Healthcare and medicine in the Former Soviet Union since the Cold War

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 during the 1990's

When western scholars attempted to discern the health care situation in Russia, it was reported that it had a falling life expectancy rate while a rising infant mortality which depicted that it was still clouded with serious health concerns. In 1990, infant mortality in eight former Soviet Union countries was reported as 17.4 per 1000 live births and it was 18.8 for the first half of 1993. These states, however, calculated the infant mortality rate differently from the international computation laid down by World Health Organization (WHO). In 1994, when WHO standards were considered and applied, the infant mortality rate in Russia increased by 20% to reach a level of 24-25 per 1000 live births (Barr and Mark, 1996).

Even now, fifty percent of all the infant deaths in these countries are caused by respiratory and contagious diseases which when compared to its United States counterpart it forms only a meager 10%. Western countries are afflicted from contagious diseases 10% lower than in former Soviet states. Infections, hemorrhage and hepatitis are some of the reasons for increasing maternal deaths. Simple needs of vaccines and vitamins are not fulfilled even in the well to do Baltic States. Increasing pollution and environmental concerns have also adversely affected the health of the citizens who can hardly hope to be provided with free and quality health and care services (Barr and Mark, 1996).

Traumatic stress, poisoning, lung illnesses, complications in pregnancy and childbirth are causing most of the early deaths. Emphasis was laid by the WHO on improved conditions of sanitation and care provided to infants and mothers. It was stated that the improvement of these conditions should be preferred of developing medical technology and care systems. The remedy of the socioeconomic and environmental causes of the spreading diseases was emphasized (Barr and Mark, 1996).

The independent states received a very chaotic and problematic health care system after the collapse of the Soviet Union. The last years of the existence of the Soviet Union were characterized by low budget spending being done on the health care system. Of the very small percentage of the funds provided, only the high-ranking people could have availed the health care benefits while the common citizens continued to face hardships (Barr and Mark, 1996).

The conditions prevailing in hospitals and clinics were dismal because some of them often lacked basic plumbing facilities and they continued to exist in an alarming state of disrepair. When the Soviet Union was on the verge of disintegration, the health care needs had been only scarcely met due to the shortages of syringes, basic medicines, surgical instruments, intravenous tubing, gloves, sterile needles and other dressing supplies. The shortages continued to occur even when the supplies had been improved (Barr and Mark, 1996).

The awful health conditions in these former Soviet Union States can be judged from the fact that abortion was the only option available to control births which was made more painful as basic medications such as anesthetics was not available. The birth control pills did not appear even after being ordered while the number of abortions underwent in the country rose to an alarming 3 million. The abolishment of physician's association made sure that the quality of the health care personnel was not maintained and the wide number of doctors available at that time were considered inexperienced according to Western standards (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).