Health care insurance in the Soviet Union.

Though uncontrollable forces seem to threaten the constitutional break up of the Soviet Union, the central government headed by Mikhail Gorbachev continues to promulgate large scale changes, which are intended to be binding on all 15 republics. A case in point is the draft law entitled "The principles of legislation of the USSR and union republics on the financing of health care." Published towards the end of October 1990, this document embodies a fundamental ideological shift; it entails abandoning the formerly much vaunted principle of financing the provision of free services from the general revenues of the state. In a sense this follows on from-while going far beyond-a radical modification of financial arrangements, which had been introduced by Yevgeni Chazov, USSR health minister until March 1990. That development, closely comparable with the introduction of an internal market in the British NHS, had been objected to by some people. Their hostility was acknowledged by Chazov in his address to the All-Union Congress of Doctors in October 1988 (see box). Practical experimental schemes needed to be launched. But as the congress was told, the Russian Republic's health ministry, party, and Soviet organisations in Leningrad, Kuibyshev, and Kemerovo agreed to implement new forms of planning, financing, and managing the delivery of health care. The search for other strategies was being conducted elsewhere in the country and a commission had been established at the USSR Ministry of Health in order to summarise the results of the different schemes and draw conclusions. Politically, however, it was necessary to adduce a powerful if not decisive refutation of the opinions to which Chazov had referred. In fact the passage quoted in the box achieves that objective by citing a supreme authority. It goes on: A correspondent ofone of the central newspapers who had not grasped the point of the matter even described such interrelationships as "trading in patients." I would like to call his attention to the classic works ofMarxism-Leninism, or at least to Lenin's programme for the creation of hospital benefit funds [my italics].'