俄罗斯免费医疗:发展历程、效果分析、困境及未来发展方向

俄罗斯现有的免费医疗体系,主要根源于苏联时期的医疗保障体系。苏联解体后,面对复杂的社会形势和严峻的经济形势,一方面,国家财政负担日益加重,已无法维持苏联时期的免费医疗体系,各种弊端逐渐显露;另一方面,原来的医疗制度已不能适应市场化的经济体制,苏联时期的免费医疗模式逐渐浮现出越来越多的负面影响,民众满意度逐渐下降。在这种大背景下,俄罗斯在沿袭苏联免费医疗体系的基础上对其进行了一系列改革,从原先无限免费医疗服务转变为当前有限基本医疗免费的新型基本医疗免费制度,形成了免费的法定强制医疗保险和自费的私人医疗保险相结合的医疗保障制度。这些改革措施使俄罗斯人免费享受到基本医疗服务,大大增强了民众对国家医疗服务体系的信心,总体来看取得了积极成效,但依然面临着医疗机制之困、医疗资金之困、医疗服务能力之困、医疗公平之困等诸多挑战,未来俄罗斯还需朝完善法律制度、加强顶层设计、加大医疗投入、扩大医疗筹资来源、完善硬软件设施、引入竞争机制、提高卫生服务供给能力等方向继续努力,兼顾免费医疗服务供给的公平性和效率性,实现全民均可享有的高质量的免费医疗服务。

Free Medical Care in Russia:Development History,Effect Analysis,Dilemma and Future Direction

Russia's existing free medical system is mainly derived from the Soviet medical security system.After the fall of the Soviet Union,the social and economic situations have become more complex and severe.On the one hand,the state's financial burden has become increasingly heavier and thus the free medical system has been unable to be maintained;on the other hand,the original medical system failed to accord with the market-oriented economic system,and the free medical model gradually showed more and more negative effects.Against this background,Russia has carried out a series of reforms on the basis of the Soviet free medical system,wherein the original unlimited free medical services are changed to the current medical system with limited free basic medical services.A medical insurance system combining free compulsory medical insurance and private medical insurance at own expense has been established.In general,these measures have achieved positive results,but problems including the faultiness of the medical mechanism,the funding of medical services,the capabilities of medical services and medical equity do exist.In the future,Russia need to improve its legal system,strengthen the top-level design, increase medical investment,expand sources of medical financing,improve hardware and software facilities,introduce competition mechanisms,and improve the capacity of health services.In this way,it can address the issue of fairness and efficiency in free medical services,and achieve high-quality free medical services for all.