Transition has trimmed Russian life expectancy by well over a decade. People lead brutish and nasty lives only to expire in their prime, often inebriated. In
republics of former Yugoslavia, respiratory and digestive tract diseases run amok. Stress and pollution conspire to reap a grim harvest throughout wastelands of eastern Europe. The rate of Tuberculosis in Romania exceeds that of sub-Saharan Africa.As income deteriorated, plunging people into abject poverty, they found it increasingly difficult to maintain a healthy lifestyle. Crumbling healthcare systems, ridden by corruption and cronyism, ceased to provide even appearance of rudimentary health services. The number of women who die at - ever rarer - childbirth skyrocketed.
Healthcare under communism was a public good, equitably provided by benevolent governments. At least in theory. Reality was drearier and drabber. Doctors often extorted bribes from hapless patients in return for accelerated or better medical treatment.
Country folk were forced to travel hundreds of miles to nearest city to receive most basic care. Medical degrees were - and still are - up for sale to highest, or most well-connected, bidder. Management was venal and amateurish, as it has remained to this very day.
Hospital beds were abundant - not so preventive medicine and ambulatory care. One notable exception is Estonia where law requires scheduled prophylactic exams and environmental assessment of health measures in workplace.
Even before demise of central healthcare provision, some countries in east Europe experimented with medical insurance schemes, or with universal healthcare insurance. Others provided healthcare only through and at workplace. But as national output and government budgets imploded, even this ceased abruptly.
Hospitals and other facilities are left to rot for lack of maintenance or shut down altogether. The much slashed government paid remuneration of over-worked medical staff was devoured by hyperinflation and stagnated ever since. Equipment falls into disrepair. Libraries stock on tattered archaic tomes.
Medicines and other substances - from cultures to vaccines to immunological markers - are no longer affordable and thus permanently in short supply. The rich monopolize little that is left, or travel abroad in search of cure. The poor languish and die.
Healthcare provision in east Europe is irrational. In healthcare chapter of a report prepared by IRIS Center in University of Maryland for USAID, it says:
"In view of fall in income and government revenue, there is a need for more accurate targeting of health care (for instance, more emphasis on preventive and primary care, rather than tertiary care), and generally more efficient use of benefits (e.g., financing spa attendance by Russian workers can be cut in favor of more widespread vaccination and public education). As formal privatization (much is already informally privatized) of health care proceeds, and health insurance systems are developed, health care access for poverty-stricken groups and individuals needs to be provided in a more reliable and systematic way."
But this is hard to achieve when even token salaries of healthcare workers go unpaid for months. Interfax reported on March 9 that 41 of Russia's 89 regions owe their healthcare force back wages. Unions are bereft of resources and singularly inefficacious.
The outcomes of a mere 6 percent of national level consultations in Lithuania were influenced by health unions. Their membership fell to 20 percent of eligible workers, same as in Poland and only a shade less than Czech Republic (with 32 percent).
No wonder that "under table" "facilitation fees" are common and constitute between 40 and 50 percent of total income of medical professionals. In countries like Czech Republic, Croatia, and chaotic Belarus, income of doctors has diverged upwards compared to other curative vocations. It is not possible to obtain any kind of free medical care in central Asian republics.
This officially tolerated mixture of quasi-free services and for-pay care is labeled "state-regulated corruption" by Maxim Rybakov from Central European University in his article "Shadow Cost-sharing in Russian Healthcare".
As though to defy this label, Russian Ministry of Health is conducting - together with Audit Chamber and Ministry of Interior - a criminal investigation against healthcare professionals. The Russian "Rossiiskaya Gazeta" quoted in Radio Liberty/Radio Free Europe:
"According to Shevchenko (the Russian minister of health), there are some 600,000 doctors and 3 million nurses working in Russia today; of this total around 500 medical workers are currently being investigated on suspicion of a variety of offenses such as taking bribes, using fake medical certificates, and reselling medicine at a profit. Shevchenko also stated that State Duma will soon adopt a law on state regulation of private medical activities, which he said will put process of commercializing medical establishments on a more legal footing."
The UN's ILO (International Labour Organization) warned, in a December 2001 press release, of a "crisis in care". According to a new survey by ILO and Public Services International (PSI):
"The economic and social situation in several East European countries has resulted in near collapse of some health care systems and afflicted health sector workers with high stress, poor working conditions and salaries at or below minimum wage - if and when they are paid."
Guy Standing, ILO Director of Socio-Economic Security Program and coordinator of studies added:
"Rapidly increasing rates of sexually-transmitted diseases, HIV/AIDS, tuberculosis and numerous chronic diseases have created a crisis of care made all more dramatic by diminishing public health structures, lack of training of health care professionals and general de-skilling of workforce. All of this has surely contributed to catastrophic fall in life expectancy rates in Russia, Ukraine and some other countries in region."
The situation is dismal even in more prosperous and peaceful countries of central Europe. In another survey, also conducted by ILO ("People's Security Survey"), 82 percent of families in Hungary claimed to be unable to afford even basic care.
This is not much better than Ukraine where 88 percent of all families share this predicament. Agreements signed in last two years between Hungarian hospitals and cash-plan insurers further removed health care from financial reach of most Hungarians.
