Healthcare is a complex system of diagnosis, possible treatment and effective prevention of diseases, injuries, illnesses and any other mental and physical impairments. As a state body activity, it is targeted to organize and provide all kinds of affordable medical services, support and treatment to population of the country, as well as supporting and improving its overall health level. The main healthcare issues in Russia include alcoholism, smoking, cancer and cardiovascular diseases, along with social disparities which block the access to professional help for those unable to afford fee-for-service medicine. The state should keep on working on improvement of healthcare system and budgeting to solve these problems.
On a state level healthcare system acts as a complex of political, economic, law, social, hygienic, anti-epidemic and cultural measures, combined to provide human safety and introduce general health improvement within the state. Elements of complex approach can vary in different states, but basic branches remain more or less the same. General health level of a nation comprises mental and psychological health, life activity support throughout the life cycle, providing every citizen with medical support if needed. In order to fulfil the above objectives a state creates a complex of social institutes that perform their tasks individually but being interconnected and supervised by Healthcare Ministries and other state bodies.
Fundamental international principles that form healthcare system are as follows:
While on the subject of the Russian Federation, it is necessary to look into the history of its healthcare system development, pointing out its main periods and features. The period of “glasnost” came along with the decay of the Soviet Union socialized medicine system in the late 1980s. This system was characterized by insured full health protection for all the citizens on free basis. The system was launched in the times of Joseph Stalin (1927-1953) emphasized the necessity of preserving a high level of health of the work force. This was one of the major goals of the USSR national policy. In the late 1980s the Soviet Union headed a vast network of neighborhood clinics, work site clinics along with a chain of first-aid facilities that were capable of providing all the necessary primary care on easily accessible basis. The other element of the system was a large polyclinics and hospitals chain that aimed at making diagnosis and treating more complex diseases as well as providing surgery services. In 1986, the USSR had over 23 thousand hospitals with about 3.5 million beds (Stockholm Region office, 2012). These facilities included over 28 thousand maternity welfare centers and pediatric clinics, along with numerous sanatoriums and emergency ambulance services. By the end of the 1980s, the USSR took the first place in the world in the ratio of a number of hospital beds to the number of population. But contrary to rather impressive numbers, there was an enormous drawback that seriously affected the USSR healthcare system efficiency. The problem resided in a multilevel chain of bureaucracy that took its roots from Moscow central healthcare institutions and CPSU bodies. The state introduced national annual programs concerning all aspects of state health service, together with a complex multilevel system of statistical account and multiple goals. Such complicated structure led to physicians spending half of their time filling forms and other documents. A huge part of USSR national healthcare budget was used to fund construction of new facilities
Due to many problems and too complicated Soviet healthcare system structure, which had strict regulations as to the terms of treatment of every illness, in many cases people were unnecessarily hospitalized suffering only from minor illnesses, like influenza. Consequently, hospitals faced an issue of overcrowding. Biggest part of the population preferred treatment in hospitals, since the latter were better equipped as compared to clinics. Other reason was living conditions. Recuperation at home was rather difficult, as homes were usually overcrowded. On the basis of big enterprises there were enterprise clinics which provided staff with healthcare with no need to leave their work places. Primary goal of these clinics was to reduce the number of sick leaves on the enterprise. In the 1980s, this number was about 3% of the work force a day.
Psychiatric treatment was extremely abuse-ridden and outdated branch of the USSR healthcare system. In the end of the 1980s hospitals still used the treatment methods which dated back to the 1950s (conditioned response treatment by Pavlov, drug therapy, heavy reliance therapy). Either individual or group therapies were almost out of practice. Therefore, most people preferred suffering from psychiatric deceases to submitting themselves to such methods of treatment (Stockholm Region office, 2012).
The USSR healthcare system outline remained practically the same up to the first half of the 1990s. Though, quality of treatment was steadily declining, except for the elite facilities. This led to crisis of public health system in the area. The number of staff remained high enough to provide adequate treatment to public, but most part of the staff did not have sufficient training and were poorly paid. A huge number of medical schools were underfunded, had no up-to-date literature or equipment. Additionally, due to low salaries, corruption level in medical facilities and schools was extremely high.
Nevertheless, Russia was a pioneer in some medical fields (heart surgery, eye surgery etc.). In 1991-1992 Russia implemented reform that changed the healthcare system. The reform paved the way to private medical services. According to the constitution, every citizen had the right for receiving medical help for free. This was done by means of compulsory medical insurance and tax funding. The insurance together with the introduction of private medical services was aimed at promoting efficiency of treatment and give patients a possibility to choose the place for receiving medical service. This new system was also expected to boost facilitating care restricting. Unfortunately, the plan was not successful. On the contrary, the reforms led to a deeper decline of the system.
Much later, in 2011, a new reform was implemeted. Starting from 2000 Russia increased its public healthcare funding. In 2006 the amount of funding exceeded the funding level of 1991. Life expectancy also significantly increased, the level of infant mortality decreased from 18.1 in 1995 down to 8.4 in 2009. Seeing rather impressive improvement, the government of the Russian Federation executed largeer scale healthcare reform (2011) which significantly rose healthcare funding (Stockholm Region office, 2012). By that time, with the customer spending growth and the governmental funding increase, the long-term outlook for the healthcare providers and manufacturers of medical goods looked promising.
