HEALTH CARE SERVICES, SOVIET

Soviet socialized medicine consisted of a complex of measures designed to provide free medical care to the entire population, at the time of service, at the expense of society. The Soviet Union was the first country in the world to grant every citizen a constitutional right to medical care. This commitment was one of the few brighter (and redeeming) aspects of an otherwise bleak totalitarian system and often held as an example to emulate by other nations. The promise of universal, free (though not necessarily equal) care was held as the fulfillment of an age-long dream of providing care to those who needed it regardless of their station in life and ability to pay. It thus promised to eliminate the commercial aspects of the medical encounter that, in the eyes of many, had turned the physician into a businessman concerned primarily with his income and his willingness to treat only those who were affluent.

In the first decade of the Soviet regime, the official ideology held that illness and premature mortality were the products of a faulty socioeconomic system (i.e., capitalism) and that the establishment of a socialist society (eventually to become communist) would gradually eliminate most of the social causes of disease and early deaths by creating improved conditions (better nutrition, decent standard of living, good working conditions, housing, and prevention). This approach was set aside when Stalin took power at the end of the 1920s. He launched a program of forced draft industrialization and militarization at the expense of the standard of living, with an emphasis on medical and clinical or remedial approach, rather than prevention, to maintain and repair the working and fighting capacity of the population. The number of health personnel and hospital beds increased substantially, though their quality was relatively poor, except for the elites.

Soviet socialized medicine was essentially a public and state enterprise. It was the state that provided the care. It was not an insurance system, nor a mix of public and private activities, nor was it a charitable or religious enterprise. The state assumed complete control of the financing of medical care. Soviet socialized medicine became highly centralized and bureaucratized, with the Health Ministry USSR standing at the apex of the medical pyramid. Physicians and other health personnel became state salaried employees. The state also financed and managed medical education, all health facilities from clinics to hospitals to rest homes, medical research, the production of pharmaceuticals, and medical technology. The system thus depended entirely on budgetary allocations as line items in the budget. More often than not, the health care system suffered from low priority and was financed on what came to be known as the residual principle. After all other needs had been met, whatever was left would go to health care. Most physicians (the majority of whom were women) were poorly paid compared to other occupations, and many medical facilities were short of funds to purchase equipment and supplies or to maintain them.

Access to care was stratified according to occupation, rank, and location. Nevertheless the population, by and large, looked upon the principle of socialized medicine as one of the more positive achievements of the Soviet regime and welfare system, and held to the belief that everyone was entitled to free care. Their major complaint was with the implementation of that principle. Soviet socialized medicine could be characterized as having a noble purpose, but with inadequate resources, flawed execution, and ending in mixed results.

See also: feldsher; healthcare services, imperial

bibliography

Field, Mark G. (1957). Doctor and Patient in Soviet Russia. Cambridge, MA: Harvard University Press.

Field, Mark G. (1967). Soviet Socialized Medicine: An Introduction. New York: The Free Press.

Field, Mark G., and Twigg, Judyth L., eds. (2000). Russia's Torn Safety Nets: Health and Social Welfare During the Transition. New York: St. Martin's Press.

Ryan, Michael. (1981). Doctors and the State in the Soviet Union. New York: St. Martin's Press.

Sigerist, Henry E. (1947). Medicine and Health in the Soviet Union. New York: Citadel Press.

Solomon, Susan Gross, and Hutchinson, John F., eds. (1990). Health and Society in Revolutionary Russia. Bloomington: Indiana University Press.

Mark G. Field