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At the end of May 2024, the Magadan Region Prosecutor's Office said The region's hospitals owe enormous debts to contractors. In total, they amount to more than 2,5 billion rubles. Plus, they owe over a billion rubles in taxes and fees. Another 17 million rubles are owed in wages to 332 employees. The accounts of the medical institutions (formally, all of them are part of the regional hospital) are frozen, and the money can only be spent on wages. Another government agency, Magadan Pharmacy, purchases medications and consumables. according to the Ministry of HealthThe debts of Kolyma hospitals account for almost 15% of the accounts payable of all medical institutions in the country. Magadan institutions are among the top three worst in terms of outstanding debts, along with the Nizhny Novgorod Region and the Karachay-Cherkess Republic. This situation would seem likely to lead to a scandal and numerous questions for the authorities. However, it has not and will not: the problem has long been known. It all began at least in 2015.

The Magadan Regional Hospital was founded in 1955. Until 2021, it was a separate entity and the largest medical facility in the region. It served as a regional, city, and emergency medical care hospital. Its structure includes 47 departments: 18 inpatient departments providing surgical and therapeutic care, an admissions department, two anesthesiology and intensive care units, an operating room, a regional vascular center, a nephrology department, a regional outpatient clinic, an occupational pathology center, a dermatovenereology center, diagnostic services, and auxiliary units. Following a reorganization and optimization that began in 2018 and was completed in 2022, all central district hospitals in Kolyma were incorporated into the regional medical institution as branches, and its administrative staff was reduced. 

Underfunding of hospitals in the Magadan region has been ongoing since at least 2015. At that time, the results of reporting periods revealed that, for example, funds for soft goods (bed linens, shoe covers, towels, etc.) were practically nonexistent, while food and medications were short by 30-40%.

The reason for the disastrous situation the authorities called Federal regulations. Medical institutions are financed by the Health Insurance Fund. The procedure for transferring funds from the Mandatory Medical Insurance Fund to regional funds in May 2012 set Putin, then Prime Minister. The funds are allocated by the federal government, using a complex scheme that takes into account residents' contributions to compulsory health insurance and includes a number of additional payments. Experience has shown that the formulas set by Moscow ministers do not align with reality; the costs of treating and feeding patients in the Far North have exceeded and continue to exceed subsidies from the center.

However, observing this situation year after year, the Magadan authorities made no significant attempts to correct it. 

Three years later, in May 2018, in the region opened up One of the most significant problems: the region's main hospital was missing out on hundreds of millions of rubles to purchase medications and supplies. closed report A report leaked to the media about a medical facility for the regional government stated that the funding shortfall amounted to 336 million rubles, and the hospital was so short of consumables that "surgeons would be forced to perform abdominal surgeries, which poses a high risk to patients."

The Magadan regional hospital's dire situation with regard to medication supplies was also noted: "The specialized departments lack the most essential medications for both routine and emergency care. <…> To provide medical care, department staff are forced to ask patients to purchase medications at their own expense." In summary, the hospital's management threatened Kolyma authorities with a "high risk of the institution's operations being shut down."

Complaints from the MOB doctors continued throughout 2018. Surgeons stated, that they have no equipment to operate on heart attack patients. Funding for mobile teams to travel to remote areas has been cut fourfold. At the hospital in the village of Omsukchan in the summer turned off hot water - for non-payment.

The accumulated problems became so critical that they were finally presented publicly: Regional Duma Speaker Sergei Abramov recognized, that due to lowered standards, Kolyma is losing a billion rubles a year in healthcare funding. The Ministry of Health confirmed figures, specifying that the reason for the shortage was the need to fulfill May decrees Putin - doctors received higher salaries, but there was no money left for medications.

Minister of Health Irina Larina then statedIf the situation continues to develop, the authorities will resort to extreme measures and reduce the number of doctors in sparsely populated areas, converting hospitals in such areas into outpatient clinics. In the summer of 2018, Kolyma deputies submitted a request to the Russian Ministry of Health to revise regional funding indices. didn't give result. The department promised to study the issue within an unspecified timeframe.

Governor Vladimir Pechyony urged against panic and assured that the situation was under control. The funding shortfall, he said, created "certain problems," but "had no impact on the quality of medical services."

"I'm confident the hospital won't experience any serious problems and will provide high-quality medical care. We don't anticipate any complications," said Pecheny at a press conference on May 28, and by the evening of the same day, he was removed from his post by Putin. The head of the region was former mayor of Nizhny Tagil Sergei Nosov.

The first new minister appointed by Nosov was was Sergei Chekanov, who heads the Kolyma Ministry of Health, is a fellow countryman of Nosov's. He was a former surgeon in Nizhny Tagil, but in the 2000s, he entered politics and was elected to the local Duma.

In Kolyma, Chekanov was cast as a radical reformer, tasked with rebuilding the region's healthcare system. As early as December 2018, the new Ministry of Health said about the inevitable optimization of medical institutions, so far promising to cut only management staff. The minister also pointed to the need to centralize the financial resources of all hospitals. With these formulations, the upcoming reform did not provoke any protests.

