Reforming the Russian health service

Health service reform is an important part of the growth of democracy in Russia, and several Western groups have been helping the Russians tackle this huge task. Since 1992, general practitioners in the United Kingdom and medical teachers at the Medical Academy of Postgraduate Studies in St Petersburg have been sharing knowledge on medical education and primary health care. In this article, Dr Peter Toon, the UK coordinator, and Russian doctors involved in the partnership describe Russian health care and attempts at its reform from different perspectives.

Otherwise it might be convenient

The Russian health service is vast. Primary care takes place, not in cosy domestic surgeries, but in polyclinics that feel like small district general hospitals without inpatients. Hospitals are correspondingly massive, often with a thousand or two thousand beds. Many were built in that architecturally depressing period that gave Britain the tower blocks we are now replacing. Unfortunately, Russia has no money for new buildings and little for maintenance, so they crumble gently away.

The Russian health service is specialist led. District physicians based in polyclinics, each responsible for 2000 patients in a neat geographical patch (patient choice has yet to reach Russia) look after primary care. They do little other than treat viral illnesses, issue medical certificates, and refer about half the patients they see to specialist colleagues. Half the doctors in polyclinics are specialists, and since patients have direct access to them, district physicians are often bypassed altogether.