Organization and financing of the zemstvo health care in the Kazan province

Abstract

«The Statute on the provincial and district local government» (1864) started a significant social and economic changes in the country. Before the introduction of zemstvo self-government the organization of health care was administered by various departments. So there was no unified system of health care provision. With the introduction of the territorials authority in the area of «national health» were divided between governmental and territorial authorities. State management covered issues of sanitary improvement and anti-epidemic measures. The task of medical care organizing was on the territorial self-government, although they did not have sufficient administrative permissions. Throughout the whole period of activity the territorials created various administrative authorities for the organization of the effective system of management: the provincial and district councils of public health, provincial and district committees of public health, medical boards. Financing of the health care system was negligible in the early years of territorials. It was carried out from the provincial and district territorial budgets, with major financial expenses fell on the county local governments. They paid for the costs of the medical personnel and medical facilities, carrying out sanitary measures. Most of the funds were spent on treatment measures. The organization of an emergency anti-epidemic measures in case of the threat of spreading epidemics as well as the organization of mental health care and provision of the provincial hospital and paramedic school were funded from the provincial budget. The amount of financing of the territorial health care increased almost annually, reflecting the strategic importance of the health care sector for territorial self-government.