Modernization of Primary Healthcare: Efficiency of Social Policy in the Post-Soviet State

Abstract

The national security depends on the health of the population, which, in its turn, depends on the healthcare system. After the collapse of the Soviet Union, Russia focused on the primary healthcare. The goals, tools, and results of the reforms that have taken place in the last three decades are usually considered from the point of view of law, economic feasibility, or organizational effectiveness. The author applied the historical and political approach to these reforms, thus evaluating their ability to preserve and increase human health. Fertility, morbidity, and mortality usually serve as national health criteria. The research relied on regulatory legal acts, speeches of senior government officials, official statistics, and sociological surveys. Demographic problems and budget deficits proved to be the main reasons behind the post-Soviet reforms, which transferred some material obligations from the federal to the local level and expended the scope of commercial medicine. Part of the financial burden moved from expensive specialized hospitals (secondary healthcare) to cheaper polyclinic and preventive medicine (primary healthcare). Federal budget expenditures decreased as patient capacity and the number of medical organizations went down and the productivity of primary healthcare went up. However, the national mortality and morbidity kept growing. The current diagnostic preventive healthcare model concentrates on primary healthcare: it reduces financial expenditures but fails to solve the demographic problems.