Russian medical care is hobbled by corruption, meager salaries, ill-conceived laws, a shortage of medical workers and an overbearing government bureaucracy, one of Russia’s most prominent doctors told a recent medical conference here. He addressed his remarks directly to Prime Minister Vladimir Putin, who was sitting just a few feet away.

Putin did not directly dispute the comments; in fact, he said he knew what Leonid Roshal was going to say and wanted to make sure the conference heard it. But the Health Ministry later posted an unsigned “collective” letter denouncing Roshal and asking Putin to “protect our honor and dignity against such criticism.”

Roshal’s address was made public Wednesday, a week after the conference, when it was reprinted in the newspaper Novaya Gazeta. It quickly became a leading topic on Russian blogs, which also noted the Soviet-style letter of denunciation that followed.

A Health Ministry representative said Wednesday that it would not comment on the letter or Roshal’s accusations. Roshal could not be reached for comment.

“He’s been thinking about this for a very long time,” said Kirill Danishevsky, an expert on Russian health-care reform who is also a doctor. “It’s impossible to disagree with some of the main points Roshal made.”

Roshal, a leading pediatrician and president of the National Medical Chamber, is perhaps best known here for his efforts to mediate during hostage-takings at a school in Beslan in 2004 and at a Moscow theater in 2002.

In his remarks, he said too much money is being budgeted for equipment, much of it useless, because it is easy for bureaucrats to “saw off” a kickback for themselves. Doctors, he noted, have to make do on official salaries of less than $300 a month. (He didn’t mention that most doctors here insist on under-the-table payments from their patients.) With just 3.9 percent of gross domestic product going to health care, he said, the result is a shortage of doctors, especially in rural areas, and of hospitals.

“There are regions where more than 50 percent of physicians are of retirement age and only 7 percent are young specialists,” he said.

And all of this, he concluded, is directed by a Health Ministry bureaucracy that is painfully lacking in people with medical training.

On Monday, when a presidential advisory committee visited the Siberian city of Irkutsk, protesters stood along the city’s main streets with signs detailing the conditions that health-care workers and teachers face. Nationally, statistics show, almost half of Russia’s hospitals lack heat or running water.

Potemkin hospital

Last week was not the first time that Putin had heard a doctor complain publicly about the health-care system here. During a TV call-in show in December, a cardiologist in Ivanovo told the prime minister that much of what Putin saw during a recent visit to a hospital there was faked for his benefit. Putin has also dropped in on some of Moscow’s less prestigious hospitals in a way that has highlighted their problems.

Despite his apparent sympathy, Putin said in reply to Roshal’s comments last week that the big problem is figuring out where more money would come from. On Wednesday, though, Putin told parliament that Russia will spend about $50 billion over the next five years on its “demographic policy.” He said the government wants life expectancy to grow from the current 69 years to 71, the birth rate to increase by 25 to 30 percent and the mortality rate to drop. But he didn’t detail how that would be achieved.

At the conference, Putin also said he is receptive, in theory, to Roshal’s proposal that medical workers be allowed more self-regulation, at the expense of the Health Ministry, although he described Roshal’s understanding of what was required as “naive.”

At the same time, he praised Roshal’s commitment to solving Russia’s medical problems. “He is constantly criticizing the Health Ministry, which I actually can appreciate,” Putin said. “I wish there were more people in other sectors who, calmly and phlegmatically, kept picking away at problem spots.”

‘Intrusive flies’

For his part, Roshal said the ministry treats doctors who care about the quality of medical attention as “intrusive flies.” He complained about its rigid, illogical directives and asked Putin when the country will have a plan for reform. Putin replied that Russia has such a plan but that if Roshal was unaware of it, it clearly needs more promotion.

He did not say what that plan entails.

Danishevsky said he believes that Putin wanted to force health officials to hear Roshal’s comments because they are not generally receptive to outside opinion. “People are so frustrated that they’re not being listened to,” Danishevsky said. He said he hopes the incident leads to more open discussion of upcoming health legislation.

“This should be in the public domain,” he said.

The prime minister’s Web site posted Putin’s comments from the medical conference, as well as the letter from the Health Ministry, but not Roshal’s remarks.

“It is unacceptable to provoke conflict and breed alienation between us and our colleagues: doctors, nurses and other medical personnel,” the unsigned letter from the ministry said. “. . . Roshal’s hobnobbing and unrestrained behavior at the forum caused sincere bewilderment and derision, even if at first his remarks were not taken seriously. It was not until later that our colleagues in the regions reacted with condemnation.”