Medical services in Russia

Medical services in Moscow

Main article: Medical services in Moscow

Medical services in the Moscow region

Main article: Medical services in the Moscow region

2024

For 5 years, 200 thousand Chinese came to Russia for treatment

Over the past five years, almost 200 thousand Chinese citizens have come to Russia to receive medical services. This was announced on August 19, 2024 by Deputy Prime Minister Tatyana Golikova at the 25th meeting of the Russian-Chinese Commission on Humanitarian Cooperation, emphasizing the importance of developing this area.

According to RBC, Tatyana Golikova noted that in the period from 2019 to 2024, 198 thousand Chinese visited Russian medical institutions of the Ministry of Health. The most popular areas were ophthalmology, psychiatry, oncology and nuclear medicine. These areas are actively developing in cooperation between Russia and China, which contributes to the strengthening of bilateral relations in the field of health care.

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Freepik

The Minister of Health Russia Mikhail Murashko in February 2024 also said that there is a stable influx of patients from various countries, including Europe Asia and Arab, states who come to Russia for treatment. The most popular areas among foreign patients, according to him, are ophthalmology, oncology, cardiology and dentistry.

Medical tourism brings significant revenues to the Russian economy. According to the Minister of Health, the annual profit from medical services provided to foreign citizens is more than $1 billion. Mikhail Murashko noted that the demand for Russian medical services continues to grow, especially in light of the high level of professionalism and modern technologies used in Russian clinics.

Health Minister Mikhail Murashko in 2024 stressed that in recent years in Russia there have also been positive changes in the beauty industry, which has become another attractive direction for foreign patients.^[1]

How medical tourism is developing in Russia

The development of medical tourism in Russia requires an integrated approach aimed at attracting foreign citizens, especially from the CIS and BRICS countries. This conclusion is made in a study published in August 2024 by the consulting company Yakov & Partners, which emphasizes the importance of updating the national strategy in this area to achieve significant results.

Medical tourism refers to the receipt of medical services outside the region of residence. It can be a special trip for treatment or combining rest with medical consultations and procedures.

source-Unsplash

According to the study, by 2030 the volume of the medical tourism market in Russia may range from $2.2 billion to $7.6 billion, depending on development scenarios. However, as of August 2024, the contribution of this sector to the country's GDP is insignificant - less than 0.01%, which is less than $0.2 billion at the end of 2023. Key barriers, such as limited infrastructure capacity and difficulties with accreditation of health facilities, need to be addressed to improve the situation, experts point out.

According to experts, in the medium term, until 2026, special attention should be paid to attracting medical tourists from the CIS countries, including English-speaking patients. It is important to ensure the readiness of the infrastructure of Russian clinics for mass reception of foreign citizens, which is especially important for friendly countries of non-CIS countries, such as the BRICS + states.

In the long term, until 2027 and beyond, experts suggest focusing on improving the quality standards of healthcare services and accreditation of healthcare facilities. As Maxim Moseiko, an expert in Yakov & Partners health care practice, noted, the successful digital transformation of the Russian health care system and the increase in the role of insurance companies in the medical care of foreign citizens play a key role in the development of this area.^[2]

2023

Growth of orthopedic services market in Russia by 15% to RUB 28.8 bln

In 2023, the market for orthopedic services in Russia reached 28.8 billion rubles. This is 15% more compared to 2022, when the costs in the relevant area were estimated at 25 billion rubles. Industry trends are considered in the review of the analytical agency "GuideMarket," published on October 25, 2024.

It is noted that a characteristic feature of the Russian orthopedics market is a high concentration of high-quality medical services in large cities and metropolitan regions. At the same time, in remote and rural areas, the availability of such services is significantly lower, which is associated with a lack of qualified specialists and medical infrastructure. In general, the industry is actively developing due to the introduction of modern technologies and methods of treatment. Innovations such as robotic surgery, 3D printing of orthopedic implants and telemedicine consultations play an important role.

According to estimates, in 2019, the cost of orthopedic services in the Russian Federation amounted to 20.5 billion rubles. In 2020, a decline of 14.7% followed - to 17.5 billion rubles. Against the background of the COVID-19 pandemic, the market faced serious challenges: restrictive measures, the transfer of planned operations and a decrease in clinic attendance. But already in 2021, the industry returned to growth, showing an increase of 16.5% with a final result of 20.4 billion rubles. And in 2022, an increase of another 23.1% was recorded.

In the monetary structure of the orthopedic market, surgery occupies the largest share with a result of 30% in 2023. This is due to the high efficiency of surgical treatment in many diseases of the musculoskeletal system, such as arthrosis, osteochondrosis, injuries and birth defects. In second place is rehabilitation and recovery with 23%, and conservative treatment closes the top three with 22%. Next come diagnostic services, which accounted for 15% of revenue. Sports medicine provided 10% of the costs.^[3]

The volume of the pediatrics market in Russia in four years increased by 2%, to 474.7 million pediatric appointments

In 2023, the number of pediatric appointments in Russia amounted to 474.7 million. For comparison, in 2019 this figure was 464.9 million. Thus, for four years, growth was recorded at the level of 2%. This is stated in a study by BusinesStat, the results of which were published in mid-October 2024.

