Health Care in Russia vs Health Care in the U.S.
According to the Institute of Medicine of National Academy of Sciences, the United States of America is a single developed industrial country that does not have universal health care. Instead there is a powerful health insurance system, partially funded by government through national programs. As a result 45% of total health care expenditures are spent on these programs (Sultz and Young 154). Unlike the U.S., Russian Federation has free universal medicine, and state constitution guarantees each citizen free health care services. Numerous debates rise regarding both American and Russian health care systems, their availability, effectiveness and expenditures. Each of the systems has its weaknesses and strengths, as well as common and distinctive features, and in order to juxtapose them the following key aspects must be described and compared: system structure, national programs, expenditures and financing, insurance, research and development, health care regulations and control. Undoubtedly, both countries need certain health reforms, which are nowadays being discussed and realized in the USA and Russia. All these changes demonstrate the increasing role of the state in providing health care, making government the main body performing control, fulfilling regulatory and finance functions.
Structure of Health Care System
Health care system in the USA is represented by independent services of three major levels: family medicine, hospital medicine and public health. Medical services are provided by private individuals and legal institutions. Various commercial, charity and national organizations offer their patients ambulatory, as well as stationary services. As Sultz and Young stated, around 47% of total health care expenditures are spent on stationary care, approximately 2% on home care, 10% on medicamentous treatment, and 10 % on elderly home care. The remaining 11 % are taken by dentists, ophthalmologists and other narrow specialists (219).
The constitution of Russian Federation guarantees a wide range of free medical and social services. This situation has not changed since Soviet Union times except that the system became decentralized and is controlled by federal, regional and municipal administration (Manning and Tikhonova 56).
Family medicine is a well-developed structure in the U.S. Family doctors examine and look after patient’s health, and if needed send them to narrow specialists or assigns for stationary treatment. Such doctors receive payment directly from patients. Usually family doctors work in their own offices or share one with other specialists. While in Russia family doctors work in state hospitals, and get their salaries from government. However, in reality patients are sometimes forced to pay additional money in order to receive quality examination, obtain fake sick-list, or simply to show gratitude and support poorly compensated doctors (Sultz and Young 167).
Hospitals and clinics comprise the most significant part of American medical services. Expensive stationary treatment is the foremost component of the U.S. health care industry. There are two types of hospitals: those who possess ownership and usually controlled by private corporations, and nonprofit hospitals, managed by district or national governments, religious congregations or independent public organizations. Likewise, Russia also has private clinics. However, this sector is far smaller than state hospital sector, and represented by rural health posts, health centers, urban hospitals and specialized polyclinics.
Hospital structure of Russia is similar to the one in the U.S. In hospitals of both countries medical staff provides certain volume of ambulatory treatment in emergency rooms and specialized clinics, however they are mostly intended for hospital care. A lot of attention is given to emergency medical service departments, where patients receive problem-focused treatment.
In both Russia and the USA ambulatory treatment includes medical services without hospitalizing a patient. Private sector of ambulatory care is represented by pediatricians and family doctors, cardiologists and endocrinologists, as well as with nurses and other medical staff.
Unlike in the U.S., government spending on doctor and nurse compensation in Russia is very low. As Field wrote, even though in 2006 Russian government launched a new plan and approved additional 3.2 million dollars to cover salaries for medical staff, the average doctor salary is approximately 200 dollars (187). Obviously, nurses and doctors in private clinics receive competitive compensation, and yet the level of their wages is lower than in the U.S.
National Health Programs
National U.S. health programs like Medicare and Medicaid, funded by government, pay for medical care of needy people who do not have insurance. For instance, TRICARE is a national health program for veterans and their families. In 1997 federal government has implemented national children’s health insurance system in case their family income is over the limit for Medicaid, but yet whose parents cannot afford to buy health insurance. In 2006 this program has helped 6.6 million children (Sultz and Young 154).
Medicare is a well-known national insurance program for people over 65 years old. It first started in 1967. Before that the majority of elderly people were not getting appropriate medical treatment. According to this program, people over 65 and those who are approaching this age but have serious health problems get free health insurance. At present 97% of elderly people, 90% people with fatal kidney disorders, and 3.6 million veterans are insured under this program.
Medicare program has proved itself as quite effective. It is partially funded by special tax paid by employees themselves and their employer. This tax comprises about 15% of income received by employed Americans. The other part of Medicare is financed from the general revenue of income-tax.
Medicaid national program was introduced in 1966 and provides insurance for low-income needy families, elderly and disabled people, pregnant women and children. Thus, 33% of newborn children, 25% of children of any age, and 40% HIV positive persons are covered by this program. Medicaid provides five main services: stationary and ambulatory treatment, consulting service, elderly home treatment, laboratory and roentgen diagnostics. It is financed by both federal and state government (Sultz and Young 180).
