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. 1996 Mar;86(3):307–312. doi: 10.2105/ajph.86.3.307

The current state of health care in the former Soviet Union: implications for health care policy and reform.

D A Barr 1, M G Field 1
PMCID: PMC1380507  PMID: 8604753

Abstract

OBJECTIVES. Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS. Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson B. A., Silver B. D. The changing shape of Soviet mortality, 1958-1985: an evaluation of old and new evidence. Popul Stud (Camb) 1989 Jul;43(2):243–265. doi: 10.1080/0032472031000144106. [DOI] [PubMed] [Google Scholar]
  2. Britten S. Health sector reform in the former Soviet Union. Lancet. 1993 Mar 6;341(8845):635–635. doi: 10.1016/0140-6736(93)90398-z. [DOI] [PubMed] [Google Scholar]
  3. Farmer R. G., Goodman R. A., Baldwin R. J. Health care and public health in the former Soviet Union, 1992. Ukraine--a case study. Ann Intern Med. 1993 Aug 15;119(4):324–328. doi: 10.7326/0003-4819-119-4-199308150-00012. [DOI] [PubMed] [Google Scholar]
  4. Field M. G. Noble purpose, grand design, flawed execution, mixed results: Soviet socialized medicine after seventy years. Am J Public Health. 1990 Feb;80(2):144–145. doi: 10.2105/ajph.80.2.144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Glowniak J. V., Bushway M. K. Computer networks as a medical resource. Accessing and using the Internet. JAMA. 1994 Jun 22;271(24):1934–1939. [PubMed] [Google Scholar]
  6. Hulick P. R. To Russia and back again: the tale of two medical missions to Moscow. Del Med J. 1995 Jan;67(1):25–32. [PubMed] [Google Scholar]
  7. Manning W. G., Leibowitz A., Goldberg G. A., Rogers W. H., Newhouse J. P. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. doi: 10.1056/NEJM198406073102305. [DOI] [PubMed] [Google Scholar]
  8. Massaro T. A., Nemec J., Kalman I. Health system reform in the Czech Republic. Policy lessons from the initial experience of the general health insurance company. JAMA. 1994 Jun 15;271(23):1870–1874. [PubMed] [Google Scholar]
  9. Moore L., Dixon J. Lessons from Lithuania: rethinking public health training. BMJ. 1993 Apr 3;306(6882):911–914. doi: 10.1136/bmj.306.6882.911. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Paton C. R. Perestroika in the Soviet Union's health system. BMJ. 1989 Jul 1;299(6690):45–46. doi: 10.1136/bmj.299.6690.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Robbins A., Caper P., Rowland D. Financing medical care in the new Soviet economy. JAMA. 1990 Sep 5;264(9):1097–1098. [PubMed] [Google Scholar]
  12. Rowland D., Telyukov A. V. Soviet health care from two perspectives. Health Aff (Millwood) 1991 Fall;10(3):71–86. doi: 10.1377/hlthaff.10.3.71. [DOI] [PubMed] [Google Scholar]
  13. Ryan M. Health care in Moscow. BMJ. 1993 Sep 25;307(6907):782–784. doi: 10.1136/bmj.307.6907.782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ryan M. Personalia and the current health crisis. BMJ. 1993 Apr 3;306(6882):909–911. doi: 10.1136/bmj.306.6882.909. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Schultz D. S., Rafferty M. P. Soviet health care and perestroika. Am J Public Health. 1990 Feb;80(2):193–197. doi: 10.2105/ajph.80.2.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Sheiman I. Forming the system of health insurance in the Russian Federation. Soc Sci Med. 1994 Nov;39(10):1425–1432. doi: 10.1016/0277-9536(94)90237-2. [DOI] [PubMed] [Google Scholar]
  17. Sloss E. M., Keeler E. B., Brook R. H., Operskalski B. H., Goldberg G. A., Newhouse J. P. Effect of a health maintenance organization on physiologic health. Results from a randomized trial. Ann Intern Med. 1987 Jan;106(1):130–138. doi: 10.7326/0003-4819-106-1-130. [DOI] [PubMed] [Google Scholar]
  18. Visser APh, Pavlenko I., Remmenick L., Bruyniks N., Lehert P. Contraceptive practice and attitudes in former Soviet women. Adv Contracept. 1993 Mar;9(1):13–23. doi: 10.1007/BF02115896. [DOI] [PubMed] [Google Scholar]

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