It is noted that a stable level of pediatric services is supported by improving the quality and availability state of medical care, reducing the shortage of doctors and nurses, opening new children's medical institutions or departments in multidisciplinary health centers and developing telemedicine. Among the significant players in the industry under consideration are named SM-Doctor LLC, Group of Companies JSC, Medsi Haven LLC, JSC, European Medical Center JSC, Family Doctor CHUZ TsKB RZHD-, medicine LLC, AlfaInsurance Medicine LLC, LLC, etc Поликлиника.ру.

In 2020, according to estimates, 420.3 million pediatric appointments were carried out in Russia, which is 9.6% less than in 2019. Against the background of the COVID-19 pandemic, Russians tried not to visit medical institutions, fearing infection. At the same time, there was a decline in commercial sectors associated with the rejection of "non-urgent" receptions due to a decrease in income. At the same time, one of the most notable trends in the medical services market was the development of telemedicine.

In 2021, due to the implementation of deferred demand, the number of pediatric appointments in the Russian Federation increased by 21%, reaching 508.7 million. Those who had had coronavirus required further observation and rehabilitation. But in 2022 there was another decline: the number of receptions decreased by 6.1% - to 477.9 million. The rise in prices due to the worsening geopolitical situation led to a decrease in the availability of paid pediatrics services.^[4]

The number of psychologists in Russia for 4 years increased by 18%

By the end of 2023, the number of psychological counseling specialists in Russia reached 57.7 thousand. For comparison, in 2019, their number was estimated at 48.8 thousand. Thus, for four years, an increase of about 18% was recorded. Such dynamics indicate an increase in the demand for psychological services in the country, as reported in the BusinesStat review, published on July 10, 2024. Read more here.

The number of appointments from gynecologists in Russia began to grow again

In 2023 Russia , approximately 142 million obstetric and gynecological appointments were held in. This is about 1% more compared to 2022, when the number of such sessions was estimated at 140.7 million. The most common reason for a visit to a gynecologist was prophylaxis, followed by appeals about. pregnancies Such data are provided in the BusinesStat review presented on July 9, 2024. More. here

Reduction in the number of tomographic medical examinations by 2.6% to 28.1 million

In 2023, approximately 27.4 million tomographic medical examinations were performed in Russia. This is 2.6% less than the previous year, when the figure was 28.1 million. Among the restraining factors are the decrease in the availability of imported equipment, difficulties with its maintenance and repair amid sanctions restrictions, as well as rising prices. Market analysis is provided in the June 21, 2024 BusinesStat review.

The study looks at diagnostics such as magnetic resonance imaging (MRI), computed tomography (CT) and positron (two-photon) emission tomography (PET). Other methods include single-photon emission computed tomography, scintigraphy, etc. Among the significant players in the Russian market are named LDC MIBS, PET-Technologies Diagnostics, PET-Technologies Center and Expert Tver Clinic.

According to estimates, in 2019, about 18.8 million tomographic studies were carried out in Russia. A year later, the figure jumped 32.9%, reaching 25 million, and in 2021 the increase was 19.8% with a final result of 30 million. Such a significant positive trend is due to the COVID-19 pandemic. During this period, computed tomographs were most intensively used, with the help of which viral pneumonia was diagnosed. As a result, the load on one CT machine increased from 16.7 studies per day in 2019 to 22.1 studies in 2021. This diagnosis made it possible to identify complications in the early stages and start treatment or hospitalize the patient as quickly as possible.

In 2022, after the end of the peak of the pandemic, the demand for CT studies began to decline: the number of procedures decreased on an annualized basis by 6.2%. The deteriorating geopolitical situation also began to have a negative impact on the industry.^[5]

The Russian market for commercial medicine began to grow again (+ 1.5%, up to 262.6 million appointments )

In 2023, the number of appointments in the sector of legal commercial medicine in Russia reached 262.6 million, which is 1.5% more than a year ago. The industry returned to growth after the recession recorded in 2022. This is stated in the BusinesStat review, which is presented in early July 2024.

The study takes into account all medical services paid for in cash or non-cash form for individuals and legal entities. The most common type of payment in this sector, as noted, is payment for appointments through the clinic's cash desk - at a time with the receipt of services. Among the significant players in the Russian market are named JSC "Group of Companies, "Medsi" JSC, "European Medical Center" LLC" Haven "(" Mother and Child "), ChUZ" TsKB "RZHD-Medicine," JSC "Medicine" (clinic of academician Reutberg), LLC "LDC MIBS," MCH "Industry Clinical and Diagnostic Center of PJSC," Gazprom LLC Medilux-TM (MedSwiss) , etc.

The review said the market is showing volatile momentum. In 2019, according to estimates, the number of medical appointments in the commercial medicine sector in the Russian Federation amounted to 244.7 million. In 2020, a drop of 7.2% was recorded - to 227.1 million visits. This is due to the COVID-19 pandemic. Multidisciplinary private clinics faced a decrease in the flow of patients, as people feared infection with coronavirus and postponed "non-urgent" appointments, such as consultations, preventive visits to doctors, planned procedures and operations.

In 2021, due to deferred demand, there was an increase in the number of receptions by 18% - to 268 million. Moreover, due to the high workload of state medical institutions, people began to turn to private clinics more often to receive medical care not related to the diagnosis and treatment of COVID-19. However, in 2022, against the background of a worsening geopolitical situation, another decline occurred: the number of visits decreased by 3.5% - to 258.6 million.^[6]

Russians spend an average of 6,100 rubles on private medicine

Residents of Russia spend an average of 6100 rubles a year on private medical care, while the highest costs were noted among residents of Moscow and the Krasnodar Territory. This became known on June 26, 2024 from the report of the National Rating Agency (NRA).

