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This patient is more likely alive, than dead...
The phrase "the collapse of public health care system" is so frequently
used, that the public begins to believe it, and there are some difficulties
and traps for those curious to find out what actually occurs in this sphere.
First, it is not quite clear: what is a public health care system? Straightforward
meaning of the term (regardless the health ministry charter, its composition,
staff and instructions) is about overall protection of health. Since a
health is very personal, the term might be misleading. On a modern stage
of epidemiological transition it is to a greater degree a subject to personal
rather than to state (governmental) responsibility. I do not think (am
I right?), that for past 10 years someone in Russian Federation has become
less care of itself. Thus, collapse is likely to be in that zone, which
concerns up to the state (government).
To search in this zone is not an easy job. In addition to Minzdrav,
there are also president administration, ministry of railroads, etc. engaged
in public health services. They differ in prosperity but all aim, mainly,
at treatment, while preventive part is visible in Minzdrav only. It would
be more correct to name this system medical (?). A State Committee on environment
protection and ecology had been abolished; there is also Goscomsport, but
its main task - records, medals and other unhealthy Olimpic undertakings.
Therefore, if public health care system is the part of Minzdrav headed
by Onishchenko, there is no not only collapse, but even about modest recession.
The data on age distribution of mortality also does not prove the thesis
of the collapse of public health care system. Infant and maternal mortality
constantly decrease, old age mortality remains more or less stable, and
overall mortality aggregate (life expectancy) drops due to increasing number
of deaths (especially male) in most active ages, before the age of retirement,
which are far from Minzdrav responsibility.
Even foolowing Minzdrav fun, considering a pregnancy as an illness,
health (especially of the women) is improving - since number of pregnancies
is decreasing. Maternal mortality is apparently decreasing, though its
influence on a death rate is insignificant. Regardless the
introduction (since 1993) the new and stricter (international) definition
of a live birth infant mortality is continuing to decrease, while child
mortality does not grow. That portion of mortality, which to a greater
degree depends on medical treatment and intervention, obviously does not
grow - at the same time adult male mortality does, but this portion of
population is a most remote to any institutional health protection.
The morbidity data can be treated
differently, but they reveal nothing catastrophic as well. Population health
in general seems better in 2000 than in 1990. The number of medical doctors
(see here) recently has grown,
i.e., the trade remains attractive regardless spreading market relations
(so much (and so insincerely) unloved by medical community).
Certainly, this system is not perfect, but is it necessary to strew
a head by ashes? I guess, it is hardly possible to find out a system of
public health care having no problems. Look at American one (a model for
many), and compare it with Russian, taking life expectancy as criterion
and dividing the number of person-years of (healthy) life by $$ total spent
on this. Ours looks much more effective (cheaper).
One of the basic shortcomings (far from unique) of Russian system is
its traditional opacity. During a long time an information about health
and epidemiological situation in the country was completely absent, thus
the quality of statisticians, employed in public health, greatly deteriorated,
leading some speakers of this system to panic
statements, on one hand, and resulting in rather mysterious medical
statistics, on the other. For example, the number
of births exceeds the number of pregnancies (there is something hidden
in that). Another example: deterioration of women health seems connected
to a sharp reduction in numbers of clients of obstetrics and gynecology
with a rather stable number of respective doctors. In other words, the
increase of attention to the women is determined by essential reduction
of both birth rate, and abortions.