Providing High-tech Health Care  in the Murmansk region 

A.D. Rubin

2008

Territory

The Murmansk region is one of the largest  and economically developed regions in European north of Russia; it is the only subject of the Russian Federation, almost entirely located beyond the Arctic Circle, it occupies the whole of Kola Peninsula, which is washed by the Barents Sea and the White Sea.

The population density of 1 sq. km is an average of 6.6 people.

It borders on Norway and

Finland

Participant of EuroArctic  Baretsregion

The nonfreezing Kola Gulf

Direct access to the Ocean

It occupies the Kola Peninsula, to the north of the Arctic Circle

The territory of 144.9 thousand sq.km.

The population density of 1 sq. km is an average of 6.6 people.

Length From West to East – 550 km, from North to South – 440 km.

Population health is influenced by extremely adverse climatic conditions of the Kola North  (a complex relief, unfavorable wind and temperature conditions, long polar day and polar night, high magnetic activity and humidity, frequent changes in atmospheric pressure, which cause a syndrome of “polar stress”).

The dynamics of the resident population size in the Murmansk region (in thousands)

The number of births  in the Murmansk region

(according to the registry office data)

8516

8455

8754

83008350840084508500855086008650870087508800

2005 2006 2007

Fertility. Mortality. Natural increase.

10,2

8,67,6 8,29,89,710

,29,39,2

8,17,9

11,712

,713,413

,41312

,411

,611,1

10,1

98,8

-1,2

-0,7

-2,5

-2,9 -3 -3,

2-3,

7 -3,2

-3,6 -2,

9

-1,5

-4

-2

0

2

4

6

8

10

12

14

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Рождаемость Смертность Ест.прирост / убыльFertility Mortality Natural increase\loss

The structure of the overall incidence of adult population  

22%

12%

11%8%5%

6%

4%5%

4%10% 3%

10%

болезни системы кровообращения болезни костно-мышечной системыболезни мочеполовой системы болезни органов пищеваренияболезни глаза болезни эндокринной системыинфекц. болезни новообразованиябол.кожи и подкожной клетч. болезни нервной системытравмы и отравления прочие

Diseases of the circulatory system  Diseases of urogenital systemEye diseases Infectious diseases Skin and subcutaneous adipose tissue  diseases Injuries and intoxication

Diseases of the musculoskeletal system  Diseases of the digestive apparatus Diseases of the endocrine system Tumors Diseases of the nervous system

Others

The structure of mortality for the main classes of reasons 

1%6%

3%13,6%12,2%

55,6%

9%

болезни системыкровообращения

несчастные случаи,травмы и отравления

новообразования

болезни органовдыхания

болезни органовпищеварения

инфекционные ипаразитарные болезни

прочие причины

Diseases of the circulatory system 

Accidents, injuries and intoxication Tumors

Diseases of the respiratory apparatusDiseases of the digestive apparatus Infectious and parasitic diseases

Other reasons

Providing high-tech health care (HHC)

to Russian population is one of the areas

of priority national project (PNP)

“Health”. It is regulated by the orders of

Ministry of Health and Social

Development  of the Russian Federation 

(MHSDRF) with the allocation of quotas

for the regions. Annually about 1000

residents of the Murmansk region 

receive treatment in federal health

centers.

To improve the quality and access to medical care for those people, who need high-tech care, the following documents were developed and adopted in the Murmansk region:1.Administrative Regulations on the provision of public service “Submission and providing high-tech health care to citizens of the Murmansk Region”;

2.An Order of the Murmansk Health Care Committee, which regulates procedure of selection and  Committee’s activity on patients referral to treatment at clinics.

3.Software product ”Referral to treatment in Research Institute (RI)”, which is the basis for annual reports.

Referral to high-tech care in federal institutions

Application allocated quota referred patients children

2005

2007

Referral to high-tech carein federal

institutions and Municipal

Regional Clinical Hospitals (MRCH) 

MoscowSt. PetersburgMRCH

MCH FSA “N.I. Pirogov NMSC”, Murmansk

Others

13%3% 7%5%

4%21%

4%

4%

25%

14%

кардиохирургия офтальмологиятравматология и ортопедия онкологиягематология эндокринологияЧЛХ урологияревматология другие

Referral to high-tech care in federal institutions in 2007 on the following profiles

CardiosurgeryTraumatology and Orthopedics Hematology Maxillofacial surgeryRheumatology 

OphthalmologyOncologyEndocrinologyUrologyOthers

Certain types of medical care keep higher-priority: implantation of large joints,

certain types of heart surgery, neurosurgical treatment,

in vitro fertilization etc. 

As at 01.10.2008, 244 persons are included into the

“waiting list “(within the allocated quota)

Murmansk population is provided by medical care of the highest level, which is financed from the federal budget. In 2007 GHA “P.A. Bayandin Murmansk Regional Clinical Hospital” (MRCH) was included in the List of Medical Practical Institutions (MPI), which take part in the public task on providing high-tech care.

