Authors
Danishevskiy K. D.
Doctor of Medicine, professor. Department for Health Economics1
1 - Higher School of Economics, Moscow, Russia
Remarks
The paper uses the outcome of the research project funded from the Basic Research Program at the National Research University Higher School of Economics.
Abstract
Russia underwent significant health reforms since the collapse of Soviet Union. We hypothesized that despite many changes, the Russian healthcare workforce structure remains largely unreformed and unique. This study conveys how human resources for healthcare are different in Russia compared to the most developed countries and examines the underlying reasons for these differences. Methods utilized include analysis of routine statistics and in-depth interviews with respondents who had experience as physicians and public health professionals in Russia and in the west, including physicians who emigrated from Russia and decision makers responsible for personnel policies. Results: Russian health system is traditionally viewed as vast, overstaffed, overspecialized while underfunded, however it is often overlooked that the total number of personnel employed in health care is relatively small. The relative understaffing of Russian health care results from a deficit of all categories of personnel except for physicians and nurses, as well as to misallocation of personnel. In Russia, the rates of health care workers that are neither physicians nor nurses is ca. 20 per 1000 population vs. 30-50 per 1000 in large OECD countries. In the past, an oversupply of physicians and nurses was created due to controlled enrolment in medical education. This allowed the salaries of medics to stay relatively low, while also reducing demand for allied health personnel. Since enrolment in medical colleges and schools is cut by about one third, this may lead to a need for rapid changes in personnel policies in the near future.
Key words
health care system, medical personnel, medical specialty, personnel structure, wage-rates
References
1. Balabanova DC, Falkingham J, McKee M. Winners and losers: expansion of insurance coverage in Russia in the 1990s Am J Public Health. 2003 Dec;93(12):2124-30
2. S. Shishkin. Ñ.Â.Øèøêèí Ðîëü ÷àñòíûõ ìåäèöèíñêèõ îðãàíèçàöèé â ðîññèéñêîé ñèñòåìå çäðàâîîõðàíåíèÿ. http://regconf.hse.ru/uploads/a998908f8075c0909f8d7cf796d568ac39326008.docx.
3. Danishevski K, Balabanova D, McKee M, Atkinson S. The fragmentary federation: experiences with the decentralized health system in Russia. Health Policy Plan. 2006 May; 21 (3):183-94.
4. Shishkin S. http://opec.ru/1346971.html
5. Sheaff R. Governance in gridlock in the Russian health system; the case of Sverdlovsk oblast. Soc Sci Med. 2005 May; 60(10):2359-69.
6. AAHSP (2012) «Association of Allied Health Schools, Definition of Allied Health Professionals». 2012 Asahp.org
7. Rechel, B.; Dubois, C.-A.; McKee, M. The health care workforce in Europe. Learning from experience. WHO Regional Office for Europe (Copenhagen) 2006.
8. http://stats.oecd.org/
9. http://www.euro.who.int/en/data-and-evidence/databases/european-health-for-all-database-hfa-db
10. http://www.gks.ru/
11. Rese A, Balabanova D, Danishevski K, McKee M, Sheaff R. Implementing general practice in Russia: getting beyond the first steps. BMJ. 2005 Jul 23;331(7510):204-7
12. Gordeev VS, Pavlova M, Groot W. Informal payments for health care services in Russia: old issue in new realities. Health Econ Policy Law. 2013 May 21:1-24
13. Ensor, T. (2004). Informal payments for health care in transition economies. Social Science & Medicine, 58 (2), 237-246.
