Chapter 2
Literature review
Russia has a very large number of hospitals, physicians, and health care workers as compared to any other country in the world. In spite of this, the medical care fraternity has failed to offer standard and acceptable health care services to its people. Russia has faced a health care system crisis for an extended period since the collapse of the Soviet Union. Significant transformation in the social, economic, and political environment has adversely affected the health care system (Britnell, 2015). The poor health care system in Russia has been precipitated by the lack of medical and technical equipment, funds, supplies, and the organizational inefficiency in health care service provision. As a result, the accessibility and quality of health care services remain on the low.
Numerous researchers and academicians have conducted numerous fragmented studies concerning the running of the Russian health care system in comparison to various other countries. However, having adopted a socialism economic system the comparison at times was difficult, especially when done with a capitalistic country such as the US. As such, this literature review evaluates the prospects of the Russian health care system in comparison with the global international health care market.
Over the recent years, global health care processes like the expansion of the World Health Organization (WHO), free trade among European Union countries, and global open markets have provided a great opening for international health facilities to operate effectively and efficiently (Alexeev & Weber, 2013). Health regulations and guidelines provided on the international level have considerably transformed the delivery of health care services in most clinics in the world. Since the beginning of the new millennium Twaddle, (2002) notes that the Russian government has initiated considerable reforms and developments in the health care. The healthcare sector is in the docket of the national government in terms of management and budget financing (Britnell, 2015). The federal state has consistently funded the health care facilities in ensuring the efficient provision of medical services.
Today, Russia has tried to incorporate international accreditation activities, the inspection of health facilities to match the expected high quality principles. In line with the health care reforms in Russia, the health care systems pushed the government to spend more $ 3.2 billion on health care projects in 2006 (Alexeev & Weber, 2013). Much of the government spending on health care has been absorbed by salaries for doctors and nurses, purchase of high-tech medical equipment, and expansion of healthcare centers within the country. According to Britnell (2015) Russia is a large country with most of the health care funding emanating from regional budgets. As a result, quality health care service and delivery varies widely across different parts in the country.
Dutkiewicz & Trenin (2011) acknowledge that over the years, the health care system has gradually evolved into a more advanced and flexible system with a core objective of adapting to the current social and medical transformations. Consistent reforms in the health care system have been triggered by the need to alleviate the already worse public health condition, and mitigate the drop in life expectancy (Fierlbeck & Palley, 2015). According to Cockerham (1999), various factors have contributed to the deteriorating health care system in Russia. Some of these factors required state intervention through funding, resource allocation, and legislative policies to monitor and control health care finances (Cook, 2011). The institutionalization of state agencies would have a positive impact on the health care system by ensuring integrity and transparency.
Origin of the health care crisis
Cook, (2011) notes that the health care crisis in Russia has continued for decades despite the availability of many hospitals and a large number of doctors and nurses. Health status has significantly declined since the independence of the Federation of Russia and the collapse of the Soviet Union. The latest economic crisis was not responsible for the health care crisis, rather intensified the situation. Russia has experienced a low growth and development of the healthcare system over the years (Transparency International, 2009). The distortion of the health care system in Russia has been precipitated by the perception that it was a set social services provided in response to a particular circumstance, rather than connected to the actual health state within the populace (Fierlbeck & Palley, 2015). As such, it caused the crisis being experienced, especially concerning the management of various aspects connected to its operation.
Information and data gathered by the State Statistics Service indicated that the number of health facilities in the rural areas dropped by 75 percent in the years 2005 to 2013 (Bagheri, 2013). Over 6,000 medical care facilities shut down including district hospitals and health clinics. This decline in health facilities has caused a devastating impact on the lives of the local populace as demand for more health facilities, and doctors heighten. Approximately 17,500 villages and towns in Russia lack medical infrastructure (Cook, 2011). Regional administrators are tasked with the responsibility of providing access and quality healthcare to the local population. It is saddening that over 11, 000 residents have to travel more than 20 kilometers in search for the closest medical facility or practitioner. The statistics show the increasing need for reforms to enhance the efficiency of the health care sector in Russia.
Previous attempts by the government to reform the health care systems have faced numerous challenges because the approach used did not address the core problem. Dutkiewicz & Trenin, (2011) notes that most Russia’s health care hurdles have emanated from the accepted state-paternalistic political model of social system development. According to the above-mentioned approach, the state government pays no or little attention to the health care issues. The approached used towards the growth and development of health care systems aims at increasing the number of health care resources rather than improve the quality of service provision (Fierlbeck & Palley, 2015). One of the health care system feature during the Soviet period was the lack of incentives to enhance service delivery in medical institutions. As a result, the quality and effectiveness of medical care deteriorated with time.
According to the Russian constitution, health care services to residents must be delivered free through the broad network of state-run health care facilities and clinics. The funding of these facilities is done by the state government spending and compulsory insurance. According to Jeffries (2012) the Russian health care system is characterized by poor management, insufficient medical equipment, understaffing, and prevalent corruption. As a result, the quality of service offered by these institutions remains comparatively low (Fierlbeck & Palley, 2015). Lack of stable preventative medical care actions and the deteriorating health care status are the major contributing elements of the increased mortality rate in the country. According to research studies, the average life expectancy in Russia is 65 years with a staggering life expectancy gap between men and women (Alexeev & Weber, 2013). Such statistics show the status of the health care system in Russia, with a need to address the challenges facing the sector to enhance efficiency.
