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Semashko model

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The Semashko model is a <a href="Single-payer_healthcare" title="Single-payer healthcare">single-payer healthcare</a> system where <a href="Healthcare" class="mw-redirect" title="Healthcare">healthcare</a> is free for everyone, and is funded from the <a href="National_budget" class="mw-redirect" title="National budget">national budget</a>. It has been extensively modified since its introduction and a number of ex-soviet countries have now abandoned much of it. It was highly centralised and prescriptive in its design and had a very strong focus on specialist medicine so that family medicine and primary care was underdeveloped.

The Bolsheviks began establishing the system in with a July 1918 decree,<a href="#cite_note-1">[1]</a> nationalizing all existing medical institutions and proclaiming healthcare being available for free for all, thus, at least nominally, establishing the world's first free and <a href="Universal_health_care" title="Universal health care">universal healthcare system</a>.<a href="#cite_note-:0-2">[2]</a> However the actual availability of healthcare in the impoverished country after the prolonged civil war and two World Wars, especially in the more remote villages, lagged well into the 1930-s and the practical universality only got established by 1950-s.<a href="#cite_note-:0-2">[2]</a> The system is named after <a href="Nikolai_Semashko_(medicine)" title="Nikolai Semashko (medicine)">Nikolai Semashko</a>, a Soviet <a href="Ministry_of_Health_(Soviet_Union)" title="Ministry of Health (Soviet Union)">People's Commissar for Healthcare</a>.<a href="#cite_note-rb-3">[3]</a> The model is largely continued in <a href="Russia" title="Russia">Russia</a>, most other <a href="Post-Soviet_states" title="Post-Soviet states">post-Soviet states</a><a href="#cite_note-nlm-4">[4]</a> (exceptions are: Turkmenistan, Kyrgyzstan and the Baltic states), and some other formerly Soviet-aligned states (such as <a href="North_Korea" title="North Korea">North Korea</a><a href="#cite_note-5">[5]</a> and <a href="Cuba" title="Cuba">Cuba</a><a href="#cite_note-6">[6]</a>) and is regarded as one of the most influential ones.<a href="#cite_note-Heinrich-7">[7]</a>

<div class="mw-heading mw-heading2"><h2 id="Features">Features</h2></div>

In the Semashko model, medical services are provided by a hierarchy of state institutions under the supervision of Ministry of Healthcare and are financed from the national budget.<a href="#cite_note-rb-3">[3]</a> For the country's citizens, medical services are free and equal, with an emphasis on <a href="Social_hygiene" class="mw-redirect" title="Social hygiene">social hygiene</a> and <a href="Preventive_healthcare" title="Preventive healthcare">prevention</a> of <a href="Infectious_diseases" class="mw-redirect" title="Infectious diseases">infectious diseases</a>.<a href="#cite_note-rb-3">[3]</a> The model features publicly owned medical facilities, salaried health workers, large providers of <a href="Primary_healthcare" class="mw-redirect" title="Primary healthcare">primary healthcare</a> and an exceptionally high degree of governmental administration, providing a <a href="Universal_healthcare" class="mw-redirect" title="Universal healthcare">universal healthcare</a>.<a href="#cite_note-nlm-4">[4]</a> The Semashko model does not allow private medical practices, as all physicians in it are state employees.<a href="#cite_note-rb-3">[3]</a> In the <a href="Soviet_Union" title="Soviet Union">Soviet Union</a> under this model all of the country's territory was divided into districts, with <a href="Outpatient" class="mw-redirect" title="Outpatient">outpatient</a> hospitals and local physicians assigned to each of them.<a href="#cite_note-rb-3">[3]</a> These physicians were multi-<a href="Medical_specialty" title="Medical specialty">special</a>, able to treat most common diseases, while more complicated cases were referred to regional hospitals.<a href="#cite_note-rb-3">[3]</a>

A special feature of the Semashko model is the "method of dynamic dispensary <a href="Public_health_surveillance" title="Public health surveillance">surveillance</a>", which holds that every detected case of a serious disease should be subjected to a certain set of <a href="Medical_guideline" title="Medical guideline">guidelines</a>, including planning curative activities, documenting them, ensuring the required number of contacts with specialists, a <a href="Monitoring_(medicine)" title="Monitoring (medicine)">monitoring</a> process and outcome indicators.<a href="#cite_note-nlm-4">[4]</a> Such guidelines were developed at a later stage, in the late 1960s.<a href="#cite_note-nlm-4">[4]</a>

<div class="mw-heading mw-heading2"><h2 id="History">History</h2></div>

The Semashko model originated in the aftermath of the 1917 <a href="October_Revolution" title="October Revolution">October Revolution</a>. In the <a href="United_Kingdom_of_Great_Britain_and_Ireland" title="United Kingdom of Great Britain and Ireland">United Kingdom</a>, the <a href="National_Insurance_Act_1911" title="National Insurance Act 1911">National Insurance Act 1911</a> provided coverage for <a href="Primary_care" title="Primary care">primary care</a> (but not <a href="Specialist_care" class="mw-redirect" title="Specialist care">specialist</a> or hospital care) for wage earners, covering about one-third of the population. The <a href="Russian_Empire" title="Russian Empire">Russian Empire</a> established a similar system in 1912, and other industrialized countries began following suit. The Semashko model was established in <a href="Russian_Soviet_Federative_Socialist_Republic" title="Russian Soviet Federative Socialist Republic">Soviet Russia</a> in 1920.<a href="#cite_note-8">[8]</a><a href="#cite_note-9">[9]</a> The model substantially improved the <a href="Population_health" title="Population health">population health</a> relative to the starting point of its implementation in the late 1920s.<a href="#cite_note-nlm-4">[4]</a> However, the model was less effective against <a href="Non-communicable_diseases" class="mw-redirect" title="Non-communicable diseases">non-communicable diseases</a> and as such failed to advance the population health further.<a href="#cite_note-Heinrich-7">[7]</a> In the 1970s, with the availability of new medical technologies and popular demand for better care, the <a href="Soviet_Union" title="Soviet Union">Soviet Union</a> put greater emphasis on <a href="Medical_specialty" title="Medical specialty">specialization</a> in outpatient care, moving away from the Semashko model. With that, the significance of the district physician has considerably reduced.

<ul><li><a href="Bismarck_model" title="Bismarck model">Bismarck model</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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<li id="cite_note-8"><a href="#cite_ref-8">^</a> <cite id="CITEREFRowlandTelyukov1991" class="citation journal cs1">Rowland, Diane; Telyukov, Alexandre V. (Fall 1991). <a rel="nofollow" class="external text" href="http://content.healthaffairs.org/content/10/3/71.full.pdf">"Soviet Healthcare From Two Perspectives"</a> (PDF). Health Affairs. 10 (3): 71–86. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1377%2Fhlthaff.10.3.71">10.1377/hlthaff.10.3.71</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1748393">1748393</a>.</cite>

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