According to the NRA, the largest spending on private medicine was recorded in Moscow - 25,300 rubles per capita per year, and in the Krasnodar Territory - 15,900 rubles. In addition to these regions, in 11 regions, the annual costs of paid health care exceed the national median by 1.5 times. Among them are Primorsky Krai, Khabarovsk Krai and Magadan Oblast.

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Unsplash

NRA analysts note that the high cost of medical services and the saturation of the supply market are the main factors affecting the level of spending in these regions. At the same time, in 40 constituent entities of Russia, the cost of private medicine is below the average. For example, in the Amur region, Tambov and Voronezh regions, annual spending per capita is about 4100 rubles, in Mordovia - 3500 rubles, and in Ingushetia - only 700 rubles.

According to the NRA report, the total volume of paid medical services in Russia in 2023 increased by 11% and amounted to 1.36 trillion rubles. The growth of paid services is most significant in regions with high incomes of the population, such as Moscow, Moscow Region, St. Petersburg, Krasnodar Territory and Sverdlovsk Region.

Larisa Popovich, Director of the Institute for Health Economics at the Higher School of Economics, notes that commercial medical institutions attract patients with no queues and a high level of service comfort. In some cases, against the background of a shortage of medical personnel, the necessary doctor is available only in a private clinic.

According to NRA estimates, the volume of the paid medical services market in Russia in 2024 may reach 1.49 trillion rubles, and in 2025 - 1.62 trillion rubles. However, according to Larisa Popovich, the commercial health sector may face difficulties due to significant government investments in the development of primary health care. These measures include the renovation and construction of polyclinics and day hospitals, which could increase competition for private clinics.^[7]

Growth of the paid medicine market by 11% to 1.36 trillion rubles

At the end of 2023, the volume of the paid medical services market in Russia reached approximately 1.36 trillion rubles. This is 11% more than the result for the previous year, when expenses in the relevant area amounted to 1.22 trillion rubles. Such data are given in the report of Rosstat, published on February 7, 2024.

It is reported that in 2023, Russians spent 9258 rubles on average on medical services. A year earlier, this amount was 8308 rubles, and in 2021 - 7486 rubles. At the same time, the share of medicine in the total volume of paid services provided in Russia decreased from 9.4% in 2022 to 9.2% in 2023.

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Rosstat

The maximum spending of the population on medicine in 2023 was recorded in the Central Federal District - approximately 509 billion rubles against 461 billion in 2022 (the figure increased by 10.5% compared to the previous year). In second place is the Volga Federal District, where costs on an annualized basis rose from 183 billion to 208 billion rubles. The Southern Federal District closes the top three with an indicator of 168 billion rubles against 148 billion rubles in 2022.

The maximum expenses of citizens for medical services among the constituent entities of the Russian Federation were recorded in Moscow. The share of the capital in the total volume of paid medical services at the end of 2023 amounted to 24.5%, or approximately 332 billion rubles. A year earlier, costs were estimated at 301 billion rubles. In second place in the ranking is the Krasnodar Territory with a result of about 93 billion rubles, which corresponds to 6.8% in the total amount of expenses for medical services. This is followed by St. Petersburg and the Moscow region - 88 billion and 72 billion rubles, respectively. The Republic of Bashkortostan closes the top five with costs of 44 billion rubles. In all these entities, the growth of expenses on an annualized basis is in the range of 10-15%.

Adygea became the leader in terms of the growth rate of expenses for medical services in 2023, where costs jumped by 36.6% compared to 2022 - from 1.1 billion to 1.5 billion rubles. In second place in this rating is the Perm Territory with an increase of 23.9% - from 17.8 billion to 22 billion rubles. The third place went to the Kirov region, in which the volume of the paid medical services market on an annualized basis increased by 23%, amounting to 8.4 billion rubles against 6.8 billion rubles in 2022. Then the Republic of North Ossetia and the Smolensk region go: the first cost rose by 21.3% year-on-year (from 1.5 billion to 1.9 billion rubles), the second - by 21% (from 3.7 billion to 4.5 billion rubles).

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Rosstat

Of the 85 subjects listed in the Rosstat data in 2023, only four have a decrease in expenses for paid medical services. These are the Nenets Autonomous Okrug (minus 1.5% in relation to 2022), the Komi Republic (minus 1.4%), the Sakhalin Region (minus 1%) and the Kaliningrad Region (minus 0.9%).

Market participants highlight several key factors contributing to increased spending on health services. One of them is the growth of the supply of high-quality paid services in the field of health care. It is often problematic to receive highly specialized urgent care in public institutions, and patients go to private clinics. In addition, thanks to the development of various programs aimed at increasing life expectancy, Russians began to take more care of their health and more often undergo preventive examinations. Plus, in the current geopolitical situation, medical institutions are forced to raise prices, since there were difficulties in importing medical equipment, medical devices, reagents and medicines.^[8]

Decrease in the number of paid visits to the dentist by 1.7% to 70.1 million

In 2023, Russians made a total of 70.1 million paid appointments to the dentist, which is 1.7% less than a year earlier. This is evidenced by the data of the analytical company BusinesStat, released in February 2024.

