Content area
Full text
Health care is receiving much higher priority and more funds than ever before in the Russian Federation. Russian health economist Igor Sheiman talks to Fiona Fleck.
Q: The "Semashko" centralized health-care system brought huge advances in population health in the former Soviet Union, which was - in some ways - one of the first countries to achieve something close to universal coverage of basic health-care services. What was the secret of the system's success?
A: I also value the role of the Semashko system in the first decades of Soviet power. The system provided an acceptable level of medical care that was needed to treat common diseases and ensured comprehensive health-care coverage for the population. It worked relatively well up to the 1970s, when new medical technologies became available and people started to demand better care. The Semashko model was built as a multi-tiered system of care with a strongly differentiated network of service providers, where each of the five levels corresponded to the severity of the disease (district, central rayon, municipal, oblast and federal hospitals) and these were all connected by a sound referral system. Central to this model was the district physician, who was responsible for providing and coordinating the medical care for the population in his or her catchment area. This model made it possible to integrate the activities of other medical services and was very efficient in the economic sense: low cost, health-care coverage could be universal and was rolled out to everyone free of charge.
Q: Why did health progress slow down in the 1970s? What went wrong?
A: In the 1970s, we moved from the Semashko model to the model that emphasizes specialization in outpatient care. The role of the district physician has reduced considerably. Today, the trend towards specialization has reached the point of absurdity. Also, district physicians have lost their responsibility for the health of the people registered with them. As a result, the system seems to be "sailing without a captain", leaving patients to navigate their way through a sea of medical technology and the public has lost confidence in district physicians. According to surveys, these doctors have only a 14% approval rating in the population. People tend to by-pass district physicians and go to...