{{Short description|Form of single-payer healthcare}} thumb|Nikolai Semashko The '''Semashko model''' is a single-payer healthcare system where healthcare is free for everyone, and is funded from the national budget. 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,<ref>{{Cite journal |date=November 2017 |title=The Essence of the Soviet Health System |journal=American Journal of Public Health |volume=107 |issue=11 |pages=1736–1738 |doi=10.2105/AJPH.2017.107111736 |issn=1541-0048 |pmc=5637657 |pmid=29019790}}</ref> 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 universal healthcare system.<ref name=":0">{{Cite web|url=https://www.researchgate.net/publication/332564887|title=The history of public healthcare in Russia}}</ref> 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 1930s, and the practical universality only got established by the 1950s.<ref name=":0" />
The system is named after Nikolai Semashko, a Soviet People's Commissar for Healthcare.<ref name="rb" /> The model is largely continued in Russia, most other post-Soviet states<ref name="nlm">{{cite journal |title=The evolving Semashko model of primary health care: the case of the Russian Federation|journal=Risk Manag Healthc Policy|author=Igor Sheiman |author2=Sergey Shishkin |author3=Vladimir Shevsky | year=2018|volume=11 |issue=11|pages=209–220 |doi=10.2147/RMHP.S168399|pmid=30464661 |pmc=6220729 |doi-access=free}}</ref> (exceptions are Turkmenistan, Kyrgyzstan and the Baltic states), and some other formerly Soviet-aligned states (such as North Korea<ref>{{Cite journal |last1=Kichae |first1=Min |last2=Hyejin |first2=Ko |date=2018 |title=Changes in the North Korean welfare System: A Comparison of the Kim Il Sung, Kim Jong Il and Kim Jong Un Eras |url=https://www.jstor.org/stable/26632405 |journal=North Korean Review |volume=14 |issue=2 |pages=46–63 |jstor=26632405 |issn=1551-2789}}</ref> and Cuba<ref>{{Cite journal |last=Huish |first=Robert |date=2021-10-14 |title=Cuban Health Care: The Ongoing Revolution, by Don Fitz & The Right to Live in Health: Medical Politics in Postindependence Havana, by Daniel A. Rodríguez |journal=New West Indian Guide / Nieuwe West-Indische Gids |volume=95 |issue=3–4 |pages=328–331 |doi=10.1163/22134360-09503027 |issn=2213-4360|doi-access=free }}</ref>) and is regarded as one of the most influential ones.<ref name="Heinrich">{{cite book |author=Andreas Heinrich|title=International Impacts on Social Policy |chapter=The Emergence of the Socialist Healthcare Model After the First World War |series=Global Dynamics of Social Policy | date=28 February 2022|pages=35–46 |doi=10.1007/978-3-030-86645-7_4 |isbn=978-3-030-86644-0 |doi-access=free}}</ref>
==Features== 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.<ref name="rb">{{cite web | url =https://www.rbth.com/history/333668-what-did-ussr-actually-get-right|title=What did the USSR actually get right?|publisher=Russia Beyond|author=Georgy Manaev| date=15 April 2021| access-date =7 December 2022}}</ref> For the country's citizens, medical services are free and equal, with an emphasis on social hygiene and prevention of infectious diseases.<ref name="rb"/> The model features publicly owned medical facilities, salaried health workers, large providers of primary healthcare and an exceptionally high degree of governmental administration, providing a universal healthcare.<ref name="nlm"/> The Semashko model does not allow private medical practices, as all physicians in it are state employees.<ref name="rb"/> In the Soviet Union, under this model, all of the country's territory was divided into districts, with outpatient hospitals and local physicians assigned to each of them.<ref name="rb"/> These physicians were multi-specialized, able to treat the most common diseases, while more complicated cases were referred to regional hospitals.<ref name="rb"/>
A special feature of the Semashko model is the "method of dynamic dispensary surveillance", which holds that every detected case of a serious disease should be subjected to a certain set of guidelines, including planning curative activities, documenting them, ensuring the required number of contacts with specialists, a monitoring process and outcome indicators.<ref name="nlm"/> Such guidelines were developed at a later stage, in the late 1960s.<ref name="nlm"/>
==History== The Semashko model originated in the aftermath of the 1917 October Revolution. In the United Kingdom, the National Insurance Act 1911 provided coverage for primary care (but not specialist or hospital care) for wage earners, covering about one third of the population. The Russian Empire established a similar system in 1912, and other industrialized countries began following suit. The Semashko model was established in Soviet Russia in 1920.<ref>{{Cite journal |last1=Rowland |first1=Diane |last2=Telyukov |first2=Alexandre V. |date=Fall 1991 |title=Soviet Healthcare From Two Perspectives |url=http://content.healthaffairs.org/content/10/3/71.full.pdf |journal=Health Affairs |volume=10 |issue=3 |pages=71–86 |doi=10.1377/hlthaff.10.3.71 |pmid=1748393 |language=en}}</ref><ref>''OECD Reviews of Health Systems: Russian Federation 2012'', page 38</ref> The model substantially improved population health relative to the starting point of its implementation in the late 1920s.<ref name="nlm"/> However, the model was less effective against non-communicable diseases and as such failed to advance population health further.<ref name="Heinrich"/> In the 1970s, with the availability of new medical technologies and popular demand for better care, the Soviet Union put greater emphasis on specialization in outpatient care, moving away from the Semashko model.{{Citation needed|date=July 2024}} With that, the significance of the district physician has considerably reduced.{{Citation needed|date=July 2024}}
==See also== *Bismarck model *Beveridge model *Health system
==References== {{reflist}}
Category:Health in Russia Category:Health in the Soviet Union Category:Publicly funded health care Category:Universal health care Category:Soviet inventions