Health care reforms in Russia and its legislational provisions

- Irina A. Petrova, Ph.D.

Dept. of Legal and Ethical Problems of Health Care, Semashko
Research Institute for Social Hygiene, Health Economics & Management, Russian Academy of Medical Sciences, I2 Vorontsovo Pole street, Moscow-103064, Russia.

Eubios Journal of Asian and International Bioethics 6 (1996), 60-61.
Significant political and economic changes in Russia have caused considerable alterations in most of the professional practices including health care. Recent Russian reforms in health care mainly consist of:
- compulsory medical insurance
- multistructured health care (not limited to state institutions)
- giving out the licenses to medically qualified professionals
- definition of medical services standards
- forming new professional and social organizations in the field of medicine.

These reforms require adequate legislational provision. In the past five years the Russian Government has adopted a series of laws and sublaw's or statements for regulation of medical activity: The basis of Russian Federation legislation on citizens health protection (22 July, 1993), Law on medical insurance for Russian Federation citizens ( 28 June 1991), Law to guarantee of human rights in Psychiatric care (2 July 1992), Law on human organs and tissue transplantation (22 Dec., 1992), Law on donation of blood and its components (9 June, 1993), Law on prevention of AIDS spread in the Russian Federation (30 March, 1995).

All of these laws may prevent potential malpractice. We shall consider those laws that are new in the context of Russian health care. The law "On human organ and tissue transplantation" defends the donor's rights and limits illegal transplantation. The first article of the law points out the obligatory donor's consent for transplantation and the prohibition for commercial use of human organs or tissues. The 9th article of law explains brain death as the criteria for death for all practical purposes. Such a definition of death is not acceptable to many religious confessions in Russia.

At the same time there are some differences between Russian and, for example, US Medical Legislation in this field. The Russian Federation law doesn't allow the informed consent norm as a donor's right for posthumous organ or tissue removal. There are no definitions of the donor's right on "anatomical gift", the doctor's actions towards vegetative state patients and embryonal transplantation in this law.

Another new medical law is "On prevention of AIDS spread in the Russian Federation". This law regulates the correlations between sick (or infected) persons, society and health care institutions. The law fixes such state guarantees as:

to inform the Population about HIV-infection prophylaxis, diagnosis and treatment, to provide safety control for medical and biological preparations, to conduct an epidemiological study on HIV spread in the Russian federation, to ensure accessibility for anonymous medical examination, to provide free-skilled medical services to HIV-infected people. The first article of the law concerns the rights and freedoms of HIV-infected persons. The 9th article determines a compulsory medical examination for some categories of people. This law gives broad rights for parents of the HIV-infected children. The specialized article of the law establishes some limitations for HIV-infected Russian citizens (prohibition on being donors) and for HIV-infected foreign citizens (including deportation).

The acceptance of new laws to a great extent depends largely on the positive changes in people's outlook. That is why the law's realization process and the trends in future work on the legal basis of health care reforms in Russia depends on serious juridical education particularly for medical professionals and common people at large.

l. Korotkikh R.V., Ritvinsky S.S., Shepin O.J.P. Legal foundation for regulating medical practise (Semashko Research Institute for Social Hygiene, Health Economics and Management, 1995, 174pp.).

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