Reform in 1991-1993
A mobile clinic used to provide health care to people at remote railway stations
The new Russia has changed to a mixed model of health care with private financing and provision running alongside state financing and provision. Article 41 of the 1993 constitution confirmed a citizen's right to healthcare and medical assistance free of charge.[30] This is achieved through compulsory medical insurance (OMS) rather than just tax funding. This and the introduction of new free market providers was intended to promote both efficiency and patient choice. A purchaser-provider split was also expected to help facilitate the restructuring of care, as resources would migrate to where there was greatest demand, reduce the excess capacity in the hospital sector and stimulate the development of primary care. Finally, it was intended that insurance contributions would supplement budget revenues and thus help to maintain adequate levels of healthcare funding.
The OECD reported [31] that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse. The population’s health has deteriorated on virtually every measure. Though this is by no means all due to the changes in health care structures, the reforms have proven to be woefully indequate at meeting the needs of the nation. Private health care delivery has not managed to make much inroads and public provision of health care still predominates. The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.
Main source: OECD: Health care reforms in Russia
Reform in 2011
After Putin become a president in 2000 there was significant growth in spending for public healthcare[5] and in 2006 it exceed the pre-1991 level in real terms.[5] Also life expectancy increased from 1991-93 levels, infant mortality rate dropped from 18.1 in 1995 to 8.4 in 2008.[6] Russian Prime Minister Vladimir Putin announced a large large-scale health-care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billon) in the next few years to improve health care in the country.[7] He also said that obligatory medical insurance tax paid by companies for compulsory medical insurance will increase from current 3.1% to 5.1% starting from 2011.[7]
Natality
See also: Demographics of Russia and Aging of Europe
In an effort to stem Russia’s demographic crisis, the government is implementing a number of programs designed to increase the birth rate and attract more migrants to alleviate the problem. The government has doubled monthly child support payments and offered a one-time payment of 250,000 Rubles (around US$10,000) to women who had a second child since 2007.[32] In 2007, Russia saw the highest birth rate since the collapse of the USSR.[33] The First Deputy PM also said about 20 billion rubles (about US$1 billion) will be invested in new prenatal centres in Russia in 2008–2009. Immigration is increasingly seen as necessary to sustain the country's population.[34]
Healthcare in Russia Introduction
With 17 million km2 of surface area, the Russian Federation is the largest country in the world. It is rich in natural resources, having major deposits of oil, natural gas, coal, timber and an assortment of minerals.
General information
Since the end of the Soviet Union and the birth of the Russian Federation (1991), the health status of the Russian population has dramatically declined. Rates of tuberculosis, cancer and heart disease are the highest of any industrialised country. Spending on healthcare was approximately 7% of Gross National Product (GNP) in the 1960’s and this was reduced to approximately 3% around the time of the break-up. Military and industrial developments were priorities and thus received the majority of finances. In the last decade, life expectancy has fallen from 70 years to 65, with Russian men, in particular, at risk. On average, a Russian man lives 13 years less than his female counterpart (60.4 men, 74.1 women), the widest gender gap in the world and, depending on which part of the country you live, life expectancies can differ by as many as 16 years, according to a World Bank report published in October 2003. Between 1996 and 2005, Russia experienced one of the fastest growing HIV/AIDS epidemics in the world. After reaching its highest level in 2001, the annual number of newly diagnosed cases has remained relatively steady. At the end of 2005, there were approximately 350,000 registered cases of HIV/AIDS in Russia. Infant mortality rates are also considerably worse that most industrialised countries, with 15.1 per 1,000 of the population being recorded in 2006. Despite the relatively poor healthcare situation and statistics, Russia has pioneered some of the most specialised fields of medicine in recent times, including laser eye surgery and different developments and breakthroughs in relation to heart surgery. Health system
Inherited from the Soviet Union, the Russian Federation was faced with a legacy of guarantees for a wide range of social services, including citizens’ right to free medical services. The guarantee of a full range of free healthcare services has not changed with independence, but rather has been confirmed through the new Russian Constitution and the new healthcare financing law. Until the late 1980s, the structure of health services in the Soviet Union was highly centralised. After the dissolution, the healthcare system followed the new decentralised administrative structure of the country and is now divided into federal, regional (oblast-level) and municipal (rayon-level) administrative levels. 30% of the population receive primary care through work related clinics and hospitals. For certain employment groups such as police, railroad workers, and high-level government officials, special health services exist. In 2006, the Russian government launched a national projects plan that aims to improve four sectors of Russian life, one being healthcare. It approved an additional $3.2 billion in spending on healthcare to cover salary increases for doctors and nurses, the purchase of new equipment for clinics and the construction of eight high-tech medical centres in Russia’s outlying regions. Because regional budgets fund the bulk of healthcare costs, standards and health statistics vary drastically across Russia’s economically diverse regions. Facilities for the disabled fall far below western standards. Wheelchairs and artificial limbs are in very short supply with wheelchair ramps rarely existing and rehabilitation centres are few and far between. Hospitals / Healthcare providers
There are a number of different types of hospitals and healthcare clinics in use. They include:
Rural Health Posts – These offer basic health checks and facilities including routine examinations, immunizations and minor injuries. They cover a population of about 4,000 people.
Health Centres – These cover larger rural populations of approximately 7,000 people and offer a range of primary care services. They are able to perform minor surgeries and are normally staffed by a team of nurses in conjunction with a paediatrician, a therapist and a midwife/gynaecologist.
Urban Polyclinics – These provide services which are normally considered general practice and include screening, treatment for chronic illnesses and on-going care. Depending on their size, urban polyclinics would also house approximately 3-4 specialists from fields such as cardio, oncology and obstetrics.
Special Focus Polyclinics – This is where paediatricians and specialist ambulatory paediatric care treat children up to the age of 19.