MOSCOW -- Neurologist Semyon Galperin has been treating patients for more than 20 years at Moscow's Hospital No. 11.
Under Russia's new health-care reform, which officials say will boost effectiveness and improve medical services, the facility was merged last year with a larger Moscow hospital.
Now Galperin is being laid off from his job -- an increasingly common scenario as the restructuring appears to be gathering pace. "I have a letter from our clinic's administration in my pocket offering me to work as a nurse since my current position is terminated," he says.
While health professionals, officials, and patients all agree on the need to overhaul Russia's creaking medical system, health-care professionals complain the reform so far has consisted chiefly in shutting down facilities and firing staff.
"In order to privatize state hospitals and avoid a public outcry, they came up with the following scheme," Galperin says. First smaller hospitals are turned into branches of "larger hospitals. Then, he adds, the smaller facilities "go bankrupt," are shut down, and are privatized.
Vladimir Putin made health-care reform a priority when he returned to the Kremlin for a third presidential term in May 2012.
Although the shakeup has been ongoing across the country for two years, medical workers say it has intensified in recent months with cuts, layoffs, and hospital closures in full swing in Moscow and other cities. "Moscow's restructuring plan for health care lays the path for its complete destruction," Galperin says.
Fuelling the spike in redundancies are looming changes in the way Russia's health-care system is being financed. Starting on January 1, 2015, medical facilities will no longer be funded by the federal budget. The costs will instead be covered entirely by the Mandatory Medical Insurance Fund, into which companies and employees must pay a portion of their salaries.
'Nowhere To Go'
Critics say officials have failed to consult health professionals on the reform, which they believe is focused primarily on commercializing hospitals rather than on offering better medical services to those for whom private medical care in unaffordable.
"What is taking place has nothing to do with the quality of health care," says Natalya Zubarevich, regional program director at Russia's Independent Institute for Social Policy. "It's tied exclusively with fiscal policies, with attempts at cutting costs. No matter what is being said, no matter what polished formulations are being used to say things will improve, these are only words. This is more than obvious."
Simmering disgruntlement over the reform turned to outright indignation in mid-October, when leaked documents revealed that Moscow's City Hall was allegedly planning to close dozens of hospitals and fire thousands of health-care professionals.
Deputy Moscow Mayor Leonid Pechatnikov has sought to soothe concerns over the documents -- according to which city authorities will shut down 28 medical centers and fire 30 percent of the city's medical staff within the next two years -- saying they were part of a proposal and no decision had been made so far.
The goal, he says, is to consolidate "large, multispecialization hospitals" that will offer patients a wide array of services on site.
The possible shutdown of more hospitals has nonetheless sparked uproar and triggered several protests in Moscow, including a November 2 rally that drew almost 7,000 demonstrators.
WATCH: Doctors Protest In Moscow (In Russian)
Medics have held similar rallies in several other Russian cities.
Olga Demicheva, an endocrinologist at Moscow's Hospital No. 11 and a driving force behind the protests, has denounced the reform as a "travesty" in an open letter to Putin. "Mr. President, I understand, the coffers are empty," she wrote. "I understand how expensive the Olympics were, and Crimea, of course, was expensive too. But these victories should not be paid for with human lives."
Like many of her colleagues, Demicheva suspects city authorities of being guided not so much by the need to improve health services than by the wish to reclaim expensive land occupied by some clinics in downtown Moscow. "For some people it's more valuable than the lives of our patients," she says.
With finalized reform plans in the Russian capital set to be unveiled by the end of the year, anxious doctors and patients are bracing for sweeping cuts.
The mood is particularly glum at Hospital No.11, which specializes in care for terminally ill patients and people suffering from life-threatening chronic diseases.
"We have nowhere else to go," says Yekaterina, who receives treatment for multiple sclerosis at the hospital. "We are not trying to cause trouble or draw attention to ourselves. We really have nowhere else to go."