Clinical, logistical, intellectual and industrial facilities of the Region allow to use high-tech treatment  in cardio vascular surgery, neurosurgery, traumatology and orthopedics.

As at 01.01.2008, using funds for residents of the Murmansk Region and Republic of Kareliafrom the federal budget, the following operations were performed:

180 cardio vascular operations (100%);70 trauma and orthopedic operations (100 %).

As at 01.10.2008, using funds for residents of the Murmansk Region and Republic of Kareliafrom the federal budget, the following operations were performed:

200 cardio vascular operations

(91% of the total quota);91 trauma and orthopedic operations (91% of the total quota).30 additional quotas in neurosurgical profile for residents of the Murmansk

region were allocated, in October 2008 7 operations were performed.

The cost of the regional budget for providing high-tech medical

service in the Region was in 2007 - 330.7 million 

rubles, scheduled for 2008 – 375,1 million rubles.

Number of high-tech care recipients in Murmansk Regional Clinical Hospital

for the period from 2003 to 2008 (from the federal and regional budgets).

The structure of patients after high-tech care surgical treatment

in Murmansk Regional Clinical Hospital in 2007

1295

492

1220

87

34

0 200 400 600 800 1000 1200 1400

офтальмология

сердечно сосудистая хирургия

травматология и ортопедия

нейрохирургия

урологияUrology

Neurosurgery

Traumatology and Orthopedics 

Cardiosurgery

Ophthalmology

The structure of patients after high-tech care surgical treatment

in Murmansk Regional Clinical Hospital for 9 months in 2008

975

560

797

333

90

0 200 400 600 800 1000 1200

офтальмология

сердечно сосудистая хирургия

урология

травматология и ортопедия

нейрохирургияNeurosurgery

Traumatology and Orthopedics 

Urology

Cardiosurgery

Ophthalmology

10,3

2912,5

64

6,3

64

3,2

62

3,1

98

2,5

118

3,2

124

6,3

96

3,9

103

2,4

82

3,1

128

4,4

137

2,4

167

4,9

223

4,1

218

4,5

269

0

50

100

150

200

250

300

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007In January 2007, the 2000-th operation

with the use of coronary artery bypass grafting was performed in

Murmansk Regional Clinical Hospital

Lethality

The number of operations

Operations with artificial blood circulation  and lethality in Murmansk Regional Clinical Hospital for the period from

1992 to 2007

The number of operations on heart with an coronary artery bypass grafting  

(including operations on the working heart)

2005 2006 2007The number

of operations 223 220 269Mortality 4,8 % 3,7 % 4,42 %

The number of operations on major arteries  

2005 2006 2007399 410 425

The number of implanted pacemakers with radiofrequency

ablation2005 2006 2007265 247 341

The number of patients with diagnostic and therapeutic endovascular interventions

2005 2006 2007

Diagnostics 4639 5058 4134Treatment

(stenting, angioplasty) 410 570 639

The number of rentgen-surgicalinterventions and operations

The data of A.N. Bakulev SCCVS, RAMNThe average frequency

of rentgen-endovascular operations to 1 million people in 2006   

RF  Northwest

regionThe Murmansk

region 

The Northwest

region 

P.A. Bayandin Murmansk Regional Clinical Hospital

takes the 15th place among all Russian clinics by the number of endovascular coronary

interventions,

but in terms of 1 mln. population andoperating room workload –

one of the ten most active clinics in Russia. (The data of A.N. Bakulev SCCVS, RAMN)

Coronary arteriography is the only method for choosing the best tactics of treatment in patients with coronary heart disease.

The need for coronary arteriography per

1 million of population  is more than 3,000 procedures a year. 

490

930

770

388312

299243

16752

1228

1104

0

200

400

600

800

1000

1200

1400

1993 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Today coronary arteriography is the «gold standard»

of coronary heart disease (CHD) diagnosis 

Replacement arthroplasty

Replacement arthroplasty

Hip joint Knee joint

New high-tech methods of treatment were introduced in Murmansk Regional Clinical

Hospital in 2003 - 2007:- Knee replacement;

- Endovascular treatment of abdominal aneurysm;

- Endovascular treatment of hysteromyoma;

- Endovascular bifurcational stenting of coronary arteries in coronary heart disease;

- New endovascular methods of treatment of ischemic stroke and hemorrhagic stroke;

- Stabilizing operations on the spine  using submersible systems;

- Laser discission of secondary cataract;

- Laser descemetogoniopunctura;

- Combined phacoemulsification with profundus sclerotomy;- Intravitrial introduction of Gemaza;- Cataract phacoemulsification with implantation of intracapsular ring in lens subluxation;- Application of allodrains in profundus sclerotomy;- Endoscopic operations on bile-excreting tractus using endoscopes with side-optics;- Operations for improving hearing;- Endoscopic operations on the nose and paranasal sinus;- Associated operations in valvular defects and coronary heart disease.

Completion of the reconstruction of

centralized operational unit in Murmansk

Regional Clinical Hospital in 2008

will increase implement of high-tech

methods of surgical treatment in 1,7 times