Perestroika and health care in the USSR: innovations in state financing

The budget of the USSR Ministry of Health has steadily been shrinking during the period 1960-1985 as a proportion of the standard measure of national productivity. In the age of perestroika, however, the Ministry of Health and various units within it have instituted a number of innovative attempts to increase available funds and resources on one hand, and make facilities operate more efficiently on the other. Some of these strategies include the expansion of pay polyclinics and hospitals, the institution of self-financing and cost accounting procedures, the initiation of health insurance forms of reimbursement, more control over the budget at lower levels, and the geographical reorganization of health care facilities. There are concerns about the effectiveness of these innovations, and the issue of quality of care. It is not clear which if any of these innovations will achieve the desired goals.