Dr Putin or how I learnt to stop whining and love the NHS
Before medical school, I studied Russian at university. After a year of lectures on obscure grammatical points, I was dispatched to an industrial town north of Moscow to study at the local university. Two months into the course, I fell ill. A couple of days’ rest and I’d be fine, I thought. How wrong I was.
A week later, I felt more feverish, my throat was achingly swollen. I needed to see a doctor. Russia has two health systems: a state funded system and a variety of private insurance schemes. My Russian professor suggested I see a doctor privately, but I insisted on going to the local poliklinika, which is similar to a general practitioner walk-in clinic in the United Kingdom. During my three hour stay in the packed waiting room, I noticed that several of the windows were smashed, with bin bags taped over to keep out the −20ºC temperatures. To add insult, quite literally, to injury, the outpatient orthopaedic clinic was up three flights of stairs with no lift. The experience left me feeling like a character in Chekhov’s short story Ward No 6.
“Sleiduyuschii [next]: What’s wrong?” the doctor barked. As I began to explain, she interrupted me: “The cause of your illness is that you do not understand Russia, you are not used to our ways. Take this herbal potion.” She handed me two pieces of paper. One was a prescription, a handwritten piece of scrap paper, embossed with her personalised ink stamp. The other was a faded sick note for my university that still had “USSR” in Cyrillic script ominously parading across the top.
I returned home and slipped into a feverish delirium. My neck felt like it was in a vice and I found it difficult to breathe. That night, my landlady persuaded me to pay 5000 roubles (£100; €139; $200) for a private ambulance. The paramedic who examined me was worried about meningitis. I had two choices: be admitted and face steep hospital charges or have treatment there and then. I don’t remember what happened next. It turns out they set up intravenous antibiotics immediately, hooked to a coat hanger, with more medicine in tablet form. I came to 48 hours later, having lost a stone in weight.
So what’s this got to do with the NHS? Before the 1991 collapse of the USSR, Soviet citizens had access to a centralised healthcare system, free at the point of use. Despite healthcare spending as a percentage of gross domestic product being a third of the Organisation for Economic Co-operation and Development (OECD) average (3.3% for the six years before the collapse versus 8.0% in the OECD), the former superpower had respectable patient outcomes. The service was a little shabby, often stretched, but dependable and something to be proud of. Sound familiar?
After the USSR’s dissolution, Western economists prescribed a mixed model of healthcare, with private financing and provision “running alongside” the state. Compulsory insurance was implemented to encourage competition, with private investment expected to lead the modernisation of a chronically underfunded system. In practice, government funding was simply slashed further. Unsurprisingly, the results were disastrous: life expectancy has decreased by almost five years, tuberculosis has returned with a vengeance on the back of an HIV epidemic, and infant mortality has doubled. An article published in the Lancet in 2009 confirmed what ordinary Russians already knew: that shock therapy was killing the patient. Private provision, proclaimed as a panacea for post-Soviet healthcare ills, barely materialised, catering only to the oligarchical elite in Moscow and Leningrad. In a two tier system with fees higher than for private medicine in the United Kingdom, the middle classes once again fear old age, and the poor simply go without.
Twenty first century Britain is not 90s Russia, but the parallels are disturbing: the cure all of privatisation and ideologically driven underfunding in our age of austerity. Last summer the government quietly announced an inquiry into alternative funding models for the NHS. Former Tory MP Patrick Cormack believes that “[whether] the extra funding comes from compulsory insurances or certain charges matters not, but it has to come.” To paraphrase the health secretary: get real.
Of course it matters where the money that funds our health service comes from. Ill health can bankrupt even well-off families, which is why the NHS was created in the first place: to deal with the appallingly unjust state of the nation’s health. Not only is general taxation the fairest way to fund the system, it is also the most efficient, despite tabloid jeers to the contrary.
At the same time as the government announced its funding inquiry, the Office for Budget Responsibility released its quarterly report. Buried within its pages, the report showed that NHS spending had fallen to 6.1% of gross domestic product —its lowest level in a decade, down from its peak of 7.8% in 2009-10—and barely half that of France or Germany. And all around us, the system is in chaos: missed targets, over-occupancy, two thirds of hospital trusts in the red. What I witnessed in Russia, the legacy of a market led solution to just such a crisis, was madness. Let’s not repeat their mistakes.Joseph O’Keeffe, second year graduate medical student
1University of Leicester, UK
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
Follow Joseph on Twitter @JOCaoihm
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Cite this as: Student BMJ 2015;23:h6039