Health care in the years of the USSR. Historical essay on public health in Russia. Post-war years Free medicine in the USSR

healthcare in the ussr

15 RGANI. F. 17. Op. 88. D. 73. L. 49.

16 GARF. F. 327, Op. 1. D 47. L. 59.

17 Ibid. L. 55.

18 Russian State Archive of Socio-Political History (hereinafter - RGASPI). F. 327. Op. 1. D. 4. L. 23.

19 See: GARF. F. 327. Op. 1 D. 32. L. 266, 267, 268.

20 RGANI. F. 17. Op. 88. D. 732. L. 51.

21 See: Russian State Archive of Economics (hereinafter - RGAE). F. 5675. Op. 1. D. 636. L. 48.

22 Ibid. L. 75.

23 Ibid. L. 25.

24 Ibid. D. 546. L. 41.

25 Ibid. D. 595. L. 8.

26 Ibid. L. 12.

27 Ibid. D. 636. L. 100.

28 Ibid. D. 595. L. 13.

29 Ibid. D. 634. L. 3.

30 Ibid. D. 636. L. 99.

31 http://www.gazetaingush.ru/index.php?option=com_ content&view=article&id=6241:2012-02-23-06-33-49&catid=3:2009-05-05-20-23-47&Itemid= 1 (date of access: 03/21/2014)

32 RGAE. F. 5675. Op. 1. D. 543. L. 71.

33 Ibid. D. 595. L. 12.

34 Ibid. D. 632. L. 39.

35 GARF. F. 259. Op. 6. D. 2603. L. 15.

36 Ibid. L. 16.

37 RGANI. F. 17. Op. 88. D. 732. L. 23.

38 Ibid. L. 38.

39 See: RGAE. F. 5675. Op. 1. D. 636. L. 49, 50.

40 Ibid. L. 51.

41 http://www.gazetaingush.ru/index.php?option=com_ content&view=article&id=6241:2012-02-23-06-33-49&catid=3:2009-05-05-20-23-47&Itemid= 1 (date of access: 03/21/2014).

42 GARF. F. 7523. Op. 75. D. 365. L. 8.

43 Ibid. L. 8.

44 Ibid. L. 12, 14.

45 Ibid. D. 364. L. 9, 10.

UDC 614(470.44/.47)(09)|19|

A. A. Gumenyuk

Saratov State University E-mail: [email protected]

The article analyzes the process of transforming specialized medical care into an integral part of the daily life of the population of the Lower Volga region during the Khrushchev era.

46 See: Myakshee A.P. Decree. op. S. 78.

47 http://www.memorial.krsk.ru/Exile/064.htm (date of access: 07.12.2014).

48 RGAE. F. 5675. Op. 1. D. 636. L. 2.

49 For more details, see: Kostyrchenko GV Stalin's secret policy. Power and anti-Semitism. M., 2003. S. 431.

50 http://kirimtatar.com/index.php?option=com_content &task=view&id=278&Itemid=47 (accessed 03/26/2014).

51 GARF. F. 327. Op. 1. D. 47. L. 61.

52 Bugay N. F. Deportation of the Peoples of Crimea. S. 117.

53 According to the districts, the evacuees were distributed as follows: Azov - 162 people, Alushta - 2447, Belogorsky - 1614, Bakhchisarai - 2364, Balaklavsky - 2076, Dzhankoysky - 158, Zuysky - 213, Kirovsky - 428, Krasnogvardeisky - 104, Kuibyshevsky - 2312, Nizhnegorsky - 320, Novoselovsky - 32, October - 103, Primorsky - 204, Soviet -216, Sudak - 2553, Old Crimean - 1374, Simferopol - 214, Yalta - 1119. (Bugay N. F. Deportation of the peoples of Crimea. S. 136).

54 Ibid. S. 136.

55 GARF. F. 327, Op. 1. D. 19. L. 62.

57 RGAE. F. 5675. Op. 1. D. 636. L. 20.

58 GARF. F. 327. Op. 1 D. 47. L. 38.

59 RGAE. F. 5675. Op. 1. D. 636. L. 18.

60 httpVZru.wikipedia.org/wiki/ (Accessed 21.03.2014).

61 RGAE. F. 5675. Op. 1. D. 636. L. 15.

62 GARF. F. 259. Op. 6. D. 577. L. 7.

63 RGAE. F. 5675. Op. 1. D. 740. L. 2, 3.

64 Ibid. D. 546. L. 72.

65 Ibid. D. 740. L. 4.

66 See: GARF. F. 327. Op. 1 D. 186. L. 6, 7.

67 Ibid. L. 63.

68 Ibid. L. 71.

69 See: Myakshev A.P. Decree. op. S. 75.

70 https://m.wikipedia.org/wiki/%CD%E0%F1% (accessed 03/01/2014).

sky and Brezhnev reforms. The article is based on rich factual material extracted from archives, published sources, periodicals. Key words: health care, polyclinic, hospital, pharmacy, medicines, medical personnel, medical equipment, bed capacity, clinical examination, infectious diseases.

healthcare development in the ussr

IN THE SECOND HALF OF THE 1950s - THE FIRST HALF OF THE 1980s (Based on materials from the Lower Volga region)

Public Health service Development in the USSR in the Second Half of the 1950s - the First Half of the 1960s (Based on the Data of the Lower Volga Region)

The paper is dedicated to the analysis of special medical care becoming

an indispensable part of daily life of the Lower Volga region during

Khrushchev's and Brezhnev's Soviet reforms.

This article is based on the vast set of factual materials from the

archives, published sources and periodical press.

Key words: public health service, polyclinic, hospital, drug store,

medicine, medical staff, medical equipment, hospital stock, health

survey, infectious morbidity.

DOI: 10.18500/1819-4907-2015-15-4-108-116

Health is a fundamental, basic condition for the existence of any person. Its state determines both the degree of vital activity of an individual and society as a whole. Therefore, health protection is the most important direction of the social policy of any state. In the Soviet Union, the state health care system finally took shape in the late 1930s and early 1940s, it was based on the availability of medical services for all categories of the population. However, the scarcity of funding did not allow the implementation of this principle in full. Therefore, as in the first decade of Soviet power, the production principle of medical care was predominantly developed. Because of this, by the beginning of the Great Patriotic War, the USSR in terms of life expectancy, infant mortality and other demographic indicators, in fact, remained at the level of the late 1920s. The hard times of war and the subsequent recovery period were indisputable proof of the need to strengthen state care for the health of the population. The validity of this statement is convinced by the materials characterizing the state of health care in the Lower Volga region in the first post-war decade. Thus, in 1944, the Astrakhan region had 75 hospitals, 11 maternity hospitals, and two dispensaries with a total capacity of 3,140 beds, which was clearly not enough for the half-million population of the region1. The absence of laboratories, X-ray diagnostic and electrocardiographic rooms in most medical institutions disrupted the timeliness of patient examination. There was a shortage of medicines and pharmacies, which were often used as living quarters. The construction of new hospitals and polyclinics was carried out slowly and of poor quality, as, for example, in the Travinsky district of this region2. The situation was no better in the Saratov region, in 30 districts of which there were no X-ray machines, in 82 state farms with a population of

from a thousand to two thousand people, one paramedic provided medical assistance, and in 22 MTS and 12 state farms there were no medical institutions at all. Therefore, in Ivanteevsky, Krasnopartizansky and Pitersky districts, cases of death among patients were observed. The increase in the number of beds in the regional center (by 40% compared to 1940) was carried out not due to new construction, but due to the use of corridors, stairwells, vestibules in medical institutions as wards. However, the shortage of hospital beds in Saratov persisted, especially for surgical, therapeutic, maternity, and tuberculosis beds. In 1954, 1,500 such places were missing3. Almost the same picture was observed in Stalingrad, in two districts of which (Stalinsky and Dzerzhinsky) there were no medical institutions. The work of infectious diseases hospitals, the ambulance station did not satisfy the needs of the working people of the city, the construction of a tuberculosis dispensary and a number of other medical institutions was carried out at a slow pace. In district hospitals, power outages were a frequent occurrence, especially during operations, and there were obvious difficulties in obtaining medicines4. Many medical institutions in the region under consideration were located in dilapidated, unsuitable premises, especially in rural areas. Very indicative in this regard is an episode from the film "Chairman" directed by A. Saltykov (1964), when a surgeon performed by young V. Solomin compares a rural hospital with a "stinking chicken hut", in which even the necessary medicines were absent.

