Healthcare in Russia is provided by the state through the Federal Compulsory Medical Insurance Fund, and regulated through the Ministry of Health. The Constitution of the Russian Federation has provided all citizens the right to free healthcare since 1993. In 2008, 621,000 doctors and 1.3 million nurses were employed in Russian healthcare. The number of doctors per 10,000 people was 43.8, but only 12.1 in rural areas. The number of general practitioners as a share of the total number of doctors was 1.26 percent. There are about 9.3 beds per thousand population—nearly double the OECD average.
Expenditure on healthcare was 6.5% of Gross domestic product, US$957 per person in 2013. About 48% comes from government sources which primarily come from medical insurance deductions from salaries. About 5% of the population, mostly in major cities, have voluntary health insurance.
The total population of Russia in 2016 was 146.8 million. Among this population, the number of employed individuals reached 72.3 million, involved in the 99 main types of productive and nonproductive activities. In modern conditions, the world experts estimate the overall health of the Russian working population (men 18–60 years, women 18–55 years) to be rather low due to the high mortality rate, significantly higher male mortality level, and a high prevalence of major noncommunicable diseases, especially those of the circulatory, respiratory, and digestive system. According to official government statistics, 1 of every 3 workers in Russia is exposed to harmful working conditions in which the levels of exposure in the workplace exceed the national hygienic standards. However, the level of occupational morbidity in Russia remains extremely low. In 2014, only 8175 cases of occupational diseases were reported, representing 5.5 cases per 100,000 in the general population, a rate much less than in many European countries.
After the end of the Soviet Union, Russian healthcare became composed of state and private systems. Drastic cuts in funding to the state-run healthcare system brought declines in the quality of healthcare it provided. This made pricier private facilities competitive by marketing themselves as providing better-quality healthcare. After Boris Yeltsin resigned, privatization was no longer the priority, with Vladimir Putin bringing back higher funding to the state-owned healthcare system. The state healthcare system greatly improved throughout the 2000s, with health spending per person rising from $96 in 2000 to $957 in 2013.
Due to the Russian financial crisis since 2014, major cuts in health spending have resulted in a decline in the quality of service of the state healthcare system. About 40% of basic medical facilities have fewer staff than they are supposed to have, with others being closed down. Waiting periods for treatment have increased, and patients have been forced to pay for more services that were previously free.
History Tsarist era
The Medical Sanitary Workers Union was founded in 1820. Vaccination against smallpox was compulsory for children from 1885.Introduced in the 1810s. Kan, Sergei: Memory Eternal, p. 95 The Russian Pharmacy Society for Mutual Assistance was founded in 1895.
Some aspects of the healthcare conditions in Tsarist Russia have been considered "appalling". In 1912, an interdepartmental commission concluded that 'a vast part of Russia has as yet absolutely no provisions for medical aid'. The All Russia League of Struggle Against Venereal Disease estimated that there were 1.5 million sufferers in 1914. 10% of those recruited to the army had tuberculosis. Expenditure on healthcare at that time amounted to 91 kopeks per head of population. There were ten factories in Moscow with their own small hospital in 1903 and 274 had medical personnel on their site. From 1912 legislation encouraged the establishment of contributory hospital schemes. Before 1914 most medical supplies, dressings, drugs, equipment and instruments had been imported from Germany. During the war mortality of the injured was very high. Most died from sepsis but more than 16% from typhus.Schaeffer Conroy, Mary: The Soviet Pharmaceutical Business During the First Two Decades (1917–1937), p. 32 As many as 10,000 doctors conscripted to the army died between 1914 and 1920.
However, in the field of school hygiene, tsarist Russia surpassed its Western neighbors in the development and implementation of school hygiene measures to protect the health of children in the nation's schools. By 1900, Russia had endowed school doctors with more authority over school buildings and children's bodies than in France, Germany and United Kingdom, and the United States.
Early Soviet period
The Bolsheviks announced in 1917 requirements for "comprehensive sanitary legislation", clean water supply, national canalisation and sanitary supervision over commercial and industrial enterprises and residential housing.Compare: The All—Russia Congress of Nurses Union, founded in 1917, in 1918 had 18,000 members in 56 branches. The People's Commissariat of Labour announced a broad and comprehensive list of benefits to be covered by social insurance funds in October 1917, including accident and sickness, health care, and maternity leave, but funding intended to come from employers was not available. By December 1917 benefits were restricted to wage earners. Social insurance was re-organised as a five-tier sickness- and accident-benefit scheme which in principle included healthcare and medical treatment by October 1918. Ongoing problems in collecting contributions from employers continued at least until 1924.