According to the authors of the study, the volume of the Russian market for commercial dentistry has decreased due to its saturation, as well as for the following reasons:

• Population outflow. The move of business abroad and the outflow of population to neighboring countries led to a decrease in the number of solvent Russians.
• Decrease in purchasing activity. Amid rising prices in dentistry, insolvent customers have delayed expensive treatment until better times.
• Reorientation of demand. Consumers with low incomes were forced to abandon the services of commercial clinics and move to the compulsory medical insurance sector or visit clinics in the low price segment.

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BusinesStat

Analysts note that the stage of rapid growth in sales of paid dental services is already behind. New players in this market appear infrequently due to high entry barriers and restrained demand.

BusinesStat believes that against the background of higher prices, potential customers are trying to save money and postpone non-urgent visits to a paid dentist for a long time.

The study explains that private medical institutions of both network and non-network format, as well as state clinics providing paid medical services, operate in the market for commercial dentistry. A noticeable market share is occupied by private dentists. The existence of the commercial medicine sector in dentistry is ensured, on the one hand, by distrust, insufficient equipment, poor quality of service and a lack of staff in state medical institutions, the report says.^[9]

Rosstat named 10 regions of the Russian Federation with the lowest assessment of the quality of children's medicine

In early February 2024, the Federal State Statistics Service (Rosstat) published the results of a study of the quality and availability of medical services in Russia. The report, among other things, highlighted the regions with the lowest assessment of the quality of pediatric medicine.

Most parents with children under 15 who are dissatisfied with the quality of free medical care for minors are recorded on Sakhalin - approximately 25.1%. This anti-rating is followed by Khakassia with 18.3%, Altai with 16% and Vladimir region with 15.2%.

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Rosstat

It is said that the share of Russians with children under the age of 15 years, not satisfied with the quality of free medical care provided to children at the place of residence, in Russia as a whole in 2023 reached the lowest value since 2013 - 5.1% of the total number of respondents. The highest value was recorded in 2015 - 11.4%.

In the Chukotka Autonomous Okrug, the share of parents with children under 15 who are dissatisfied with the quality of free medical care is 13.8%. Then come the Udmurt Republic with 13.5%, the Republic of Crimea and Dagestan with 13.3% and 12.3%, respectively, the Oryol region with 11.9% and the Republic of Sakha (Yakutia) with 11.5%.

When checking pediatric hospitals and polyclinics, according to Roszdravnadzor, one of the most frequent types of violations is the lack of qualified specialists. In addition, during inspections in 2021 and in the first half of 2022, the department recorded isolated violations of the procedure for providing pediatric care in medical organizations and pediatric departments.

In 2023, Rosstat was first interested in how long it took patients to get to a medical organization for a consultation or diagnosis, and 60-70% (depending on the purpose) noted that this takes less than 20 minutes.^[10]

Roszdravnadzor revealed violations in 80% of tested private clinics

In 2023, the Federal Service for Supervision of Health Care (Roszdravnadzor) inspected approximately 1,380 medical institutions. They included 191 private clinic, which is 13.8% of all verified medical organizations. Such data on January 16, 2024 was published by the Public Council under Roszdravnadzor.

It is said that among the inspected private clinics, various violations were identified in 154 institutions, that is, in 80.6% of cases. What kind of problems the specialists found is not specified as of the specified date. At the same time, the department says that the results obtained "make us think about the advisability of lifting the moratorium on scheduled inspections by Roszdravnadzor of medical institutions due to the presence of unscrupulous players in the medical services market and the special importance of the health protection of citizens."

Roszdravnadzor revealed violations in 80.6% of the inspected institutions

The moratorium in question was introduced by the Russian government in 2022, and in March 2023 it was extended until 2030. The measure affects organizations whose activities are not classified as extremely high and high risk of harm. In December 2023, the government replaced scheduled inspections of medical institutions with preventive visits lasting one day.

The head of the territorial body of Roszdravnadzor in Moscow and the Moscow region, Roman Kurynin, says that more violations are recorded in private clinics than in state ones. At the same time, the department points to the problem of unfair advertising of medical services. So, the case is mentioned in Dagestan, when the patient attracted by aggressive advertising of the medical center paid a substantial amount for his services, but the quality of the services provided remained dissatisfied. In this regard, Roszdravnadzor points to the need to regulate advertising in the field of medical services by the FAS.^[11]

The volume of M&A transactions in the Russian medical services market for the year is estimated at 33.1 billion rubles

At the end of 2023, the total volume of the largest M&A transactions (M&A) in the Russian medical services market amounted to 33.1 billion rubles. This is stated in the study of the analytical company Eqiva, the results of which are presented on January 8, 2024.

The largest deal in 2023 was the sale of the Invitro laboratory network to businessman Roman Mironchik. Analysts estimate the value of this asset at 30 billion rubles. Thus, this deal accounted for about 90% of the total medical M&A sector in the Russian Federation in 2023. Another major deal was the purchase by the MD Medical group of companies ("Mother and Child") of a ready-made hospital in Moscow, located on 31 Michurinsky Prospekt: the acquisition of the facility cost 2.24 billion rubles, another 600 million rubles were allocated for retrofitting.

The study notes that, despite the intensification of investors in other sectors of the Russian economy, it is difficult for "non-core" investors to reach clinics. In addition to Mironchik (a member of the board of directors of Transcapitalbank and the microfinance organization Viva Money), Kismet Capital Group of the ex-general director of Megafon Ivan Tavrin, Interros Vladimir Potanin, Region Group, Severgroup are named among the interested market participants.