Such a deplorable situation with medical care began to change for the better only after the September 1953 plenum of the Central Committee of the CPSU, from which a report is kept of N. S. Khrushchev's reformist activities5. The materials of this and subsequent plenums and congresses of the Central Committee of the CPSU repeatedly emphasized the need to bring specialized medical care closer to the rural population, including those in virgin lands. Legislative initiatives aimed at the need to raise medical care for rural residents to the level that existed in cities. To this end, the legislation aimed at expanding the construction of rural hospital complexes, both at the expense of state funding and at the expense of the collective farms' own funds, and only according to standard projects. This rule extended to cities and workers' settlements. The use of private apartments and other unsuitable premises for the placement of medical stations was prohibited6. The Decree of the Council of Ministers of the USSR of January 14, 1960 "On measures to further improve medical care and health protection of the population of the USSR" determined the optimal

the size of the bed fund of urban and rural hospitals, necessary to provide versatile qualified medical care to the population. In cities, it ranged from 300-400 beds to 600 or more, depending on the population. In rural settlements, it was ordered to create enlarged district hospitals, which were complex centers of the district level of health care with the number of beds in them 100-120 or more. The construction of new rural district hospitals with less than 35 beds was allowed only in exceptional cases and with the permission of the Ministry of Health of the Union Republic7. At the same time, a number of party decisions ordered the creation of comfortable living conditions for medical workers, especially in villages8.

The modernization of the material and technical base of health care provided for measures to eliminate the shortage in providing the population and medical institutions with medicines, as well as improving their quality9. The Ministry of Health of the RSFSR, by its order of January 9, 1957, ordered to make dental and prosthetic care more accessible to the population through the expansion of the network of self-supporting polyclinics10. By the end of this decade, a whole package of orders from the Union Ministry of Health was adopted, designed to improve the general outpatient and polyclinic services for the urban population, the work of the ambulance service, and also to eliminate diphtheria, measles, scarlet fever, whooping cough, typhoid fever, brucellosis, malaria, tularemia , poliomyelitis, anthrax and tuberculosis11. The adoption of new regulations on the Ministry of Health of the USSR (1959, 1964 and 1968) and the RSFSR (1960 and 1969) also testifies to the increased attention of the state to the healthcare sector12.

The first results from the implementation of the legislative initiatives adopted by the new collective leadership of the USSR in the field of medicine began to be gradually felt by the inhabitants of the Lower Volga region by the mid-1950s, including through the growth of state allocations for health care. So, in the Saratov region for 1951-1955. they doubled and amounted to 215 thousand rubles, in the Stalingrad region - 197 thousand rubles. or 26 thousand more than in 1953.13 Nevertheless, the increase in hospital beds in this region was higher than in Saratov: 44 and 22%, respectively. The same picture was observed in relation to medical personnel14. The hospital network grew much more slowly in the Astrakhan region. In terms of the annual increase in hospital beds, this region, neither in 1958 (4%), nor in 1963 (6%)15 was able to "catch up" with the Stalingrad region, where in 1950-1955. it averaged 7.3%. This explains the allocation in 1961 to Astrakhan by the Council of Ministers of the RSFSR from its reserve funds of 1.5 million rubles additional

of financial resources, of which 0.4 million were intended for the construction of healthcare facilities16. However, the rehabilitated and returning population of the Kalmyk autonomy, which was recreated by a decree of the Central Committee of the CPSU of November 24, 1956, demanded much more attention from the republican and union leadership17. Only from September 2, 1957 to July 1, 1958, medical equipment and various supplies for 431.4 thousand rubles were purchased for medical institutions in this region. units in

1955 to 54 by the beginning of 1960. The number of hospital beds during this period increased from 655 to 1200, and doctors and nurses increased from 666 in

1956 to 1339 by the beginning of 196120 New equipment began to arrive at the medical institutions of the region, the number of X-ray units and clinical laboratories increased21. But despite the large financial injections in terms of material and personnel support, the health authorities of Kalmykia lagged significantly behind the neighboring regions of the Lower Volga region, among which, according to official statistics, the Saratov region was in the lead. By the beginning of 1961, she had 20,782 doctors and paramedical workers, 319 hospitals for 19,000 beds. The second and third places, respectively, were occupied by the Stalingrad and Astrakhan regions22. If we consider only regional centers, then the ratio looks different. Only according to such a criterion as the ratio of doctors to the population, Stalingrad with 38 doctors per 10 thousand inhabitants was ahead of Saratov with 31 doctors. At the same time, in both cities this figure was higher than the national level - 19-20 doctors23.

The improvement of the material, technical and personnel base of health care was accompanied by an improvement in medical care for the population. Polyclinics switched to an extended working hours on working days, in order to reduce queues, preliminary appointments with specialists were practiced, and patients were admitted on weekends. Due to the growth in the number of medical stations, medical care became closer and more accessible to patients24. A certain result of all these innovations was the transition from the district to the polyclinic principle of medical care, which took place in 1962. The improvement in the functioning of these structures is also eloquently evidenced by the data on the decrease in infectious and ordinary morbidity in various regions of the Lower Volga region. So, in the Saratov region by the mid-1950s. malaria was eradicated as a mass disease

levanie, in comparison with 1946, 2.3 times less people began to suffer from tuberculosis. In just one year (from 1954 to 1955), the incidence of measles decreased by 21%, scarlet fever by 12%, typhoid fever by 20%, and cheese fever by 28%. The incidence of brucellosis decreased, anthrax and tetanus occurred in isolated cases27. From 1958 to 1963, in rural areas of the region, the number of cases of diphtheria decreased by 375, typhoid - by 44, dysentery - by 16,628. .5%, poliomyelitis has been virtually eradicated, especially among children29.

The decrease in incidence was primarily noticeable in cities. In general, for 1953-1964. in archival documents in the Saratov region, we found 82 references to the growth of various types of infections, of which only 20 documents accounted for urban settlements. In Stalingrad, the incidence of osteoarticular tuberculosis decreased from 2.4%o in 1953 to 1.4% in 1955. reducing the use of funds from the social insurance budget for the payment of temporary disability benefits31. Demographic indicators also testify to an increase in the degree of accessibility of specialized medical care to the population, an increase in its quality. For example, in the Kalmyk ASSR, the natural increase in population from 1956 to 1958 increased from 20.5% to 26.4%. For 1959-1965 the population of the republic grew by another 38%, the annual increase was approximately 9 thousand people. The average life expectancy of people has risen to 70 years. Child mortality has decreased, especially in rural areas32. In the Saratov region, the birth rate increased from 18.0% in 1953 to 20.0% in 196133 Volgograd in the first half of the 1960s. also had a high natural increase - annually 14-15 thousand children were born in it. On the whole, the life expectancy of the population in the country has doubled34.

However, the inconsistency, and sometimes even the obvious inconsistency, of many of Khrushchev's undertakings could not but affect the state of public health. In many settlements of the Lower Volga region, a considerable number of small, low-capacity hospitals remained. So, in the Saratov region in the first half of the 1960s. 11 hospitals serving urban adults had 50 or fewer beds. In Engels, the actual provision of the population with hospital beds per thousand of the population was 7.3 beds at a rate of 11.235. The average capacity of central district hospitals was 138, zonal hospitals 70, district hospitals 24.1 instead of the 300-400 beds required by law.

The staff of 76% of rural district hospitals consisted of almost one doctor who provided medical care, slightly different from paramedical care. In 97 hospitals there were no X-ray rooms, in 75 laboratories, in 93 physiotherapy equipment. 50% of the rural population received primary health care at feldsher-midwife stations36. Often this was explained not only by economic difficulties, but also by the adoption of decisions that do not take into account the interests of rural residents. Deprived as a result of the closure of unprofitable rural hospitals, from the point of view of the authorities, of any medical care, the collective farmers were forced to seek “the truth” even from the head of state37. Therefore, it is quite understandable that the number of references in archival documents to the increase in the incidence of children and adults in rural areas of the region increased from 25 in 1953-1958. up to 37 in 1959-1964 However, if we take into account the number of orders expressed by the population to the regional Soviets, then the situation in the healthcare sector of the Saratov region was much better than, for example, in the neighboring Volgograd region. Indeed, if in 1961 about 1.7% of orders and wishes were expressed to the deputies of the Saratov Regional Council by voters regarding the construction and expansion of the network of medical institutions, the organization of well-functioning work of communal systems, providing them with transport and medical workers, then in the Volgograd region in 1962 the regional council received about 23.2% of such orders, and in 1965 - 19.6%38. There were problems in other regions of the Lower Volga. So, in Kalmykia in 1962, only 42.2% of capital investments were spent on the construction of hospital beds, and in 10 months of 1963 - 69%. Due to unsatisfactory working and living conditions, out of 70 doctors sent to the republic in 1963, 5439 left. For the same reason, in the Astrakhan region, the number of doctors in rural areas practically did not grow. In the Astrakhan villages, a quarter of all the doctors available in the region40 worked. Thus, the above data allow us to state that by the end of the Khrushchev decade, the majority of the rural population of the region did not reach the majority of the rural population of the region. In villages and villages, it never became a mass phenomenon, as evidenced by the speech of the chairman of the All-Union Central Council of Trade Unions V. V. Grishin at the March 1965 Plenum of the Central Committee of the CPSU41.

