USSR healthcare
The processes of natural population movement in the USSR in comparison with pre-revolutionary Russia are characterized by a decrease in the birth rate and a decrease in mortality while maintaining sufficient high performance natural growth. Compared to 1913, a significant decrease in the birth rate (45.5 per 1 thousand inhabitants in 1913 and 18.1 in 1975) is associated, in particular, with an increase in the number of elderly people; The active involvement of women in production plays a certain role in reducing the birth rate. A particularly pronounced decline in the birth rate in the 60s. associated with the consequences of the war, since the birth rate in 1941-46 was extremely low. Since 1970, with the entry into fertile age of the post-war generation, the birth rate has stabilized and is gradually beginning to increase.
Overall mortality in the USSR during the years of Soviet power decreased by more than 3 times (9.3 per 1 thousand inhabitants in 1975 compared to 29.1 in 1913), infant mortality - almost 10 times (27.9 per 1 thousand . live births in 1974 compared to 268.6 in 1913). A slight increase in overall mortality in the 70s. partly caused by changes in the age structure of the population. This can be found by comparing indicators standardized by the age structure of the population and analyzing age-specific mortality rates. As a result of the decrease in mortality in the USSR, average life expectancy has increased significantly compared to the pre-revolutionary period (70 years in 1971-72 compared to 32 in 1896-97).
Improving living conditions and measures taken by the Soviet state to protect children's health contributed to a steady increase in the level of physical development of representatives of all segments of the population of the USSR. Already in the 30s. in the USSR there was no difference in the level of physical development of children and youth from families of workers and employees. Measures taken by the state to eliminate the sanitary consequences of the Great Patriotic War 1941-45 contributed to the fact that by 1956 indicators of physical development were higher than in the pre-war years.
Health care organization. The first information about the organization of care for patients in the territory Kievan Rus(the establishment of shelters for the sick and disabled at monasteries and churches) date back to the 10th-11th centuries. The first state medical management body - the Pharmacy Chamber (later the Pharmacy Order) - arose in Russia in 1581 simultaneously with the first (“tsar’s”) pharmacy. In 1592, the first border station was established, designed to prevent the importation of infectious diseases.
In the 18th century Health issues were in charge of the Medical Chancellery, and from 1763 - the Medical College. In 1775, “orders of public charity” were established in the provinces (under whose jurisdiction charities and medical institutions were transferred), and then - medical boards in provincial cities (except for both capitals) and county medical boards - local medical management bodies. In 1803, the Medical College was replaced by the Medical Department within the Ministry of Internal Affairs. From the end of the 19th century. Such forms of healthcare as zemstvo medicine and factory medicine were developed. Each department had its own medical units; There was no single government health authority. Hospitals, outpatient clinics and other medical institutions were opened by various departments and individuals in insufficient numbers. Medical care was provided primarily by private practitioners. Residents of outlying areas were practically deprived medical care. Pre-revolutionary Russia did not have a state health care system.
The healthcare system created in the USSR is one of the outstanding achievements of the Soviet people. The tasks of the state in the field of health care were defined by V.I. Lenin and reflected in the 1st Program of the RSDLP (1903). It noted the need to establish an 8-hour working day, prohibition of child labor, establishment of nurseries at enterprises, state insurance of workers, sanitary supervision at enterprises, etc. From the first days of Soviet power, concern for the protection of workers' health was proclaimed the most important task of the socialist state. In conditions of devastation, epidemics and the fight against internal and external enemies, the construction of the world's first public health care system began, which was based on the most progressive and most humane principles: universal accessibility and free medical care, preventive care, participation of the broad masses of workers in solving health care issues health. The policy of the Soviet state in the field of health care was formulated in the 2nd Program of the RCP (b), adopted at the 8th Congress in 1919. Among the priority tasks were the improvement of populated areas, the protection of soil, water, air, the development of public catering in the scientific and hygienic basis, the creation of sanitary legislation, providing the population with publicly accessible free qualified medical care, etc. During the years of the 1st Five-Year Plan (1929-32), costs for health care and physical education increased almost 4 times compared to 1913. By 1940, the number of doctors increased almost 6 times, paramedical workers - more than 10 times, bed capacity - 3.8 times (see Table 1).
During the Great Patriotic War of 1941-1945, all healthcare efforts were focused on helping sick and wounded soldiers and preventing epidemics in the army and home front. The activities of medical institutions contributed to the victory of the Soviet people over fascism: more than 72% of the wounded and 90% of the sick were returned to duty; For the first time in the history of wars, it was possible to protect the rear and the army from epidemics. The war caused enormous damage to Soviet healthcare, amounting to 6.6 billion rubles; 40 thousand hospitals, clinics and other medical institutions were destroyed and destroyed. The mobilization of the country's economic potential and the heroic work of the Soviet people contributed to rapid recovery material base health care: in 1947 its main indicators reached pre-war levels. In 1950, compared to 1940, the number of doctors increased by 71%, average medical workers by 52%, hospital beds by 28%. From 1940 to 1975, spending on health care increased more than 13 times.