Potential investors in the Russian medical market face a number of obstacles. These are difficulties with evaluating the medical business, as well as the fragmentation of the industry. According to estimates, in 2023, investors brought at least 59.1 thousand square meters to the market of medical services. For comparison: a year earlier, this figure was 105.8 thousand square meters. Thus, the fall on an annualized basis was at the level of 44%. The volume of investments in the creation of the ten largest facilities amounted to 7.39 billion rubles.^[12]

The Ministry of Health of the Russian Federation named the top 10 clinics for income from foreign patients

In January-July 2023, the revenue of Russian clinics from the provision of paid medical services to foreign citizens amounted to approximately $437.7 million. At the same time, more than half of this amount - $271.9 million - fell on the organizations of the Central Federal District (CFD), in which more than 4.44 million people received assistance. Such data were published on December 5, 2023 by the Ministry of Health of the Russian Federation.

We are talking about the implementation of the federal project "Development of the export of medical services." Its goal is to increase the income of Russian medical organizations from servicing foreign patients to $1 billion in 2024. For comparison: in 2017, this figure was approximately $250 million. In 2022, revenue in the area under consideration reached $729.94 million, which is 92% more compared to the value for 2021 - $378 million.

The revenue of Russian clinics from the provision of paid medical services to foreign citizens amounted to approximately $437.7 million

According to the results of the first seven months of 2023, the top 10 Russian clinics for income from foreign patients were headed by the N.N. Fedorov with a share of 18.9% of the total revenue. The rating also includes N.N. Blokhin National Medical Research Center of Oncology (14.1%), N.N. Burdenko National Medical Research Center of Neurosurgery (8.8%), A.N. Bakuleva National Medical Research Center of Cardiovascular Surgery (6%), Sechenov State Medical University (5.1%) and N.I. Pirogov Russian National Research Medical University (3.9%). All these clinics are located in Moscow.

Following the Central Federal District, the level of income from the provision of paid services to foreign citizens is followed by medical institutions of the North-West and Ural Federal Districts: their revenue for January-July 2023 was recorded in the amount of $37.6 million and 40.2 million, respectively. During this period, 2.15 million people received assistance in these organizations. The most popular services are preventive examinations, neurology, oncology, radiology and radiotherapy, obstetrics and gynecology, as well as pediatric cardiology.^[13]

2022

The number of tomographic examinations in Russia soared by 87.3%

The number of tomographic examinations in Russia conducted in 2022 reached 28.1 million, which is 87.3% more than 5 years ago. Such figures in July 2023 were cited by BusinessStat analysts.

According to them, the market in question has grown largely due to state support: the purchase of equipment for state medical institutions within the framework of the national project "Healthcare," the allocation of standards and tariffs for tomographic examinations in the program of state guarantees of free medical care, a reduction in the maximum permissible waiting times for CT and MRI studies.

According to the BusinessStat report, computed tomography is the most common type of tomographic examination in Russia. In 2018-2022, the share of CT studies in the total market volume increased from 70.1% in 2018 to 80.9% in 2022. The predominance of CT in the total volume of tomographic examinations is explained by the wide prevalence of devices of this type and the active increase in the demand for CT examinations due to the coronavirus pandemic.

In second place in the number of studies in Russia in 2018-2022. was MRI diagnostics. Due to the active growth of the CT diagnostics sector, the share of MRI studies in the total market volume decreased from 25.7% in 2018 to 16.4% in 2022. PET and PET/CT share averaged 0.8% of the market.

Together with the increase in the number of medical institutions offering tomography services in Russia, the number of tomographic diagnostic personnel increased. In 2022, it amounted to 65.4 thousand people, which exceeded the value of 2018 by 8.7%.

Market participants note a lack of qualified specialists who can work on modern equipment. Work in the field of tomographic diagnostics involves regular advanced training, which may not be provided by all medical institutions.

In addition, the market is characterized by the outflow of specialists from state medical institutions to private ones. Commercial clinics offer radiologists and radiographers a higher salary and comfortable working conditions, the study said.^[14]

The number of applications of foreigners reached 12 million

In 2022, 12 million visitors turned to Russian clinics, spending more than $700 million on treatment. The most popular areas among foreigners are orthopedics, ophthalmology, oncology, cardiac surgery, pediatrics and other areas. At the same time, only 5% of the total were medical tourists.

Yevgeny Chernyshev, President of the Association for Medical Tourism and Export of Medical Services, said that the main factor restraining the development of the medical tourism industry is the lack of legal ability of state hospitals to pay commissions to agents (tour operators and agencies specializing in medical tourism). As for the advantages, Russia as a player in the medical tourism market, this is a serious level of personnel qualification and a high technical equipment of medical institutions. Chernyshev also reported that 80% of the flow of medical tourists are Russian-speaking citizens of neighboring countries of the Commonwealth of Independent States. High interest in medical tourism in the Russian Federation is also observed among residents. In China their case, one of the most popular profiles is reproductive, medicine since such technologies are China prohibited.

12 million visitors turned to Russian clinics

In April 2022, the Russian Ministry of Health proposed launching a national online booking system for medical tourism. According to the authors of the project, this innovation will expand the list of services in Russian medical institutions and facilitate the process of their choice. The platform is an analogue of the Booking system and is designed to rank the country's clinics by attractiveness, quality and accessibility for patients.

