TitleThe Role of Law in Russian Health Reform
AuthorsMariner W. K., Feeley F.
Book TitleFinal Report
PublisherBoston University School of Public Health
LocationBoston, MA
AbstractTrue reform necessarily entails new law. In the newly independent Russian Federation, law has played a formative role in efforts to reform the health care system. Both historically and structurally, the health care system in Russia is more dependent on legal authorization than that in most Western industrialized countries. Reforms that providers might institute independently elsewhere are not likely to happen in Russia without specific laws authorizing them. Policy makers often formulate the substance of policy in the context of developing legislation, instead of drafting legislation to codify settled policy decisions. Thus, identifying and developing suitable laws has become an essential component of health care reform in Russia since the early 1990’s. The promise and peril of Russian health reform centers around its constitutional guarantee of free health care, contained in the Constitution of the Russian Federation:1 “Everyone shall have the right to health care and medical assistance. Medical assistance shall be made available by state and municipal health care institutions to citizens free of charge, with the money from the relevant budget, insurance payments and other revenues.” Russian health reform held promise because Russian health policy makers remained committed to the principle of solidarity—universal access to health care for the entire population. The peril arose from urgent needs for care from a health care system that no longer had either the money or the infrastructure to provide it. In the 1990’s, most European countries struggled to control the cost of health care while preserving health care as a social good based on the moral principle of social solidarity.2,3 But they did so largely in response to increasing pressure on reasonably well functioning health care systems.2,4 Aging populations with more medical needs, expanding use of new and expensive technologies, and tighter national budgets led Western European governments to seek new ways to reduce the cost of care.5,6,7,8,9,10,11 Russia, in contrast, did not have the comparative luxury of planning for a more expensive future. As described in the first section below, Russia faced mounting pressure for reform to save its health care system. The need for reform created an acute need for new law. The role of law in Russian health reform is summarized in the second section. The third section describes four subjects of legal reform in Russia, as well as limitations on the effectiveness of law to achieve health goals. Paradoxically, although new laws cannot guarantee health to theRussian population, Russia may need even more new laws to enable it to honor its constitutional guarantee.