The basic principles of Soviet healthcare were further developed in the CPSU Program adopted at the 22nd Party Congress (1961). A number of resolutions of the CPSU Central Committee and the Soviet government are devoted to issues of health care and medical science (for example, the resolution of the CPSU Central Committee and the Council of Ministers of the USSR dated January 14, 1960 “On measures to further improve medical care and health protection of the population of the USSR” and July 5, 1968 “On measures to further improvement of healthcare and development of medical science in the country"). The approval by the Supreme Soviet of the USSR in 1969 of the Fundamentals of the legislation of the USSR and the union republics on health care enshrined the principles and forms of medical care to the population - free, generally accessible, qualified, preventive, maternal and child health, sanitary and anti-epidemic service, etc. It is emphasized that health care population is the responsibility of all government bodies and public organizations. Measures are envisaged to further improve healthcare: continued construction of large specialized and multidisciplinary hospitals, clinics, dispensaries in order to improve the quality of medical care and more fully provide the population with all its types; expansion of the network of ambulance stations and sanitary-epidemiological stations; an increase in the number of hospital beds, etc. (indicators of health care development in 1940-75 are presented in Table 2).
Morbidity. Pre-revolutionary Russia ranked 1st in Europe in terms of the prevalence of infectious diseases among the population; Epidemics of smallpox, cholera, plague, intestinal infections, typhus and relapsing fever, malaria and other diseases did not stop, causing enormous damage to the health of the population and the economy. In 1912, about 13 million infectious patients were registered. The main cause of high child mortality was childhood infections. The sanitary condition of the country remained extremely unfavorable: unsatisfactory living conditions and low cultural level of the population (sewage was available only in 23 major cities; the majority of the population used water for drinking that was unsuitable for bacteriological indicators). 1st World War 1914-18, Civil war and the military intervention of 1918-1920 created an extremely difficult sanitary and epidemiological situation. According to incomplete data, from 1917 to 1922 about 20 million people suffered from typhus, from 1919 to 1923 - about 10 million; in 1918-19, about 65 thousand cases of cholera were registered; In 1919, there was a threat of a smallpox epidemic, and the incidence of malaria and other infections increased. Under these conditions, the fight against infectious diseases was considered one of the main issues of the internal policy of the Soviet state. Sanitary and anti-epidemic measures, improvement of living conditions, improvement of populated areas in a short time allowed to sharply reduce the incidence infectious diseases, especially liquidate dangerous infections. Already in 1922, the incidence of typhus decreased by more than 2 times compared to 1919, and in 2927 - by 89 times. After 1927, it was sporadic in nature (a certain rise in 1942-45 was noted mainly in the territories liberated after the temporary Nazi occupation). The incidence of relapsing louse-borne typhus had decreased by more than 100 times by 1927; by 1938 it was practically eliminated. On April 10, 1919, V.I. Lenin signed the decree of the Council of People's Commissars on compulsory smallpox vaccination. As a result of mass anti-smallpox immunization, smallpox in the USSR was completely eradicated by 1936-37. In pre-revolutionary Russia, from 5 to 7 million cases of malaria were registered annually. In 1920, the Central Institute of Protozoal Diseases was organized, in 1921 - the Central Malaria Commission under the People's Commissariat of Health, under whose leadership a scientifically based program for the elimination of malaria in the USSR was developed. By 1930, its incidence had decreased by more than 3 times compared to the pre-revolutionary period. Since 1963, malaria has not been registered as a widespread disease in the country. Significant successes have also been achieved in the fight against other infectious diseases: in 1971, compared to 1913, the incidence of anthrax decreased by 45 times, typhoid fever and paratyphoid fever - almost 40 times, whooping cough (1975) - 53 times; Diphtheria, polio, and tularemia have become rare.
Since the 50s The structure of morbidity and causes of death in the USSR became typical for economically developed countries. Characteristic distribution of cardiovascular diseases and malignant neoplasms associated, in particular, with the “aging” of the population. Advances in medicine have ensured an extension of the life span of patients with pathology of the heart and blood vessels, which contributes to a certain “accumulation” of such patients. More advanced diagnostics, in turn, leads to more complete detection of diseases. The most common are atherosclerosis, hypertension, coronary heart disease, rheumatism. Infectious diseases are dominated by influenza and others. respiratory infections, which are one of the main causes of temporary disability. Intestinal infections, in particular dysentery, as a rule, do not have an epidemic spread. Respiratory and gastrointestinal infectious diseases are of a pronounced seasonal nature. Among childhood infections, measles, scarlet fever, whooping cough, and mumps are noted; the number of diseases is constantly decreasing. In the structure of accidents, the leading place is occupied by non-occupational injuries, in some cases associated with a state of intoxication.
Medical personnel. In 1913 there were 28.1 thousand doctors in Russia, most of whom lived in large cities. There was one doctor for every 5,656 people. The uneven distribution of doctors led to the fact that the population of many areas was practically deprived of medical care. On the territory of the current Tajik SSR and Kirghiz SSR there was 1 doctor per 50 thousand inhabitants, in the Uzbek SSR - per 31 thousand, in the Kazakh SSR - per 23 thousand inhabitants. By 1975, the number of doctors had increased 30 times compared to 1913, and the supply of doctors had increased 18 times (see Table 1). The USSR ranks first in the world in terms of the number of doctors and the provision of them to the population.