The new leadership of the country, which came to power in mid-October 1964, began to take more decisive measures to improve medical care for the population, while maintaining the continuity of the social course of N. S. Khrushchev. Analysis of the materials of party congresses, plenums of the pre-perestroika twenty years and legislative acts that appeared

in the development of the resolutions adopted at these forums, shows that those in power sought to ensure that highly qualified medical care became an integral part of the daily life of not so much the urban as the rural population42. In this regard, the resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR dated July 5, 1968 "On measures to further improve health care and develop medical science in the country" deserves special attention. Comparison of its content with a similar resolution of January 14, 1960 convinces of the real desire of the party and the government to provide the population with highly qualified medical and preventive care. Thus, in cities, the maximum bed capacity of hospitals now had to be not 600, but 1000 or more beds, and in rural areas it increased from 120 to 400 beds. The capacity of rural district hospitals was increased to 150 beds. In addition, the document prescribed the organization of inter-republican, republican, inter-regional, regional and regional departments (centers) for the most important types of specialized medical care (cardiac surgery, burns, neurosurgery, neurological and others)43. The same attitudes were reproduced in similar resolutions of September 22, 1977 and August 19, 1982. At the same time, these documents contained more extensive propaganda than before of elements of a healthy lifestyle (preventive examinations, clinical examination, sanitary and hygienic education of the population ), it was ordered to pay increased attention to protecting the health of women and children44. Delegates of the June 1983 and April 1984 plenums of the Central Committee of the CPSU45 also recognized the need for a speedy solution of these important problems. Thus, the developed measures were aimed at building a welfare state in the USSR.

The implementation of a deliberate program to bring highly qualified medical care closer to a specific person required a significant increase in healthcare financing. Among the regions and republics of the Lower Volga region, it was the largest in the Volgograd region: in 1967, almost 64 million rubles were spent on medical care for the population of the region, and in 1975 - already about 96 million rubles. 46 If in 1966 medical institutions of the Kalmyk ASSR received the latest equipment for 176.8 thousand rubles, then in the first half of the 1970s. for these purposes, an average of 400 thousand rubles was spent annually. . During 1966-1985. this process proceeded most intensively in the Volgograd region, where

Over the past 20 years, the number of beds in hospitals has increased by 11,503, in the Saratov region this increase was 8,609 beds, in the Astrakhan region - 6,300, and in the Kalmyk ASSR - only 2,730 beds49. However, in terms of provision of the population with a bed fund, the leadership was in the Astrakhan region, where by the end of 1985 there were 156.6 thousand beds per 10 thousand people, the second place was occupied by the Kalmyk ASSR with 149 beds, the third - by the Volgograd region (138 beds per 10 thousand .). As of January 1, 1986, there were only 130 beds per 10,000 population in the Saratov region, which was lower than the national average of 135 beds per 10,000 population50. Only in some districts of the region, the provision of beds exceeded this indicator, in particular, in Arkadaksky, Ivanteevsky and Rivne51.

The medical and preventive network of the region changed not only quantitatively, but also qualitatively, becoming more accessible, especially to the rural population. In the Astrakhan region by the mid-1970s. in almost all districts, the buildings of modern regional hospitals in combination with polyclinics were renovated or erected. By that time, 29 inter-district specialized centers for the main types of medical care had been created in the Saratov region. If in 1975 in the Volgograd region such centers existed only at eight district hospitals, then in 1979 they appeared already in 14 districts. In the Kalmyk ASSR in the early 1980s. medical care in the countryside was provided in 10-12 specialties, in the central district hospitals there were clinical diagnostic laboratories and physiotherapy rooms52. Ordinary inhabitants began to feel the successes in the field of health care53, which was manifested in the reduction of their orders to local authorities. For example, in the Saratov region from 1969 to 1975 the number of orders decreased by 2.4 times54.

The clearest idea of ​​the degree of accessibility of medical care to the rural population allows us to draw up the ratio of hospital beds to the population. Particularly significant in this regard is the period from 1965 to 1975. The population of the Astrakhan region was most fully provided with specialized medical care in the Lower Volga, where by the end of the 9th five-year plan there were 66.3 beds per 10 thousand rural population, which was higher than the national average. level (62.9 per 10 thousand people). In the Volgograd region, this indicator was not achieved. in this area in the mid-1970s. there were 58.1 beds per 10 thousand inhabitants of villages and villages. By this time, the situation was worst in the Saratov region, the provision of the rural population of which with hospital beds decreased from 50.9 in 1965 to 49.0 in 1975. The level of 1965 in the region was surpassed only in the autumn of 1985, but not on the-

a lot: there were 51 hospital beds per 10,000 rural residents55. Such a meager advantage was partly due to the implementation of the program for the reconstruction of the settlement structure, which was actively pursued by the state everywhere. Therefore, a reduction in the number of medical institutions was also observed in other regions of the Lower Volga region, in particular in the Astrakhan region56.

The main achievements of the health care system of the country and the region under consideration concerned mainly regional and district centers. This is confirmed by the analysis of the ratio of the number of references in the sources to the incidence of the rural and urban population. So, in archival documents for the Saratov region for the end of 1964 - at the end of 1985, we found 36 references to the growth of various types of diseases, of which only 16 documents accounted for urban settlements. The reduction of such dangerous infections as diphtheria, tularemia, poliomyelitis, rabies, brucellosis, whooping cough and others in the region was the result of an increase in the number of medical personnel, their advanced training, and the organization of dispensary observation of the population. The first successes of this process in the Kalmyk ASSR are evidenced by the fact of an increase in 1965-1966. dispensary observation coverage of the rural population from 77% to 85%57. Medical care for rural workers of the republic improved in the future, especially during the days of health months. In 1976, the level of clinical examination of the entire population of Kalmykia increased to 97.9 per thousand population58. In the Saratov region in 1984, 241 people per thousand of the population were registered at the dispensary, which was higher than the national average - 232 people per thousand. By the beginning of 1986, 11,600 doctors of all specialties stood guard over the health of the population in this area59. In the Volgograd region, the health of workers by this time was guarded by 10.6 thousand doctors and 30.9 thousand paramedical personnel; in the Astrakhan region, respectively, 5.8 thousand and 13 thousand. By the end of the period under review, there were much fewer medical workers in the Kalmyk ASSR - only 1.2 thousand doctors60.

The growth in the number of medical personnel contributed to bringing specialized highly qualified medical care closer to those in need. This assistance became more accessible to the working categories of the population due to the ongoing since the early 1960s. the practice of organizing the reception of patients on weekends, the transfer of medical institutions to an extended mode of operation, as well as in the evening. In order to reduce queues in polyclinics, a coupon system was introduced with a preliminary appointment with a doctor61. All of these steps have contributed to a reduction in workers' complaints about health care. Yes, in

In the Saratov region, only from January to September 1983, the number of such complaints received by the regional committee of the CPSU decreased from 115 to 9962. At the same time, the number of orders on health issues given by voters to deputies of the Supreme Soviet of the RSFSR and the USSR increased. So, in the Saratov region in 1979, about 7.5% of such orders were issued, and in 1985 already about 14%. The inaction of local authorities forced people to petition the deputies of the Supreme Council. If in 1975 about 5% of orders were addressed to the deputies of the Saratov Regional Council, then in 1979 it was already about 8%63.

