Russia's Failed Universal Health Care Program Exposes the Perils of Single-Payer Systems
Despite outgoing Russian President Vladimir Putin's doubling of state spending on health care over the past two years, complaints about crumbling infrastructure, poor quality of medical services, and overall mismanagement of the government's so-called universal health care program have been on the rise.
The Russian Federal Assembly is currently considering different options to improve the state-run system, but analysts say the system can't be improved without opening it up to market influences.
Article 41 of the Russian Constitution directs the Russian government to fund a federal health care system and guarantees its people the right to health care and medical assistance "free of charge." Understaffed hospitals, inadequate equipment, and widespread corruption have left millions of Russians without quality health care.
Depending on local economic conditions, health care quality varies considerably among Russia's 88 administrative regions. Many state-run hospitals, particularly in remote areas, do not have hot water, and some do not have running water at all. Even the most basic medicines are often in limited supply.
"Health care is far too important to leave to politicians--be they autocrats or democrats," said John R. Graham, director of health care studies at the Pacific Research Institute.
"The Russian 'free health care for all' system is nothing of the sort," said Jeff Emanuel, research fellow for health care policy at The Heartland Institute and managing editor of Health Care News. "Instead, it is simply another program built on governmental taking of taxpayer funds and mismanagement of the services it promises to provide.
"The result is millions of people pay into the system through their taxes, but when they need care they are stranded without the basic medical services their taxes are paying for," Emanuel added.
Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.
Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care.
Reforms drafted this spring by the Russian Federal Assembly include placing higher emphasis on primary care, shutting down numerous substandard hospitals, scaling down the scope of free medical assistance guaranteed by the state, and increasing physician salaries by reimbursing doctors according to the number of individual treatments given instead of by the number of hours worked.
"Instead of forcing people to pay into this failed program, Russia's government should allow the market to influence the health care system, which it can begin to do by allowing its citizens to choose how their own health care money is spent," Emanuel said.
So-called "universal" health care does not actually exist, says Graham.
"At best, in a functioning democracy like Canada or Britain, it results in unequal access to health care by government rationing, lack of investment in innovation, and shortage of medical professionals," Graham pointed out. "At worst, in a country with little democratic bona fides, it results in the situation we are seeing in Russia."
Rina Shah (firstname.lastname@example.org) writes from Washington, DC.
For more information ...
Bulletin of the World Health Organization, "Ailing Russian health-care system in urgent need of reform" May 2004: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004000500015