Doctors and the State in the Soviet Union

213 Pages·1990·18.487 MB·English

by  Michael Ryan (auth.)

DOCTORS AND THE STATE IN THE SOVIET UNION
Also by Michael Ryan
THE WORK OF THE WELSH HOSPITAL BOARD, 1948-1974
THE ORGANIZATION OF SOVIET MEDICAL CARE
SOCIAL TRENDS IN THE SOVIET UNION FROM 1950 (with Richard
Prentice)
Doctors and the State in
the Soviet Union
Michael Ryan
Lecturer in Politics and Russian Studies
University College of Swansea
Palgrave Macmillan
ISBN 978-1-349-09769-2 ISBN 978-1-349-09767-8 (eBook)
DOI 10.1007/978-1-349-09767-8
C Michael Ryan 1990
Softcover reprint of the hardcover 1st edition 1990
All rights reserved. For infonnation, write:
Scholarly and Reference Division,
St. Martin's Press, Inc., 175 Fifth Avenue,
New York, N.Y. 10010
rii'St published in the United States of America in 1990
Library of Congress Cataloging-in-Publication Data
Ryan, Michael, 1937-
Doctors and the State in the Soviet Union/ Michael Ryan.
p. em.
Includes bibliographical references.
ISBN 978-0-312-04029-1
I. Medicine, State-Soviet Union. I. Title.
RA395.S65R93 1990
610.69'52'0947-dc20 89-24049
CIP
For Judith
Contents
List of Tables Vlll
Acknowledgements ix
1 Quantity versus Quality 1
2 Low-paid Employees 19
3 Patterns of Recruitment 36
4 Material Resources 54
5 The Missing Generalist 72
6 Entrepreneurial Medicine 91
7 Doctors and Administration 110
8 Matters of Life and Death 128
Conclusion 146
Transliteration table 150
Notes and references 152
Appendix I Supply of doctors by Union Republic, 1986 166
Appendix II Medical and pharmaceutical higher educational
establishments 167
Appendix IIINomenclature of health service institutions 180
Appendix IV Causes of death in the USSR by age and sex
in 1985, per 100 000 population 184
Index 200
vii
List of Tables
1.1 Supply of doctors in selected countries 3
1.2 Supply of doctors in the USSR, 1950-86 4
2.1 Average monthly earnings in roubles, 1950-86 22
3.1 Women doctors, 1950-86 41
3.2 Women doctors and women in the workforce: by
Union Republic, 1983 42
4.1 Breakdown of USSR state budget expenditure on
health protection and physical culture, 1986 57
4.2 Public expenditure on health protection and
physical culture, 1970-86 60
5.1 Numbers of specialists, 1986 80
5.2 Urban sector general physician service by Union
Republic, 1986 83
8.1 Average expectation of life at birth (in years),
1938-39 to 1986 133
8.2 Average expectation of life at birth (in years) by
Union Republic, 1985-86 135
8.3 Number of children dying before the age of one year
per 1000 live births, 1970-86 136
8.4 Number of children dying before the age of one year
per 1000 live births by Union Republic, 1985 and 1986 137
8.5 Death rates by age groups per 1000 relevant
population, 1958-59 to 1985-86 140
8.6 Main causes of death among persons of working age
per 100 000 population, 1970-86 141
Vlll
Acknowledgements
I wish to express my thanks first to the University College of Swansea
for the award of travel grants which helped to defray the costs of
study tours of health service institutions in the Soviet Union. I am
much indebted to staff of the College Library, especially to Merlyn
Brown, Ann Preece and Gwenda Bailey. Over the years many people
have been kind enough to take an interest in my work on Soviet
society; the fact that they are not all mentioned here by name is not to
be interpreted as ingratitude on my part. Particular thanks are due to
David and Taya Martin for their assistance, always most willingly
given, in elucidating tricky passages of Russian text, and to Ian
Jeffries who, having scanned the newspapers at an early hour,
generously draws the attention of colleagues to articles in their areas
of interest. I also wish to thank George Boyce and Neil Harding for
helping to facilitate my research during their successive tenure of the
Headship of the Department of Political Theory and Government at
this College.
Permission to rework material which first appeared in the British
Medical Journal was kindly given by the Editor, Dr Stephen Lock.
During part of the time that I spent collecting material for this study I
was in receipt of a Nuffield Social Science Research Fellowship, and I
am immensely grateful to the Nuffield Foundation, a latter-day
Maecenas.
Michael Ryan
University College of Swansea
ix
1 Quantity Versus Quality
In many economically developed societies, doctors have considerable
collective power to influence the numbers of men and women who
qualify as practitioners of medicine. A case can be made out for the
contention that such influence is essential, mainly on the ground that
assessment of suitability for training requires appropriate specialist
knowledge and experience. The maintenance of high standards of
competence among students in this field, as in others, may be
regarded as very much to the advantage not only of the occupational
group but also of the public at large.
Admittedly it is conceivable that, far from coinciding, interests will
in fact conflict. The latter case would result from protectionist
tendencies - a concern to prevent what is perceived as a surplus of
new recruits and to avoid the various consequences which would flow
from such a surplus. In practice, however, national requirements on
the one hand and the collective opinion of doctors on the other
appear to be generally reconcilable through the normal processes of
consultation and accommodation. Nations whose political systems
allow for the wide dispersion of power can be held to have demons
trated considerable success at increasing the medical workforce while
still maintaining or improving the quality of instruction in the
academic biomedical disciplines and the relevant practical skills.
In the United Kingdom and other countries with pluralist political
systems, increases in the supply of medical practitioners have tended
to be fairly modest over the short or even medium term. A
fundamentally different picture emerges from an examination of the
experience of the Soviet Union. There, virtually from its inception,
the state has consistently pursued a strategy of rapid expansion in the
numbers of medical personnel.
Following the October Revolution of 1917, the Bolsheviks consoli
dated their military and political control over a vast land-mass which
had been lagging far behind most of Western Europe as regards
various aspects of social and economic development. The extent of its
backwardness in the provision of health care can be suggested by
reference to that key 'input' or 'production' indicator, the doctor-to
population quotient. According to Soviet statistical yearbooks, in
1913 this indicator stood at the very low level of 1.5 doctors per
1