Situation in Russia regarding national programs is quite different. There are no multiple health programs providing health care for low-income, elderly or disabled people. Instead there is obligatory medical insurance (OMI) for all, a law which appeared as result of health reform in 1991. It had to improve poor financing of health care system and would be right in time for people, striving for market economy. In the new scheme Federal and Regional Funds of OMI became key financing bodies (Manning and Tikhonova 67).
Regional Funds are responsible for collecting and distributing insurance payments. There are two types of insurance payments: 3.6% of wages for employed citizens (paid by employers), and for unemployed citizens like children, retired people, etc. (paid by local authorities).
Unfortunately, obligatory medical insurance system failed to improve the quality of Russian health care. It failed to offer patient freedom of choice, never created new financing sources, did not create additional incentives for doctors, but significantly complicated their job.
“Health” national program is a project which aims to improve medical help quality in Russian Federation. Its main tasks are: extensive training of doctors; salary increase for medical workers. Plans to provide high technology health care services imply the following: increase in quality and volume of high technology medical help; construction of new medical centers and personnel training. This national program also includes additional drug supply for special categories of people like disabled, elderly, war veterans and so on.
Health Care Expenditures
Medicare and Medicaid statistics office has published U.S. health care expenditure analysis, stating that in 2006 2.1 trillion dollars or 16% of GDP were spent on it. Comparing to 2004, this amount has increased by 6.7%. The forecast for GDP shows a further increase to 19.5% by 2017. According to the survey conducted by the U.S. Congress Senate Committee on the Budget, the increase in health care expenditures is directly connected changes that occurred due to new developing technologies, income level and price increase. Spending on hospitals and doctor salaries comprise the biggest part of total medicine spending, while prescribed drugs comprise only 10% (Sultz and Young 56).
State expenditures on health care system in Russia are more than 3 times lower than in the U.S. It happens not only as a reason of overall Russian poverty, since only 5.4-5.3% of GDP are being spent on it. Thus, their health care system is severely underfinanced and without serious changes the quality of medical services will never reach necessary level.
In USA people of mature and elderly age spend significantly more money on medical services than working age or child population. Dartmouth Atlas of Healthcare (2008) published information, according to which medical services provided to chronic disease patients during the last two years of their life under Medicare program increase expenses, as a result of extensive diagnostic and medical procedures.
There is a drastic geographical variability of medical help level, provided to chronic disease patients. It mainly depends on availability of costly methods in one or another geographic region, and only around 4% of expenditures correlates to the number of severely ill patients in a certain region.
Spending on emergency medical treatment and comprise over 55% of Medicare expenses, herewith, the difference in volume of services if far greater than the price difference. Researchers failed to prove that increase in ambulatory spending reduce the need to hospitalize patients and vice versa. They also claim that in most cases preventive medicine does not save money, since it is applied to healthy people.
Health Care Financing System
The U.S. health care has partial public financing system, and receives funding from national and private funds. In 2004 private insurance policies covered 36% of health care expenses, 15% were paid by private persons themselves, 34% by federal government, 11% by state government or local authorities, 4% by other private funds (Jonas and Goldsteen 233).
In Russia there are following sources of health care financing: budget resources; recourses directed for obligatory and voluntary medical insurance in accordance with Russian Federation insurance law; payments from state and municipal organizations and other public unities; securities income; bank credits; payments from charity organizations.
In 2006 federal government and other nongovernment funds spent 78.98 billion rubles for “Health” national program. Additional contribution was made by municipal educational institutions. In the next few years state government plans to double this sum.
The majority of Americans (59.7%) get employer-provided insurance. Apart from medical insurance, there are additional benefits in case workability loss, and life insurance benefits. Even though employer is not obliged to provide employees with insurance, large companies usually do it. The state supports employers who provide their staff with health insurance by not imposing tax on the sums spent on them. The total sum of tax subsidies constitutes approximately 150 billion dollars annually (Jonas and Goldsteen 267).
Around 47 million of uninsured Americans pose a big problem in the view of the fact that most of them cannot afford treatment and postpone it. Ultimately it increases expenses on medical services. Moreover, treatment of numerous uninsured patients can result in bankruptcy of a hospital or doctor.
In accordance with data, provided by Census Bureau, 36.7 million of uninsured patients are legal citizens of the U.S. The rest 10.2 million are illegal population. It has been concluded that almost 1/5 of uninsured people could have afforded to buy insurance, almost 1/4 can count on national programs, and 56% are in need of financial support (Jonas and Goldsteen 245).
Medical Products, Research and Development
Medical products such as drugs and equipment are produced by private companies. The United states of America spend tremendous sums on medical research mainly funded by nongovernmental institutions. The major financing is received from private pharmaceutical companies, which increase their spending every year. They conduct research in laboratories in order to create new drugs, methods and equipment, which can be soon registered and represented on pharmaceutical market. Government and universities prefer base research. This kind of research is conducted by state research institutes, such as National Institute of Health and National Institute of Mental Health (Jonas and Goldsteen 176).
