I just returned from a week’s visit to Moscow, a city I had not visited in 18 years. During my time as a volunteer, and subsequently Medical Director for Project HOPE, a Virginia-based international medical educational foundation that was famous for the white hospital ship SS HOPE, I had witnessed the dissolution of the Soviet Bloc and with it, their healthcare infrastructure. Under central planning in the USSR, all pharmaceuticals and medical supplies were manufactured in Eastern Europe for consumption in the Republics of the Soviet Union, from the Baltics to Central Asia and the Soviet Far East. When the Soviet Union dissolved, so did the healthcare supply chain. In the late 80’s Project HOPE was designated the lead agency by USAID for distribution of pharmaceuticals and medical supplies donated by the US healthcare industry. As the Medical Director I traveled to virtually all of the Republics of the USSR during this time when things looked pretty dire. Virtually all measures of the health of the population were in decline. Hospitals were outdated and without supplies of any kind. Professionals were treated poorly with low salaries, long hours and no real direction. Clinical management was frozen in time from the Stalin era. A visit this many years later to explore the feasibility of supporting healthcare privatization was an opportunity for me to have a Rip Van Winkle moment and to assess what progress had taken place.
My plane landed into a brand new terminal on a quiet Sunday morning at Sheremetyevo Airport, and I breezed through immigration and customs with efficiency that could have only been dreamed of in the 80’s. Highways were new and modern, the city was considerably cleaner with new skyscrapers, Red Square and other famous sights were sparkling and inviting. The city was bustling with many local and visiting tourists enjoying a particularly lovely weekend in what now looked like a modern European city. The weather during this June week was something one could only expect to experience once in a lifetime.
Although it was clear that the hard infrastructure had changed quite considerably, as my colleagues and I visited healthcare facilities and met healthcare professionals, it was clear there was still a way to go with regard to the evolution of systems and attitudes toward health despite the fact that health statistics are beginning to turn around with increasing life expectancy and growth of the population for the first time in a long time. We heard many stories of the distrust that the public still harbors regarding the public system of care and the challenges of providing patient focused, customer oriented care in the nascent private system. There is a hope for the future and there appears to be an effort to transition some of the public hospitals into a new privatized healthcare model financed through medical insurance vehicles, but there appears to be a long way to go in this regard. Insurance companies are still looking for modern facilities to refer their customers and patients yearn to be cared for in a way they have experienced in the West. Private investors see the opportunity but understand the system cannot and will not be transformed overnight. Several healthcare leaders indicated medical education and healthcare regulation will need to be overhauled before real change can be realized and institutionalized. We talked to many who felt that knowledge and systems developed and practiced in the West would need to be adapted for, and embraced by Russia over the next generation if real change was to take place. This, of course, is not really surprising. We have learned that we can build new facilities in a year or two, but it takes at least a generation if not two, to implement new systems and incentives that encourage changes in culture that will translate to better health and health care.
There is still a long way to go, but there clearly has been a start and hopefully they will to see it through. I look forward to seeing if my colleagues and I can play some small role in supporting its advance, as it would be a privilege to be part of that process 20 years later.
Robert K. Crone, MD
President & CEO
Strategy Implemented, Inc.