It was mainly the population of remote settlements that turned to power, in which the state's concern for the health of the population was still weakly felt64. This was a consequence of the entry of the USSR in the late 1970s. into a tougher phase of the Cold War and a significant reduction in the inflow of petrodollars into the economy. The weaknesses of social policy were gradually manifested with great force. The health care budget began to shrink rapidly. If in the first half of the 1970s. in the Kalmyk ASSR, an average of 20% of money was spent annually on the purchase of the latest medical equipment, then in the early 1980s. - only 9%65. And in some areas of Saratov and the region in the early 1980s. health care funding ranged from 2% to 4%66. These very few funds were directed mainly to regional, district centers and rural settlements that are promising from the point of view of the authorities. All other settlements were deprived of the necessary material support. As a result, the material, technical and personnel base of health care in them gradually approached the level of the early 1950s. The shortage of narrow specialists was felt in the “unpromising” villages of Olkhovsky, Bykovsky, Oktyabrsky, Nekhaevsky districts of the Volgograd region67. The population of Arkadaksky, Ivanteevsky, Engelssky, Novoburassky, Balashovsky districts of the Saratov region complained about overcrowding in medical institutions, where two specialists were receiving in one room68. District hospitals worked in cramped conditions in Priyutny, Sovetsky, Yashalta, Komsomolsky, and Troitsky;

The anthropogenic factor also influenced the decline in the quality of medical care throughout the period under review. The harmony between the external and internal decoration of medical institutions being built in large numbers according to the latest science and technology was quickly violated. The image of a hospital or polyclinic began to collapse in the process of equipping them with medical equipment, which was often accompanied by damage to the coating of walls, floors and ceilings. Those who moved into

medical institutions, health workers, settling in their workplaces, thought, first of all, about their own cosiness and comfort, and last of all, about how patients who came to the appointment felt like that. This was manifested, firstly, in the irrational arrangement of furniture, which creates inconvenience for patients. Secondly, the interests of visitors to medical institutions were sacrificed to the desire of chief physicians to save on water and light: the caretaker unscrewed the light bulbs in the common areas, closed the doors to the toilet rooms, considering them superfluous70. Faced with such domestic turmoil, the workers strove to avoid going to the doctor, especially if there was no serious need for this. As a result, such important events as a medical examination or medical examination turned into a formality, and this, in turn, led to a decrease in the quality of life of people. Nevertheless, compared with the period of "Khrushchev's thaw" in 1965-1985. highly qualified specialized medical care has nevertheless become more accessible to the population, especially the rural population. So, in the Saratov region for 1953-1964. we found in archival documents 62 references to the increase in the incidence of rural residents, and over the next 20 years - only twenty such references, and the overwhelming majority of this concerned the adult population. Information about the incidence of children was extremely rare, which once again proves the effectiveness of the "Physical Culture and Sport" project, the implementation of which began in 1966. highly qualified specialized medical care has also become more accessible, since, as it is clear from the above, the provision of beds for the population was higher than the national average.

The existing differences in the degree of accessibility of medical care to workers in each of the regions of the Lower Volga are explained by the status of a particular subject of the region and the resulting amount of funding, as well as the ability of local authorities to defend the interests of the population of a given region or republic before the federal or republican government. In a relatively privileged position in this respect were residents of the hero city of Volgograd and Saratov, which was closed to foreigners. The population of Astrakhan and Elista, with the exception of the party nomenklatura, was deprived of any advantages. Nevertheless, during the pre-perestroika thirty years, specialized medical care became an integral part of the everyday life of an ordinary Soviet person, which contributed to a significant improvement in the quality of his life.

Notes

1 History of the Astrakhan region. Astrakhan, 2000, p. 800.

2 See: GARF. F. A-482. Op. 50. D. 214. L. 54; Volga. 1953. 14. 02. L. 3; 21.10. L. 3; 25.11. L. 3.

3 See: GANISO. F. 594. Op. 2. D. 2888. L. 12-13; D. 3052. L. 119-120.

4 See: GAVO. F. R-523. Op. 1. D. 124. L. 142-143; D. 336. L. 24, 45-46; F. R-2115. Op. 6. D. 301. L. 204; Stalingrad truth. 1953. 10. 01. L. 3; 17. 03. L. 3; 1955. 3. 09. L. 3. 16. 09. L. 3.

5 of the CPSU in resolutions and decisions of congresses, conferences and plenums of the Central Committee. T. 8. 1946-1955 M., 1985. S. 344.

6 See: GANISO. F. 594. Op. 2. D. 2728. L. 275; D. 4522, L. 5a; F. 129. Op. 31. D. 29. L. 4; RGANI. F. 3. Op. 3. D. 18. L. 12; CPSU in resolutions ... T. 8. S. 368, 528; T. 9. 1956-1960. M., 1986. S. 48-487; Resolutions of the XX Congress of the Communist Party of the Soviet Union. February 14-25, 1956. M., 1956. S. 85-85; SP USSR 1957. No. 16. Art. 162; SP RSFSR 1960. No. 4. Art. 9 ; Materials of the Extraordinary XXI Congress of the CPSU. M., 1959. S. 239; Materials of the XXII Congress of the CPSU. M., 1962. S. 76, 392.

7 See: SP USSR. 1960. No. 3. Art. fourteen ; GANISO. F. 594. Op. 2. D. 3854. L. 14-15v.

8 See: RGANI. F. 3. Op. 31. D. 21. L. 23; Plenum of the Central Committee of the CPSU March 5-9, 1962. Verbatim report. M., 1962. S. 394.

9 See: SP USSR. 1957. No. 5. Art. 54; 1962. No. 7. Art. 58; Health legislation. T. VI. M., 1963. S. 647-649.

10 See: GANISO. F. 594. Op. 2. D. 3854. L. 6, 57-58 a.

11 See: Health legislation. T. IV. M., 1960. S. 196-200, 227-233, 238-241, 251-255; T. VI. pp. 201-202, 234-235, 299-301; RGANI. F. 3. Op. 31. D. 21. L. 109.

12 See: SP USSR 1959. No. 19. Art. 158; 1964. No. 24. Art. 142; 1968. No. 14. Art. 91; SP RSFSR. 1960. No. 11. Art. 46; 1969. No. 9. Art. 45.

13 See: GANISO. F. 594. Op. 2. D. 3439. L. 71; TsDNIVO. F. 113. Op. 52. D. 1. L. 67.

14 In 1955, there were 2459 doctors in the Stalingrad region, and only 1301 doctors in the Saratov region. (See: GAVO. F. R-523. Op. 1. D. 453. L. 25; GANISO. F. 594. Op. 2. D. 3334. L. 233, 239.)

15 See: Volga. 1959. 10.02. L. 3; 1964. 25.01. L. 3.

16 GARF. F. A-259. Op. 42. D. 6028. L. 1 rev.

17 See: RGANI. F. 89. Op. 61. D. 13. L. 1-7.

18 Calculated according to: GARF. F. A-259. Op. 42. D. 1959. L. 29.

19 During the period from 1960 to June 1964, 147 thousand rubles were spent on the purchase of medical equipment. (See: Doynikova E.A., Sysoev P.N. On the experience of health // 50 years under the banner of October. Elista, 1967. P. 180.)

20 See: Essays on the history of the Kalmyk ASSR. The era of socialism. M., 1970. S. 358; National Economy of the RSFSR in 1960. Statistical Yearbook. M., 1961. S. 521, 532, 536.

21 See, for example: GAVO. F. R-523. Op. 1. D. 336. L. 45; Volga. 1956. 26.01. L. 1; 30.11. L. 1; Komsomolets of the Caspian. 1960. 16.12. L. 3.

22 See: National Economy of the RSFSR in 1960, pp. 521, 532, 536.

23 See: Vodolagin M.A. Essays on the history of Volgograd. M., 1969. S. 418; GANISO. F. 136. Op. 19. D. 88, L. 129.

24 See: GARF. F. A-482. Op. 50. D. 1229. L. 35; GANISO. F. 74. Op. 34. D. 43. L. 26; F. 2329. Op. 35. D. 57. L. 64; D. 78. L. 103; GASO. F. R-1738. Op. 3. D. 932. L. 4.

25 See: GANISO. F. 594. Op. 2. D. 4914. L. 54-55; Communist. 1962. 30.10. L. 3.

26 See: GANISO. F. 2485. Op. 26. D. 1. L. 77; F. 136. Op. 14. D. 1. L. 176; Op. 19. D. 18. L. 169-169v. ; GASO. F. R-1738. Op. 3. D. 1294. L. 2; D. 1239. L. 2; Soviet Kalmykia. 1961. 12.12. L. 4.

