At the same time up to 2007 Belarus was the only country of CIS, which bought Russian crude oil at prices much lower than world prices. In 2005 the average price for oil grade Urals for Belarus was USD 29.per barrel, while on average at world market it was USD 50.4 per barrel. This was due to the fact that export duty was not included in the price. For its part, in accordance with the bilateral agreement on the creation of common tariff and non-tariff regulation, Belarus, following Russia, should have increased export tariffs for oil and oil products and transfer 85% of the duty to the Russian budget. This agreement, however, was not observed: allocations to the Russian budget were not made, Belarus export duties were more than 30% lower than Russian’s. For instance, from 1 December 2006 Russian export duty for light distillates and gas oils was equal to USD 134 per ton, Belorussian – to USD 75.8; furnace fuel oil, lubricating oils and used oil products export duty from Russia - USD 92.9 per ton, while from Belarus – USD 72.2.
As this situation violated state-of-the-art agreements Russia introduced export duty for oil supplies to Belarus at the rate of USD 180.7 per ton since 1 January 2007. As retaliation Belarus introduced transit duty for Russian oil at the rate of USD 45 per ton. Russia however refused to pay it. After it became known that Russian fuel was taken away by Minsk to pay for new duties, Russian side stopped crude oil pumping through the Belarus’s part of pipeline.
As a result, oil supplies to some European countries were stopped on 8 January 2007. After signing Russia- Belarus agreement on January 12, 2007, oil supplies to Europe were recommenced in corpore.
The signed agreement presupposes the establishment of duty for oil, exported to Belarus in the years 2007, 2008 and 2009 at the rate of 29.3; 33.5 and 35.6% from the Russian export duty, correspondingly, and the introduction of export duties for light oil products by Belarus in accordance with the Russian legislation.
To compensate for privileged oil supply schemes for Belarus abolition, the Ministry of the Economy of Belarus announced a sharp rise in transit costs for Russian oil starting from 15 February 2007.
According to the government decree tariffs for oil transit services net of VAT are established at the rate of USD 1.26 to 3.5 per ton for 100 km. Heretofore tariffs in force for oil transit through the territory of Belarus were adjusted with the Ministry of Fuel and Energy of Russia as long ago as December 1995 and did not change since then: they were equal to USD 0.41- 0.6 per ton.
New expenses for oil transit to Poland through Belarus will come to USD 1197.7 mln. Under old tariffs this service cost USD 153.4 mln. Transit to the Ukraine will cost USD 69.3 mln, while earlier it was only USD 23.94 mln. In total after new tariffs being introduced Belarus will get USD 1267 mln annually. Earlier this income item was a little more than USD 177 mln.
Tariffs imposed by Belarus are significantly higher than European transit rates. Poland, for instance, pumps oil coming from Belarus further to Germany for USD 0.9 for 100 km, the Ukraine, which pumps oil to Czech Republic, Hungary and Slovakia charges 0.89 per ton for 100 km.
N.Volovik Priority National Project in the Field of Public Health Service: First Results Preliminary results of the implementation of the national project “Health” in 2006 testifies to the number of changes for the better in the availability of medical care, on one hand, but, on the other hand, to the difficulties of existing administration mechanisms transformation, which is required to secure its effectiveness.
The first year of the two-year period, for which the implementation of the priority national projects was designed, has passed. According to authorities’ estimations, the project “Health” is considered to be the most effective. Indeed, the available data on the progress of its implementation demonstrate the achievement of certain positive results, but also give evidence of existence of serious problems.
The national project was predesigned as inflow of extra funds to the public health service as an alternative to the reform that could not be put off. The effectiveness of the project is however initially restricted by the fact that the funds allocated for its implementation, envisaged in the federal budget and the budgets of the Federal CMI Fund and the Fund for Social Insurance of the Russian Federation in 2006 accounted for just 10% of joint expenses of the government for the public health care.
