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No. of organizations involved in strikes:

TOTAL:

5305

972

95

169

69

11

11

15

192

359

341

729

of which:

Education

5280

952

84

157

52

-

-

3

176

343

305

702

Health care

8

2

2

-

1

2

1

-

-

4

27

3

No. of employees involved in strikes (‘000 persons):

TOTAL

134,3

31,1

4,5

6,5

4,7

0,7

2,7

3,6

5,7

11,4

5,7

28,5

of which:

Education

131,7

25,9

3,1

5,8

2,4

-

-

0,1

3,9

9,2

4,3

25,5

Health care

1,0

0,6

0,4

-

0,2

0,2

-

-

-

0,4

0,4

0,3

Source: RF Statistics Agency

Health Care

In 1999, the incidence of many diseases, including intestinal infections, measles, rubella, viral hepatitis, and tuberculosis, among the population continued to rise. The trend toward lower mortality and longer life expectancy that emerged in 1995 continued, but whatever positive changes have occurred are minimal.

Government policy in health care in 1999 differed from that followed in previous years essentially in two respects: adoption of planning principles in providing government-backed guarantees of health care services for the population and expansion of pharmaceutical market regulation.

Implementation of the Government Guarantee Program. In the fall of 1998, the government approved a Program for Government Guarantees of Free Health Care Services for the Population of the Russian Federation (Federal Government Directive No.1096 of September 11, 1998). There were no changes in the list of free health care services to be provided to the population. It specified, however, rates at which health care services were to be provided per 1,000 of the population with government financial backing. Adoption of the program was meant to specify the government’s commitments and to set up a mechanism to make structural changes in the health care system. The program is aimed at radically transforming the health care structure to make it less costly by reducing the scale of hospitalization and making wider use of outpatient and clinical facilities. The number of hospital beds has been declining during the last decade (Table 5). The program encourages continued movement toward these goals and reduction in the number of hospital beds, which have a low cost efficiency. The scale of hospital health care is to be decreased by 18.5 per cent and treatment of some diseases is to be provided in daytime hospital and outpatient clinics (Table 6). The share of government outlays on outpatient and clinical health care, now standing at an average 27 per cent for the country as a whole, is to rise to between 35 per cent and 40 per cent. As a result, outlays on health care services on a scale outlined in the government guarantee program will be smaller than they were in 1998. In particular, the costs of health care actually provided to the population in 1998 equaled 4.0 per cent of GDP, while the new government guarantee program adopted for 1999 accounted for 3.6 per cent of GDP.

Table 5

Indicators of the network of health care centers

1985

1990

1991

1992

1993

1994

1995

1996

1997

1998

No. of hospital-type institutions (‘000)

12,5

12,8

12,7

12,6

12,6

12,3

12,1

12,0

11,5

11,2

beds therein (per 1,000 persons)

13,5

13,8

13,5

13,1

12,9

12,7

12,6

12,4

12,1

11,9

No. of out-patient health care centers (‘000)

19,4

21,5

20,9

20,7

20,9

21,6

21,1

22,0

21,7

22,0

No. of physicians with various specializations

Total, ‘000

620,7

667,3

632,2

637,2

641,6

636,8

653,4

669,2

673,7

682,0

Per 10,000 persons

43,2

45,0

42,6

43,0

43,4

43.3

44,5

45,7

46,2

46,9

Paramedical personnel

Total, ‘000

1756,7

1844,0

1717,3

1709,1

1674,2

1613,2

1628,4

1648,6

1626,0

1615,0

per 10,000,000 persons

122,4

124,5

115,8

115,3

113,1

109,7

110,0

112,7

111,5

111,1

Source: RF Statistics Agency.

After the adoption of the federal government guarantee program, the government persisted in promoting planning practices in territorial (regional and municipal) health care systems, determining their requirements for funding from different sources, and, for this purpose, coordinating the efforts of various government agencies. Federation members were asked to develop territorial programs of government guarantees on the basis of the federal program. The Federal Health Ministry and the Federal Mandatory Medical Insurance Fund (MMI) adopted, on October 16, 1998, Methodological Recommendations on the Formation and Economic Substantiation of Territorial Programs of Government Guarantees of Free Health Care for Citizens of the Russian Federation, which were endorsed by the Federal Ministry of Finance.

Table 6

Indicators of the program of government guarantees for free health care provision

Type of health care service

Scope per 1,000 persons

Design rate of health care unit cost in 2000, Rbs

Per capita cost in 2000, Rbs

1998

actual

1999

2000

Emergency aid calls

320

340

318

310,7

98,8

In-patient, bed days

3476,0

2901,5

2812,5

200,3

563,3

Daytime in-patient medical aid, bed days

29

660

749

70,6

52,9

Out-patient

visits

8731

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