According to Andrei Gayderov, Deputy Director of the Department of International Cooperation and Public Relations of the Ministry of Health of the Russian Federation, the organization of medical tourism in Russia is the goal of the federal project "Development of Export of Medical Services" (part of the state project "Healthcare"), which has been operating since January 1, 2019, due to it it is planned to increase the export value of medical services to $1 billion by 2024.

In early November 2019, the Central Research Institute of Organization and Informatization of the Ministry of health care Health launched the portal "Development of Export of Medical Services." On the website, users can search for clinics in various areas of medicine, such as orthopedic surgery, transplantology and oncology. According to the Ministry of Health of the Russian Federation, the largest number of foreign patients from 2019 to 2020 were from such countries Belarus Kazakhstan Serbia Germany:,,,,,,,,. In Latvia Uzbekistan Tajikistan Azerbaijan 2022, Moldova Ukraine^[15]

The number of complaints to Rospotrebnadzor about paid medical services increased by 18.9%

Residents of Russia began to complain more often to Rospotrebnadzor about paid medical services. The number of such appeals in 2022 increased by 18.9% compared to 2021.. This is evidenced by the data of Rospotrebnadzor, published in early June 2023.

According to the statistics of the department, the first three places were taken by the number of complaints: dental services, the share of which in the total number of admissions was 21.5%; obstetrics and gynecology - 4.4%; cosmetology - 4.4%.

The number of complaints to Rospotrebnadzor about paid medical services has increased

In general, there were fewer complaints about medical services - both paid and free - in 2022: 13,808 complaints were received by the territorial bodies of the department regarding the protection of consumer rights in the field of medical services, which is 32.8% less than in 2021, when 20,572 appeals were registered. In 2020, for comparison, there were 21,055, in 2019 - 10,300.

The main violations of the rights of citizens in the provision of medical care: low availability, refusals, failure to provide a guaranteed amount of assistance and information about the state of health, violation of the right to choose a doctor and medical organization, non-compliance with medical secrets.

In 2022, Roszdravnadzor recognized 20.3% of all appeals as justified (in 2021 - more than 30%). At the same time, Russians have become less likely to apply to insurance companies and territorial funds of OMS Campus Management. The number and proportion of appeals on such issues as unreasonable collection of funds for services provided for by the state guarantee program, receipt of drug provision, the quality of medical care, the possibility of choosing a doctor, is not decreasing, the Federal Compulsory Medical Insurance Fund recently reported.

According to the All-Russian Union of Insurers (ARIA), in 2022 the quality and availability of compulsory medical insurance medicine worsened, and the number of complaints from insured persons on these items increased by 14%.^[16]

Growth in the turnover of the medical services market in cities with a population of over 100 thousand people by 57% in 5 years to 3.29 trillion rubles

In 168 cities of Russia with a population of over 100 thousand people, the turnover of the medical market increased by the end of 2022 to 3.29 trillion rubles, which is 57% more than five years earlier. The increase was largely due to an increase in the average cost of admission, BusinesStat analysts said in their May 2023 study.

In 2022, among the cities of Russia, the following leaders in the turnover of the medical market were: Moscow (817 billion rubles), St. Petersburg (336 billion rubles), Novosibirsk (69.8 billion rubles), Krasnoyarsk (60.6 billion rubles), Yekaterinburg (57.8 billion rubles).

According to BusinesStat, the volume of the medical market in the Russian Federation in terms of the number of appointments in 2022 decreased. In the public sector, this was due to the stabilization of demand for medical services. Patients of private clinics in the conditions of the sanctions crisis were forced to save, including through the services of paid medicine. There was a partial redistribution of demand for clinics in the lower price segment, as well as for the compulsory medical insurance sector.

Analysts add that under the sanctions, clinics were forced to raise prices more, as there were problems with the import of medical equipment, medical devices, reagents and drugs. The sanctions led to the failure of logistics, the complication of mutual settlements and the rise in price of products. During 2022, medical market operators were looking for new suppliers and distributors from countries that did not impose restrictions on trade with Russia. As a result, delivery times and transportation costs increased significantly. Thus, the rise in the cost of paid medical services has become inevitable. With low consumer incomes, commercial medicine has become less affordable, BusinesStat noted.^[17]

Decrease in the volume of the medical services market by 6% to 2.2 billion appointments

In 2022, residents of Russia made a total of 2.2 billion doctor's appointments, which is 6% less than a year earlier. This is evidenced by data from BusinesStat analysts, which were released in April 2023.

Experts called the deterioration in consumer solvency amid the sanctions crisis the reason for the decline. The reduction in the number of receptions in the public sector was associated with the stabilization of demand after strong growth in 2021, the study said.

It also notes that in 2019-2020. in the context of the COVID-19 coronavirus pandemic, the volume of the medical services market in the country decreased by 10%: from 2.19 to 1.97 billion appointments. In 2021, the market grew by 19% due to the implementation of deferred demand after severe quarantine restrictions and due to increased anxiety due to the pandemic. In 2022, there was a decrease in the number of medical appointments both as a result of stabilizing demand and due to a decrease in the availability of paid medical services. Instability of exchange rates, problems with imports and payment under foreign economic transactions accelerated the rise in prices for private clinic services.