In pre-revolutionary Russia, most residents could not use specialized medical care, since it was possible only in large cities. In 1975, compared to 1940, the number of therapists and sanitary and anti-epidemic doctors increased more than 4 times, surgeons - 6.9 times, obstetricians-gynecologists, pediatricians, ophthalmologists - almost 5 times, neurologists - almost 7 times, radiologists and radiologists - more than 10 times. The provision of the population with medical specialists in most Union republics has reached the all-Union level.
In 1913, there were 46 thousand paramedical workers (including so-called company paramedics and midwives). By 1976, the number of paramedical workers increased 55 times (see Table 1). The provision of the population with paramedical workers in some union republics (for example, Ukrainian, Estonian) is higher than the national level.
The USSR occupies a leading place in the world in producing doctors, pharmacists and paramedics. In pre-revolutionary Russia, 17 medical faculties of universities and medical institutes graduated 900 doctors annually. By 1975, the number of medical students increased 36 times, and the number of doctors graduated more than 50 times. On the territory of each union republic there are higher and secondary medical educational institutions; the graduation of specialists satisfies the population's needs for medical personnel. Among medical students educational institutions There are representatives of more than 100 nationalities. A network of institutes and faculties for advanced training of doctors has been created (in 1974 there were 13 institutes and 18 faculties). Doctors undergo specialization or advanced training at least once every 3-5 years.
Sanitary and Epidemiological Service. In 1913-14, there were sanitary organizations in 73 cities and 40 provinces of Russia, 257 doctors worked, and there were 28 sanitary and hygienic laboratories; Zemstvo sanitary bureaus performed mainly statistical work. A unified state sanitary and anti-epidemic service has been created in the USSR. Already in 1918, a sanitary-epidemiological section was organized as part of the People's Commissariat of Health, and sanitary-epidemiological subsections were organized in the health departments of the executive committees of local Soviets (since 1919); The decree of the Council of People's Commissars of the RSFSR “On the sanitary bodies of the republic” (1922) established a unified organization of sanitary affairs and defined the tasks, rights and responsibilities of sanitary bodies. The rapid pace of development of the sanitary and anti-epidemic organization required the training of qualified personnel and the expansion of the network of special institutions. In 1936, the first sanitary and hygienic faculties were opened at medical institutes; in 1939, the regulations on sanitary-epidemiological stations were approved as comprehensive and leading institutions of the sanitary-epidemiological service. By 1940, the sanitary and anti-epidemic organization covered over 12.5 thousand doctors, 1,943 sanitary and epidemiological stations, 1,490 sanitary and bacteriological laboratories, 787 disinfection stations, points, and detachments (see Table 2). The elimination of the consequences of the Great Patriotic War of 1941-45 and the economic development of the USSR determined new requirements for the work of sanitary authorities and required changes in their structure. In 1948, the mandatory organization of sanitary-epidemiological stations was introduced at all territorial health authorities (republican, regional, regional, city, district); In 1963, a resolution of the Council of Ministers of the USSR “On State Sanitary Inspection in the USSR” was adopted. Fundamentals of legislation USSR and union republics on health care (1969) and the Regulations on state sanitary supervision in the USSR (1973) provide the sanitary and anti-epidemic service with broad powers to protect the external environment from pollution, supervise industry, construction, public catering, water supply, landscaping, planning of populated areas and etc. In the USSR, the commissioning of industrial enterprises without treatment facilities is prohibited; Maximum permissible concentrations have been established for all environmental pollutants, which are included in mandatory norms and regulations; the construction of any facility and the planning of populated areas are carried out in compliance with sanitary standards and rules; The sanitary doctor's orders are mandatory for all state and public organizations, institutions and individual citizens. The sanitary service organizes preventive vaccinations population, carries out anti-epidemic measures in case of threat of emergence and spread infectious diseases, as well as sanitary and quarantine measures, etc.
