Field M G
Davis Center for Russian Studies and School of Public Health, Harvard University, Cambridge, Mass., USA.
Croat Med J. 1999 Jun;40(2):202-9.
After the collapse of the Soviet Union in 1991, Russia decided to replace its deeply flawed and under-funded system of socialized medicine by a scheme of health insurance that involved the decentralization of health services and of off-budget financing. Every enterprise would pay 3.6% of its salary fund into a Regional Health Insurance Fund, and the Fund would finance private insurance companies that would compete for clients. The non-working population would have its insurance premiums paid from the budgets of regions or municipalities. The transition from one system to another has been problematic and plagued with a variety of problems not the least of which is that the Russian economic structure is not geared to sustain an insurance system at the present time. The Russian case presents an instructive experiment with the premature introduction of a scheme touted as an "anti-model" to socialized medicine and geared to market and legal arrangements that are, as yet, largely non-existent. Under-funding of health services remains and leads to the polarization of the population into those few who can afford private care, and the vast majority for whom this care is difficult to obtain, or unobtainable. This has ominous political implications.
1991年苏联解体后，俄罗斯决定用一种医疗保险计划取代其存在严重缺陷且资金不足的公费医疗体系，该计划涉及医疗服务和预算外融资的分权。每家企业都要将其工资基金的3.6%缴纳到地区医疗保险基金中，该基金将为争夺客户的私人保险公司提供资金。非在职人口的保险费将由地区或市政预算支付。从一个体系向另一个体系的过渡一直存在问题，且饱受各种问题困扰，其中最主要的问题是，俄罗斯的经济结构目前并不适合维持一个保险体系。俄罗斯的案例是一个具有启发性的试验，过早引入了一个被吹捧为公费医疗“反模式”的计划，该计划面向的是目前很大程度上还不存在的市场和法律安排。医疗服务资金不足的问题依然存在，并导致人群两极分化，少数人能够负担得起私人医疗服务，而绝大多数人则难以获得或根本无法获得这种服务。这具有不祥的政治影响。