27 See: GANISO. F. 594. Op. 2. D. 3334. L. 266, 274, 301-302.

28 Calculated from: GANISO. F. 1012. Op. 1. D. 268. L. 215.

29 See: GASO. F. R-1738. Op. 4. D. 199. L. 3, 10-11; Op. 7. D. 613. L. 23.

30 Komochkov A. V. Analysis of the incidence of osteoarticular tuberculosis in Volgograd // Healthcare in the Volgograd region. Volgograd, 1963, p. 4.

31 See: GAVO. F. R-523. Op. 1. D. 453. L. 24. D. 858. L. 23.

32 See: Essays on the history of the Kalmyk ASSR. pp. 353, 373; Soviet Kalmykia. 1957. 22.09. L. 3

33 See: GANISO. F. 594. Op. 2. D. 3052. L. 86; D. 4864. L. 59.

34 See: VodolaginM. A. Decree. op. S. 418; CPSU in resolutions ... T. 11. 1966-1970. M., 1986. S. 318.

35 See: GASO. F. R-1738. Op. 4. D. 199. L. 4v., 24; Op. 7. D. 613. L. 6.

36 See: GANISO. F. 1012. Op. 1. D. 268. L. 210-211.

37 Ibid. F. 5411. Op. 1. D. 1. L. 35; F. 1012. Op. 1. D. 136. L. 10, 12, 19v., 20v. - 21 rev., 23 rev. - 24v., 41.

38 Calculated according to: GASO. F. R-1738. Op. 1. D. 1068; GAVO. F. R-2115. Op. 6. D. 1877, 2026.

39 Soviet Kalmykia. 1963. 26.11. L. 3.

40 See: History of the Astrakhan region. S. 834; Volga. 1959. 20.01. L. 3; 21.01. L. 3; 1962. 10.01. L. 3.

42 See: Materials of the XXIII Congress of the CPSU. M., 1966. S. 162, 262-263; Materials of the XXIV Congress of the CPSU. M., 1972. S. 181; Materials of the XXV Congress of the CPSU. M., 1976. S. 123, 220; Materials of the XXVI Congress of the CPSU. M., 1981. S. 106, 182, 183; SP USSR 1966. No. 9. Art. 93; 1973. No. 25. Art. 144; SP RSFSR 1968. No. 15. Art. 76; Food program of the USSR for the period up to 1990 and measures for its implementation: materials of the May Plenum of the Central Committee of the CPSU 1982. M., 1984. S. 58, 103.

43 SP USSR. 1968. No. 13. Art. 82.

44 See: CPSU in resolutions ... T. 13. 1976-1980. M., 1987. S. 206-211, 215-216; T. 14. 1981-1984. M., 1987. S. 366-368.

45 See: Yu. V. Andropov. Leninism is an inexhaustible source of revolutionary energy and creativity of the masses.

Selected speeches and articles. M., 1984. S. 478, 480; CPSU in resolutions ... T. 14. S. 523-524.

46 See: Volgogradskaya Pravda. 1968. 14.02. L. 3; 1976. 17.02. L. 3.

47 See: Essays on the history of the Kalmyk ASSR. S. 391; Su-seev P. Ya. Achievements of health care in Kalmykia during the years of Soviet power // Healthcare of the Russian Federation. 1978. No. 11. S. 9.

48 See: Kommunist. 1965. 11. 07. L. 3; GASO. F. R-1738, Op. 8. D. 1304. L. 33.

49 Calculated from: Volga. 1971. 21.01. L. 2; 1976. 1.01. L. 3; Volgograd truth. 1971. 23.01. L. 2; TsDNIVO. F. 113, Op. 98. D. 1. L. 30; Op. 110. D. 3. L. 13; GANISO. F. 594. Op. 14. D. 99. L. 128; GASO. F. R-1738. Op. 8. D. 1189. L. 4; Op. 8-ave. D. 1774. L. 15; Soviet Kalmykia. 1971. 20.01. L. 2; 1981. 23.02. L. 3; 1986. 21.01. L. 2; National Economy of the RSFSR in 1975. Statistical Yearbook. M., 1976. S. 416; National Economy of the RSFSR in 1980. Statistical Yearbook. M., 1981. S. 305; National Economy of the RSFSR in 1984. Statistical Yearbook. M., 1985. S. 364, 365; National Economy of the RSFSR in 1985. Statistical Yearbook. M., 1986. S. 360, 361.

50 See: Volga. 1986. 7.02. L. 3; Soviet Kalmykia. 1981. 5.11. L. 2; National economy of the RSFSR in 1985. S. 362, 363; Communist. 1986. 1.02. L. 2; GANISO. F. 594. Op. 33. D. 1. L. 137.

51 See: GANISO. F. 5. Op. 56. D. 1. L. 60; F. 196. Op. 51. D. 1. L. 74; Op. 65. D. 1. L. 45; F. 4816. Op. 44. D. 1. L. 19.

52 See: Petrova V. Ya. Problems of rural life in the activities of the party organizations of the Lower Volga region (1965-1975): dis. ... cand. ist. Sciences. Saratov, 1988. S. 132, 134-135; GANISO. F. 594. Op. 18. D. 1. L. 27; GAVO. F. R-523. Op. 1. D. 1600. L. 51; TsDNIVO. F. 113. Op. 110. D. 96. L. 101-102; Soviet Kalmykia. 1983. 29.10. L. 3.

53 See: Kommunist. 1970. 9.09. L. 4; Volga. 1976. 24.03. L. 2; GAVO. F. R-523. Op. 1. D. 1318. L. 149.

54 Calculated according to: GASO. F. R-1738. Op. 8. D. 139, 1108.

55 See: Petrova V. Ya. Decree. op. S. 136; GANISO. F. 138. Op. 44. D. 35. L. 10.

56 See: History of the Astrakhan Territory. S. 839.

57 Calculated according to: Naminov L. V. History of the organization of health care and medical care in the Kalmyk ASSR: author. dis. ... Dr. med. Sciences. Rostov n / D, 1968. S. 14.

58 See: Soviet Kalmykia. 1973. 16.06. L. 4; Suse-ev P. Ya. Decree. op. S. 9.

59 See: GANISO. F. 138. Op. 44. D. 35. L. 12; Communist. 1986. 1.02. L. 2.

60 See: Volgogradskaya Pravda. 1986. 1.02. L. 2; Volga. 1986. 7.02. L. 3; Soviet Kalmykia. 1986. 25.01. L. 3.

61 See, for example: Reznikov VD Stages of development of Soviet health care in Saratov // 50 years of Soviet health care in Saratov. Saratov, 1969. S. 11-12; GANISO. F. 594. Op. 32. D. 147. L. 3, 6, 10, 13, 17, 19, 24, 38, 40, 45, 46; F. 77. Op. 41. D. 1. L. 52; F. 3509. Op. 46. ​​D. 1. L. 61; F. 196. Op. 65. D. 24. L. 52.

62 See: GANISO. F. 594. Op. 15. D. 3. L. 4-5; Op. 32.

D. 138. L. 11; F. 4254. Op. 28. D. 12. L. 14; Op. 29. D. 9. L. 19; F. 138. Op. 30. D. 1. L. 81; F. 5. Op. 60. D. 15. L. 6; F. 341. Op. 29. D. 16. L. 14, 17; TsDNIVO. F. 113. Op. 98. D. 1. L. 47.

63 Calculated according to: GASO. F. R-1738. Op. 8. D. 1108; Op. 8-ave. D. 1588 a, 1588 b, 2538.

64 See, for example: GAVO. F. R-2115. Op. 11. D. 1207. L. 30; D. 1348. L. 104; TsDNIVO. F. 113. Op. 110. D. 3. L. 53; D. 96. L. 102, 108.

65 See: Suseev P.Ya. Decree. op. S. 9; Soviet Kalmykia. 1981. 5.11. L. 2.

66 See: Pages of life. The history of the Kirovsky district

in Saratov (1936-2001). Saratov, 2001, p. 93; GANISO. F. 85. Op. 56. D. 1. L. 51.

67 See: GAVO. F. R-523. Op. 1. D. 2050. L. 72;

68 See: GANISO. F. 5. Op. 56. D. 1. L. 35; F. 77. Op. 45. D. 14. L. 18; F. 196. Op. 65. D. 15. L. 30-31; F. 470. Op. 46. ​​D. 1. L. 56; F. 3193. Op. 46. ​​D. 1. L. 78.

69 See: Soviet Kalmykia. 1981. 5.11. L. 2; 1983. 26.10. L. 3; 29.10. L. 3.

70 See: Made in the USSR. M., 2001. S. 194-195.

71 Materials of the XXIII Congress of the CPSU. S. 162; Materials of the XXV Congress of the CPSU. S. 222; Materials of the XXVI Congress of the CPSU. pp. 106, 183.