Table 1. - Hospital network of the USSR and union republics; number of doctors and paramedical workers and the provision of them to the population of the USSR and union republics
| USSR | Number of hospitals | Number of hospital beds, thousand | Number of hospital beds per 10 thousand inhabitants. |
||||||
| 1913 | 1940 | 1975 | 1913 | 1940 | 1975 | 1913 | 1940 | 1975 |
|
| 5300 | 13793 | 24250 | 207,6 | 790,9 | 3009,2 | 13,0 | 40,2 | 117,8 |
|
| Including the RSFSR | 3149 | 8477 | 13066 | 133,4 | 482,0 | 1649,2 | 14,8 | 43,3 | 122,5 |
| Ukrainian SSR | 1438 | 2498 | 4122 | 47,7 | 157,6 | 578,3 | 13,6 | 37,7 | 117,8 |
| BSSR | 240 | 514 | 913 | 6,4 | 29,6 | 107,0 | 9,3 | 32,6 | 114,2 |
| Uzbek SSR | 63 | 380 | 1159 | 1,0 | 20,3 | 145,6 | 2,3 | 30,1 | 103,4 |
| Kazakh SSR | 98 | 627 | 1770 | 1,8 | 25,4 | 178,6 | 3,2 | 39,5 | 124,6 |
| Georgian SSR | 41 | 314 | 500 | 2,1 | 13,3 | 48,0 | 8,0 | 36,0 | 96,9 |
| Azerbaijan SSR | 43 | 222 | 748 | 1,1 | 12,6 | 54,8 | 4,8 | 37,8 | 96,3 |
| Lithuanian SSR | 44 | 77 | 229 | 2,2 | 8,9 | 36,9 | 7,7 | 30,0 | 111,2 |
| Moldavian SSR | 68 | 109 | 354 | 2,5 | 6,1 | 42,0 | 12,2 | 24,6 | 109,2 |
| Latvian SSR | 50 | 89 | 187 | 6,2 | 12,0 | 31,7 | 24,9 | 63,0 | 126,9 |
| Kirghiz SSR | 6 | 112 | 263 | 0,1 | 3,8 | 37,4 | 1,2 | 24,1 | 111.2 |
| Tajik SSR | 1 | 121 | 278 | 0,04 | 4,5 | 33,5 | 0,4 | 28,6 | 96,0 |
| Armenian SSR | 6 | 96 | 228 | 0,2 | 4,1 | 24,4 | 2,1 | 30,1 | 86,0 |
| Turkmen SSR | 13 | 99 | 270 | 0,3 | 5,6 | 25,8 | 2,7 | ||
Healthcare is a system of state and public measures to protect public health. In the USSR and other socialist states, caring for the population is a national task, in the implementation of which all parts of the state and social system take part.
In pre-revolutionary Russia there was no state healthcare organization. Opening of hospitals, outpatient clinics and others medical institutions was carried out by various departments and organizations without a unified state plan and in quantities extremely insufficient to meet the needs of protecting public health. Private practitioners occupied a significant place in medical care for the population (especially urban ones).
For the first time, tasks in the field of protecting workers' health were developed by V.I. Lenin. The Party Program, written by V.I. Lenin and adopted by the Second Congress of the Party in 1903, put forward demands for an eight-hour working day, a complete ban on child labor, a ban on the work of women in hazardous industries, the organization of nurseries for children at enterprises, free medical care for workers account of entrepreneurs, state insurance of workers and the establishment of an appropriate sanitary regime in enterprises.
After the Great October Socialist Revolution, the Party Program adopted at the VIII Congress in 1919 identified the main tasks of the Party and the Soviet government in the field of protecting the health of the people. In accordance with this Program, the theoretical and organizational foundations of Soviet healthcare were developed.
The main principles of Soviet healthcare were: state character and planned preventive direction, universal accessibility, free and high quality of medical care, unity of medical science and healthcare practice, participation of the public and the broad masses of workers in the activities of healthcare bodies and institutions.
On the initiative of V.I. Lenin, the VIII Congress of the Party decided to decisively carry out in the interests of workers such measures as improving the health of populated areas, organizing public catering on a scientific and hygienic basis, preventing infectious diseases, creating an organized fight against tuberculosis, venereal diseases, alcoholism and others social diseases, provision of publicly available qualified medical care and treatment.
On January 24, 1918, V.I. Lenin signed a decree on the formation of the Council of Medical Colleges, and on July 11, 1918, a decree on the establishment of the People’s Commissariat of Health.
Lenin's decrees on land, on the nationalization of large-scale industry, on the eight-hour working day created the political, economic and social-hygienic prerequisites for improving the material well-being of workers and peasants, and thereby strengthening their health, improving working and living conditions. Decrees on health insurance, on the nationalization of pharmacies, on the Council of Medical Colleges, on the creation of the People's Commissariat of Health and many others raised health problems to the level of national, national tasks. V.I. Lenin signed over 100 decrees on the organization of healthcare. They provide guidance on all important areas of workers' health. They reflect the policy of the Communist Party and the Soviet government in resolving the most important health problems.
HEALTHCARE IN THE USSR, state system, socio-economic. and medical san. measures to preserve and strengthen our health, ensure high working capacity and active longevity of people. Health protection in the USSR is one of the most important social tasks of the CPSU and the state. The Constitution of the USSR enshrines the right of citizens to health care and establishes material and legal guarantees to ensure the implementation of this right. (See also Fundamentals of the legislation of the USSR and union republics on healthcare.)
As special government industry management 3. covers issues of improving the system of treatment and preventive services. assistance, sanitary and hygienic and anti-epidemic provision, preparation and improvement of medical services. personnel, women's and children's health, medicines. assistance, medical development science, etc. The implementation of tasks 3. is facilitated by increasing the standard of living of us, the creation favorable conditions labor and life, labor protection, social security, social insurance, recreation, rational system education and training, etc. Health protection measures are provided for by the state. social and economic plans. development, which creates conditions for max. used in the interests of preserving and strengthening our health. all resources of society, for constant capacity building 3., ensures the unity of measures in the field of health protection, their effectiveness, and the real possibility of implementing society’s measures. prevention, protection environment, systematic and consistent with our needs. and adv. x-va development of services 3. Socialist. 3. has a planned and preventive nature. focus, provides free and publicly available medical care. help, unity of medical. theory and practice, widely uses the achievements of science and technology, cooperation with other states in the field of medicine. science.