Spending on state medical research in Russia is low due to low expenditures on health care system. Regardless powerful potential and professionalism of Russian researchers and scientists, they are unable to conduct quality research in such conditions. That is why many Russian specialists immigrate to the United States to seek professional grown and development, significantly higher wages and opportunity to devote themselves to science.
In the past few years drug market of Russia became one of the largest in the world. State segment of pharmaceutical drugs is the market leader. It is connected to state financing of additional drug supply program. Sales of drugs in Russia are increasing progressively. In August 2008 commercial segment of drug market was represented by 54% prescription drugs and 46% of nonprescription drugs. It is also important to highlight that unlike in the U.S., 12% of total drugs available in Russia are falsified.
Regulation and Control
Centers for Disease Control and Prevention are meant to eliminate public health threats. Besides, there are regulatory bodies such as Food and Drug Administration, which reviews and approves new drugs for sale. Many organizations, providing medical services, voluntarily undergo certification by Joint Commission hospital accreditation.
In the U.S. federal and partially state government are responsible for health insurance system according to McCarran-Ferguson Act, 15 U.S.C. §§ 1011-1015. States can regulate the volume of medical services, supplied through national programs (Jonas and Goldsteen 46).
Although American health care system is the most expensive in the world, it has certain drawbacks. Many residents of the USA fail to receive adequate medical help, morbidity rate does not decrease, and preventive measures do not give expected result. Nevertheless, USA continuously makes steps towards improving health care system and overall population health. Considering close correlation between financing system and medical service providers, particularly new mechanisms of financing lead to changes in the system, and simultaneously help improving nation’s health.
Nowadays big debates rise regarding the level of availability, effectiveness and quality of the U.S. health care services. The hottest discussion topic of American political parties is the question of implementing free universal government-run health care system. Defenders of universal medicine claim that huge expenses on providing medical services to uninsured citizens could be avoided by universal health coverage. Their opponents appeal to freedom of choice that each person has, claiming that this kind of system will result in tax increase while the quality of medical services decrease.
Nonetheless, both sides agree that U.S. government spends colossal amounts on health care, and the most reasonable solution would be stimulating market solution, as well as increasing and introducing innovative approaches. Furthermore, all political forces stand for the right of every person to receive medical help that must be protected by government.
According to Field, Ministry of Health and Social Development of Russian Federation is a federal ministry which performs regulatory functions in health care, including medical prevention and medical help; controls pharmaceutical activity, as well as quality, effectiveness and safety of drugs (164).
Health care leadership of Russia is greatly concerned with issues of heath system development. Total remodeling of the system is hardly ever considered, but at the same time there appears no other solution to increase health sector budget.
Life Expectancy and Mortality Rate
On the whole mortality rate in Russia is almost three times higher than in the U.S. The difference between female and male mortality in Russia is significantly higher as well. Mortality due to infectious diseases is 4.6 times higher, due respiratory disorders – 3.8 times higher.
Another important indicator is average life expectancy, which is a final result of common effort in improving health and increasing life span. For Russia it is almost ten years lower and equals to 68.67 years in 2009, whereas United State’s life expectancy is 78.2 years (Field 130).
Indeed, USA is a world leader in health care research and innovation. However, even though the quality of medical services is one of the highest in the world, this quality is uneven depending on location. Having universal medicine, Russia fails to organize effective health care system. It still lacks financial and operation integration between organizations providing health care services. Hospitals and polyclinics are incapable of providing satisfactory medical services, and what is worse, government does not take actions in order to control service utilizations or check and improve their cost-effectiveness. The structure of health care delivery is not balanced and expenditures are distributed inefficiently.
Although Russian Federation has a vast amount of doctors and hospitals per person, which is higher than almost in any other country, the health sector receives very low funding. All these problems result in high mortality rate and relatively low life expectancy, comparing to USA. Solution of health care problems should be found not further increase of state control, but in market reforms. In other European countries state health care system is more effective than in Russian, and different from American system. And yet, they also have serious problems, including rise of expenses, service normalization, and shortage of contemporary medical technologies. Obviously, a universal model of health care system suitable for each country does not exist.
Field, M. G., ed. The Health and Demographic Crisis in Post-Soviet Russia: a two-phase development in "Russia’s Torn Safety Nets”. Martin’s Press, 2000.
Jonas, Steven, and Raymond Goldsteen, eds. An Introduction to the U.S. Health Care System. 6th ed. Springer Publishing Company, 2007.
Manning, Nick, and Nataliya Tikhonova. Health and Health Care in New Russia.Ashgate, 2009.
Sultz, Harry A., and Kristina M. Young. Health Care USA: Organizing Its Organization and Delivery. Jones & Bartlett Publishers, 2010.