Institute for Health and Human Development

Health and Development

Project: Health Service Reform in Russia

Lead: Martin Wall
Partners: Elena Schmidt, Adrian Renton, Rifat Atun (Imperial College Business School)

Description:

The health care system inherited by the Russian Federation from the Soviet Union was the “Semashko model”. Its main features were an emphasis on inpatient care and hospital based services rather than primary care or preventative medicine, input based planning, rather than needs, or cost effectiveness based planning and a reliance on funding from the state budget rather than through social insurance or direct . By the end of the Soviet period this model had already shown itself to be inadequate to meet the evolving health needs of the population and following the economic collapse suffered in Russia during the 1990s this centrally funded model of health care became unaffordable. The 1990s also saw a significant worsening in many health indicators, especially life expectancy among men.

In 1993 the Russian Government began to introduce a number of reforms including compulsory health insurance, both to address the shortage of funding for health services and to move towards more cost effective, responsive and efficient health care delivery. Key objectives were to decentralise funding and planning, to promote the development of primary care, and to reduce unnecessary hospitalisation. Unadjusted annual hospitalisation rates in Russia have been 4 to 5 percentage points higher than the western European average since the 1980s. Although the period of the early 1990s saw falling rates of hospitalisation, since the mid 1990s these rates have climbed again to stand currently at about 23 per 100 persons compared to 18 per 100 persons in the European Union. In this project we analysed data collected through the Russian Longitudinal Monitoring Survey (RLMS), a large nationally representative survey of households carried out annually or biannually since 1992. We used the data available from 1996 to 2003. We used panel data methods to identify health, demographic and economic factors associated both with hospitalisation and with the length of inpatient stay and thus controlled, as far as possible with this data, for the mixture of morbidity factors and socio-economic factors that influence hospitalisation. We found that over the whole period of our study there was no systematic decline in either the rate of hospitalisation or the length of time patients stayed in hospital once admitted. This suggests that the reforms have failed to address the underlying flaws in the Russian system and that Russians will continue to suffer from inadequate and inappropriate health care

For Further Information contact: Martin Wall

References: The results are more clearly outlined in several papers currently under review. Once the outcome of these reviews is known a fuller reference for this work will be available here. For a good introduction to the Russian health care system and the reforms see Tragakes E, Lessof S, Health care systems in Transition: Russian Federation. Health Care Systems in Transition. Copenhagen: European Observatory on Health Systems and Policies, 2003

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© 2010