Reach the kidney: patients asked to eliminate inequalities in access to hemodialysis
The public organization of patients "Nephro-League" demanded to cancel the order of the Ministry of Health of Udmurtia, which changes the organization of free transportation of patients with renal insufficiency for hemodialysis. Now in the republic, patients will not be able to choose the place of the procedure on their own, and the route will be determined by a special commission. Public activists believe that people's rights are being violated in this way, and local authorities explain these measures by their desire to strengthen control over spending. Patients across the country have problems with transportation for hemodialysis, and public activists are asking the Russian Ministry of Health to introduce a single standard for the regions. For more information, see the Izvestia article.
Why is Udmurtia asking to cancel the order of the Ministry of Health
Alexander Zolotarev, chairman of the Udmurt regional branch of the public organization Nefro-League, spoke about the problems that may be caused by the order of the Ministry of Health of Udmurtia dated September 23, 2025, No. 37. He appealed to the prosecutor's office demanding that the document be declared illegal.
In the order, the republican Ministry is changing the rules for organizing free transportation of patients for hemodialysis. The delivery route will now be determined by the patient selection committee. The patient will not be able to choose the place of receiving the procedure on his own, which Zolotarev is sure will violate the rights of patients.
According to him, previously they could choose a hemodialysis center that was more suitable for them according to certain criteria.: convenient time, availability of specialized specialists, certain materials, the possibility of hemodiafiltration, etc. Zolotarev believes that patients who live in rural areas will suffer the most: for them, free transportation to the hemodialysis site is the only opportunity to receive this procedure.
The public figure said that the order is likely to really come into effect in 2026.
—Hemodialysis is a lifelong life—saving procedure," Galina Goretskaya, chairman of the board of the Nephro-League NGO, explained to Izvestia. — It should be done three times a week. Even skipping one procedure can negatively affect your health and lead to death.
Why did Udmurtia change the order of delivery for hemodialysis
Alexander Zolotarev is sure that the only goal pursued by officials from the regional Ministry of Health is to save budget funds.
"Problems with hemodialysis in Udmurtia have begun to arise in the last two or three years due to a lack of funding," he told Izvestia. — The funds allocated from the budget of Udmurtia were sufficient until October-November, and then it was often necessary to achieve the procedure by contacting the prosecutor's office or through media coverage.
Now, Zolotarev believes, the Ministry of Health of Udmurtia, instead of correcting the mistakes of previous years and allocating additional funding, is going to save on patients who will be deprived of any right to choose.
Currently, Udmurtia has a free taxi system for patients who need to be provided with hemodialysis. Transportation operates according to two schemes: either the hospitals themselves provide patients with transport, or contracts are concluded with a taxi service that delivers patients, including specialized ones, for certain categories of patients with limited mobility.
Alexander Zolotarev said that last year the Investigative Committee revealed serious violations in the republic when concluding transportation contracts. In particular, the facts were revealed when several patients were transported in a taxi car at once, and the carrier reported for five different trips. Transportation of "dead souls" was discovered — the patient was no longer alive, but his trips continued to be carried out according to documents. Taxi rides were also attributed when the patient reached the hemodialysis unit on his own.
"A criminal case was opened against this carrier, and his contract was transferred to another, who, in my opinion, fulfills his obligations decently," the source told Izvestia. — All this time, the Ministry of Health could independently verify and identify these facts, but did not do so. And now they are going to save money at the expense of patients and sometimes hospitals, who are required to find funds on their own if they do not have enough until the end of the year.
Udmurtia's Minister of Health, Sergei Bagin, explained that the changes were introduced because "last year, departmental inspections revealed violations of contracts by shipping companies, as well as cases of misuse of transportation by patients." The order was adopted "to improve control over the execution of contracts."
According to him, a commission with the chief freelance specialist of the Ministry of Health of the Republic and specialists in renal replacement therapy will now determine the route of patients. The location of hemodialysis will be chosen "as convenient as possible for the patient and close to his place of residence." At the same time, the changes will primarily affect new patients, those who have been undergoing therapy for a long time can continue to go to their usual places for hemodialysis.