National project includes extra cash payments for the doctors of the primary health care (district physicians, pediatricians, general practitioners) and nurses who work with them at the rate of RUR 10,000 and RUR 5,000 correspondingly. The growth in wages of the mentioned categories of the doctors was 2.2-2.times. Besides, payments for medical personnel of first aid and obstetric stations, doctors, medical assistants and nurses of the emergency were included in the project: RUR 5,000 a month for doctors, RUR 3,500 a month – for medical assistants (midwives) and 2,500 a month - for nurses.
Extra payments for the personnel of the primary health care proved to be effective in solving the problem of the lack of this group of medical staff. The number of doctors, involved in the primary health care, increased by 9.7% during the year – from 66.9 thousand to 73.4 thousand, and the number of nurses – from 74.9 thousand to 81.9 thousand. The number of open vacancies for these positions reduced, the factor of combined jobs reduced from 1.6 to 1.3. These changes have a positive impact on the availability of the primary health care.
While elaborating the project in autumn 2005 it was supposed to transfer to new forms of remuneration of labor for doctors and nurses of primary health care not by automatic increase of their wages but by means of introduction of the system of financial stimulation, connecting the amount of wages with the results of their work. This, however, did not come to life. The personnel of primary health care regard the increase in wages as due, as fair compensation for their usual work and not as a stimulus to improve it. According to some evidence, measures envisaged by the project did not significantly change the quality of their work.
The increase in primary health care personnel wages was not accompanied with the similar simultaneous increase in wages of specialist doctors. This gave rise to social tensions in medical institutions. Indeed, later some specialists got additional payment for clinical examination of the employees of a government-financed organizations, working in the environment of harmful and (or) dangerous production factors. The data on the increase in average wages of specialists are not available yet, but it is obvious that this increase is not comparable with the increase in wages of primary health care personnel and tension in outpatients’ clinics remains.
According to the project, 4 mln people in 2006 and 8 mln people in 2007 have to be examined by the additional programs of clinical examination. In fact, clinical examination started only in summer 2006 and only 3.8 mln of employees have been examined.
In the framework of the project 6.8 thousand ambulances were purchased, which enabled to renew one third of the fleet of such vehicles in the country. According to estimations of the Ministry of Health Care and Social Development, the average period of waiting for emergency teams has reduced as a result from 35 to 25 minutes. National project implied the equipment of 11 thousand outpatients’ clinics (that is more than the half of them) with diagnostic equipment. In 2006 22.7 thousand articles of diagnostic equipment of total worth of RUR 14.3 bln were delivered to outpatients’ clinics. Massive equipment of primary health care with electrocardiographs (8.8 thousand of units), ultrasonic equipment (4.1 thousand of units), endoscopic equipment (3.6 thousand), rontgenologic equipment (3.3 thousand) and laboratory equipment (2.9 thousand) provides conditions to make medical care more available for the population. According to the Ministry of Health Care and Social Development of the Russian Federation data, the average waiting time for check-up in outpatients’ clinics, which received new equipment, reduced from 10 to 7 days, and the share of respective chargeable inspections reduced by 30%.
In this part of project the traditional approach is carried out: to solve a particular problem certain types of medical institutions should be created/ equipped in some number. At the same time the measurable results, which will be achieved with the help of new equipment, are not specified. National project does not imply the monitoring or analysis of the efficiency of delivered equipment usage. The control for equipment utilization is entrusted to Federal Service for Health Care and Social Development Supervision and subjects of the Russian Federation, but development of the methods of such a control or funds allocation for implementation of effective monitoring of the equipment usage was not envisaged.
The efficiency of inclusion of some components into the project, especially the check-up of the new-born children for galactosemia, adrenogenital syndrome, mucoviscidosis, seems doubtful. To carry out this task RUR 0.4 bln was spent and 120 cases of these illnesses were detected, making the expenses for each detected case more than RUR 3 mln..
