- © 2005 Canadian Medical Association or its licensors
Paul Webster, in his description of the Russian government's plans “to ‘monetize’ its social commitments”1 through reform of a variety of Soviet-era entitlements, fails to cover some important details.
It is true, as stated by a health care analyst from Moscow, that “Russia's system of privileges was never designed to support the poor.” But the estimate that “the poorest 10% of the population receive 4% of existing benefits, while the richest 10% receive 20%” is nothing more than speculation. The government used such estimates to prove that the system of natural entitlements must be changed. Shortly after the new law was enacted, when the government started to check how many poor people were eligible for “monetization” of their entitlements, it found that the numbers had been underestimated by up to 30%. Now nobody knows how many people are entitled to monthly subsistence. Of course, this detail is not relevant to the government; the president set the amount without any supporting research.
Economist Mikhail Zurabov, who chairs the Health and Social Development Ministry, is leading the transformation of the most attractive health care institutions to an intermediary propriety state, which would to allow them to be privatized in the short term. Former health minister Yuri Shevchenko, during his years in cabinet, created the huge “national hospital,” using federal money to equip it; he then slipped from his ministerial position to that of director of the hospital.
At the other end of the health care spectrum, the new legislation prevents municipal health care services from having access to any monies from the federal or regional budgets; as a result, the wages of staff as well as health care expenditures must come from the limited resources of the municipal bodies. Finally, in the budget for 2005 military spending will increase by up to 30%, but there will be no increase for health care.
The title of Webster's article is absolutely correct: “Reforms mean [that] Russians lose free health care.” In January people all across Russia took to the streets to protest against the “monetization” of their entitlements. Members of parliament have called on the government to resign, but in fact, by approving the proposed regulations, they share responsibility for these reforms. The problem of natural entitlements has become the starting point for a huge crisis.
Reference
- 1.↵