Russian regions lack the funds to comply with federal Ministry of Health recommendations on patient care, including cancer treatment. Lawmakers have criticised the government for giving regions conflicting instructions: the Ministry of Health wants them to spend tens of times as much on treatment than the federal Ministry of Finance permits. Closing that funding gap would require a 19-fold increase in regional healthcare spending.
Russian regions cannot meet federal clinical guidance on oncology because their territorial state-guarantee healthcare programmes lack the necessary funding. The issue was raised by Badma Bashankayev, first deputy chair of the State Duma’s health committee. Citing calculations by one regional health minister, he said that treating all cancer patients in line with the guidance would require a 19-fold increase in the relevant territorial programme budget. Prosecutors and courts, meanwhile, are ordering regions to provide such treatment to patients.
‘Clinical guidance is essentially the distilled body of modern knowledge on each disease. But when regions start putting a price on it, they are horrified. Each regional minister now faces an average of 30 to 40 orders from prosecutors and courts demanding that treatment be provided. Patients say: “A federal centre said I need this treatment, and that’s what the clinical guidance says,”’ the lawmaker was quoted as saying by Medvestnik.
Tigran Gevorkyan, deputy director for federal project implementation at the Blokhin National Medical Research Centre of Oncology, said that, in theory, the inclusion of new therapies and innovative drugs in clinical guidance should be aligned with budget capacity and assessments of their expected impact in extending patients’ lives. At present, he said, no such alignment exists.
Clinical guidance consists of protocols setting out diagnostic criteria, assessments of complications and risks, preventive measures, drug prescriptions and rehabilitation methods. It is essentially a framework for diagnosing and treating patients, covering the nature of the disease, its clinical presentation, diagnostic standards, risk assessments and other factors doctors must consider when providing care. But industry experts have warned that small regional hospitals cannot implement all such guidance. They argue that the cost of complying with is yet to be calculated.
‘For example, what should a facility do if it cannot provide care in the way clinical guidance requires? Not all hospitals are equipped with state-of-the-art technology. It appears the guidance was drafted without regard to funding,’ said Larisa Popovich, head of the Institute for Health Economics at the Higher School of Economics. She argued that the cost of implementing mandatory treatment guidance should be calculated before it is introduced. Without financial backing, she warned, clinical guidance could trigger a collapse in the healthcare system.
Russian healthcare institutions moved to the new clinical guidance in 2025. But in October last year, Ministry of Health had already approved an order setting out how the guidance should be applied. Under the document, where a medical organisation cannot provide a patient with the care they are entitled to, it may arrange for ‘medical care using telemedicine technologies’. The patient may also be referred to another facility capable of providing the necessary treatment.
According to the All-Russian Union of Patients, regional spending on cancer care still varies sharply. Its estimates show that the highest spending on anti-cancer therapy in 2024 was in the Yamalo-Nenets Autonomous District, at more than RUB 193,000 per patient a year, followed by Kaluga Region at RUB 173,000 and Chechnya at almost RUB 160,000. By contrast, Penza Region spent RUB 18,000 per cancer patient over the year, Kursk Region RUB 24,000 and Ingushetia less than RUB 26,000.
‘We are seeing stark regional disparities in access to treatment, sometimes differing by tens of times. This inequality has a direct impact on patients’ chances of receiving high-quality care,’ said Yury Zhulev, co-chair of the All-Russian Union of Patients.
The union proposed reviewing funding levels for oncology care and introducing a transparent indexation mechanism.
Russian regions face a ‘global shortage of funding’ for cancer care, said Irina Borovova, president of the Zdravstvuy! All-Russian Association for Assistance to Cancer Patients.
Regions differ significantly in their level of development and population size, creating serious difficulties in ensuring patients receive the treatment they need. The current shortfall in funding for medicines ranges from RUB 300 mln to RUB 1.5 bln across different regions, and no systemic solution has yet been found,’ she said last year.
The organisation proposed indexing federal budget funding for subsidised regions that cannot cover the costs from their own budgets.
Russian regions are short of funds to provide cancer care, Elena Perminova, head of the Federation Council’s social policy committee, told Gazeta.ru. Zhanna Chefranova, the committee’s first deputy chair, said the gap between cancer patients’ needs and actual provision in the regions stands at about 12 to 15%. They proposed increasing inter-budgetary transfers under the federal cancer control project by about RUB 57 bln. Alternatively, they suggested creating a special federal reserve fund of the same size, with the amount subsequently indexed to forecast inflation
Russia has been implementing a new federal project, ‘Combatting Cancer’, since last year. It forms part of the national project ‘Long and Active Life’. The Ministry of Health has said its main aim is to increase life expectancy by improving the availability and quality of medical care for cancer patients. The project’s key target is to increase by 7% by 2030 the number of patients with malignant tumours who survive for more than five years. The proportion of people living for at least five years after diagnosis is expected to rise to 67% by 2030, from 62% in 2023.
The total budget for the ‘Long and Active Life’ national project through 2030 exceeds RUB 2 trln. Most of the funding will go to two federal projects: ‘Modernising Primary Healthcare’ and ‘Combatting Cancer’. The cancer control project is expected to receive RUB 140 bln a year, bringing total funding to RUB 840 bln. Experts say oncology spending is substantial, but part of the allocation is being eroded by inflation.
Comparable sums had been allocated before. The Federation Council noted that funding for cancer care through the compulsory medical insurance system doubled between 2019 and 2024, rising from RUB 186 bln to RUB 380 bln
‘However, the federal budget subvention for cancer care under clinical guidance, or treatment protocols, within the “Combatting Cancer” federal project remained unchanged and unindexed in 2021–2024 at RUB 140 bln. The same amount is also planned for 2025–2027, despite growth in the number of cancer patients and the emergence of new diagnostic and treatment methods,’ senators said. They warned that insufficient funding could restrict access to innovative therapies.
According to the Federal Fund for Mandatory Medical Insurance, funding for cancer care under the compulsory medical insurance programme exceeded RUB 433 bln in 2025. The figure was 12% higher than in 2024 and 2.3 times the amount allocated in 2019, the fund said.
ORIGINAL: NG/Russian Regions Lack Funds to Meet Ministry of Health Cancer Care Guidance
