SOVIET HEALTH-CARE FROM 2 PERSPECTIVES

During the summer of 1991, the Soviet people brought the Communist party to its knees, demanding an end to centralized control and autonomy for the Soviet republics. Even before these dramatic events took place, Soviet reformers were striving to reconstruct a health care system plagued by ''chronic underfunding, antiquated and deteriorating facilities, inadequate supplies and outmoded equipment, poor morale and few incentives for health care workers, and consumer dissatisfaction,'' as the authors of this study report. Even with their greater number of providers, Soviet citizens lag behind Americans in general health status, life expectancy, and infant and maternal mortality. Soviet physicians earn only 70 percent of the salary of the average nonfarm worker in the Soviet Union. Striking disparities in health status and outcomes exist as well among the fifteen Soviet republics. In this paper, Diane Rowland and Alexandre Telyukov collaborate to present a unique dual perspective on the health systems of the two superpowers. They provide an overview of the issues facing Soviet health reformers, whose task is enormous, especially in the context of the massive reforms that the Soviet Union is currently undertaking in the midst of a shaky political union. These reforms reflect the overwhelming desire of the Soviet people to decentralize decision making to the republics and replace the rigidity of the centralized planning system with more democratic control at the republic level. Rowland is assistant professor and Brookdale National Fellow in the Department of Health Policy and Management, The Johns Hopkins University School of Hygiene and Public Health, in Baltimore, Maryland. Telyukov is head of the Division of Comparative Economics of the Institute for Economic Studies in Moscow. From September 1990 to July 1991, he was a visiting scholar at the Russian Research Center, Harvard University.