Doctors from Moscow's Hospital No. 11 speak to demonstrators protesting cuts to city medical centers. About 28 inpatient care centers are slated for closure, with cutbacks planned for dozens of others. (Karoun Demirjian/The Washington Post)

As the city’s premiere public facility providing palliative care for patients suffering from late-stage cancer, multiple sclerosis and other serious illnesses, Hospital No. 11 is normally a placid place.

But in the past several weeks, it has become the epicenter of a fast-growing protest movement against cuts to public health services — steps that threaten to deliver the first major blow to the city’s social welfare system at a time when the country is in an economic crisis.

By early next year, Moscow plans to close 28 hospitals and clinics — almost a quarter of its inpatient facilities — and downsize several dozen other medical centers while reducing the city’s medical staff by as many as 10,000 positions. Doctors and nurses, who rarely speak out because they are government employees, staged protests twice last month. And opposition parties from across the political spectrum have joined the demonstrations, criticizing Moscow and Kremlin officials for poor planning and bad timing.

The overriding fear is that patients who depend on Moscow’s already-oversubscribed health-care system will find themselves shut out or forced to seek pricey alternatives to the free care Russians are guaranteed by law.

“We never had a lot of money in health care, but these changes are even worse because of the financial crisis,” said Olga Demicheva, an endocrinologist at Hospital No. 11. “The way they are doing this is criminal for the patients. For us, too, but especially for the patients.”

Dr. Semyon Galperin, foreground left, and Olga Demicheva, in white, carry a poster reading " The Hospital 11 lives and will live!" during a march in Moscow Nov. 30, 2014. (Alexander Zemlianichenko/AP)

Plans to reform Russia’s health services have been in the works since 2012, when President Vladimir Putin, having weathered a series of protests against his lock on power, promised to boost the salaries of medical personnel.

But the mandatory medical insurance program that is supposed to pay for health-care services is underfunded, and the government is reducing subsidies for health care.

Doctors are reporting salary cuts, and many specialists say they face an ultimatum: Relocate from hospitals to outpatient clinics, where the focus is on primary care and the pay is lower — or take a severance package of up to 500,000 rubles (about $9,350).

“You know, I was in the middle class, and now, I’ve become part of the poorer class because of these reforms,” said Aslan Goradze, an endoscopist and gastroenterologist who took part in a protest Sunday. He had earned $2,000 a month in his job at Hospital No. 53. Now, at an outpatient clinic, he earns $700. “Yes, reforms are necessary,” he said. “But firing doctors and nurses — that’s reform?”

A lack of doctors, hospital beds

Russia spends about 3.6 percent of its budget on health care. In Moscow, the figure is about 2.4 percent. That’s not enough to sustain a functional system, experts say, especially one trying to modernize and streamline care.

“We need to improve efficiency. But efficiency doesn’t mean shrinking capacity,” said Guzel Ulumbekova, executive director of the Association of Russian Medical Societies for Quality Health Care. She said that not only are there not enough primary care doctors, there also aren’t enough hospital beds. Moscow has fewer than many European countries, although Russians tend to rely more on medical services.

“This started from incorrect, incompetent things,” Ulumbekova said. “We can spend additional money for health care. From my point of view, the health-care system is of the same importance for national security as is defense spending.”

But institutions such as Hospital No. 11 challenge the bottom line.

“Multiple sclerosis patients are a very unprofitable business. Treatment is expensive; rehab is expensive,” said ­Semyon Galperin, a specialist in rehabilitative care at Hospital No. 11. “The clinics do not offer any of these benefits. So, because they want to save money, they cut.”

Also slated to be shut down is Hospital No. 14, one of the main hospitals treating severe psychiatric cases.

“Outpatient clinics only work for those who can make it there,” Yelizaveta Zhestkova, a psychiatrist at Hospital No. 14, said in a recent interview with Russian radio station Ekho Moskvy. She described her patients as too unstable to get to their appointments without help. “Our patients are people who society does not need. We help society because we help these patients.”

‘We will not trust anybody’

Many of the doctors taking part in the protests share a common theory: That hospitals on the chopping block are being targeted so Moscow can sell the real estate, most of it in prime downtown areas. They blame Deputy Mayor Leonid Pechatnikov, the architect of reforms who came from the private health-care sector, for being out of touch with what patients need and can afford.

Moscow city health officials did not respond to requests for interviews. Pechatnikov has said that reforms will create hospitals that are more efficient and multifaceted.

Yet the backlash has been strong enough that even Putin has taken notice, criticizing Moscow for bumbling health-care reforms last month. Since then, bands of government officials have paid visits to the staffs of hospitals slated to close. Hospital No. 11 received one such delegation last week.

So far, it’s all talk, Galperin said.

“Until we get written decisions and written confirmation from the city administration, we will not trust anybody,” Galperin said. “Until then, we cannot believe this process will be stopped.”

In such a climate, even Putin’s stated frustration with how Moscow has handled reforms may not be enough to insulate him from the anger of the crowds.

“Our biggest problems all come from the head,” Nadezhda Rebkina, 64, said at Sunday’s rally, referring to Putin. A retired stomatologist who worked in city hospitals for 36 years, she blames the government for misrepresenting the country’s health-care situation — and the doctors’ cause — to the public. “One head creates all the problems,” Rebkina said. “And that head, in my opinion as a doctor, is not healthy.”