In recent years, the reform of the Russian public medical system has made great progress，has changed from unlimited free medical services to basic medical services for basic medical services，A combination of free legal and compulsory medical insurance with self -funded private medical insurance、The medical security system combined with budget security and insurance。But its overall medical level is still lower than the average level of most European countries，The actual effect of the reform is not satisfactory，There are still some defects and deficiencies to make up and improve。

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At the end of the 20th century，Russia has begun to implement a reform from public medical care to the medical insurance system.，Basically established the national compulsory medical insurance system framework through the "Federal Mandatory Medical Insurance Law"，At the same time, encourage the creation of private medical service agencies。The compulsory fixed premium system it implements it，It plays a role in slowing down the overall decline in health care financing。From 2000 to the present, Russia's medical system reform has been further deepened。2003 Russia established the Federation、Regional and municipal and municipal three -level decentralized medical management system。officially implemented the "National Free Medical Rescue Outline" since 2005，Provide residents with roughly equal free medical services in the form of legislation。In 2006, the national development plan with "health" as the priority，The level of people's livelihood services aimed at improving Bet365 lotto review the medical system，Mainly cover primary medical care、Disease Prevention、Medical assistance to women during pregnancy、High -tech medical services、Modernization of the medical system、Medical Rescue of patients with vascular disease、Medical Rescue of the injured of a traffic accident、Develop blood collection station、Perfect the rescue of cancer patients、Take measures to advocate a healthy lifestyle、Improve medical assistance to patients with tuberculosis。In 2011, Russia revised the Federal Mandatory Medical Insurance Law，Further development of the medical insurance system，reduced obstacles to private medical institutions participating in compulsory medical insurance，promoted the development of private medical institutions; at the same time, the payment rate of compulsory medical insurance was increased to 5.1 % of the total salary，Late the economic foundation for the establishment of a limited free medical care。

Through reform，Russian public medical services have improved significantly compared to the past。This is mainly manifested in，First，Medical expenditure has increased significantly。Russia started the "Medical Priority" new medical reform in 2006，The focus is to increase public financial medical expenditure，Improve the use of medical funds。This prompted the proportion of various medical expenditures in its domestic GDP，increased from 3.5%in 2008 to 5.3%in 2018。2，Streamline the medical institution and medical staff and improve the efficiency of medical services and the wage level of medical staff。third，The related situation of medical infrastructure has been improved to certainly。Increased infrastructure that can be used for medical services increases，Some old medical facilities Bet365 lotto review are rebuilt，A significant changes in medical institutions，The community clinic develops rapidly。

　Insufficient resource and facilities, unevenness of uneven problems

Reform，Russia's public medical services have improved，But there are still some problems that need to be solved。

First，Insufficient supply of medical resources is still prominent。In the past 15 years，Especially after the implementation of the new medical reform，Russia not only has a significant reduction in the number of medical institutions，And the number of infectious diseases and the number of sick beds are also significantly reduced，This inevitably weakened the ability to treat the Russian medical system to patients with large -scale epidemic diseases。Statistics data show，At the end of 2019，1.314 million intermediate medical staff in Russia，decreased by 9.3 % compared to early 2013; the total number of doctors was 704,000，dropped 2.0 %。

Next，Public medical infrastructure construction lag。Although many medical infrastructure in Russia has been updated and improved，But the existing investment is still insufficient，The health and technical conditions of most medical institutions need to be further improved。According to the report of the Russian Federal Audit Office，As of January 1, 2019，41.1 % (more than 116,000) in the country's medical institutions do not have a central heating system;，Need to be rebuilt or repaired; more than 30.5 % of medical institutions do not have a water supply system。Infrastructure construction and update issues of Russian medical institutions，Obviously not to be solved in a short time。Not only that，Many Russian medical institutions are still facing key treatment equipment.、Unavailable questions。