In 1918 the Commissariat of Public Health was established. A Council of Medical Departments was set up in Petrograd. Nikolai Semashko was appointed People's Commissar of Public Health of the Russian Soviet Federative Socialist Republic (RSFSR) and served in that role from 11 July 1918 until 25 January 1930. It was to be "responsible for all matters involving the people's health and for the establishment of all regulations (pertaining to it) with the aim of improving the health standards of the nation and of abolishing all conditions prejudicial to health" according to the Council of People's Commissars in 1921. It established new organisations, sometimes replacing old ones: the All Russia Federated Union of Medical Workers, the Military Sanitary Board, the State Institute for Social Hygiene, the Petrograd Skoraya Emergency Care, and the Psychiatry Commission.
In 1920 the world's first state rest-home for workers was set up, followed in 1925 by the world's first health resort, in Yalta, for agricultural workers.
Most pharmacies and pharmaceutical factories were nationalised in 1917 but it was not a uniform process. In 1923 25% of pharmacies were still privately owned. There was heavy reliance on imported medicine and ingredients. 70% of all pharmaceuticals and 88% of drugs were produced locally by 1928. Local pharmacy schools were established in many cities.Compare:
In 1923 there were 5440 physicians in Moscow. 4190 were salaried state physicians. 956 were registered as unemployed. Low salaries were often supplemented by private practice. In 1930 17.5% of Moscow doctors were in private practice. The number of medical students increased from 19,785 in 1913 to 63,162 in 1928 and to 76,027 by 1932. When Mikhail Vladimirsky took over the Commissariat of Public Health in 1930 90% of the doctors in Russia worked for the State.
There were 12 bacteriological institutes in 1914. 25 more opened in the years up to 1937, some in the outlying regions such as the Regional Institute for Microbiology and Epidemiology in South East Russia which was based in Saratov. The emergency service, Skoraya Medical Care, revived after 1917. By 1927 there were 50 stations offering basic medical aid to victims of road accidents and of accidents in public places and responding to medical emergencies. The Scientific Practical Skoraya Care Institute opened in 1932 in Leningrad, running training courses for doctors. 15% of the emergency work was with children under 14.
Spending on medical services increased from 140.2 million rubles per year to 384.9 million rubles between 1923 and 1927, but funding from that point barely kept up with population increases. By 1928 there were 158,514 hospital beds in urban areas, 59,230 in rural areas, 5,673 medical-centre beds in urban areas and 7,531 in rural areas, 18,241 maternity beds in urban areas and 9,097 in rural areas. 2000 new hospitals were built between 1928 and 1932. In 1929 Gosplan projected health spending to be 16% of the total government budget.
Semashko system and later Soviet era
As a self-defined socialist society, the Union of Soviet Socialist Republics (USSR, founded in 1922) developed a totally state-run health-care model—the Semashko system — centralized, integrated, and hierarchically organised with the government providing state-funded health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. On the whole, the Soviet system tended to prioritize primary care, and placed much emphasis on specialist and hospital care. P. Mihály, writing in 2000, characterized the original Semashko model as a "coherent, cost-effective system to cope with the medical necessities of its own time".Quoted in:
The integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The Soviet healthcare system provided Soviet citizens with competent, free medical care and contributed to the improvement of health in the USSR.Leichter, Howard M.: A Comparative Approach to Policy Analysis: Health Care Policy in Four Nations, p. 226 By the late 1970s, free medical care existed for the whole population, although charges existed for certain surgical appliances, together with spectacles, dentures and drugs. However, exemptions from these charges were provided to almost half of the country's population.National Health Insurance Resource Book By United States. Congress. House. Committee on Ways and Means. Subcommittee on Health, 1976, P.389
By the 1960s, life and health expectancies in the Soviet Union approximated to those in the US and in non-Soviet Europe.
In the 1970s, a transition was made from the Semashko model to a model that emphasizes specialization in outpatient care.
The effectiveness of the new model declined with under-investment, with the quality of care beginning to decline by the early 1980s, though in 1985 the Soviet Union had four times the number of doctors and hospital beds per head compared with the USA. The quality of Soviet medical care became low by developed-world standards. Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training. Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but one still often below Western standards. In the post-Stalin era, as the Soviet bureaucracy gained more power and autonomy, this priority medical access became an especially coveted privilege of party and state elites.