By Irina Glushchenko
MOSCOW — "You can't buy good health in a pharmacy!" That was a frequent refrain in Soviet newspapers during the era of Brezhnevite "stagnation". Writers used to stress that instead of treating yourself with medicines, it was better to engage in sports and lead a healthy way of life.
Now, in the 1990s, the phrase springs to mind again — only this time in the literal sense. For present-day citizens of our country who fall ill, it's better to stay away from the pharmacies.
There are two reasons for this. First, many medicines are not on sale there. Second, those that are to be had are unbelievably expensive.
A year or so ago earnest, sincere people were explaining on Russian television that the system of state pharmacies was stifling the initiative of the workers. Excessive centralisation was said to be creating shortages of medicines and making effective work with patients impossible.
Then, as economic reform gathered pace, the pharmacies were turned into commercial operations, whose aim was to make money. If they earned more, that meant their work was successful, even if more people died.
Under the old system, Soviet-produced medicines were sold practically at cost. Imported drugs were much more expensive, but with other prices low, patients could afford them. The pharmaceutical industry did not provide profits for the state treasury, but with its stable market, it did not make losses either.
The assault on the pharmacies began earlier than the commercialisation of other spheres of the economy, largely because of the hatred the new authorities felt for free medical care as one of the pillars of socialism. Large numbers of pharmacies were not privatised, remaining municipal enterprises. However, their functions were completely altered; they were obliged both to sustain themselves and to bring profits to the city treasury.
In 1992 the prices of medicines began a steep rise which outstripped by a considerable margin the rises for other goods. As early as the beginning of February 1992, cheap medicines had disappeared from the shelves. At the end of 1992 the newspaper
Trud reported: "The pharmacies are finding deals with commercial structures especially profitable. They buy medicines abroad for dollars, and sell them at hard currency prices."
Pharmacies are now unwilling to stock medicines which do not turn a profit. The state has tried to get pharmacies to sell a few medicines at concession prices, making up their losses out of the budget, but nothing has come of this. Obtaining full compensation for losses is impossible in conditions of high inflation, and pharmaceutical entrepreneurs are put off by the complex accounting and the bureaucratic procedures involved.
With the new high prices, consumption of medicines by the population fell by 30% in the course of 1992. While drugs were becoming unobtainable in retail outlets, stocks worth some 5 to 6 billion roubles accumulated in the warehouses.
What has happened with the pharmacies is typical of what is now occurring with the health system as a whole. In 1991, 3.4% of Russian gross national product went on health care. In 1992 this figure was cut by half. There is a lack of money not just for updating equipment, renovating hospitals and performing research, but even for doctors' wages.
This year medical insurance schemes are to come into operation, and free, state-provided health care will largely cease to exist. However, many Russians will be able to pay health insurance premiums only if they go without food; experts predict that in many regions, between a quarter and a third of the population will not take out any insurance at all. Furthermore, the price of medical services is likely to increase so rapidly that no insurance will be enough to cover the bills.
With prices spiralling upwards, imports of medicines declining and the pharmaceutical industry cutting its output, it is futile to trust in the effectiveness of insurance funds. Even acting health minister Andrei Vorobyev admitted recently that state-funded medical care was the only reliable system, and that in this case one could not trust the market. Then, contradicting himself, Vorobyev placed all his hopes in the development of medical insurance.
In a recent interview with the paper Izvestiya, Vorobyev acknowledged that not even he has much idea of how the new system will work. Declaring himself a supporter of the German model of medical insurance, the minister admitted that German experts themselves were not enthralled by this model.
Instead of fighting for a review of government policies, the bureaucrats of the Ministry of Health are battling with their rivals from the Committee on Health Care of the Supreme Soviet
for control of the available funds.
Vorobyev recently accused his opponents from the parliamentary apparatus of careerism and of aiming to "destroy the state system of health care", recalling that the World Health Organisation had singled out this system as a model to be followed. He then spoke indignantly of conservatives in the Supreme Soviet who were holding up the transition from state health care to health insurance.
According to Vorobyev, the main victory scored by Russian medicine during 1992 was the fact that it survived at all. If his "reforms" continue, this achievement is unlikely to be repeated in 1993.