Health care of the USSR in the post-war period (1952-1991)

During these years, there were searches for new forms and methods of providing medical and preventive care to the population.

A reform of health care management in rural areas was carried out. The district health departments were abolished, and all administrative and economic functions in relation to the health care institutions of the district were transferred to the district hospital, the chief physician of which became the chief physician of the district. Central district hospitals have become organizational and methodological centers of qualified medical care.

In the 1960s, along with the further development of the network of medical institutions, more and more attention was paid to the development of specialized services, providing the population with emergency and emergency medical care, dental and radiological care. Specific measures were taken to reduce the incidence of tuberculosis, poliomyelitis, and diphtheria. Minister of Health SV Kurashov considered the construction of large multidisciplinary hospitals and an increase in the capacity of existing central district hospitals to 300-400 beds with all types of specialized care as the general line for the development of healthcare.

More attention began to be paid to the organization of medical care for patients with pathology of the respiratory organs, cardiovascular, oncological, and allergic diseases.

However, it was more and more clearly seen that the results of the activities of the health authorities no longer corresponded to the needs of the population, the urgent tasks of the time.

Financing of health care continued to be carried out on a residual basis. Compared with other countries of the world, where funding is assessed based on indicators of the share of national income going to health care, in the 1970s and 1980s, the USSR ranked in the 7th ten countries. An assessment of the share of the state budget allocated for these purposes showed that this share was steadily declining: 1960 - 6.6%, 1970 - 6.1%, 1980 - 5.0%, 1985 - 4 .6%, 1993 - 3.5%. The increase in appropriations in absolute terms barely covered the costs associated with the growth of the country's population.

Health care began to be included in the service sector, the attention of the administrative and managerial apparatus to the protection of people's health decreased.

The preventive direction of medicine in its traditional sense as the fight against mass, mainly infectious, acute diseases through sanitary and anti-epidemic measures has begun to exhaust itself. One of the reasons for this is the rapid transformation of pathology: the increasing prevalence of non-epidemic chronic diseases, which formed the basis of the modern structure of mortality and morbidity. New issues emerged related to the underestimation not only in the 1930s and 1940s, but also in the 1950s and 1960s, of environmental and occupational health problems. Thus, as before, the declared preventive direction was not carried out in practice, the medical section of work prevailed among doctors, while doctors were engaged in prevention formally, often “for reporting”.

A special place belongs to the importance of extensive ways of health care development. There is no doubt that at a certain stage of development, when many health problems were associated with a lack of doctors, hospitals, polyclinics, sanitary and epidemiological institutions, these ways played their role. But they could lead to success only to a certain extent, under certain conditions. The moment was missed when it was necessary to make a qualitative leap from quantitative indicators of health care development on the basis of additional funding, a different approach to the use of resources, the search for new forms and methods of work of all parts of health care with the inclusion of material incentives, with new approaches to training personnel. Despite the continued growth of the network and the number of medical personnel, the provision of the population with doctors and beds was far from desirable, the availability of highly qualified and specialized care decreased and was insufficient even in cities. The shortage of medicines, medical devices and equipment did not disappear. The morbidity and mortality of the population decreased at an insufficient pace. Tasks in the field of healthcare were determined by the resolutions of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve healthcare" (1960, 1968, 1977, 1982): to develop long-term plans for the development and rational placement of a network of outpatient clinics, taking into account the number and structure the population, bearing in mind the full provision of the population with all types of highly qualified and specialized medical care, the expansion of the volume of mass preventive examinations and medical examinations; to carry out the construction of large, predominantly independent polyclinics with a capacity of 750 or more visits per shift; when deploying new treatment and diagnostic rooms in polyclinics, strictly observe sanitary standards; to ensure a fundamental improvement in the organization of the work of registries, taking into account specific conditions, to introduce new forms and methods of their work: self-registration of patients, expanding information on the opening hours of medical, diagnostic and treatment rooms, pre-registration by phone and others, to use automated systems for these purposes more widely; expand the introduction of progressive forms and methods of organizing the work of doctors in the activities of health care institutions, aimed at maximizing their release from work not directly related to the examination and treatment of patients (dictaphone method of documentation, the use of cliché stamps, prescription books, etc.). ); to organize, in agreement with the executive committees of local Soviets of People's Deputies, the mode of operation of polyclinic institutions, ensuring the provision of specialized medical care in the required volume by medical, diagnostic, X-ray rooms and laboratories during off-hours on all days of the week, incl. Saturdays, and on Sundays and holidays, ensure the duty of general practitioners to receive patients in the clinic and provide medical care and perform medical appointments for patients at home; to carry out in 1978 - 1985 the disaggregation of territorial therapeutic and pediatric areas, bringing the number of adults served per district general practitioner in 1982 to an average of 2 thousand people and by 1985 to an average of 1.7 thousand people, and the number serviced children per district pediatrician by 1980 - 1982, an average of up to 800 people. To ensure, starting from 1978, an annual increase in the number of medical posts of district therapists and pediatricians and their full staffing with doctors; to establish, starting from 1978, specific annual assignments to the regional (territorial) health departments and the ministries of health of the autonomous republics on the division of medical districts and the increase in the number of positions of district therapists and pediatricians. Exercise strict control over the observance of planned discipline in the field; To improve the work of emergency and emergency medical care institutions, to strengthen their material and technical base, to expand the construction of ambulance stations and substations according to standard designs; to ensure by 1985 in all regional, regional, republican centers and large industrial cities the organization of emergency hospitals, combined with ambulance stations; ensure the further development of emergency specialized medical care, primarily the organization of cardiological teams, intensive care teams, pediatric, toxicological, traumatological, neurological and psychiatric teams. Order of the Ministry of Health of the USSR of October 31, 1977 N 972 On measures to further improve public health (from the site http://www.bestpravo.ru)

Much of these decrees also remained at the level of declarations; instead of cardinal decisions, optional half-measures were provided.

On the other hand, the forms and methods of medical and preventive care that have developed over decades have largely justified themselves and received international recognition. WHO positively assessed the principles of Soviet health care. The international meeting in Alma-Ata (1978) under the auspices of WHO recognized the organization of primary health care in the USSR, its principles as one of the best in the world.

During these years, a lot of work has been done to improve the quality of training of doctors. Curricula and training programs are being improved in medical institutes, the 6th year is being introduced - subordination and after graduation - internship with an exam in the main specialty. "PUBLIC HEALTH AND HEALTH" Ed. prof. V.A. Minyaeva, prof. N.I.Vishnyakova Sixth edition, 2012 / pp. 36-37

On December 26, 1991, the USSR collapsed. Political, economic and social changes have led to the need to revise the system of medical and preventive care for the population.

Thus ends a huge chapter in the history of Russia called "Soviet health care." For 74 years, the state managed to build a strong health care system (despite all the difficulties that the USSR went through), which causes admiration and respect from everyone who got acquainted with the formulation of health care in the USSR.

After the revolutionary devastation of the early 20th century, the government and part of the medical community came to the conclusion that the only way for the existence and development of healthcare in the young republic was the concentration of resources and the centralization of management and planning of the industry. At the V All-Russian Congress of Soviets, which adopted the new Constitution of the RSFSR, on July 11, 1918, the People's Commissariat of Health was established. N.A. was appointed the first people's commissar. Semashko, his deputy - Z.P. Solovyov.

Nikolai Semashko based the health care system he proposed on several ideas:

• unified principles of organization and centralization of the healthcare system;


• equal access to healthcare for all citizens;


• priority attention to childhood and motherhood;


• unity of prevention and treatment;


• elimination of the social foundations of diseases;


• public involvement in health care.

A coherent system of medical institutions was built, which made it possible to ensure uniform principles for organizing healthcare for the entire population, from remote villages to capital cities: a feldsher-obstetric station (FAP) - a district clinic - a district hospital - a regional hospital - specialized institutes. Although the departmental medical institutions of the army, railway workers, miners, etc., still remained.

The availability of health care was ensured by the fact that medical care was free, all citizens were attached to local polyclinics at their place of residence and, depending on the complexity of the disease, could be sent for treatment higher and higher on the steps of the healthcare pyramid.