Formation and development of owls. 3. closely related to economics. and social transformations systematically carried out in the country after Oct. revolution of 1917. And July 1918 V.I. Lenin signed a decree on the formation of the People's Commissariat of Health. In 1936 the Union Republic was created. People's Commissariat 3., from 1946 - Ministry of 3. USSR; accordingly bodies have been created in all union and auto. republics Departments 3. are available in the executive committees of the regional, regional, and city districts. and district councils of people. deputies. For honey service department sectors of the economy, departments have been created within a number of ministries, medical-san. services. Since 1965 in both chambers of the Upper House. The Council of the USSR has permanent commissions on 3. and social security, since 1976 - commission on issues of labor and life of women, protection of motherhood and childhood. At the local councils of people. deputies have permanent commissions on 3. The most important tasks of the socialist. 3. indicated in the decisions of the CPSU congresses and in special. resolutions of the CPSU Central Committee and the Council. pr-va.
A unified system of outpatient clinics has been created in the USSR. and inpatient institutions. All types of honey assistance is free and publicly available (polyclinic, inpatient, laboratory tests, assistance during childbirth, etc.). Patients suffering from certain chronic diseases (oncological, hematological, mental, etc.), as well as disabled people of the Great Fatherland, the 1941-45 war and children under the age of 1 year, medications are dispensed free of charge not only for inpatient, but also outpatient clinics. treatment. State social insurance provides for the payment of benefits in case of temporary incapacity for work, pregnancy and childbirth (see Protection of motherhood and childhood); most of the expenses are covered spa treatment and rest, therapeutic nutrition, health promotion. work among children, adolescents, and students. 6 million people are employed in the 3. area, including St. 1 million doctors and St. 2.8 million people avg. honey. personnel.
Out-of-hospital care is provided in local areas. principle providing max. proximity to us. and continuity of treatment and prophylaxis. service. In the beginning 1980s there was St. 35 thousand clinics and outpatient clinics; for every 2 thousand adults. the position of a local general practitioner is allocated, who, in addition to medical care, provides preventive care. events. Plot-terr. The principle is also the basis for organizing out-of-hospital care for women and children. A network of women has been created. consultations, children's clinics and outpatient clinics. 80% of patients receive medical care in outpatient clinics and clinics, which indicates the high effectiveness of this type of care. St. also howled. 23 thousand inpatient medical institutions with 3,324 thousand beds (12.5 beds per 1 hour). There are multidisciplinary and specialized ones. hospitals, on the basis of which specialized hospitals have been created. centers of regional, interregional, republican and all-Union significance. Every year an ambulance. assistance is provided (outpatient and on-site; including cardiology, intensive care, children's and other specialized teams) to more than 80 million sick and injured people. A wide network of medical services has been deployed. institutions for medical-san. services for workers, medical services have been created at large enterprises. parts. All this made it possible to bring honey as close as possible. assistance to the place of work. Honey. serving us. sat down The area is organized taking into account the economic-geographical and demographic features and is built on the principle of staging of medical care. help. Out-of-hospital care is provided in the hospital. outpatient clinics and at medical and obstetric stations; inpatient treatment is carried out in district, central, district, regional, regional and republican centers. hospitals.
Honey. service in general and above all preventative. the activities of bodies 3. play an important role in the implementation of the government's demographic plan. policy, in ensuring a favorable demographic trend. processes. Means. (compared to pre-revolutionary times) decrease in general and infant. mortality, increase avg. life expectancy, improvement in physical indicators. developments are largely associated with a radical improvement in dignity. state of the country, with the elimination of some and a sharp decrease in others infections. diseases, systematic implementation of preventive measures. and anti-epidemic measures, a constant increase in the level of honey. assistance, effective activities to raise a healthy generation. Women's work consultations, children's clinics and outpatient clinics not only helps to reduce maternal and infant mortality. mortality, but also ensures proper physical. development of children, prevents the occurrence of diseases, laying the foundation for health and active longevity. The work of outpatient clinics is especially important in this regard. institutions for medical examination and prevention. examinations of sick and healthy persons, which ensures prevention, early detection and timely treatment of various. forms of non-infectious diseases and ultimately contributes to increasing the life expectancy and working capacity of citizens.
The importance of this work increases due to changes in fundamentals. type of pathology: in the USSR non-infectious. diseases (cardiovascular, oncological, endocrine, chronic respiratory diseases) are the main ones. cause of death, disability and temporary incapacity for us. To prevent them, it is planned to implement a broad program of primary prevention, in which the leading place is occupied by the fight for a healthy lifestyle, the elimination of bad habits, and the identification of people with the so-called. risk factors, i.e. those who are likely to develop the disease due to conditions or lifestyle, and persons with initial manifestations diseases - to provide timely treatment and preventive care.
The most important preventive measures. functions are carried out by the san.-epidemiological. service, the region provides control over compliance by all enterprises, institutions, organizations and departments. citizens of existing dignity. standards (which eliminates or significantly reduces the impact on the body of unfavorable factors of the natural and industrial environment), and also organizes sanitary and hygienic procedures. and anti-epidemic events. Preventative the direction of the owls. 3. The system of prof. adopted in the USSR also reflects. selection and periodic honey. inspections.
