The evolving Semashko model of primary health care: the case of the Russian Federation

Abstract

This paper addresses the major developments in primary care in the Russian Federation under the evolving Semashko model. The overview of the original model and its current version indicates some positive characteristics, including the financial accessibility of care, focus on prevention, patient lists, and gatekeeping by primary-care providers. However, in practice these characteristics do not work according to expectations. The current primary-care system is inefficient and has low quality of care by international standards. The major reasons for the gap between the positive characteristics of the model and the actual developments are discussed, including the excessive specialization of primary care, weak health-workforce policy, the delay in the shift to a general practitioner model, and the dominance of the multispecialty polyclinic, which does not prove advantageous over alternative models. Government attempts to strengthen primary care cover a wide range of activities, but they are not enough to improve the system and cannot do this without more a systematic and consistent approach. The major lesson learnt is that the lack of generalists and coordination cannot be compensated for by the growing number of specialists in the staff of primary-care facilities. Big multispecialty settings (polyclinics in the Russian context) have the potential for more integrated service delivery, but to make it happen, action is needed. Simple decisions, like merging polyclinics, do not help much.

International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants

“…To understand the contribution of system-level factors on FSU immigrants' health literacy, it is necessary first to consider the original Soviet and current post-Soviet healthcare systems. Throughout the USSR, 15 Soviet republics used the Semashko model of primary care, named after the USSR Minister of Health Nikolai Semashko [89]. The government, based on the centralized planning and administration, financed the provision of basic services through publicly-owned healthcare facilities which were universally accessible and free at the point of delivery across dispersed populations [90,91].…”

“…The government, based on the centralized planning and administration, financed the provision of basic services through publicly-owned healthcare facilities which were universally accessible and free at the point of delivery across dispersed populations [90,91]. Thus, all medical workers were public employees, and private practices were not allowed [89,91]. The "standardized planning norms" distributed services while aiming to reach the entire population [90] (p. 421).…”

“…This model suited previous population needs, such as control of communicable diseases and immunizations, but it was not adequate for the current challenging conditions such as NCDs [91]. For example, the communicable disease approach did not direct resources towards preventive healthcare services [17]; thus, in the USSR, the public healthcare system was underfunded and dominated by costs for inpatient care and a lack of incentives for better performance for health providers [89]. Nevertheless, the extensive coverage and universal access to free care provided an equitable system, although there were some qualitative differences between geographical regions [91].…”

“…Although the Russian Federation and Kazakhstan have undertaken significant efforts in reforming their post-Soviet healthcare systems, the is still an emphasis on the older administration and the centrality of the state [14]. The number of private providers, especially in the specialty care areas, has increased dramatically, offering services for out-of-pocket payments [89]. However, this increase comprises a small percent of publicly funded care [89].…”

Nursing’s public image in the Republic of Georgia: A qualitative, exploratory study

“…Over the last two decades, the government of Georgia has initiated several reforms in the health sector to move away from the highly centralized Semashko model inherited from the Soviet Union. Semashko was a primary care model controlled by publicly owned medical facilities and salaried workers with major government oversight and administration (Sheiman, Shiskin, & Shevsky, ). The initial reform agenda included changes in healthcare financing, the removal of all healthcare personnel from the state payroll, and the decentralization of the provider network by granting autonomy to providers, followed by privatization of service providers (Curatio International Foundation, ).…”