Systemes de prestations de soins prioritaires dans les pays de l'est: Le cas de l'union Sovietique

Abstract

The Soviet Union has been selected as a case for the study of medical priorities in Eastern socialist societies. Contrary to Marx's prediction, socialist revolutions did not take place in economically advanced societies, but in underdeveloped ones. The Soviet Union was such a society in 1917. This kind of society is characterized by the existence of a ruling body (the Communist Party) with quasi- absolute powers of policy and decision-enforcement in practically all spheres. The concern of the Party has been, almost from the beginning, the economic development of Soviet society for defensive purposes and to build an economic base that would eventually ensure the material abundance implied in the Communist promise. In the light of limited trained human and material resources, the Party has run Soviet society with definite programs and short-term goals, and has husbanded these resources to accomplish these goals. Because of its importance in maintaining the health and the productive capacity of the population, the health system has received fairly constant attention from the regime almost from the beginning. But in order to enforce its scheme of priorities the regime has seen to it that health personnel all become state employees and that all health facilities become property of the state. This has allowed a degree of control over the health system consistent with the goals of the regime, with competing other sectors of the society, and available resources. The priority formula for the health system are the minimum resources compatible with a certain level of functioning on the part of the population. In general, the Soviet health system is characterized by its bureaucratic centralization, its labor rather than capital intensiveness, the very high percentage of women in medicine and other health occupations, and the relative neglect of the rural population. It is a national health service and not a national insurance scheme. The relevance of the Soviet pattern and priorities for other under-developed societies is limited by the fact that this system is a product of the Soviet political system, and implies certain structures of total control that other societies might be reluctant to adopt. There are, however, other features of that system that present an interest to those concerned with providing a modicum of health care in under-developed societies.