Financing Medical Care in the New Soviet Economy

The Soviet Union is undergoing a peaceful—but massive—revolution. Everywhere, old institutions are being challenged, and old beliefs are being rejected. Soviet society is beginning to ferment with entrepreneurial zeal, a thrust toward decentralization and democratization of decision making, and a blossoming of interest in competition and free enterprise as a way of reviving the stagnant economy. The health care sector is no exception.1Although the Soviet Union was the first country in the world to guarantee free medical care as a constitutional right to all its citizens,2the quality and accessibility of that care are now in question. In the face of deteriorating health status indicators and dissatisfaction among Soviet citizens, restructuring the health care system has been joined to the economic reform. The major goal is to infuse new resources into the system and make it part of the self-supporting economy. This reform initiative has been