page_title: Healthcare in Russia
section_title: Semashko system
hierarchical_section_title: Healthcare in Russia / History / Semashko system
caption_attribution_description: English: Life expectancy in Russia and the US, 1960-2015. Data source: World Bank - World Development Indicators
context_page_description: Healthcare in Russia is provided by the state through the Federal Compulsory Medical Insurance Fund, and regulated through the Ministry of Health. The Constitution of the Russian Federation has provided all citizens the right to free healthcare since 1996. In 2008, 621,000 doctors and 1.3 million nurses were employed in Russian healthcare. The number of doctors per 10,000 people was 43.8, but only 12.1 in rural areas. The number of general practitioners as a share of the total number of doctors was 1.26 percent. There are about 9.3 beds per thousand population—nearly double the OECD average.
  Expenditure on healthcare was 6.5% of Gross Domestic Product, US$957 per person in 2013. About 48% comes from government sources which primarily come from medical insurance deductions from salaries. About 5% of the population, mostly in major cities, have voluntary health insurance.
  The total population of Russia in 2016 was 146.8 million. Among this population, the number of employed individuals reached 72.3 million, involved in the 99 main types of productive and nonproductive activities.
context_section_description: As a self-defined socialist society, the Union of Soviet Socialist Republics (USSR, founded in 1922) developed a totally state-run health-care model—the Semashko system — centralized, integrated, and hierarchically organised with the government providing state-funded health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. On the whole, the Soviet system tended to prioritize primary care, and placed much emphasis on specialist and hospital care. P. Mihály, writing in 2000, characterized the original Semashko model as a "coherent, cost-effective system to cope with the medical necessities of its own time".
  The integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The Soviet healthcare system provided Soviet citizens with competent, free medical care and contributed to the improvement of health in the USSR. By the 1960s, life and health expectancies in the Soviet Union approximated to those in the US and in non-Soviet Europe. The effectiveness of the model declined with underinvestment, with the quality of care beginning to decline by the early 1980s, though in 1985 the Soviet Union had four times the number of doctors and hospital beds per head compared with the USA. The quality of Soviet medical care became low by developed-world standards. Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training. Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but one still often below Western standards.
  Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the lack of money that had been going into health was patently obvious. Some of the smaller hospitals had no radiology services, and a few had inadequate heating or water. A 1989 survey found that 20% of Russian hospitals did not have piped hot water and 3% did not even have piped cold water. 7% did not have a telephone. 17% lacked adequate sanitation facilities. Every seventh hospital and polyclinic needed basic reconstruction. By 1997, five years after the reforms described below, WHO estimated health expenditure per capita in the Russian Federation in 1997 as 75 "international dollars", as opposed to $24 in Spain, $26 in the UK, $18 in Finland and $1 in the United States.
caption: Graph 1. Life expectancy in Russia and the US, 1960–2015
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