Twigg Judyth L
Department of Political Science and Public Administration, Virginia Commonwealth University, Box 842028, 923 West Franklin Street, Richmond, VA 23284-2028, USA.
Soc Sci Med. 2002 Dec;55(12):2253-65. doi: 10.1016/s0277-9536(02)00004-7.
In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending on the particular element of reform under discussion, for and against specific avenues of continuity and change in Russia's health policy. As Russia struggles to devise policy strategies and tactics that balance access, equity, quality, and efficiency, it confronts not only policy choices but also political challenges that look not dissimilar to those faced by health reformers elsewhere in the world.
自苏联解体以来，随着市场化改革的推行，俄罗斯的医疗保健系统自1992年起经历了一系列全面变革。这些改革旨在彻底改革医疗保健融资和服务的社会化方式，代之以竞争性激励结构，以提高医疗服务的效率和质量，但其实施程度和效果参差不齐。本文探讨了俄罗斯医疗保健融资和服务体系变革的一些支持和阻力来源。通过对该体系中两个关键参与群体进行全国性调查来实现这一目的：俄罗斯诊所和医院的主任医师，以及地区层面准政府医疗保险基金的负责人。调查结果表明，总体而言，主任医师和医疗保险基金负责人都声称支持近期的医疗保健系统改革，尽管后者的支持在统计上始终显著强于前者。此外，保险基金负责人对调查问题的回答往往围绕平均回答呈标准钟形曲线分布，少数受访者比平均水平更认同调查陈述，同样少数受访者则不然。相比之下，主任医师在各种改革措施上分为两个阵营：一个强烈支持医疗保健市场化，另一个则倾向于回归苏联式的社会化医疗。调查结果显示出显著的全国一致性，不因受访者的地理位置、地区人口水平或其他人口统计学或健康特征、受访者年龄或所代表的医疗机构规模而有所不同。这些发现表明，在俄罗斯卫生政策中，支持和反对特定连续性和变革途径的明确官僚和政治选民群体已经出现，其构成因所讨论的改革具体内容而异。在俄罗斯努力制定平衡可及性、公平性、质量和效率的政策战略和策略时，它不仅面临政策选择，还面临政治挑战，这些挑战与世界其他地方的医疗改革者所面临的挑战并无二致。