A specialized system of medical institutions for children was organized, repeating the system for adults, from the local polyclinic to specialized scientific institutes. The medical system paid special attention to the issues of motherhood and birth. To support motherhood and infancy, the same vertical system was organized - from women's clinics (the number of which increased from 2.2 thousand in 1928 to 8.6 thousand in 1940) and district maternity hospitals, again to specialized institutes. For young mothers, the best medicines and conditions stood out, and training in obstetrics and female gynecology was considered one of the most prestigious medical fields. In parallel with this, the government itself stimulated the birth of a new generation, paying solid subsidies for children. A network of specialized children's polyclinics was also created, which contributed to a serious reduction in child mortality rates. Thus, the population of the country almost doubled in the first 20 years.

Another important reform was the prevention of diseases, as well as the elimination of the initial causes of their occurrence, both medical and social. At various industrial enterprises of the country, which at that time were created at a high speed, medical units were organized, which were engaged in the detection, prevention and treatment of occupational diseases. They also provided first aid in case of occupational injuries of varying severity, and supervised the appointment of workers to actively built health resorts.

Prevention was understood by Semashko both in the narrow and in the broad sense. In a narrow sense - as sanitary measures, in a broad sense - as a health improvement, prevention and prevention of diseases. The task of every doctor and the entire system of medical institutions, according to Semashko, was not only to cure, but to prevent the disease, which was considered as a result of unfavorable social conditions and an unhealthy lifestyle. In this regard, special attention was paid to such social diseases as venereal, tuberculosis and alcoholism. For this, a system of appropriate dispensaries was created, which were supposed not only to treat, but also to monitor the living conditions of patients, informing the authorities about the non-compliance of these conditions with sanitary standards and the potential threat that patients could pose to others.

An important preventive measure, according to Nikolai Semashko, was vaccination, which for the first time took on a nationwide character and helped to eradicate many contagious diseases, and sanitary and hygienic propaganda, which received great attention as one of the means of preventing epidemics and promoting a healthy lifestyle.

Rest houses and sanatoriums were naturally included in the harmonious system of rehabilitation, prevention and health care. The sanatoriums, the stay in which was part of the treatment process, were subordinated to the People's Commissariat of Health, and the rest houses were subordinated to the trade unions, that is, the public, or, in modern terms, civil society, which was supposed to monitor the recovery of workers.

By a decree of the Central Executive Committee and the Council of People's Commissars of the USSR of December 23, 1933, the State Sanitary Inspectorate was established to manage the work of the bodies of the state sanitary anti-epidemic service throughout the country.

VIII Extraordinary Congress of Soviets of the USSR on December 5, 1936 adopted a new Stalinist Constitution of the USSR, which, by Article 124, was the first in the world to guarantee the right of citizens to free healthcare.

By 1950, the war-ravaged economy had been restored. The number of medical institutions, hospital beds, doctors not only reached the pre-war level, but also significantly exceeded it. In 1950, there were 265 thousand doctors (including dentists) and 719.4 thousand paramedical workers in the country, 18.8 thousand hospitals with 1010.7 thousand beds worked. and feldsher-obstetric stations. Since the 1950s, allocations for health care have increased year by year, and by 1965, over 4 post-war five-year plans, funding had reached a record figure of 6.5% of GDP. It was possible to increase by an order of magnitude all the main indicators of the material and economic base of health care. The number of doctors from 14.6 per 10 thousand people. the population in 1950 rose to 23.9 in 1965; paramedical workers from 39.6 to 73.0; hospitalization in cities increased at this time from 15% of the population to 20.1%, in rural areas - from 7.7% to 18.9%; the number of hospital beds increased from 57.7 to 96.0 per 10,000 population; the number of clinics and outpatient clinics reached 36.7 thousand, antenatal clinics and clinics for children - 19.3 thousand (Source: The System of Public Health Services in the USSR / By red. U.P. Lisitsin. - M .: Ministry of Health of the USSR, 1967. - R. 44.)

Since 1948, under the Minister of Health of the USSR E.I. Smirnov, a reform was carried out aimed at restructuring the structure of the healthcare organization, it was planned to unite hospitals and polyclinics, create so-called central (CRH) and simply united (numbered) hospitals in the districts, as well as change the subordination sanitary and epidemiological service, according to which district SES became independent institutions. Subsequently, the entire sanitary and epidemiological supervision service became independent, was separated from the subordination of the Ministry of Health.

In the 1960s developed a new branch of medicine - space medicine. This was due to the development of cosmonautics, the first flight of Yu. A. Gagarin on April 12, 1961, and other events in this area.

In the 60-70s, under the Ministers of Health S.V. Kurashov and B.V. Petrovsky, steps were taken towards the intensive development of the industry.

Along with the further development of the network of medical institutions, more and more attention was paid to the development of specialized services, providing the population with emergency and emergency medical care, dental and radiological care. more) and increasing the capacity of existing central district hospitals to 300-400 beds with all types of specialized care (In therapy, separate specialties began to stand out and develop (cardiology, pulmonology, etc.).

Surgery advanced by leaps and bounds, as the principles of microsurgery, transplantation and prosthetics of organs and tissues were developed. In 1965, the first successful living donor kidney transplant was performed.) This was the general line of public health development.

In the mid 1970s. Diagnostic centers were actively opened and equipped, maternal and child health was improved, and much attention was paid to cardiovascular and oncological diseases.

Despite all the achievements, by the end of the 1970s. Soviet medicine experienced a period of decline due to insufficient funding and the underdevelopment of certain state health programs.

In the 1970s, an experiment began to strengthen the economic independence of health authorities and institutions. This is already a departure from the traditional Soviet health care system - from its purely budgetary version and completely state regulation. Chief physicians receive the right to operate with financial resources according to the estimates of medical institutions. This limited-scale experiment became the forerunner of the introduction of a new economic mechanism (NHM), which develops self-supporting relations, establishes new economic principles for the distribution of funds (not for institutions, but for residents of the territories); strengthening the economic independence of regions and districts; allowing paid medical services; obliging to determine wages by the quantity and quality of work of physicians. And already in the late 80s. the difficult financial condition of budgetary hospitals led to the introduction of NCM in a number of regions of the USSR. The National Art Museum caused changes in the structure of the governing bodies of medical institutions, in particular, the creation of so-called territorial medical associations in a number of regions. Many medical institutions have transferred their activities to the principles of self-supporting and received the right, along with budget financing, to receive income from other sources, and, above all, from the provision of paid services. From that moment, the transition from a rigid system of budgetary financing of health care to a multi-channel system began.

The experiment in the form of NCM health care provided for:

· the transition from the allocation of funds from the budget to health care facilities for individual items of expenditure to financing according to long-term stable standards that comprehensively reflect the targeted activities of institutions;

· combination of budget financing with the development of additional paid services to the population, as well as the performance of work under contracts with enterprises and organizations on a self-supporting basis;

· development of independence and initiative of the labor collectives of health care institutions in solving the main issues of production activity and social development;

Establishing a close relationship between the size of the funds for the production and social development of healthcare facilities and the remuneration of each employee from the final results of the activities of the institution (subdivision),

· the use of various forms of management, including intra-system lease relations, cooperative and other activities.

For territorial polyclinics and territorial medical associations, the norms of budget financing were established per capita standard. Polyclinics had to pay for inpatient treatment of patients living on their territory under the system of advance reimbursement of costs based on the average cost per patient treated, taking into account the profile of the bed; ambulance services and consultative and diagnostic centers. Polyclinics were interested in reducing the cost of inpatient treatment, in connection with this, day hospitals and outpatient surgery centers in polyclinics, as well as home hospitals, were greatly developed.

Along with budgetary funds, health care facilities got the opportunity to use additional sources of funding, including:

paid services to the population and enterprises;

· social insurance funds saved as a result of a decrease in morbidity with temporary disability;

Voluntary contributions from enterprises, institutions and citizens, etc.

The NHM failed to solve the health care financing problems. There were many reasons for this. Firstly, budgetary funds were allocated, all in smaller amounts and could not ensure the normal functioning of medical institutions. And additional income could not ensure even the meager functioning of health facilities, and it is not necessary to consider them as a serious source of financing.

(NXM was a prerequisite for a multi-channel system of financing healthcare facilities after the collapse of the USSR).

But this system is already beginning to deviate from the given canons of the Semashko system.

The structuredness of the Semashko system is often cited for its lack, since patients were attached to a certain doctor, to a certain hospital, then patients could not choose a doctor and a medical institution, which made competition between them impossible. This "liberal" shortcoming, which was most likely invented by contemporaries. Competition between hospitals or doctors of Russian-Soviet doctors is generally nonsense. The traditions of Soviet medicine provided for mutual assistance and collegiality.