The 2022 geopolitical crisis greatly complicated the work of both government and commercial medical organizations. Sanctions hit logistics the hardest. Russian medicine remained to various degrees dependent on the import of equipment, consumables and components for it, diagnostic reagents and drugs.

Sanctions were not imposed on the supply of medical goods. However, Western companies were afraid to cooperate with clinics and trade organizations from Russia. One of the significant risks for them was the problems with receiving payment for the goods supplied due to sanctions against Russian banks. During 2022, medical institutions were looking for new suppliers and distributors of medical devices from countries that did not impose restrictions on trade with Russia, analysts say.^[18]

The number of purchases of medical services in Russia decreased by 21%

The number of purchases of medical services in Russia in 2022 decreased by 21% compared to 2021, and the market sank 12% in money. This is stated in a study conducted by the online medical service "SberZdorovye" and the analytical resource "Check Index" of the company "Platform OFD" (the largest operator of fiscal data, which processes 50-55 million cash checks daily from more than 1.1 million online cash registers in Russia). The data was released in March 2023.

As Kommersant writes with reference to this report, the average check for private medical services in the Russian Federation in 2022 amounted to 3376 rubles, which is 9% more than a year earlier. Most of all, it grew in Moscow, to 7865 rubles - 19% more than a year earlier. The main reason for the increase in the average check, according to the authors of the analysis, was a decrease in the number of purchases of relatively inexpensive services - mainly testing for coronavirus COVID-19. In addition, the increase in costs from clinics due to the rise in price of a number of materials, medicines and equipment affected. However, as indicated in SberHealth, with the development of parallel imports and the selection of analogues in the domestic market by the end of the year, the situation improved markedly.

In Russia, the cost of medical services has sharply decreased

According to specialists of the SberZdorovye service, a decrease in the number of purchases of medical services and a decrease in sales is associated with a decrease in the incidence of COVID-19 in Russia. For this reason, citizens began to spend less on diagnostics and laboratory tests.

According to Aleksei Remez, director of the Point of Care clinic network, interest in the services of commercial clinics has decreased for several reasons, and the main ones are:

• return of demand to the pre-pandemic (coronavirus pandemic COVID-19) format;
• citizens began to save money.

Referring to the doctor and receiving a full examination plan, the patient is forced to choose only a few services from the entire list and often determines the set on her own, "Niarmedic Anna Rybakova, chief physician of one of the clinics of the network, said in a conversation with the newspaper.[19]

The Russian market for paid medical services grew by 8%

The volume of the Russian market for paid medical services in 2022 reached 1.2 trillion, rubles an increase of 8% compared to 2021, when the indicator was measured at 1.1 trillion rubles. This is evidenced by the data Rosstat released in March 2023.

Compared to 2020, the total volume of medical services provided not under the Campus Management compulsory medical insurance policy in 2022 increased by 36% due to a 26% rise in 2021. Russian patients receiving paid medical services spent about 8 thousand rubles on average in 2022, which is 591 rubles more than a year ago.

According to Rosstat's calculations, the share of commercial medicine in the total volume of paid services provided in the Russian Federation increased from 9.3% in 2021 to 9.6% in 2022. The maximum expenses of the population in the category of medical services were recorded in December 2022. Then the Russians spent about 109 billion rubles on paid medicine. The minimum indicators are observed in January - 82 billion rubles. In January 2023, 92 billion rubles were spent.

Rosstat cited data from 85 regions (excluding four new entities). In 74, an increase in expenses for paid medical services was recorded, for example, in the republics of Adygea and Kalmykia.

The Russian government at the end of February 2023 received the right to hide some open statistics, including on health care. They will be able to restrict access only to official statistical information, which is posted publicly by Rosstat. The rest of the data types are now available only for internal use by authorities and data providers.

It is noted that in 2022, two main trends for the future were noticeable in the segment of private medicine: the first implied a strong drop in patient flow, the second - difficulties with the supply of medicines and consumables. However, these predictions did not materialize.

For example, in Moscow and St. Petersburg in 2022, not only was there no decrease in the number of records to medical specialists, but there was also an increase in some clinics. Medical organizations focusing on VHI also generally did not notice an increase or drop in the number of customers from insurance companies compared to last year. The reason first of all is that most of the big players who buy policies do so at the end of the year.

As for the most popular areas, in 2022 there was a jump in demand for aesthetic services, for example, for implants in dentistry. In some areas, there were difficulties with the availability of consumables, but in general, private medical organizations managed to quickly build new logistics chains, experts say.

If we talk about negative aspects, then today several dozen private clinics in Russia have closed. These were mainly medical institutions with long-term financial difficulties. However, so far these are more isolated cases than a widespread trend.

According to RBC, in 2022, clinics lost the opportunity to work with promotion tools on Google, as well as on Facebook and Instagram (both social networks belong to Meta, which is recognized as extremist and banned in the Russian Federation). Until the end of February 2022, they were one of the key platforms for attracting customers. Despite the fact that access to familiar platforms and their capabilities is now limited, the goals and objectives of the business that they solved have not disappeared. Clinics tried to transfer all budgets from Google to Yandex, so at the moment there was a strong "overheating of the auction" on this site and an increase in the cost of attracting patients by 1.5, or even 2 times from the usual.^[20]

The Russian market for paid dental services grew by 8.2% to 71.3 million appointments

The Russian market for paid dental services in 2022 grew by 8.2% compared to the volume of one year ago and amounted to 71.3 million appointments. BusinesStat analysts reported this in a study released in March 2023.

