Download Health Policy - Health - Lecture Slides and more Slides Public Health in PDF only on Docsity! HEALTH POLICY IN RUSSIA Part 2. Macro health measures such as mortality and morbidity rates were applied in the human capital model of health for assessing the social and economic costs of illness, disability, or death within Soviet society. The regional variation in fertility and mortality rates by republic also affected the skilled labor supply. Skilled workers were located primarily in the urbanized European republics, like the Russian Federation, which also had the lowest fertility rates (Brui 1991). PERESTROIKA HEALTH POLICY Two other major health problems, which became more acute during Perestroika (and after the explosion of the nuclear plant at Chernobyl in 1986), were alcoholism and mental illness. The politically tumultuous period of Perestroika interfered with the implementation of several proposals: increasing GNP spending on health from 3.6 percent to 6 percent by the year 2000; increasing funding for medical equipment by 25 percent; construction of diagnostic c1inics and over 1.4 million beds; and annual preventive health exams for children, veterans, pregnant women, and agricultural workers. In regulating resource allocation and costs, policy during Perestroika followed previous health plans by altering input factors without adequately evaluating concomitant changes in health status as output. Although the organizational impediments to preventive care were recognized as serious drawbacks to implementing health policy, no immediate recommendations were made until the provisions of the first Health Insurance Act in 1991. Private insurance medicine was seen as a major cause of escalating costs. A draft law was published in October, 1990, entitled “The Principles of Legislation of the USSR and Union Republics on the Financing of Health Care”. The deputies of the Supreme Soviet of the Russian Republic moved swiftly to propose their own version of insurance medicine. 1991 HEALTH INSURANCE ACT OF RUSSIA AND LIFE CHOICES As an initial step toward decentralization and privatization of government medicine, a network of health insurance agencies was authorized, similar to the Clinton Administration's proposal for market- based health alliances. Insurance plans were divided into two categories: mandatory and voluntary. The health care funds were responsible for financing professional medical education, biomedical research, catastrophic insurance, geographic redistribution of medical care for under-served populations, and public health programs in the case of epidemics or natural calamities. Given the cumbersome bureaucratic heritage of socialized medicine that the insurance legislation was designed to replace, the drafters of the HIA acknowledged the difficulty and complexity of encouraging market forces, regionalization of services, decentralized decision-making, and individual choice and responsibility. Given the provisions of universal coverage in a basic benefits package of mandatory insurance, the medical professionals were empowered to run medical facilities and group practices based on consideration of health needs and quality rather than minimizing expenditures. The health care market is not one of self-regulated, unconstrained supply and demand between providers and consumers. Legislative mandates notwithstanding, progress in public health improves quality of life to a point partly dependent upon individual choice in taking health risks. Under the market incentives provided by the HIA, an insurance plan had the option of changing premiums based on the changing health needs of the patient after a three-year period.
