Post-industrial countries’ experience in medical care restructuring and lessons for Russia

The countries of Europe and North America, transferred to a postindustrial stage of development in the second half of the 20th century, carried out restructuring of healthcare with more or less success in the same period. The Western countries’ experience in healthcare restructuring allows us to identify a number of general laws and principles of restructuring. For example, the reduction in hospital bed funds is more successful in countries with the centralized system of medical institutions management and, on the contrary, decentralization of management and financing is an obstacle to structural transformation. Such examples are extremely relevant for Russia, where structural reorganization of the healthcare system started only in the early 21st century. Although the results of structural transformations in the post-industrial countries are rather heterogeneous, the experience, they have accumulated over the years of reforms, even with regard to political differences, socio-cultural and socio-economic contexts is highly useful in implementing similar reforms in the Russian conditions. In Russia the decrease in hospital bed funds and the closure of hospitals began in the 1990s and was caused by the socio-economic crisis and transformational changes, but it continued in the economically prosperous 2000s in the framework of transformations aimed at optimizing the health network and enhancing its effectiveness. However, these changes lead to increased social tensions and limited access to medical care for citizens, as restructuring is tended to the reduction in stationary capacities, whereas the constructive changes, formation and dissemination of alternative types of medical care, hospital technologies leg behind. Restructuring should be based on the specifics of socio-economic and cultural contexts, have not only “quantitative measure” accompanied by the decrease in basic indicators of hospital care, but also “qualitative”, consisting in expanding the role of outpatient care in the total structure of medical care. The experience of post-industrial countries shows that restructuring does not, contrary to popular belief, lead to substantially lower costs of health care.