piece of medtech from Phillips, you also have to buy spare parts from Phillips and they continue to become more expensive. The official inflation rate is 12-15%, but in our industry it is 25% or more.
On the other hand, the price of comparable European hospitals in roubles is now 2.5 times lower than us. Before the crisis we were only a little cheaper.
I have been reading Warren Buffet’s book and he has a wonderful comment about 2008: “Only when the tide goes out do you find out who has been swimming without a bathing suit”. The crisis will separate the wheat from the chaff.
Does the inpatient market suffer more than the outpatient market when it comes to the grey sector?
The grey sector is our strongest competition and it has always been this way. The assessments run by the consulting companies clearly demonstrate this.
Building a system where patients pay over the counter instead of under it takes time. People will always try to pay less. But in the grey sector the patients only pay to the doctors.
The only option for the manager of a private hospital is to be much, much better than anyone else.
We hear that there has been a shift in attitudes towards healthcare in the last year, which mirror broader shifts in attitudes within Russian society, and now the European brand is not as desirable. Would you agree that European medicine faces something of a problem?
Well, I am a scientist, and I prefer to answer questions scientifically. But what I would say is that no more than 30,000 people left post-Soviet block countries for treatment in Europe last year. That is not a great deal.
People used to think that European hospitals could perform miracles. Now they see that many doctors are not that good. If you look at mortality rates for coronary stents, they are at 0.5% in our hospital and 1% in private European hospitals.
Half the patients that we treat were getting help abroad and they are happier with us.
And that has nothing to with the crisis?
Do you have any designs on working for the MHI at all?
We are doing a little work for the state, for example, in IVF. Where the tariffs allow a small margin. The high tech medicine tariffs are all more attractive. But they are exceptions.
What are your expansion plans?
We have no plans to expand within the next two years. We have good facilities here and our ambition is to be the best not the biggest.
Published in February 2016