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Negotiating the Post-Soviet Medical Marketplace: Growing Gaps in the Safety Net

  • Julie V. Brown
  • Nina L. Rusinova
Chapter

Abstract

Soviet era constitutions proclaimed the fundamental right of their citizenry to essential medical care that would be free at the point of delivery. That commitment was renewed in the early 1990s by the new constitution of the post-Soviet Russian Federation. Among the many problems facing the Russian government since the breakup of the USSR has been figuring out how to finance and rehabilitate the troubled medical care system it inherited from the former regime. Sharply negative trends in national health statistics have served as a constant reminder of both the extent and the urgency of the problem. As other chapters in this volume amply demonstrate, those macro-level indicators present a disturbing picture of a system in deep crisis. Many commentators have questioned whether the medical care system is currently capable of providing adequate care to the Russian people. As for the extent to which medical care (irrespective of quality) can be had free of charge, that also remains open to question.

Keywords

Medical Care Poor Health Economic Deprivation National Health Statistic Medical Care System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Notes

  1. 1.
    This comment was made repeatedly by people we interviewed in St. Petersburg, although many of them insisted that they were exceptions to that rule. In addition to the findings of our research, which are discussed later in this chapter, reports of popular opinion surveys assessing attitudes toward the medical care system are summarized in K. Muzdabaev, Dinamika urovnia zhizni v Peterburge 1992–1994 (St. Petersburg: SMART Publishers, 1995).Google Scholar
  2. 3.
    N. L. Rusinova and J. V. Brown, “Women’s Work and Women’s Careers: Effects of Gender Expectations on Female Physicians in St. Petersburg, Russia” (paper presented at the International Congress on Women, Work, Health, Barcelona, Spain, 1996).Google Scholar
  3. 4.
    J. V. Brown and N. L. Rusinova, “Russian Medical Care in the 1990s: A User’s Perspective,” Social Science and Medicine 45, no. 8 (1997): 1265–1276.CrossRefGoogle Scholar
  4. 5.
    Martin Bobak, et al., “Socioeconomic Factors, Perceived Control and Self-Reported Health in Russia: A Cross-Sectional Survey,” Social Science and Medicine 47, no. 2 (1998): 269–279; J. V. Brown and N. L. Rusinova, “Health Inequalities in Post Soviet Russia: A Case Study of St. Petersburg” (paper presented at the Annual Meeting of the Southern Sociological Society, New Orleans, 1997).CrossRefGoogle Scholar
  5. 6.
    A thorough description of this instrument can be found in J. E. Ware, Jr., SF-36 Health Survey: Manual and Interpretation Guide (Boston: The Health Institute, 1993).Google Scholar
  6. 7.
    A minimal score on the General Health scale indicates that the individual “evaluates personal health as poor and believes it is likely to get worse.” See Ware, SF-36 Health Survey. In other words, this scale is based on respondents’ subjective assessment of their overall health. The scale is constructed from answers to four questions. Research has consistently indicated that such assessments are very good predictors of future mortality and medical care utilization. See, for example, I. McDowell and C. Newell, Measuring Health (New York: Oxford University Press, 1987).Google Scholar
  7. 8.
    See, for example, M. Pilisuk and S. Parks, The Healing Web: Social Networks and Human Survival (Hanover, NH: University Press of New England, 1986).Google Scholar
  8. 12.
    See, for example, J. A. Clark, et al., “Bringing Social Structure Back into Clinical Decision Making,” Social Science and Medicine 32, no. 8 (1991): 853–866; and J. A. Hall and M. C. Dornan, “What Patients Like about Their Medical Care and How Often They Are Asked: A Meta Analysis of the Satisfaction Literature,” Social Science and Medicine 27, no. 9 (1988): 935–939.CrossRefGoogle Scholar
  9. 14.
    _The USSR’s disability programs are described in some detail in Bernice Madison, “Programs for the Disabled,” The Disabled in the Soviet Union, eds. William O. McCagg and Lewis Siegelbaum (University of Pittsburgh Press, 1989), 167–198.Google Scholar
  10. 16.
    L. S. Levin and E. I. Idler, The Hidden Health Care System: Mediating Structures and Medicine (Cambridge, MA: Ballinger, 1981).Google Scholar
  11. 17.
    See, for example, E. Brody, Women in the Middle: Their Parent-Care Years (NY: Springer, 1990).Google Scholar
  12. 18.
    E. K. Abel, Who Cares for the Elderly? (Philadelphia: Temple University Press, 1991) discusses the positive aspects of care giving. We are also grateful to E. S. Pushkova, head geriatric physician of St. Petersburg, for her contributions to our understanding of the difficulties for families posed by the absence of social supports and home health products.Google Scholar

Copyright information

© Mark G. Field and Judyth L. Twigg 2000

Authors and Affiliations

  • Julie V. Brown
  • Nina L. Rusinova

There are no affiliations available

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