The system of organization 3. in the USSR has stood the test of time and received international recognition. confession. In the resolution adopted by the 23rd World Assembly 3. (1970) on the basic. principles of national development services 3. important principles and the provisions of the socialist 3. recognized as the most effective and recommended to all member states of the World Organization 3. (WHO) for use when choosing a medical organization scheme. help us. The Sov system is highly rated. 3. received at the International. conference on primary health care. assistance (1978, Alma-Ata).
Excellent definition
Incomplete definition ↓
Healthcare- a system of state and public measures to protect public health. In the USSR and other socialist states, concern for health population is a national task, in the implementation of which all parts of the state and public system take part.
In pre-revolutionary Russia there was no state healthcare organization. The opening of hospitals, outpatient clinics and other medical institutions was carried out by various departments and organizations without a unified state plan and in quantities that were extremely insufficient to meet the needs of protecting public health. Private practitioners occupied a significant place in medical care for the population (especially urban ones).
For the first time, tasks in the field of protecting workers' health were developed by V.I. Lenin. The Party Program, written by V.I. Lenin and adopted by the Second Congress of the Party in 1903, put forward demands for an eight-hour working day, a complete ban on child labor, a ban on the work of women in hazardous industries, the organization of nurseries for children at enterprises, free medical care for workers account of entrepreneurs, state insurance of workers and the establishment of an appropriate sanitary regime in enterprises.
After the Great October Socialist Revolution, the Party Program adopted at the VIII Congress in 1919 identified the main tasks of the Party and the Soviet government in the field of protecting the health of the people. In accordance with this Program, the theoretical and organizational foundations of Soviet healthcare were developed.
The main principles of Soviet healthcare were: state the nature and plannedness of the preventive direction, universal accessibility, free and high quality medical care, the unity of medical science and healthcare practice, the participation of the public and the broad masses of workers in the activities of healthcare bodies and institutions.
On the initiative of V.I. Lenin, the VIII Congress of the Party decided to resolutely carry out such measures in the interests of workers as improving the health of populated areas, organizing public catering on a scientific and hygienic basis, preventing infectious diseases, creating sanitary legislation, and organizing the fight against tuberculosis, sexually transmitted diseases, and alcoholism and other social diseases, providing publicly available qualified medical care and treatment.
24/1 1918 V.I. Lenin signed decree on the formation of the Council of Medical Colleges, and 11/VII 1918 - decree on the establishment of the People's Commissariat of Health.
Lenin's decrees on land, on the nationalization of large-scale industry, on the eight-hour working day created the political, economic and social-hygienic prerequisites for improving the material well-being of workers and peasants, and thereby strengthening their health, improving working and living conditions. Decrees on health insurance, on the nationalization of pharmacies, on the Council of Medical Colleges, on the creation of the People's Commissariat of Health and many others raised health problems to the level of national, national tasks. V.I. Lenin signed over 100 decrees on the organization of healthcare. They provide guidance on all important areas of workers' health. They reflect the policy of the Communist Party and the Soviet government in resolving the most important health problems.
Our Soviet experience is being used to its fullest by the whole world, and only here is it being destroyed in the bud. International companies love teamwork, a planned economy, and governments provide state control in strategic areas. The UK, Sweden, Denmark, Ireland and Italy have a budgetary healthcare system first created in the Soviet Union by Nikolai Semashko, known throughout the world as the Semashko system. G.E. Zigerist, a medical historian who visited our country twice and highly appreciated the achievements of Soviet medicine, wrote in his book dedicated to healthcare in the USSR:“What is happening in the Soviet Union today is the beginning of a new period of history in medicine. Everything that has been achieved so far in the 5 thousand years of medical history is only a new era - a period therapeutic medicine. Now new era, the period of preventive medicine, began in the Soviet Union."
After the revolutionary devastation of the early 20th century, the government and part of the medical community came to the conclusion that the only way to exist and develop the healthcare of the young republic was to concentrate resources and centralize the management and planning of the industry. At the V All-Russian Congress of Soviets, which adopted the new Constitution of the RSFSR, on July 11, 1918, the People's Commissariat of Health was established. N.A. was appointed the first People's Commissar. Semashko, his deputy - Z.P. Soloviev.
Nikolai Semashko based his proposed healthcare system on several ideas:
- unified principles of organization and centralization of the health care system;
- equal access to healthcare for all citizens;
- priority attention to childhood and motherhood;
- unity of prevention and treatment;
- liquidation social foundations diseases;
- involving the public in health care.
A coherent system of medical institutions was built, which made it possible to provide uniform principles of organizing healthcare for the entire population, from distant villages to capital cities: first aid station (FAP) - local clinic - district hospital - regional hospital - specialized institutes. Although there were still departmental medical institutions for the army, railway workers, miners, etc.
Access to healthcare was ensured by the fact that medical care was free, all citizens were assigned to local clinics at their place of residence and, depending on the complexity of the disease, could be sent for treatment higher and higher up the steps of the health care pyramid.
