Centrally planned versus free market economy in Soviet healthcare

Healthcare and Medicine in the Former Soviet Union, From the Times of the Cold War Until Now Abstract

The health and medicinal facilities have been a cause for concern for the Soviet Union from the times of cold war. The Marxism theories have led to the adoption of bureaucracy and rigidly defined rules and objectives which are difficult to attain when the administration, funding, production and the other health care tasks are handled centrally. Even when the intentions were clear about improving the health standards in the country, the quality of the services provided suffered. The doctors and health care personnel increased in number but their education and training were not up to the mark leading to severe health related problems. The ecological problems did not assist the health issues and the political and economic setbacks suffered by the country led to worsening of the entire situation.

Objectives

The objective is to discern whether the Marxism rule was able to resolve the health care problems better or whether the freedom or decentralization methods given under free market economy eliminated the deep rooted health problems in the country. The health care problems never entirely finished from the country and remained in the major parts of their history and continue to exist till today.

Method

In order to answer these questions, the researcher did a meta-analysis of recent publications. The researcher reviewed articles from several articles published in journals and magazines (Public Administration Review, American Journal of Public Health, European Observatory on Health Care Systems Series, Health Services Research) and analyzed information published in these sources to determine the status of healthcare and medicine in the Former Soviet Union, from the times of the cold war until now.

Results

The outcome of the research was that neither the free market economy nor the centrally planned economy can achieve the health care goals alone and efficiently. Even though free market economy faced a lot less problems in dealing with health care than a centrally planned economy, the goals of providing free and universal health care is still hard to achieve. Standardized services have been found lacking in both the economies and there is an imbalance in the treatment provided to the high-ranking people compared with lowly, poor and common people.

Conclusions

It has been a difficult and slow transition for the Russian economy from the inflexible centrally planned economy to the more receptive free market economy. However, the health care concerns have not been fully dealt with. It is up to the policy makers who are responsible for drawing up the health reforms to learn from experience and to keep all the relative factors in mind before aiming for something unrealistic. As can be seen from the history of Soviet Union that even though, the economy achieved its target of enlarging the health care system and producing many doctors, the quality level was dropped to a very low level to a point where it was equal to the health care system being non-existent. In future, the policy makers and the helpers need to find out the most efficient way of utilizing resources so that the maximum return can be achieved from the investment. The government has got to play its part by bridging the imbalance of wealth among its citizens and improving the socioeconomic and ecological conditions so that fair treatment is accorded to every one and the health care does not worsen because of external factors.

Introduction

Restructuring and transforming a deteriorating health care system is not an easy task, as is becoming clear in the United States. However, the problems faced in reorganizing the system by various countries including the U.S. appear quite insignificant in front of the health care issues Russia and the other independent former Soviet Union states were confronted with. An extraordinary emphasis on centralization in the former Soviet Union (FSU) for seventy years destroyed any hope of the economy, specifically, the health care system of ever functioning efficiently. Also, it posed problems in the movement towards a free market economy that was not quite in favor of centralization. Now, the pressing concern of the Soviet Union is to uplift its health care system from further ruin and modify it according to current health standards (Mikesell and Mullins, 2001).

The question that arises is how the health care system can be transformed, keeping in mind the present requirement of medical services by people and the development that the almost-collapsed health care system demands. Another concern that is raised is how the move towards market economy will affect the health care system and whether it will lead to further destruction. These types of concerns demand notice (Barr and Mark, 1996).

Background of the healthcare system in former Soviet Union

The period of mayhem following the Bolshevik Revolution in October 1917 was also highlighted by the bringing in of Soviet's "socialized medicine." The country had faced great economic and military challenges and survival was difficult to envision. To crown it all, the poverty-stricken and half-starved people were also facing health problems in the shape of spells of plagues that kept occurring. The administration then had to firstly stem the attacks of epidemics in the country before launching on any other program (Barr and Mark, 1996).

Two time periods can be made out in the ensuing years of the Soviet's health care history. One time period of the 1920s was characterized by Marxist theories that made health care problems appear as an outcome of following capitalism and stated that communalism will bring an end to health woes in the country through rigid order. These perceptions, however, had the effect of stifling modern medical researches and gave birth to a whole lot of untrained doctors (Barr and Mark, 1996).

The closing stages of the decade saw Stalin's policies of collectivizing agriculture and to bring industrialization in the Soviet Union under a forcible plan. This eliminated the growth of Marxism or anti-capitalists ideas. The health care system underwent a change as it became more systematic with the purpose of it being to develop the working capability of the labor force. The importance of health care in the country was emphasized and it was declared that every citizen had the right to claim it. The operation and functioning of this system was given under the control of the government while all the health care employees were also hired by the state. Its control lay mainly in the centre and the system was homogeneous and unvarying with defined rules and objectives. Patients were given free medical treatment and other facilities which the state endured out of the corporate tax and its budget while the private associations of doctors were stopped from functioning (Barr and Mark, 1996).

