Perestroika in the Soviet Union's health system.

Recent experiments in the Soviet Union mirror the debates in the United Kingdom about improving incentives in health care. The most interesting innovation to emerge under perestroika is a pilot project in Leningrad and at two other sites which could radically change the financing of hospitals. Hitherto, the budget has gone from the ministry to the hospitals and to the polyclinics by bureaucratic procedure, a scene familiar in Britain. In future, however, the polyclinics (several under the territorial aegis of one hospital) will hold the budget. The hospital will be paid by the polyclinic for treatment carried out, and this payment apparently includes all costs from patient care to ancillary services and supplies. The polyclinic will receive something resembling a capitation fee and will pay the hospital at a fixed rate per operation. In February 1987 Yevgeny Chazov became minister ofpublic health in the Soviet Union. Already known in the West through International Physicians for the Prevention ofNuclear War, Chazov is a reformer and is promoting a policy ofhonesty about the health system. He wants to go beyond collecting mere quantitative data on inputs and move on to measuring achievement and output. Until recently crude quantification has dominated the health care statistics, just as crude norms have dominated the planning process.