A specialized system of medical institutions for children was organized, repeating the system for adults, from a local clinic to specialized scientific institutes. The medical system paid special attention issues of motherhood and birth. To support motherhood and infancy, the same vertical system was organized - from antenatal clinics(the number of which increased from 2.2 thousand in 1928 to 8.6 thousand in 1940) and district maternity hospitals, again to specialized institutes. The best medicines and conditions were provided for young mothers, and training in obstetrics and gynecology was considered one of the most prestigious medical directions. At the same time, the government itself stimulated the birth of a new generation by paying substantial subsidies for children. A network of specialized children's clinics was also created, which contributed to a significant reduction in child mortality rates. Thus, the country's population almost doubled in the first 20 years.
Another important reform was the prevention of diseases, as well as the elimination of the initial causes of their occurrence, both medical and social. At various manufacturing enterprises in the country, which at that time were created with high speed, medical units were organized that were engaged in detection, prevention and treatment occupational diseases. They also provided first emergency assistance when receiving work-related injuries of varying severity, and supervised the assignment of workers to health resorts that were actively under construction. 
Prevention was understood by Semashko in both a narrow and a broad sense. In a narrow way - how sanitary measures, in a broad sense - as health improvement, prevention and prevention of diseases. The task of every doctor and the entire system of medical institutions, as Semashko believed, was not only to cure, but to prevent the disease, which was considered as a consequence of unfavorable social conditions and an incorrect lifestyle. In this regard, special attention was paid to such social diseases, like venereal diseases, tuberculosis and alcoholism. For this purpose, a system of appropriate dispensaries was created, which were supposed to not only treat, but also monitor the living conditions of patients, informing the authorities about the inadequacy of these conditions sanitary standards and the potential threat that patients may pose to others.
An important preventive measure, according to Nikolai Semashko, was vaccination, which for the first time took on a nationwide character and helped eradicate many infectious diseases, and sanitary and hygienic propaganda, which received great attention as one of the means of preventing epidemics and the formation healthy image life.
Rest homes and sanatoriums were naturally included in the coherent system of health improvement, prevention and healthcare. Sanatoriums, where stay was part of the treatment process, were subordinated to the People's Commissariat of Health, and rest homes were subordinated to trade unions, that is, the public, or, in modern terms, civil society, which was supposed to monitor the health of workers.
By the Decree of the Central Executive Committee and the Council of People's Commissars of the USSR dated December 23, 1933, the State Sanitary Inspectorate was created to manage the work of the state sanitary anti-epidemic service throughout the country.
The VIII Extraordinary Congress of Soviets of the USSR on December 5, 1936 adopted a new Stalin's Constitution of the USSR, which was the first in the world, Article 124, to guarantee the right of citizens to free healthcare..
By 1950, the war-ravaged economy had been restored. The number of medical institutions, hospital beds, and doctors not only reached the pre-war level, but also significantly exceeded it. In 1950, there were 265 thousand doctors (including dentists) and 719.4 thousand paramedical workers in the country, there were 18.8 thousand hospital institutions with 1010.7 thousand beds. rural areas there were more than 63 thousand paramedic and paramedic-obstetric stations. Since the 50s, allocations for health care have increased from year to year, and by 1965, during the 4 post-war five-year plans, funding reached a record figure - 6.5% of GDP. It was possible to increase by an order of magnitude all the main indicators of the material and economic base of healthcare. The number of doctors from 14.6 per 10 thousand people. population in 1950 grew to 23.9 in 1965; paramedical workers from 39.6 to 73.0; hospitalization in cities increased at this time from 15% of the population to 20.1%, in rural areas - from 7.7% to 18.9%; the number of hospital beds increased from 57.7 to 96.0 per 10 thousand population; the number of clinics and outpatient clinics reached 36.7 thousand, antenatal clinics and clinics for children - 19.3 thousand (Source: The System of Public Health Services in the USSR / By red. U.P.Lisitsin. - M.: Ministry of Health of the USSR, 1967. - R. 44.)
Since 1948, under the Minister of Health of the USSR E.I. Smirnov, a reform was carried out aimed at restructuring the structure of the healthcare organization, providing for the unification of hospitals and clinics, the creation in the regions of the so-called central (CRH) and simply united (numbered) hospitals, as well as a change in subordination sanitary and epidemiological service, according to which district sanitary inspection stations became independent institutions. Subsequently, the entire sanitary and epidemiological surveillance service became independent and was separated from subordination to the Ministry of Health.
In the 1960s A new branch of medicine has developed - space medicine. This was associated with the development of astronautics, the first flight of Yu. A. Gagarin on April 12, 1961 and other events in this area.
In the 60-70s, under the Ministers of Health S.V. Kurashov and B.V. Petrovsky, steps were taken towards intensive development of the industry.
Along with the further development of the network of medical institutions, more and more attention was paid to the development of specialized services, providing the population with ambulance and emergency medical care, dental and X-ray care. The primary development of the so-called primary links- outpatient clinics and construction of large multidisciplinary hospitals (with 1000 beds or more) and increasing the capacity of existing central district hospitals up to 300-400 beds with all types specialized assistance(In therapy, separate specialties began to emerge and develop (cardiology, pulmonology, etc.).