Izvestia sent a request to the Ministry of Health of Udmurtia, but no response had been received at the time of publication.
Are there any problems in other regions
Currently, 713 people are undergoing hemodialysis in Udmurtia, and 14 dialysis centers are operating. In total, more than 74 thousand people in Russia are on kidney replacement therapy, including 57 thousand people on hemodialysis.
The Popular Front expert. Analyst Irina Blinkova explains that currently the transportation of patients from their place of residence to the place of receiving hemodialysis and back is paid for at the expense of regional budgets. However, the conditions and procedure for transportation are established by regional legislation and may vary greatly from region to region. This depends primarily on the financial capabilities of each subject of the Federation.
— For example, in one region, patients are compensated for travel expenses from their place of residence to the place of hemodialysis and back, based on the estimated amount: the cost of mileage, the distance from home to the place of the procedure, and the actual number of procedures performed. And in another region, compensation is provided upon presentation of documents confirming the actual travel expenses," the source told Izvestia.
The region can also transport patients itself, as is the case in Udmurtia.
Galina Goretskaya said that a Nephro-League study conducted several years ago showed that patients in many regions face restrictions. For example, there is a social taxi in the Kaliningrad region, but it does not work on Saturdays, whereas many patients with kidney failure should go for hemodialysis according to the schedule "Tuesday, Thursday, Saturday".
"In Dagestan, they take patients for hemodialysis from the districts, but they no longer transport patients through Makhachkala itself," the source told Izvestia. — Our representative is currently facing problems there, who suffered a stroke at the age of 70 and now finds it very difficult for him to move around, but they still can't take him for dialysis.
Very often, as now in Udmurtia, patients do not have the opportunity to choose a center where it is more comfortable to receive the service. The regions prescribe that you can only get to the nearest hemodialysis unit.
— The most inconvenient system is when the patient collects all the information about travel expenses himself in order to receive a refund, — said Galina Goretskaya. — In this case, for example, it is impossible to receive compensation if a person was taken to a dialysis center by relatives.
How to change the system
Yan Vlasov, co-chairman of the Russian Patients' Union, notes that the disparity in access to a vital procedure could be corrected by a single federal standard.
"He would guarantee timely and safe delivery to patients, regardless of their region of residence," he told Izvestia.
However, so far, Galina Goretskaya notes, there is, in fact, no control over the system on the part of the federal authorities. She admits that the whole country will not be able to work according to a single standard of care for people with kidney failure, but it is possible to streamline this process.
"I would like the patient to have the opportunity to choose whether he receives compensation or uses transportation," she said. — The second option is especially important for patients who have complications and concomitant diseases, it is difficult for them to move independently.
The main problem is with bedridden and low—mobility patients, says Galina Goretskaya. In this case, it is often necessary to look for urgent solutions to provide a person with a life-saving procedure.
— A patient recently arrived in Moscow from Krasnoyarsk, who joined the waiting list for a transplant. He hardly sees, and he needs an escort for a hemodialysis procedure," she said. — However, there is no Moscow registration yet, so we had to look for volunteers who could accompany him. But there is a volunteer today, and it is unknown whether he will arrive tomorrow.
The Chairman of the Board of Nefro-League notes that the lack of a clear regulatory system at the federal level makes tens of thousands of patients dependent on local decisions.
— We consider it necessary to take measures aimed at creating a unified state policy in the field of providing transport to this category of citizens, — said Galina Goretskaya. — Possible solutions are the introduction of special social taxi companies for low-mobility groups of the population, the expansion of the practice of providing compensation for transportation costs and the development of national standards for the quality of transport services for patients on hemodialysis.
She noted that regional specifics should be taken into account, but it is important to ensure timely and affordable delivery to the place of treatment for each patient, regardless of their territorial affiliation.
Izvestia sent a request to the Ministry of Health of the Russian Federation.
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