Observations on health care issues in the former Soviet Union.

Abstract

With the demise of the Soviet Union, the health care systems that remain in the component countries face many problems not seen in Western countries since the late 1800s or early 1900s. The author traveled to several countries of the newly independent states (NIS) of the former Soviet Union and observed problems in hospital sanitation, public health, medical equipment and supply distribution, food quality and safety, and the delivery of medical services. The author makes several suggestions to improve the delivery and quality of health care services in the NIS. His recommendations include: developing health care standards similar those that were first implemented in the U.S. by the American College of Surgeons in 1919; the use of practice guidelines and outcomes measures; building on organizational structures from the old state health system for professional and public health education; and restructuring the old delivery system to form a new delivery model based on centers of excellence and group practice managed care. Because of so many needs, the author stresses keeping reforms as simple as possible so as not to overburden the health professionals. The author also calls on Western countries, particularly the U.S., to assist with rebuilding of the health care delivery system of its Cold War adversary as it helped Germany and Japan after World War II. Such aid should be viewed as humanitarian in nature and should be distributed to private/public partnership efforts. The author says recent Congressional proposals to cut off aid in order to influence the Russian government's position on nuclear technology sales to Iran and the Chechen war are short sighted and will only hurt the citizens of these countries while having little or not impact on the leadership.