In the spring of 2019, Chekanov, having inspected all the districts, at a meeting with chief physicians, saidthat those “have no desire to work,” and criticized bloated administrative staff. In addition, he made claims regarding non-payment of lifting allowances Visiting specialists who left the region because of this. Locals also complained about doctors' salaries: for example, an ophthalmologist in the city of Susuman (700 km from Magadan, surrounded by taiga) is working full-time. was getting 50 thousand rubles. 

It is a turned against Chekanov's professional community (considering, moreover, that he was an "outsider" in Kolyma). Even local authorities reacted to the minister's demarche. The mayor of Magadan took the criticism as an insult and publicly demanded from the minister, “from now on, communicate more politely with the population and voters.”

With such difficult inputs in April, Chekanov presented A plan for reforming medical institutions was presented to the regional Duma: all district hospitals would become branches of the Magadan Regional Hospital, and Magadan's outpatient clinics would be merged into a single legal entity. The authorities intended to reduce the size of the administrative apparatus through optimization: all accountants, economists, record keepers, and other non-medical staff would be consolidated into a single structure in Magadan. Only medical workers providing direct care would remain in local hospitals.

Some bleak figures were announced at the Duma meeting. The Magadan Compulsory Medical Insurance Fund allocates approximately five billion rubles for regional healthcare. The regional government is providing an additional two billion, but the funds are still insufficient. According to Chekanov, approximately eight billion rubles are needed, meaning the sector is underfunded by at least a billion rubles annually. 

Despite Chekanov's statement that "not a single doctor will be fired," the new measure met with unanimous opposition from deputies. They were also unconvinced by a report from Anastasia Shcherbakova, head of the regional compulsory medical insurance fund, who pointed out that 96% of the fund's funds are spent on medical salaries, leaving no money left over for purchasing medications. According to Shcherbakova, no other region in the country has such figures.

The deputies explained their resistance to the reform by citing a lack of consultation with them (and "the people"). The governor suspended all optimization measures for six months that same day. This occurred against the backdrop of the freezing of the regional hospital's accounts, which, It turned out, failed to pay contributions for its employees to the Pension and Social Funds for three years in a row. In district hospitals began blocking funds. Problems with medications and consumables are also not stopped.

When the passions subsided, Chekanov continued to pursue his "reformist" line. By the end of 2018, he introduced new pay conditions: incentive payments were reduced and the fixed portion of the salary was increased. During 2019, Magadan's clinics were unitedDistrict hospitals remained separate medical institutions for the time being.

Chekanov promised an updated optimization plan approved by the Russian Ministry of Health endure for public discussion at the beginning of 2020—the year of the coronavirus—but the federal agency sent it back for revision. And in the summer, the Kolyma minister, without explanation, gone resigned (unofficially, due to family circumstances). He was replaced by Ivan Gorbachev, manager subsidiaries of the state corporation Rostec - the medical holding company Shvabe.

Under Gorbachev, in February 2021, without any resistance, all district hospitals steel branches of the Magadan Regional Hospital. They also centralized obstetric beds: childbirth now take Only in Magadan and the village of Yagodnoye (the distance between them is 532 km); in other areas, pregnant women receive only emergency care. 

The shortage of medical professionals is the second most serious problem facing Kolyma healthcare after chronic underfunding. The number of unfilled positions remains roughly the same year after year: in 2020 not enough 245 medical workers (17,1% of the total number), in 2021 - 265 (21,2%).

The problem is not only quantitative, but also qualitative – there may not be enough “narrow” specialists more than one throughout the region. Summer holidays (northern ones - 56 days) can "knock out" up to half medical personnel in Kolyma, which is why huge queues are forming to see doctors.

Moreover, the problem that Governor Nosov directly raised with Putin at a 2021 meeting ("Citizens' dissatisfaction with the quality of healthcare is one of the key reasons for population outflow") was dashed by a rebuke from Finance Minister Anton Siluanov. 

"Generally, our tone is: there's a shortage here, there's a shortage there. There's plenty of everything! There are plenty of resources, and plenty of tools, we just have to use them! Enough money is being allocated! We have to use it," said Head of the Ministry of Finance of the Russian Federation.

Moscow does allocate funds, but not for the healthcare facility's ongoing operations, but for repairs and construction. For example, under Nosov, federal funds were used made High-quality renovations in clinics in Magadan and some villages. The main achievement is expensive major repairs in the main city polyclinic No. 1, in a building built in 1947.

Construction of a new maternity hospital has also begun (the current It was built in 1980, and the gynecological building is located in a building that is 68 years old. for 7,7 billion rubles. This project is one of the most expensive in the region in terms of costs. 

True, not everything is going well with the maternity hospital: on Putin's orders It should be commissioned by the end of the year, but the contract runs until October 2025, and the contractor has only been paid a billion rubles so far. As revealed during the inspection, repairs have been completed in hospitals in remote areas. inspections of ministers, turn out to be far from ideal.

