Semashko system

Soviet Russia had a totally socialist health care model—the Semashko system with a centralized, integrated, hierarchically organised with the government providing state-funded health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. On the whole, the Soviet system tended to primary care, and placed much emphasis on specialist and hospital care. The Semashko model has been considered as a "coherent, cost-effective system to cope with the medical necessities of its own time".

The integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The Soviet healthcare system was successful in providing Soviet citizens with competent, free medical care and contributed to the improvement of the nation's health condition. By the 1960s, life and health expectancies in the Soviet Union approximated to those in the US and other parts of Europe. The effectiveness of the model declined with underinvestment, with the quality of care beginning to decline by the early 1980s, though in 1985 the Soviet Union had four times the number of doctors and hospital beds per head compared with the USA. The quality of Soviet medical care became low by developed world standards. Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training . Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but which was still often below Western standards.

Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the lack of money that had been going into health was patently obvious. Some of the smaller hospitals had no radiology services, and a few had inadequate heating or water. A 1989 survey found that 20% of Russian hospitals did not have piped hot water and 3% did not even have piped cold water. 7% did not have a telephone. 17% lacked adequate sanitation facilities. Every seventh hospital and polyclinic needed basic reconstruction. Five years after the reforms described below per capita spending on health care was still a meagre US$158 per year (about 8 times less than the average European social models in Spain, the United Kingdom and Finland, and 26 times less than that of the U.S. which spent US$4,187 at that time).