The main problem of the Semashko system is called underfunding. But is this really a problem for the healthcare industry itself? This is the problem of the whole state! And this generally does not characterize the system itself.

Financing of health care began to be carried out according to the residual principle. An assessment of the share of the state budget allocated for these purposes showed that this share was steadily declining: 1960 (65) - 6.6% (6.5%), 1970 - 6.1%, 1980 - 5 .0% 1985 - 4.6%, 1993 - 3.5%. The increase in appropriations in absolute terms barely covered the costs associated with the growth of the country's population. Health care began to be included in the service sector, the attention of the administrative and managerial apparatus to the protection of people's health decreased.

At the same time, health care expenditures amounted to 20th century per capita: in the USA - $2000, Turkey - $150, in Russia - $50. The residual principle of financing the healthcare industry has led to the fact that the state of health of the population of the Russian Federation began to deteriorate constantly.

De facto, with the collapse of the Soviet Union, funding for the healthcare industry collapsed sharply. The total discrediting of the Semashko system and the Soviet health care system in general began. There was a paid part of the previously free health care. Medicine was divided into paid for the wealthy and public for the poor.

The Great October Socialist Revolution and the building of socialism opened up new paths of development for medicine and public health. Protecting the health of the people has become one of the most important functions of the state. A wide network of medical institutions and universities was created. The organizational principles of health care formulated already in the first years of Soviet power proceeded from the Marxist provisions developed by V. I. Lenin on the social conditionality of public health, the tasks of building a socialist state that takes care of the health of workers through socio-economic and medical measures.

The material and technical base of medical science was created. The State Institute of Public Health became the prototype of subsequent more powerful associations of medical research institutes. The All-Union Experimental Medicine Institute named after A. M. Gorky was organized as a complex institution designed to synthesize the natural sciences, in particular, experimental biology and medicine. The successes of medical science and Soviet health care have led to significant changes in the state of health of the population. Many epidemic diseases were eliminated, the overall mortality in 1940 decreased to 18.3% per 1,000 inhabitants, when in 1913 this figure reached 30.2%.

The war with fascist Germany required the creation of a scientifically based organization of medical care for the wounded and sick. The precise work of the medical service of the army made it possible to return to service after treatment 72.3% of the wounded and over 90% of the sick. For the first time in the history of mass wars, it was possible to prevent the outbreak of epidemics and to eliminate the sanitary consequences of war relatively quickly. The results of this work were summed up in a collective scientific work - a multi-volume publication "The experience of Soviet medicine in the Great Patriotic War of 1941-1945."

In 1944, despite the difficulties of wartime, the Academy of Medical Sciences of the USSR was established, which united the leading medical research institutes and led the development of problems in medical science. In the postwar years, scientific research in the field of medicine acquired a particularly wide scope. In 1972, more than fifty-five thousand scientists were doing research work in more than 350 research institutions and more than 100 medical and pharmaceutical institutes, at medical faculties of universities and at institutes for the improvement of doctors.

In 1972, there were 731,000 doctors, of which 29,000 doctors accounted for 10,000 inhabitants. The number of beds in hospitals increased in the same year to 2,793,000, and in 1940 there were 791,000. Overall mortality has decreased by almost 4 times, child mortality - by more than 10 times, the average life expectancy has increased from 32 to 70 years.

Theoretical medicine, based on the methodology of dialectical materialism, developed in the struggle with both mechanistic and idealistic understanding of the problem of causality and mechanisms of disease development. Already in the 1920s, attempts were made to revise the general doctrine of the disease, etiology and pathogenesis. The study of the problem of causality in medicine led to the conclusion that it is necessary to distinguish between the main cause, without which the disease in its qualitative specificity cannot develop, and conditions that are not capable of causing the disease, but affect its occurrence, course and outcome.

Many studies have revealed the inconsistency of attempts to build a theory of disease on the basis of particular patterns relating to the role of the endocrine, autonomic and other individual systems in the process of illness and recovery. At the present stage of the development of medical science in the USSR, the problem of disease is being solved as a problem of a multifaceted disturbance of the regulation of functions, involving various levels of the nervous, endocrine, connective tissue, and other physiological systems down to the molecular level. Recognizing the great importance of internal factors - heredity, constitution and others, Soviet medical science believes that the real source of disease must be sought in the adverse effect on the body of environmental factors - physical, biological and social, taking into account at the same time that the effect of various causes of diseases on of a person depends on working conditions, life, the nature of socio-economic relations and the state of the organism itself, which is not passive, but actively relates to the influences of the external environment.

The works of Soviet physiologists had a great influence on the development of the theory of medicine. The physiological direction not only became the leading one in Soviet theoretical medicine, but also was the embodiment of a creative union of physiologists and clinicians, having been applied in various clinical disciplines. Thus, G. F. Lang and his school developed the concept of hypertension as a neurosis of the vasomotor centers. Neuropathologists and psychiatrists used the doctrine of higher nervous activity to explain the pathogenesis of neuroses and some psychoses. The materialistic reflex theory, which established the dependence of human consciousness on the environment, had a decisive influence on the development of Russian psychiatry, which in the USSR took a pronounced physiological direction.

A distinctive feature of medicine in the USSR and other socialist countries is its preventive direction. In the conditions of free, publicly available and highly qualified medical care to the population, prevention has acquired national importance, has become the basis for the protection of the health of the people by the state and society. The solution of its tasks in the USSR, and then in other socialist countries, merged with the transformation of the human environment. The forms of prevention are different: the implementation of general sanitary measures to protect nature and improve the environment, living and working conditions; control over the implementation of sanitary legislation, hygiene standards, anti-epidemic measures; organization of a network of medical institutions, rest homes, sanatoriums, orphanages, boarding schools, nurseries; conducting mass preventive examinations of the population and much more. The most important method of synthesizing prevention and treatment is clinical examination. The implementation of a system of preventive measures made it possible to achieve significant results in the fight against so-called social diseases (venereal diseases, tuberculosis, and others).

The preventive direction determined the characteristic features of the clinic of internal diseases in the USSR: interest in the study of pre-morbid conditions, a thorough analysis of the social factor in the etiology of the disease, the doctrine of labor prognosis, and connection with healthcare practice. In pediatrics, obstetrics and gynecology in Soviet times, this direction became the leading one, which found expression in the state system for the protection of motherhood and childhood. A reflection of the preventive direction of public health is the creation of a network of resorts and the foundations of social balneology first developed in the USSR. The founders of social hygiene in the USSR N. A. Semashko, Z. P. Solovyov, A. V. Molkov and others, relying on the Marxist position on the leading role of social conditions in the occurrence and prevention of diseases, developed the theoretical foundations of Soviet health care and outlined social conservation measures and restoration of public health. The goals of prevention are health education, as well as the activities of the Union of Red Cross and Red Crescent Societies of the USSR.

The preventive direction, the state, social character of medicine, public health planning and other principles, embodied in practice in the USSR and other socialist countries, are finding growing international recognition. The 23rd World Health Assembly, at the initiative of the USSR delegation, adopted resolutions in which it recommends as the most effective principles for building and developing national health systems “declaration of the responsibility of the state and society for protecting the health of the population”, “creating a single national plan” (health), “ carrying out measures of public and individual prevention”, providing the entire population with “qualified and free preventive and medical care”, etc. A new stage in the implementation of state measures to improve the working and living conditions of the Soviet people is associated with the “Fundamentals of the legislation of the USSR and the Union republics on health care” . The protection of the health of the population is recognized not only as the work of doctors and the state medical department, but also as the duty of everyone before the Law.

Medicine faces important tasks of studying the nature of cardiovascular diseases and malignant tumors, ways of their prevention and treatment; development of problems of molecular biology of viruses, chemotherapy and prevention of viral infections, immunology and many others. Consideration of the ever-increasing impact of environmental factors, scientific and technological progress on human health and work capacity, anticipation of the consequences of these impacts and the development of scientifically based measures to improve the environment are of great importance.

The growing importance of medical science and health care as a branch of the national economy, an expanding sphere of human activity, is also manifested in the field of international relations. An example of this is the agreements between the USSR and the USA, France and other countries on issues of environmental protection, joint research on problems of cardiology, oncology and other topical issues. Soviet medical scientists participate in the activities of international scientific societies, associations, international medical journals, specialized organizations of the United Nations, primarily the World Health Organization. The holding of international medical congresses, conferences and symposiums in the USSR contributes to the development of scientific cooperation.