Surgery moved forward by leaps and bounds, as the principles of microsurgery, transplantology and prosthetics of organs and tissues were developed. In 1965, the first successful kidney transplant from a living donor was performed.) This was the general line of health care development.
In the mid-1970s. actively opened and equipped diagnostic centers, the protection of motherhood and childhood was improved, and much attention was paid to cardiovascular and oncological diseases.
Despite all the achievements, by the end of the 1970s. Soviet medicine was experiencing a period of decline due to insufficient funding and underdevelopment of certain government health care programs.
In the 70s, an experiment began to strengthen the economic independence of health care bodies and institutions. This is already a departure from the traditional Soviet healthcare system - from its purely budgetary option and completely state regulation. Chief doctors receive the right to operate with financial resources according to the estimates of medical institutions. This experiment, limited in scale, became the forerunner of the introduction of a new economic mechanism (NHM), developing self-accounting relations, establishing new economic principles for the distribution of funds (not to institutions, but based on the inhabitants of the territories); strengthening the economic independence of regions and districts; allowing paid medical services; obliging to determine wages based on the quantity and quality of work of doctors. And already at the end of the 80s. The difficult financial condition of budget health care facilities led to the introduction of NHM in a number of regions of the USSR. The NHM caused changes in the structure of management bodies of medical institutions, in particular, the creation in a number of regions of so-called territorial medical associations. Many medical institutions have transferred their activities to the principles of self-financing and received the right, along with budget financing, to receive income from other sources, and, above all, from the provision of paid services. From that moment on, the transition began from a rigid system of budgetary financing of healthcare to a multi-channel system.
The experiment in the form of NHM healthcare included:
· transition from the allocation of funds from the budget to health care facilities according to individual expense items to financing according to long-term stable standards that comprehensively reflect the target activities of institutions;
· a combination of budget financing with the development of additional paid services to the population, as well as the performance of work under contracts with enterprises and organizations on a self-supporting basis;
· development of independence and initiative of labor collectives of healthcare institutions in resolving basic issues of production activities and social development;
· establishing a close relationship between the size of the funds for the production and social development of health care facilities and the remuneration of each employee from the final results of the activities of the institution (division),
· usage various forms management, including intra-system rental relations, cooperative and other activities.
For territorial clinics and territorial medical associations, budgetary financing standards were established per capita per resident. Polyclinics had to pay for inpatient treatment of patients living on their territory using a pre-reimbursement system based on the average cost per patient treated, taking into account the profile of the bed; emergency medical services and consultation and diagnostic centers. Polyclinics were interested in reducing the costs of inpatient treatment, and in this regard, they received great development day hospitals and ambulatory surgery centers in clinics, as well as home hospitals.
Along with budget funds, healthcare facilities were given the opportunity to use additional sources of funding, including:
· paid services to the population and enterprises;
means social insurance, saved as a result of reducing morbidity with temporary disability;
· voluntary contributions from enterprises, institutions and citizens, etc.
The NHM failed to solve the problems of health care financing. There were many reasons for this. Firstly, budget funds were allocated in ever smaller amounts and could not ensure the normal functioning of medical institutions. And additional income could not ensure even the meager functioning of health care facilities, and it is not necessary to consider them as a serious source of financing.
(NHM was a prerequisite for a multi-channel system of financing healthcare facilities after the collapse of the USSR).
But this system is already beginning to depart from the given canons of the Semashko system.
The structured nature of Semashko’s system is often cited as its shortcoming, since patients were assigned to a specific doctor, to a specific hospital, then patients could not choose a doctor and medical institution, which made competition between them impossible. This “liberal” flaw, which was most likely invented by contemporaries. Competition between hospitals or Russian-Soviet doctors is generally nonsense. The traditions of Soviet medicine provided for mutual assistance and collegiality.
The main problem of Semashko’s system is called underfunding. But is this a problem with the healthcare industry itself? This is a problem for the entire state! And this cannot characterize the system itself at all.
Health care financing began to be carried out on a residual basis. An assessment of the share of the state budget spent on these purposes showed that this share has been steadily declining: 1960 (65) - 6.6% (6.5%), 1970 - 6.1%, 1980 - 5 .0% 1985 - 4.6%, 1993 - 3.5%. The increase in allocations in absolute terms barely covered the costs associated with the growth of the country's population. Healthcare began to be included in the service sector, and the attention of the administrative and managerial apparatus to protecting people's health decreased.
At the same time, healthcare costs in the 90s amounted to. XX century per capita: in the USA - $2000, Turkey - $150, in Russia - $50. The residual principle of financing the healthcare industry has led to the fact that the health status of the population of the Russian Federation began to constantly deteriorate.
De facto with camber Soviet Union funding for the healthcare industry has plummeted. A total discrediting of the Semashko system and the Soviet healthcare system in general began. A paid part of previously free healthcare has emerged. Medicine was divided into paid for the wealthy and public for the poor.
Twenty-five years after the collapse of the Soviet Union, we understand that, despite all the problems, the healthcare system in Soviet Russia was exemplary and in need of polishing rather than radical reform. An international meeting in Almaty (1978) under the auspices of WHO recognized the organization of primary health care in the USSR and its principles as one of the best in the world.