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Present day, Russia has a broad healthcare infrastructure. Russian Expedition and Congress is the controlling body of the Hospital infrastructure in the state. The Russian public healthcare reform is seen as a top priority of Russian government of today. It has made profound regulatory changes with the intension to improve the quality of medical services and enhance public access to the latter. The objective is to be fulfilled in several steps:
National project “Health” funded by the federal budget was introduced in 2006 with the main goal to improve the healthcare system of the county. . The project includes improvement and update of hospital equipment and ambulance services, construct new medical centers, along with providing nation-wide programs of vaccination and free of charge health checks-up. The initial budget for this purpose was set in the amount of 2.5 billion dollars (2006). The project gained popularity among the population. A number of industry branches also benefited from the project. It also enabled the government to fund 15 specialized health centers in the country (Snapshot Report on Russia’s Healthcare Infrastructure Industry, 2013).
Healthcare development concept 2020. This new legislation lays emphasis on the need of improving technological base. It also emphasizes that high technology should be used in most medical sectors and provides better primary care, hospital capacity reduction, management system improvement, the launch of new payment systems for private medical service providers and state medical facilities. There is also an emphasis on cardiology centers building and a transition to the healthcare model that is based on insurance. Other project objectives include: population growth increase, life expectancy increase, infant mortality decrease, healthy lifestyle encouragement, quality and accessibility of healthcare services improvement. The key targets are: to provide possibilities and motivate population to choose a healthy lifestyle, to develop healthcare system, to support and guarantee free medical services for the citizens, to improve pharmaceutical supply, to create an effective system of financial management of the state-guaranteed programmes, medical personnel further trainings and motivation system, to establish medical science healthcare centers and IT development (Snapshot Report on Russia’s Healthcare Infrastructure Industry, 2013).
Guarantee Package Programme for Medical Services. The proramme is designed to enable free services that will be funded by the government. The free service includes urgent care, clinic, ambulatory, hospital and polyclinic care for people with socially significant illnesses (AIDS, tuberculosis, chemical addiction, mental health problems etc.) A mandatory medical insurance is to cover free services, including patients with contagious diseases, blood diseases, cancer, pathologies of immune system, circulatory diseases and heart diseases, ENT, bone and muscle diseases, all kinds of trauma injuries (Snapshot Report on Russia’s Healthcare Infrastructure Industry, 2013).
Health Insurance. In 1991 the government adopted the law on Mandatory Medical Insurance. There were several changes as to healthcare financing. The law transferred insurance premiums for active population mandatory insurance to private enterprise. Insurance premiums for non-active population mandatory insurance are covered by the state budget (Snapshot Report on Russia’s Healthcare Infrastructure Industry, 2013). There was a radical change owing to the new insurance policy – the appearance of the private insurance medical agencies in Russian healthcare system.
On Federal level the main body that regulates healthcare in the Russian Federation is the Ministry of Healthcare and Social Development. This is the central institution that formulates healthcare policy and controls all the work and decisions taken locally. The Ministry budget funds all kinds of medical research institutes, Russian Academy of Medical Sciences and other research centers and activities of medical institutions. On regional level there are administrative units that govern regional healthcare. Healthcare facilities in regions include a general profile hospital with about 1000 beds and children hospital with outpatient department. Other regional specialized facilities include primary care facilities and diagnostic centers. On municipal level the government adopted the law on General Principles of Organization of Local Self-Government in the Russian Federation. Municipal governments do not report to regional and federal level governments, but they comply with federal Ministry orders (Snapshot Report on Russia’s Healthcare Infrastructure Industry, 2013). Activity of private practice is regulated by the Constitution of the Russian Federation and the regulatory bodies.
In 2008, over a half of deaths in the Russian Federation were caused by cardiovascular diseases. The second disease that took about 290,000 lives is cancer. About 2 per cent of people’s lives were taken by suicide. 1.7 per cent – by road accidents, 1.1 per cent – by murders, the same amount – by alcohol poisoning, 0.5 per cent – by accidental drowning. Other main causes are digestive system diseases, infectious and parasitic diseases and respiratory diseases including tuberculosis. The rate of infant mortality was 8.5 deaths per 1000 in 2008 (Stockholm Region office, 2012).
Smoking and alcohol consumption stand out among the key issues of national healthcare. The Russian Federation is considered to be a world leader in tobacco consumption with about 400,000 people dying annually from diseases caused by smoking. According to statistics, Russians drink 15 liters of pure alcohol per year and the level of alcohol consumption increases every year (Stockholm Region office, 2012).
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Another key problem of the healthcare sector is AIDS. In 2007 the registered number of HIV cases in Russia was about 416,000, including about 43 new cases registered. The biggest risk group of HIV transfer is drug addicts (83 per cent of infections), 6 per cent – sex industry workers, 5 per cent – prisoners. In spite of increasing efforts to fight HIV, this disease is still a big challenge for Russian healthcare system (Stockholm Region office, 2012).
The problem of healthcare disparities presents another challenge for the Russian healthcare system. Despite all the improvements of state-based and insurance-based medical service, people with low income, especially those retired can hardly afford even basic health support. “If I hadn’t made it to this hospital, I wouldn’t be alive anymore. I’m sure of this. “I believe the Lord sent me here,” says Mrs. Nikolaeva, whose 8000-ruble ($264) monthly pension does not allow her to afford even low-budget state care (Tom Balmforth, 2013). The old lady said that getting to a free hospital in time to be saved was a real miracle, not a normal day-to day practice. Many Russian citizens complain that free medical service in practice turns to be a kind of service where they have to bribe doctors to be helped. “The disparity in health care access reflects what analysts call a widening gulf between the rich and the poor in a country” (Tom Balmforth, 2013). It becomes evident, that to solve the problem of healthcare disparity the government should deal with a profound problem of general social disparity and economic problems in the country.. Insurance policy also should be improved to enable non-active population to get a kind of insurance which can cover their needs.
To sum up, Russian healthcare system has greatly improved since the USSR times, but much work still needs to be done in order to fight major national diseases and provide effective medical support for all social classes.