HEALTH%20POLICY%20IN%20RUSSIA

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• HEALTH POLICY IN RUSSIA
• Part 2.
• Irina Campbell, PhD, MPH
• ivm1_at_columbia.edu
• www.CampbellHealthAssociates.com

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Macro health measures such as mortality and
morbidity rates were applied in the human capital
model of health for assessing the social and
economic costs of illness, disability, or death
within Soviet society.
3
Soviet health policy was limited in maximizing
national economic output by demographic changes
in the structure of the working population there
were twice as many pensioners in the Slavic and
Baltic Republics of the 1980s as in the 1970s,
but twice as many births in the Asian Republics
of the 1980s as in the Slavic Republics of the
1970s (Feshbach, 1982b).
4
The problem for Soviet decision-makers became
even more apparent when almost two-thirds of all
industrial output was centered in the Slavic
Republics, where demographic projections
indicated a population decrease of two million in
1981-1995 compared with 1971-1975.
5
The regional variation in fertility and mortality
rates by republic also affected the skilled labor
supply. Skilled workers were located primarily in
the urbanized European republics, like the
Russian Federation, which also had the lowest
fertility rates (Brui 1991).
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PERESTROIKA HEALTH POLICY
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Two other major health problems, which became
more acute during Perestroika (and after the
explosion of the nuclear plant at Chernobyl in
1986), were alcoholism and mental illness.
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Women's health issues received greater
recognition during Perestroika, primarily because
of declining fertility and population growth
rates, projected to fall 75 percent below 1980
levels in 1995.
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For all the ideological bravado of Perestroika,
health spending was not appreciably increased.
10
The politically tumultuous period of Perestroika
interfered with the implementation of several
proposals increasing GNP spending on health from
3.6 percent to 6 percent by the year 2000
increasing funding for medical equipment by 25
percent construction of diagnostic c1inics and
over 1.4 million beds and annual preventive
health exams for children, veterans, pregnant
women, and agricultural workers.
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In regulating resource allocation and costs,
policy during Perestroika followed previous
health plans by altering input factors without
adequately evaluating concomitant changes in
health status as output.
12
Although the organizational impediments to
preventive care were recognized as serious
drawbacks to implementing health policy, no
immediate recommendations were made until the
provisions of the first Health Insurance Act in
1991.
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POST-PERESTROIKA HEALTH POLICY
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In their search for private medical care, Russian
health reformers rejected the monolithic British
health bureaucracy that gave government control
over providers, financing, and public
administrative decision-making.
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Private insurance medicine was seen as a major
cause of escalating costs.
16
A draft law was published in October, 1990,
entitled The Principles of Legislation of the
USSR and Union Republics on the Financing of
Health Care.
17
The deputies of the Supreme Soviet of the Russian
Republic moved swiftly to propose their own
version of insurance medicine.
18
A series of conferences with American and other
international health care experts was organized
in the Soviet Union.
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The health care crisis facing Russia after the
1991 Coup was one of cost and access, as much as
the sharp decline in population health status,
quality of medical services, and availability of
pharmaceuticals and health-related goods.
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1991 HEALTH INSURANCE ACT OF RUSSIA AND LIFE
CHOICES
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As an initial step toward decentralization and
privatization of government medicine, a network
of health insurance agencies was authorized,
similar to the Clinton Administration's proposal
for market-based health alliances.
22
Insurance plans were divided into two categories
mandatory and voluntary.
23
The HIA made health insurance compulsory for all
employees.
24
Financing of the health care system with direct
taxation to the central budget was replaced by
local government budgets and premium payments to
health care and insurance funds.
25
The health care funds were responsible for
financing professional medical education,
biomedical research, catastrophic insurance,
geographic redistribution of medical care for
under-served populations, and public health
programs in the case of epidemics or natural
calamities.
26
Given the cumbersome bureaucratic heritage of
socialized medicine that the insurance
legislation was designed to replace, the drafters
of the HIA acknowledged the difficulty and
complexity of encouraging market forces,
regionalization of services, decentralized
decision-making, and individual choice and
responsibility.
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Given the provisions of universal coverage in a
basic benefits package of mandatory insurance,
the medical professionals were empowered to run
medical facilities and group practices based on
consideration of health needs and quality rather
than minimizing expenditures.
28
The structure of insurance plans varied in the
size of the insurance premiums and the domain,
duration, and quality of medical services
provided under specific benefits.
29
The provisions of the HIA assumed that
competition between financial packages offered by
insurance plans and between different
organizational forms of delivering medical care
offered by private providers would contain the
cost of premiums.
30
The health care market is not one of
self-regulated, unconstrained supply and demand
between providers and consumers.
31
Legislative mandates notwithstanding, progress in
public health improves quality of life to a point
partly dependent upon individual choice in taking
health risks.
32
Under the market incentives provided by the HIA,
an insurance plan had the option of changing
premiums based on the changing health needs of
the patient after a three-year period.
33
The insured was obligated to eliminate voluntary
risk factors that could adversely affect health
status or, alternatively, pay higher premiums.
34
Despite the preventive health habits provisions,
the HIA mechanisms did not encourage consumer
well-being or market competition between
providers as much as it fostered the expansion of
the health care industry.