As a result of the Soviet health care model referred to as the Semashko, private practicing of medicine is rare in the country. Despite the paramount achievements associated with the medical model, some major setbacks cannot be ruled out (Bagheri, 2013). According to research studies, the Semashko model exhibited some positive outcomes in its key aim of fighting infectious diseases. On the contrary, it could not ensure efficiency in the treatment of chronic diseases. Transition into an international health care market has seen the implementation of various health care reforms and policies (OECD, 2010). Strategic introduction of the compulsory health insurance (CHI) and the regionalization of the financing and management of the health care system was a strategy aimed at bridging the gap and addressing the inefficiencies..
In the late 1990s, it was clear that the introduction of compulsory health insurance failed to achieve the projected results; enhanced quality and ease access to medical services. On the contrary, the health status of the general populace and quality of medical service delivery consistently declined (Johnson & Stoskopf, 2009). Medical facilities and health clinics face the similar hurdles that include lack of medical equipment and medication among others. The development of the compulsory health insurance system was introduced amidst numerous major challenges. First, the system is associated with numerous irregularities that have resulted in a serious problem in the usage of insurance policies. On the other hand, payment collection to the compulsory health insurance has become difficult. The predicament has been triggered by the failure of regional administrators to fulfill their obligations. Most of the regions have lagged in the provision of medical services as a result of health authorities’ unwillingness to fund for the economically inactive populace (Reisinger, 2013). Health care system reforms did not come with the respective organizational transformation required to effectively enhance health care services.
Current state policies
The state government has embarked on various policies in resolving the health care crisis facing the country. The healthcare sector is one of the most crucial and fundamental sectors in the country that needs government intervention to match the international market (Tikhonova, 2009). As a result, the government has increased its funding to the health care facilities around the country, and established more medical institutions. According to Scott, (2013) besides funding, health care system needs an extensive overhaul from employees to the entire operational system. The deterioration of the health care system in Russia is a problem that needs to be solved independently for a long-term solution. Some of the principles that Russia has accepted and adopted include decentralization of management (Watson, 2013). The regionalization of health care management has helped the national government reach out to people in the rural areas. As a result, regional authorities are charged with the health care responsibilities of development.
Health system efficiency in Russia can be enhanced through transparency and accountability of public resources. The increase in public participation ought to be encouraged in the development of health care policies through platforms such as online consultation (Bagheri, 2013). The lack of integrity, openness, and accountability in the system increases the chances of corruption and office mismanagement. As a result of the current economic crisis, most health facilities have focused on the financial problems in stabilizing the system. Russia’s initial health reforms had placed the medical system in a market environment through liberalization of economic ties. The predicament of the health system was brought by the fact that the federal government financed the entire system, resulting in environment market complexities (Reisinger, 2013). Medical facilities from different regions are faced with the challenge of financing their routine activities resulting in financial instabilities within the system. Health facilities are forced to cut down expenses through prioritizing on expenditures. For instance, construction and reconstruction of health institutions had to be left pending to create funds for day-to-day activities and current needs.
Insufficient financial aid from the federal government forced most medical organizations to function in the market economy autonomously. The shift in health, medical practice meant that people had to pay more for services that were previously offered free of charge. In some instances, the treatment charges in these organizations have become unbearable for the local people. As a result, the state government has entered into a partnership with the private health providers to ensure access and affordability of health services to all individuals. The federal government took the initiative in the financing of health care by shifting the responsibility to the local level. Healthcare budgetary financing is currently done at the local budget level. The shift in budgetary financing has adversely affected medical organizations relying on the federal budget . Consequently, disruption of the former health system occurred since people had to travel to other regions to get specialized service.
Fee-for-service financing in the health care system has induced financial pressure on family budgets. The demand for high quality and reliable health service in the country has led to increased treatment charges by private medical practitioners. Demand for health care services remains restricted to the simple and cheapest service available and those facilities offering free of charge. As a result of the simultaneous restraint in supply and demand for medical health services, the health care service will be highly susceptible to degradation. The state government intervention on health care system is imperative in the modern age to enhance service delivery within health care facilities. Additionally, policies and regulations governing health practices need modification to ensure international health care standards are achieved.
Conclusion
It is evident that the prospects of Russia’s health care are directly linked with the country’s future social and economic development. Funding of the health care from the state government or individual parties will have a paramount impact on the health care system. According to research studies, most countries that have depended on the public health services have faced poor allocation and shortage of resources, the quality decline in health care service, and deteriorating health conditions. A positive transformation of the Russia’s health care even though the system lacks transparency and accountability has been experienced after the implementation of the new reforms. Food and Drug Administration (FDA) approval is not acknowledged, and the country has continued to undertake product testing as the major product approval procedure. Some of the product safety assurance practices like the quality systems, plant auditing, and post-market vigilance are yet to be improved.
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