During the coronavirus pandemic, the financial situation improved slightly due to widespread injections of funds into healthcare, primarily "coronavirus payments" to medical workers, who received additional compensation for risking infection. However, after the start of the "SVO," the funding shortage returned with the same severity. In November 2023, the MOB's accounts were frozen, and by May 1, 2024, the hospital was in debt. rose up to 2,5 billion rubles.

There is no comment on this matter from the authorities.

Chief Physician of the Ministry of Health Sergei Timofeev resigned He left Magadan that same November. He did not respond to requests for comment on the debt situation.

In July 2024, Ivan Gorbachev resigned from his post as Minister of Health. replaced Alexander Vitko, who held a similar position in Khabarovsk Krai for 13 years, said: "After reviewing the situation in hospitals, the new head of the Kolyma Ministry of Health gave program interview state channel. They talked about vaccinations and the problem of labor shortages "in some places," which the authorities are addressing by searching for specialists on job boards. Not a word was said about the debt situation. 

From January to September 2024, Magadan Regional Hospital received More than 500 claims in the Arbitration Court. Suppliers are trying to recover payments for goods and services (light and warmth, medications, security of premises, Products). In most cases, the MOB recognizes claims, often even without sending their representatives in court, but cannot pay the bills, complying with the court's decisions. The Ministry of Health, which is participating in the hearings as a founder, explains that the agency no money, and asks judges to reduce the amounts of administrative fines.

Over the past three years, the regional hospital has had three new chief physicians. The most recent, Yuri Lednev from St. Petersburg, was appointed by the current Minister of Health, Alexander Vitko. 

Due to the blocking of accounts in the summer ремонт A broken CT scanner at the regional hospital (the only one in the entire region) was purchased not through its own account, but through the government's "Procurement Center." The machine was idle for two months, and patients were referred to private clinics, but the costs of the scans were not reimbursed—all due to the same debts and frozen accounts. Three months later, the machine was repaired, but in October, it broke down again. For two weeks, patients were again referred to private clinics. The costs are still not reimbursed, and people are left without compensation. address to court. 

The head of the regional Ministry of Health placed the blame for the breakdown on medical personnel and saidthat part of the repair costs will be covered by hospital staff. 

A source connected to the Magadan Region Ministry of Health told NeMoskva that progress has been made in addressing the problem, but it won't radically change the situation: 

"We've been walking a tightrope for a while now. Starting in 2024, the Magadan Region is supposed to receive additional compulsory medical insurance funds; a new coefficient has been introduced—population density for regions with low accessibility. They'll add some, but nothing fundamentally will change. Where will we get 2,5 billion to pay off the debts? The region has already transferred over 540 million rubles to hospitals and clinics since the beginning of the year—just to keep the lights on. And from 2019 to 2023, 6,3 billion rubles were transferred from the local budget. We could probably find the money... Take out a loan, for example. But that's not profitable for us. Then the center will say, "Well done, you can handle it yourself," and they won't increase any payments, or even cut them. So we're cutting back on some emergency funding to avoid social tension and optimizing where we can. Basically, we're waiting for the center to step up and solve the problem. After all, it's their budgets, calculations, and coefficients."

Alexander Vitko hasn't yet offered a clear solution to the crisis. But he's been busy with public relations: he's been in his office daily. telegram channel several posts about his work appear, almost always with a lot of photos (1, 2, 3). The reasons are sometimes quite controversial. For example, news that he met with the only Magadan resident who came to the announced meeting-lecture about mass medical screening. But Vitko (or his press service) quotes classics, teaching doctors morality. 

Also, the new official was apparently given control of the local channel MediaMedicIt was allegedly created by medical students, but from the very beginning it covered the work of Ministry of Health officials, and now it is almost entirely devoted to the new minister and his visits to districts, hospitals, and clinics. 

Sometimes posts remind parody:

“Do you know what the minister of your industry looks like? 
This question has been floating around for a while, but it came to light yesterday in a conversation with the guys from the MIATS [Medical Information and Analysis Center] after a surprise visit. We'll relay it almost verbatim: 
"I'm sitting here working, pushing buttons, and then a man in a suit walks into the office. It's good that I follow you and recognized you, but to have him come like this without warning, without a week's worth of fuss, without having to scrub the entire office, not in the assembly hall with the whole crowd? He introduced himself, of course, but it was truly a surprise to me!" 

For comparison: a fragment from Victor Pelevin's novel "Generation P"

“There’s a special service, ‘People’s Will.’ Their job is to go around and tell people they’ve just seen our leaders. <...> The old man had already managed to gather a few homeless listeners around him. “Guys,” he said in a thin, astonished voice, “you’ll never believe it! I’m just getting half a liter at Kursky’s grocery store, right? And you know who walks into the store? Chubais! Damn it… He’s wearing this little gray coat, a mohair scarf, and a cap, and he has no security at all. He went up to the canned food section, picked up a three-liter jar of Bulgarian pickled tomatoes, and shoved it into the bag. I looked at him, my mouth open—and he noticed, winked, and walked out.” At the end of October, in one of his posts about the non-functioning MRI, the minister писал“I fully support the position of telling the truth and not hiding from problems.” 

He hasn't said a word about the problem of Kolyma hospitals' billion-dollar debts since his appointment.