The project counts on the reinforcement of the centralized administrative control for its undertakings implementation, but for most tasks does not envisage the changes in control procedures. Monitoring of project implementation is carried out by standard managerial methods of control by administrative institutions for scheduled undertakings proceedings; only the list of indicators requested from local organizations was widened. There is a risk that traditional forms of control will not, on one hand, guarantee data receiving and, on the other hand, will not become serious obstacles for ineffective use of funds allocated for the project..
Table Expenses for the Priority National Project in the Field of Public Health Care, billions of RUR Directions of national project and ttypes of expenses Planned for Indeed % of 2006 transferred fulfill in 2006 ment Federal budget Priority “Development of the primary medical care” Training and retraining of general practitioners (family doctors), district 0,2 0,15 doctors, district pediatricians Payments for general practitioners, district therapeutists, district pedia15,4 14,6 tricians and nurses who work with them Payments for medical personnel of first aid and obstetric stations, doc5,2 4,1 tors, medical assistants and nurses of emergency Equipment of municipal outpatients’ clinics with diagnostic equipment 14,3 14,3 Equipment with ambulances of emergency units and offices 3,6 3,6 Population immunization 4,5 4,5 Population check-up in order to reveal people, infected with hepatitis В 2,8 2,8 and С, HIV, and their treatment Check-up of the new-born children for galactosemia, adrenogenital 0,4 0,4 syndrome, mucoviscidosis Priority «Provision of high-tech medical care for population” Construction of high-tech medical care centers 12,6 3,6 High-tech medical care rendering 9,9 9,8 Carrying out information support and project administration 0,6 0,6 Total from the federal budget 69,5 58,5 Means of Federal Fund for Compulsory Medical Insurance Conducting of extra clinical examination of employees of a government2,0 1,6 financed organizations at the age of 35-55 years Extra payment for primary medical aid for pensioners who do not work (tariff increase within the limits of regional compulsory medical insur- 6,4 4,4 ance programs by 25%) Total by FFCMI 8,4 6,0 Means of the Fund for Social Insurance of the Russian Federation Payments for medical aid for women in the period of pregnancy and 10,5 9,0 childbirth (“childbirth certificate”) Payment for additional clinic examination of the workers and primary 7,0 3,9 medical aid provided for them Additional medical check-ups of employees in the industries connected 1,9 1,9 with harmful and (or) dangerous factors of production Total by FSI RF 19,4 14,8 Total 97,3 79,3 Source: Ministry of Health Care and Social Development of the Russian Federation; http://www.mzsrrf.ru/main/ The expenditures for government assignment for free provision of expensive (high-tech) medical care at the rate of RUR 9.9 bln were included in the project (in 2005 RUR 6.3 bln was spent for this purpose), the number of patients treated for this sum was 128 thousand of people. The main investment component of the project is the construction of 15 high-tech medical care centers during 2 years. In 2006 expenses of RUR 12.6 bln were planned, but in fact only RUR 3.6 bln was spent. The construction of 7 such centers in towns of Astrakhan, Penza, Krasnodar, Cheboksary, Krasnoyarsk, Tyumen, Khabarovsk was started. But there is the risk that in spite of the increase in the number of centers and the amount of medical assistance both in old and in new centers the practice of informal payments for treatment will be reproduced. Respectively, the effect of the growth in high-tech medical aid will be diminished by persisting necessity for patients to pay extra to clinic’s personnel informally.
The comparison of the data on planned and real expenses as broken by the directions of national project leads to interesting conclusions (see Table). The funds in the directions of the project connected with equipment, vaccines, test-systems purchase were drawn entirely (equipping of the outpatients’ clinics with diagnostic equipment, emergency stations with ambulances, population immunization, population check-up to reveal people, infected with viruses of hepatitis B and C, HIV, their treatment, neonatal screening). Besides, the expenses for additional medical check-ups of employees in the industries with harmful and (or) dangerous factors of production and for information support and project administration were made as was planned.
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