Biomaterial Database

Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia. 1996

T H Tulchinsky, and E A Varavikova

School of Public Health Hadassah-Hebrew University, Jerusalem, Israel.

OBJECTIVE This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

UI	MeSH Term	Description	Entries
D008136	Longevity	The normal length of time of an organism's life.	Length of Life,Life Span,Lifespan,Life Spans,Lifespans
D009017	Morbidity	The proportion of patients with a particular disease during a given year per given unit of population.	Morbidities
D009026	Mortality	All deaths reported in a given population.	CFR Case Fatality Rate,Crude Death Rate,Crude Mortality Rate,Death Rate,Age Specific Death Rate,Age-Specific Death Rate,Case Fatality Rate,Decline, Mortality,Determinants, Mortality,Differential Mortality,Excess Mortality,Mortality Decline,Mortality Determinants,Mortality Rate,Mortality, Differential,Mortality, Excess,Age-Specific Death Rates,Case Fatality Rates,Crude Death Rates,Crude Mortality Rates,Death Rate, Age-Specific,Death Rate, Crude,Death Rates,Determinant, Mortality,Differential Mortalities,Excess Mortalities,Mortalities,Mortality Declines,Mortality Determinant,Mortality Rate, Crude,Mortality Rates,Rate, Age-Specific Death,Rate, Case Fatality,Rate, Crude Death,Rate, Crude Mortality,Rate, Death,Rate, Mortality,Rates, Case Fatality
D011635	Public Health Administration	Management of public health organizations or agencies.	Administration, Public Health
D006292	Health Priorities	Preferentially rated health-related activities or functions to be used in establishing health planning goals. This may refer specifically to PL93-641.	Priorities, Health,Health Priority,Priority, Health
D006301	Health Services Needs and Demand	Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.	Health Services Needs,Needs,Needs and Demand, Health Services,Target Population,Health Services Need,Need, Health Services,Needs, Health Services,Population, Target,Populations, Target,Target Populations
D006305	Health Status Indicators	The measurement of the health status for a given population using a variety of indices, including morbidity, mortality, and available health resources.	Health Risk Appraisal,Health Status Index,Health Status Indexes,Appraisal, Health Risk,Appraisals, Health Risk,Health Risk Appraisals,Health Status Indicator,Health Status Indices,Index, Health Status,Indexes, Health Status,Indicator, Health Status,Indicators, Health Status,Indices, Health Status,Risk Appraisal, Health,Risk Appraisals, Health
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012426	Russia	A country located in north Asia bordering the Arctic Ocean, extending from Europe (the portion west of the Urals) to the North Pacific Ocean. The capital is Moscow.	Russian S.F.S.R.,Russian Federation (Europe),Russian SFSR
D018166	Health Care Reform	Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.	Healthcare Reform,Health Care Reforms,Healthcare Reforms,Reform, Health Care,Reform, Healthcare,Reforms, Health Care,Reforms, Healthcare