again，Unewal and inefficient medical resources。Regional distribution of medical bet365 Play online games resources in Russia is huge，It is mainly manifested in both medical staff and equipment distribution。Different from the area of ​​wages，The number of doctors per 10,000 people with a higher average salary is relatively high，And whether it is the average salary of the medical staff or the number of doctors corresponding to the corresponding person per 10,000 people，The gap between the highest value and the minimum value is generally expanding。From 2005 to 2019，In terms of the proportion of doctors at all levels，The gap between urban and rural areas has not been obviously improved。In terms of medical equipment allocation，Statistics data show，Many key treatment equipment is concentrated in Moscow、St. Petersburg and other large cities，There are very few other regions。This distribution differences lead to relatively less developed regions. Medical conditions are often not satisfactory。Russian medical system still has serious structural imbalances，with a general doctor mode、Insufficient junior medical development of primary medical development in integration of prevention and treatment，Specialized Comprehensive Clinic occupies an absolute dominant position。Only 16%of doctors in Russia are district -level doctors and general doctors who are responsible for providing primary medical services，and this proportion of Western European countries is between 30%-48%。Digestion activities of many specialized hospitals are not reasonable enough，The average hospitalization time of patients is too long，and occupy more medical funds。other，There is an unreasonable phenomenon in the salary distribution of medical staff。Doctor、Nurse and other medical personnel have a large salary gap，This also cracks down on the work enthusiasm bet365 live casino games of medical staff to a certain extent。

Last，Emergency medical treatment capabilities serious insufficiency。Facing major public health events，Many Russian medical institutions face medical staff、Mitsu shortage of protective and therapeutic equipment and infectious diseases。Trained medical experts in short supply，And such experts are difficult to quickly train through short -term training，Need long -term daily work accumulation and professional training。

　Multi -angle to improve the public medical system

To sum up，From the author's view，Russia may start from the following four aspects to improve its public medical system。

One，Deeply reflect on the lack of reform of the reform of the public medical system。Judging from the development history of the past ten years，Russia attaches great importance to the traditional security issues in the fields of military and other fields，Insufficient investment in non -traditional safety such as health and safety。Previously, the optimization reform of the Russian medical system before considering the response to major emergencies in public health incidents，Nor does it not fully pay attention to the experience and lessons of other countries and regions in this area，Leadage to the emphasis on related issues is not high，The problem of personnel and equipment reserves that are not enough to deal with emergencies。Relevant agencies in Russia should fully recognize the severity of such problems and the necessity of preventing problems before。

Its two，Increase public medical expenditure，Improve the public medical system。International experience show，The proportion of public medical and health investment in a country's GDP is an important factor affecting the country's health indicators，Generally, when the proportion accounted for 7%, the resident health Bet365 app download indicator reaches a good level，and 2018 Russian public health expenditure only accounts for 3.2%of its GDP。The Chief Economist of the Russian National Development Bank of Economist Andre Claph recently pointed out，It is necessary to carefully modify the development plan of the Russian medical department，Create additional fund，Make it capable of dealing with extreme situations; at the same time, the training of doctors, especially infectious disease experts,。He also called on the public to provide the public with more comprehensive medical care services，instead of just focusing on economic efficiency。

Its three，Reform of the medical appropriation model to promote the equalization of the distribution of medical resources。Russia currently implements a mixed funding mode combined with national budget allocation and compulsory medical insurance，This leads to multiplication of capital management，Low use efficiency，There are obvious uneven and unfair issues in the region of medical resources。Transforming the funding model into a single channel management for centralized and unified regulation in the country，distribution of medical funds through marketization，It will be able to help them solve the above problems。

Four，Further expand international medical cooperation。Through international cooperation，Not only can improve the strength of Russian medical institutions，Improve its service quality，Help them participate in the research and development of new equipment and drugs; and it can promote relevant Russian institutions and personnel while learning advanced experience in other countries，Share the idea of ​​the Russian medical community with the peers in other countries，helps to maintain global public health and safety。

(This article is the bet365 best casino games major special project of the National Social Science Fund, "Construction of the Opportunities for the Belt and Road" in the next 3-5 years、Risk and Challenge Study "(19VDL002) phased results)

(Author Unit: School of Nursing, Beijing Union Medical College; University of Friendship University of Russia)