Doctors were asked to take training to improve their skills while the government took measures to increase the capacity of clinics and hospitals by making space and providing more hospital beds. This sudden and hasty attempt to meet the overwhelming medical needs and to build the collapsed health care system also meant a certain decline in quality of the health care staff and the facilities provided. The unlimited demands for the goods and services coupled with the availability of limited resources and provisions of products led to the problem of scarcity. Moreover, the health care system developed in such a way so as to cater to only the high-ranking people or individuals who belonged from a certain class. It diverted its attention away from the common men who were only offered low quality and limited medical facilities (Barr and Mark, 1996).

The Brezhnev era which lasted from 1964 to the beginning of 1980s did not experience developments in the health care systems of the country but instead was forced to tackle with deep rooted administrative problems. Mikhail Gorbachev, in 1985 let the people know about the major health care problems. From the view point of Evgenii I. Chazov who was Gorbachev's first health minister, the underlying cause for the collapse of the health care system was a lack of finance and resources that were needed for the necessary and urgent improvement of such an important sector in the country. In the ensuing years, Soviet Union actually cut down the resources going from its gross national product to health and services sector and it was the only country to do so at that time (Barr and Mark, 1996).

The quality of the health services provided were dreadful, considering the fact that Soviet Union was a host to the largest number of doctors and hospital beds in any country. Criminal practices had crept in while doctors who graduated had usually cheated or bribed their way to get their degree and were often at a loss at performing the most simplest of tasks. Dishonest and fraudulent measures seeped anything of quality that was left in the health care system. Some of the experienced health care providers were drivers to charge high fees from their patients which they were thought to be supplied with for free. The issue of grey and black markets often arose as a result of the shortages of experienced health care personnel. The system could not adapt to a flexible environment as it was led by rigid official procedures and the mentality of the people who controlled it was commanding, their vision short-sighted and hardly beneficial in such a situation (Barr and Mark, 1996).

The breaking up of Soviet Union which brought crippling economic and political problems to the countries also aggravated the health care situation making it reach an all-time low. The collapse of the health care system ran by the government led to the belief that turning towards a market economy or more capitalistic notions and perceptions would have been a better idea. The competition in the private sector would have had improved efficiency and averted an inevitable collapse of the health care system in the Soviet Union. This transformation, often advocated by the Western economies could have been inappropriate for the Soviet Union as it would have been impossible to solve the health care problem individually without keeping in mind the other social, political and economics problems gripping the country (Barr and Mark, 1996).

The Health Status of the Former Soviet Republics in the 21ST Century

The conditions in the 21ST century have not changed at all. The funding of the healthcare is still extremely low. The poor and underprivileged class still finds it difficult to gain access to quality healthcare facilities and treatment. The rich continue to reap the benefits of a highly impartial healthcare system. The conditions of the doctors and physicians (though, has improved slightly) is still not up to the international standards. Similarly, the shortage of syringes, basic medicines, surgical instruments, intravenous tubing, gloves, sterile needles and other dressing supplies still continues to exist in most of these former Soviet Republics resulting in higher healthcare expenditures by individuals. While birth control now is being done through pills, many women still consider abortion as an option as it has become a norm in these states (Balabanova, Haerpfer, McKee, Pomerleau and Rose 2004).

The Former Soviet Republics in the 21st Century are no longer under communist rule and so have been driven away from the older centralized models of healthcare systems. These former Soviet Union states believe in adhering to strict rules and defined ways of pursuing their goal of providing free health care services of an unvarying nature to every citizen. However, this inflexibility coupled with the administrative problems of centralization has not made them successful in achieving their highly ambitious goals, even if it drastically increases the number of doctors and health care personnel available. Also, there has been a difference in the provision of health care facilities depending upon the organizations it is providing service for. The elite industrial class of people has been given the option of taking advantage of high-quality services while the common men, women and children have been left unattended (Balabanova, Haerpfer, McKee, Pomerleau and Rose 2004).

In addition, there are several healthcare issues emerging out of the rural areas. These people cannot gain assess to these health care facilities because of a lack of communication and/or transportation barriers. The need for changing the Soviet system of healthcare is clear, as the communist system of providing goods and services has been criticized by many countries and the political, economic and social damage the country received is enough to ensure that funding to the health care system will unlikely increase (Balabanova, Haerpfer, McKee, Pomerleau and Rose 2004).

The changes that have occurred include the decentralization of both funding and delivery of medical services. There have been shifts to decentralization in the over all organization and funding from health insurance. In many countries, the rigid system of providing health care has disintegrated and there have been an increase in informal payments (Lewis 2002). However, there is no confirmed way of research to gauge how the anti-Soviet system had changed the health care system for the people and additional research needs to be carried out in order to fully comprehend the current status of healthcare in these former Soviet Union republics (Balabanova, Haerpfer, McKee, Pomerleau and Rose 2004).

Conclusion

The establishment of democratic institutions while also enhancing the general health level of society at large is no easy task to accomplish. According to the World Bank's World Development Report (1993) the achievement of health care aims is an ongoing struggle which neither the government nor the free market alone can achieve efficiently. It is the responsibility of the policy makers of health reforms to consider alternative use of natural resources to decide upon the most efficient one and to ensure that none of the resources go to waste so that society can benefit most effectively.