Primary medical care in the Soviet Union.

Abstract

The development of the Soviet Health Service reflects centrally determined decisions on the deployment of resources throughout all sectors of the economy. The fragmentation of first-line care and disaggregation of patients in urban areas have occurred in response to government dictates. Specialization has proceeded to the point where almost 90 percent of the medical work force are classed as specialists, although many have no formal postgraduate qualifications. In urban areas, primary care is provided by general physicians and pediatricians assigned to districts and by a range of specialists based in polyclinics and similar units. Norms for ambulatory care predict nearly 10 visits per person each year, only 4.3 of which are in connection with the treatment of symptoms. District physicians form a small percentage of the total work force and spend about half their time on district work. Surveys reveal a rate for first visits to patients at home of 186.5 per 1000 persons and a hospitalization rate of 148.4 per 1000. There are plans to increase the supply of hospital beds (10.92 per 1000 population in 1970), although interest is also being shown in the “hospital at home” concept. The grievances of district physicians include their isolation from hospital medicine. One critic recommends that the district general physicians should be assigned the function of interpreting specialist findings to patients and should receive broader training.