05 January 2004 12:37
Services of special interest for the Government
 - Rumors have abounded recently that the Russian government is going to go over to either fully paid or 90 percent of paid for education, especially professional education, and health care. This is a special subject within your blocks - did you consider it?
- Shuvalov: This is wrong, I can say it outright. No such proposals have been drafted. But in fact, both education and health care are now paid services to a large extent, this is no secret. There are official data indicating that the health care and educational systems have extra payments - they sell certain services. This is allowed by the laws, and it is practiced.
In addition to legal payments made by every family for education and health care, there are, as we know, informal payments, for example, to technical personnel, and also to teachers and doctors. That is why it would be wrong to discuss any transition to paid services.
- 15 years ago there were free health care and free education in the Soviet Union, but now we are denied it.
- No one is denied either free education or free health care. The main thing to understand is that both education and health care are not spheres of social expenditures - they should be well organized economic mechanisms producing certain products that should be denominated in GDP units. They are undoubtedly services, and in principle, they are no different from cars, machine tools or steel. But these are special services, the state has a special interest in them, and it will pay for health care and education, too, but on very different terms.
This is the point of a great debate, there are no solutions yet, and we spend three or four times every week in discussions on the subject in the presidential administration, the government and the Strategic Studies Center. We need to clearly understand what the state is responsible for, and on what scale. The Constitution says that higher professional education one can get on a competitive basis. But we are not giving too much thought to figures. At present more people in the Russian Federation are getting higher professional education than 10-15 years ago - far more people. But then they are do not take jobs according to training.
- They cannot find such jobs -- or don't want to?
- There are different reasons. But most of that education is paid for out of the budget. The system is rather distorted. Even the US does not produce as many specialists with higher education in per capita terms. So, we need to say that the state will continue to provide opportunities for getting higher education free of charge on acompetitive basis - just as the Constitution says - but this should be real pay, not cross subsidy, and those who make really good academic progress should have an opportunity to get their education at government expense. Such opportunities will be provided not only to successful school graduates, but also to other social groups.
- Who will they be?
- First, those who deserve it by their diligence, second, those who have served in the Russian Army under contract and thus deserved such educational opportunity. Certain social groups need special protection: children from broken families or children in large families.
- A social safety net.
- Absolutely right. But those who can pay for their education and we are talking about higher professional education, should do so. Because at present if you look at the structure of the student body in higher education, as a rule the children from successful families, I mean the children of well-off parents, usually pay no tuition fee. This is unfair. If they are outstanding children who have got an excellent mark at the state examination and have been academically advanced throughout their years in secondary school then the state must support such children. All the rest should contribute to financing education legally. Because a professor or lecturer at a higher education institution will only be able to occupy a worthy place in society through transparent economic institutions, not through direct budget subsidies to that institution. The link between each teacher with his student should consist in the teacher providing quality instruction and in the teacher being competitive in the market by turning out well-instructed students.
- What task is such a change supposed to solve?
- First, all the payments in the system should be legal. Everything should be transparent and it should be known exactly what the citizen pays for, what the future employer pays for if he is involved in this system. That would attract much more legal money into the education system, create competition between higher education institutions, it will enable professors to compete for the right to teach students and that would improve the final product of education.
- To introduce that reform, several pieces of legislation will need to be adopted. Will that be stretched out in time?
- One has to pass laws, but in addition to laws it is necessary to have a certain transitional period during which we will
pass on from one system to a different one. It will not happen tomorrow or the day after, it will take several years.
- You spoke about modern professional education. But what about health care? People will be afraid that they will be deprived of free medical care such as it is.
- We proceed on the basis that under the Constitution medical care is free in state and municipal medical institutions. But we should understand that the state's obligation to provide free medical care has its limits. Obviously, the Russian budget for the following year is much better and larger than that of four years ago. We hope that it will be still better in four years time and in eight years time. The state as it develops will earmark more money for health. But we should be realistic. We only have so much money.
At present the health system is such as it is and the government is able to pay a certain amount of money for it. Specialists estimate that additional payments approximately equal the amount of official financing through the budget. And if we accept that this is the reality, we should make it quite clear what the state is actually responsible for. Experts suggest that we should talk about certain standards available to every citizen regardless of his or her income. This is the joint obligation of all the citizens of the Russian Federation to contribute money to the community chest.
You know that there are special taxes and deductions that depend on the wage fund. One can say that those who earn more contribute more to that system and those who earn less contribute less. Plus the budget money. The principle of joint responsibility in this case consists in the fact that, whether you are healthy or not, young or not, everyone helps everyone else within the system.
- A sort of pension fund?
- Yes, by the principle of formation. We put certain financial capabilities in place to provide for everyone, but within certain limits. It is clear, of course, that not everyone can be provided with top-class care delivered by professors in the best institutions of the country. So, we need to determine what health care services will be provided through guaranteed budgetary funds and special taxes, and what care should be paid for by patients themselves by means of insurance policies or direct payments to health care institutions.
This is already practiced, for example, by prosthetics centers: domestically produced devices are issued free of charge, but imported ones are offered for money. That is why it is necessary to establish an absolutely transparent mechanism to make everyone understand what amount of health care is due free of charge, or rather, is guaranteed by the state within this system of everyone supporting everyone else, and this amount will vary depending on the economic capabilities of the state. Clearly, the better the budget situation, the more money the system will get.
- I think this will be far more difficult to calculate than in the case of education.
- This is difficult, but not as difficult as you think. Indeed, the country already has clinics in certain regions that operate under these schemes. They get financing on an entirely different basis.
Interviewed by Ekho Moskvy radio
[Ekho Moskvy radio] |
RUSSIA IN FACTS
