‘Compulsory’ medical examination: Kazan residents are indignant, doctors talk about saved lives
In the first quarter of 2025, over 350,000 Tatarstan residents were examined and more than a hundred were diagnosed with early-stage cancer
In Kazan, complaints about the refusal of medical care without undergoing a medical examination have become more frequent among patients at outpatient clinics. According to the population, medical institutions set a condition: if you undergo a planned comprehensive examination, you will receive the service, and if not, the doctor will insist on undergoing it. Realnoe Vremya looked into the issues of at what cost Tatarstan doctors fulfil the ever-increasing plans under the programme, the effect of “obligation”and the problems it creates.
“By law, I have the right, but I am not obliged”
Residents of the capital of Tatarstan are outraged by the “compulsory” one. More and more often, clinics are making referrals for examinations, appointments with specialists, and even issuing sick leave dependent on passing a medical examination.
“I went to my Clinic No. 7 to make an appointment for an MRI,” Irina Luzanova told Realnoe Vremya.” A neurologist prescribed the examination for me at the same clinic to make a diagnosis: I started having frequent dizziness. The therapist said that she would only give me a referral after I had a medical examination — I would take tests, undergo the required examinations, and visit her again. I tried to explain that this would take time and that I needed to first get a diagnosis, but to no avail. The deputy head physician of the clinic also refused to give me a referral.”
Luzanova reasons: dizziness is no joke — it’s a risk of falling on the street, getting hit by a car. This means that measures must be taken urgently, and a medical examination can be done later. Moreover, she is a pensioner with a “whole bunch of diseases” and often visits the clinic, recently took tests, had cardiograms and other examinations. Almost all the information about her health is in the medical institution — the doctors just need to look into the computer and copy the data from one line to another. She is also ready to undergo the missing examinations — so what is the problem with issuing a referral, with which you still need to get in line, because under the compulsory medical insurance, an MRI will not be done on the day of the request?
“In addition, according to the law, I have the right to a free medical examination, but I am not obliged to undergo it,” the woman reasons.
On the same day, she filed a complaint on the hotline of the Ministry of Health of the Republic of Tatarstan. There, they listened to her, registered the request and have not responded for almost a month. Luzanova never received a referral for the examination prescribed to her by the doctor of the same city clinic — and it is unknown when she will receive it.
It turned out that such a problem is encountered not only in Kazan. Recently, on 15 April, a resident of Naberezhnye Chelny complained about the refusal to provide services at a clinic, posting his message in the city public.
“A medical examination should not affect other examinations”
“A medical examination is aimed at identifying diseases, but should not affect other examinations,” explained to Realnoe Vremya in the insurance company Ak Bars Med. “If you are denied them on the basis that you have not undergone a medical examination, you can contact the head of the clinic or the insurance representative at this clinic. Based on the State Guarantees Programme, you have the right to medical care, while based on the federal law on the protection of citizens' health, you have the right to refuse any type of intervention, and this should not affect other examinations.”
However, the insurance company noted that the State Guarantees Programme stipulates that the examination prescribed to you under the compulsory medical insurance must be carried out no later than 14 working days. And if you have been given less time to prepare for hospitalization, doctors are not obliged to speed up the process, but they can meet you halfway and look for an appointment for a closer date.
Similar recommendations are given on “hotlines” to insured patients by other insurance companies.
Attempts by citizens who are forcibly driven to a medical examination to find support in the Territorial Fund of Compulsory Medical Insurance are doomed to failure. Patients said that on the “hotline” an automated voice offers to call insurers, and when choosing the option “Your rights in receiving free medical care under the compulsory medical insurance policy have been violated” the message sounds: “Sorry, your call cannot be serviced.” Realnoe Vremya contacted the Territorial Compulsory Medical Insurance Fund with a request for complaints about violations of patients' rights, expressed in the refusal of medical care in the event of failure to undergo a medical examination, recommendations for patients in this case, and at the same time — about the reasons why patients are actually denied access to the hotline with complaints of this kind.
“Take advantage of the free opportunity”
“As part of the preventive examinations and medical examinations of certain groups of the adult population for 2024 more than 1.5 million people were examined in Tatarstan. This is approximately 92% of the plan,” the republican Ministry of Health Care reported to Realnoe Vremya. “Every third patient was sent for additional examination, that is, certain health problems were identified. In total, in 2024, thanks to medical examinations, more than 160,000 diseases were identified for the first time. Most often, these are cardiovascular diseases (more than 33%). Also, during medical examinations, 2,354 cases of malignant neoplasms were identified for the first time, most of them in the early stages, that is, they can be effectively treated.”
In total, in 2024, thanks to medical examinations, more than 160,000 diseases were identified for the first time in Tatarstan.
The ministry also reported that the population medical examination plan for 2025 for preventive examinations and medical examinations includes more than 1.6 million people. According to the results of the first three months of 2025, more than 350,000 people underwent medical examinations, about 70,000 underwent preventive examinations, and the planned indicators for January-March were fulfilled. In the first quarter of 2025, more than 100 Tatarstan residents learned that they had cancer during medical examinations, in most cases at an early stage, which opens up good prospects for treatment.
Medical examinations are carried out on a voluntary basis, free of charge under the national project Long and Active Life, the ministry emphasized and called on all residents of the republic to take advantage of this opportunity.
Not enough time to explain
Salikhova gave a recent example — a woman born in 1985 underwent an annual medical examination at her aircraft plant, and on 4 April she came to the clinic, and the local therapist managed to persuade her to undergo a medical examination. And for the first time she had the opportunity to be tested for all tumour markers — skin cancer, bowel cancer, breast cancer, and so on. And on 10 April, based on the results of the examination, she had a colonoscopy, there was a suspicion of rectal cancer and she was urgently sent to the oncology dispensary. On 15 April, she was operated on, happy that they “caught” oncology at an early stage.
“Of course, we have no right to force anyone, but we try to devote more time to the patient and convey information about why he needs it, and not us,” Salikhova noted. “We have been telling for 12 years how important it is to get examined while nothing is bothering you, but not everyone knows about it. People come to me for certificates for the State Traffic Safety Inspectorate, I understand that these people ended up in the clinic by accident because they need to renew their license. And I start to “spin” them — I ask their year of birth, talk about the possibility of getting examined for cancer for free, I offer young people a free reproductive health examination in parallel with the usual medical examination. And when you pay attention to a person, explain the essence, no one refuses to undergo a medical examination. But in the flow, when the doctor has 12 minutes per person, a line outside the door, sick leaves, some emergency conditions, I admit that patients do not receive enough information. It is very important to establish communications! Then, perhaps, a fashion for family medical examinations will appear. Then there will be an understanding that it is my family that needs it, and not a doctor who requires a plan.”
The head of the prevention department also explained that it is not at all necessary to observe a yearly interval between medical examinations, because each year people of different years of birth are assigned a different set of examinations. And if, for example, in December of last year a woman underwent a mammogram, in January or February she will have the opportunity to take additional tumour markers that she did not take last time, update her tests, take a blood test for sugar, find out her cholesterol level. Why wait a whole year for this?
It is for the sake of an early diagnosis, and not for the sake of a plan, assures Irina Salikhova, that doctors call patients, invite them to a medical examination, persuade them when they go to the clinic for “extra”, but in fact not at all unnecessary examinations.
“In the first quarter of 2025, we identified 21 cases of cancer,” she says. “These are “walking” cancers, when people have not yet had complaints. And 90% of them are stage one, which is very important.”