According to experts, the decrease in demand for paid medical services was due to a sharp increase in prices for dentistry and a partial outflow of solvent customers from the country. Geopolitical tensions in 2022 led to a complication of logistics, instability of exchange rates, difficulties in paying for supplies through a number of Russian banks, outflow of business and the population abroad. The availability of imported materials and equipment for domestic dental market operators has decreased, and the cost has increased. As a result, prices for dental appointments have risen at a record, the study said.

The Russian market for paid dental services for the year grew by 8.2%

Analysts also note that amid rising prices for dentistry in Russia, purchasing activity froze, patients with low incomes moved to dental clinics in a lower price segment or began to treat their teeth according to Campus Management compulsory medical insurance policies. At the end of 2022, the pre-crisis volume of the client base of dental clinics could not be maintained.

According to BusinesStat, in 2018-2020. the number of paid dental appointments in Russia decreased by 12.9%: from 85.2 to 74.2 million. The main decline occurred in 2020 (-12.1%). Due to the strict quarantine to contain the spread of the coronavirus COVID-19, there has been a sharp decrease in the level of consumption of dental care.

In 2021, the volume of the domestic market for paid dental services partially recovered and amounted to 77.7 million appointments. The key influencing factor was pent-up demand after the severe coronavirus restrictions of 2020.^[21]

2020: The volume of paid medical services in Russia has almost tripled in 10 years

According to data Rosstat that were released at the end of May 2022, in 2020, Russians were provided with paid services in the amount of 694 billion, rubles which is 2.8 times more than in 2010. With their share in the total volume of medical services over 10 years increased from 5.1% to 7.7%.

According to Rosstat's calculations, Russians' spending on medical care has also increased over 10 years: in 2010, one resident of the country spent an average of 1.8 thousand rubles on medical services, in 2020 - already 4.7 thousand rubles.

The volume of paid medical services in Russia has almost tripled in 10 years

The document also includes data on the volume of paid services provided to elderly citizens and disabled people. This category spent more than 28 million rubles on these services in 2020. Compared to 2015, the figure increased by 78%. On average, one patient from this category spent 195 rubles in 2020, which is 86 rubles more than in 2015.

Among the services provided to elderly citizens and disabled people, the most expensive in 2020 was the manufacture of a removable prosthesis. The consumer price for one prosthesis is more than 11 thousand rubles. In 2010, it amounted to about 4 thousand rubles. The most budgetary turned out to be physiotherapy treatment - 204 rubles.

According to analysts BusinesStat, in 2020 the volume of the medical services market in the country decreased by 10.8% compared to 2019 and amounted to 1.93 billion appointments. The reason for the decline was a decrease in the volume of outpatient polyclinic medical care. In 2020, 74.6% of medical appointments in Russia were provided in the outpatient and polyclinic unit. The suspension of planned medical care in the context of the COVID-19 pandemic contributed to a decrease in the number of appointments provided in the Campus Management compulsory medical insurance sector . The decline in the commercial sectors was associated with the rejection of "non-urgent" receptions due to a decrease in income. In addition, the Russians tried not to visit medical institutions, as they were afraid of infection with coronavirus, the study says.

Statistical collection of Rosstat 2021

2021: Foreign spending on medical services in Russia increased by 52%

The spending of foreigners on medical services in Russia in 2021 increased by 52% compared to 2020 and amounted to $539.6 million. Such data in April 2022 was published by the Central Bank of the Russian Federation.

According to the regulator's estimates, in 2021, medical organizations in Moscow ($254.76 million) and St. Petersburg ($41.13 million) became the leaders in the export of medical services. At the expense of clinics from these regions, the Central Federal District and the North-Western Federal District are also leading in terms of medical care to foreigners in monetary terms - $315.01 million and $63.7 million at the end of 2021, respectively. $14.18 million was provided by the clinic in the Tyumen region, $11.02 million - in the Krasnoyarsk Territory, $10.8 million - in the Krasnodar Territory.

Foreign spending on medical services in Russia increased by 52% over the year

Least often, foreign patients sought medical care in the Southern Federal District ($23 million) and the North Caucasus Federal District ($10.47 million). For example, in the Republic of Ingushetia, the value of the services provided by the visitor was at the level of $110 thousand. In the Chukotka Autonomous Okrug, there were no such patients at all.

At the same time, according to the Coordinating Center, the Ministry of Health of the Russian Federation of the Ministry of Health, due to closed borders and restrictions on movement of export revenues of Russian medical organizations decreased in 2020 from $223 million to $197 million a year later. According to analysts from the Ministry of Economic Development, which were data in 2022, it will take at least three years to restore this market at least to the level reached before the COVID-19 pandemic.

Specialists of the Center for Medical Statistics of the State Budgetary Institution "NIIOZMM DZM" calculated that in 2021 the amount of the cost of medical services provided to foreign citizens in medical organizations of the state health care system of the city of Moscow amounted to 3.6 billion rubles, which is significantly more than a year earlier. The positive dynamics of the indicator was influenced not only by an almost twofold increase in the number of foreign citizens who applied for medical services, which became more accessible after the weakening of short-term restrictive measures introduced in the country in 2020 due to the threat of the spread of COVID-19, and the opening of international borders for citizens of some foreign countries, but also the growth of the "average check" for services, the report says.^[22]

Notes