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Fragmentation in organization and discontinuities in the provision of medical care are problems in all healthcare systems, whether it is the mixed public-private system in the USA, national health services in the UK, or insurance-based ones in Western Europe and Russia. In all of these countries, a major challenge is to improve integration in order to improve efficiency and health outcomes. This article assesses issues related to fragmentation and integration in conceptual terms and argues that key attributes of integration are teamwork, coordination, and continuity of care. It then presents a summary of integration problems in Russia and presents the results of a large survey of physicians concerning the attributes of integration. It is argued that the characteristics of the national service delivery model do not ensure integration. The Semashko model of service delivery, although designed as an integrated model, has been distorted under pressure of the process of specialization of care. It is also argued that larger organizational forms of service provision, like policlinics and integrated hospital-policlinics, do not have higher scores of integration indicators than smaller ones. Proposals to improve integration in Russia are presented with the focus on the regular evaluation of integration and fragmentation, regulation of integration activities, enhancing the role of PHC providers, and economic incentives.
The populations of both developed and developing countries are aging, a trend that means that all countries need to pay particular attention to providing health and social care to the elderly. The aging of the population is one of the key global drivers for integration of care. The increasing incidence of chronic diseases and comorbidities requires more coordination across care providers and settings. Improving health and social services for elderly people is one of the priorities for the government of the Russian Federation. This report attempts to address that gap by presenting the results of a study conducted in three Russian regions to assess the needs of the elderly for integrated health and social services. The main objective of this study is to find out to what extent the national social and health care policies targeting the elderly meet their needs and consider their abilities.
This volume explores the nature of health and health-care experiences in Russia by comparing societies and communities with different socio-cultural conditions. The unique use of longitudinal data collected over ten years, allows the authors to address key questions on Russians individual experiences of health care and their understanding of its influencing factors. They explore the methods of self treatment and illness prevention in combination with the effects poverty and treatment availability can have on the standards of living for the people surveyed. This pertinent issue follows a time of rapidly worsening health status amongst the Russian population and a grave decline in male life expectancy. The findings are set within the context of experience from Finland and the UK, allowing the authors to explore the challenge of the Russian health-care crisis to Western European models of health status and health care.
Exploring the capacity and impact of decentralization within European health care systems, this book examines both the theoretical underpinnings as well as practical experience with decentralization.
This volume examines Russian discourses of regionalism as a source of identity construction practices for the country's political and intellectual establishment. The overall purpose of the monograph is to demonstrate that, contrary to some assumptions, the transition trajectory of post-Soviet Russia has not been towards a liberal democratic nation state that is set to emulate Western political and normative standards. Instead, its foreign policy discourses have been constructing Russia as a supranational community which transcends Russia's current legally established borders. The study undertakes a systematic and comprehensive survey of Russian official (authorities) and semi-official (establishment affiliated think tanks) discourse for a period of seven years between 2007 and 2013. This exercise demonstrates how Russia is being constructed as a supranational entity through its discourses of cultural and economic regionalism. These discourses associate closely with the political project of Eurasian economic integration and the "Russian world" and "Russian civilization" doctrines. Both ideologies, the geoeconomic and culturalist, have gained prominence in the post-Crimean environment. The analysis tracks down how these identitary concepts crystallized in Russia's foreign policies discourses beginning from Vladimir Putin's second term in power.
Having one of the highest physician-population ratios in the world, Russia - paradoxically - also faces shortages of physicians. This paper explores the reasons for this paradox through examining the structural characteristics of the Russian health workforce and its development. In comparing Russia with mainstream European countries and in particular the "new" EU countries we argue that the shortage of physicians is determined mostly by the prevailing model of health workforce development with its enduring emphasis on quantitative rather than structural indicators. First, the traditional perception of physicians as inexpensive health resources determines the long-term growth of their jobs - irrespective of the new opportunities for substitution and other structural innovations. Second, there is a persistent distortion in the composition of physician supply, of which the most important is the very low share and narrow remit of primary health care providers in comparison to European standards. Third, the international trends in the division of labor between physicians, medical nurses and allied health personnel are not followed in Russia with the result of an inevitable overburden of physicians, the reproduction of a large supply of physicians, while also the paradoxical shortage. Fourth, the system of professional development of physicians does not match international standards. Although with a substantial delay, Russia has now started transition to a workforce model focused on structural characteristics of human resources and so, in the final part of the paper, these new initiatives of the Government are critically assessed.