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Coordination and private investmentA much more basic problem, which is the lack of coordination among outpatient clinics and hospitals in Moscow, will also have to be addressed. Pechatnikov in particular cited the appalling problem of cooperation between clinics for expectant mothers and actual hospitals where women go to give birth. "A woman is being looked after by one doctor in her clinic - and where she may end up giving birth may not be clear right away," he said. "So then she is hospitalized around her due date, and the medical history of her pregnancy is either completely shrouded in mystery, or almost completely shrouded in mystery." Though pregnant women in Moscow usually arrive to give birth with a hefty amount of paperwork and analysis data from their primary OB/GYNs, the paperwork itself often resembles useless bureaucratic documents, and does not always reflect the most important information on the health of the expectant mother and the baby. Outpatient clinics are also suffering from a lack of specialists in narrow fields, whereas inpatient programs often have an excess of them, resulting in hospitalization requirements that can turn out to be costly for both the patient and the state. "As we hospitalize people less, we can create more and more combined centers with both outpatient and inpatient treatment programs," Pechatnikov said. "So local medical specialists can see all of their patients in one spot, instead of having to trek across Moscow to different hospitals as they often do now." Another aspect of modernization is giving patients free rein to choose their doctors and treatment centers, banning the use of so-called tickets to see a doctor only at one's local clinics. This practice is particularly useful for many patients who arrive to Moscow from elsewhere in Russia and have not gone through the cumbersome process of establishing official residency in the capital. City Hall also admits that some "problem" hospitals can be aided via private investment - pointing out the story of Moscow Hospital 63, long considered one of the most run-down medical establishments in the capital. The city found a long-term investor for the hospital who put up four billion rubles. "For a project like this, the investor expects to get his money back within 15 to 17 years," Pechatnikov said.
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