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What constitutes adequate medical care and how to deliver it is a problem states across the world confront as they face similar problems of rising costs, access, changing demographics, quality of service, and technological development. This article compares health care reform in the United States and the Russian Federation between 1990 and 2015. The Russian Federation begin this period with a process of rebuilding a health care system out of the previous centralized state-run Soviet system whereas the United States sought to change a health care system largely privately run and which separated health care delivery from health care insurance. Yet, despite differences these two countries and their health care systems have, they show interesting parallels, convergences, and lessons in terms of how reform occurs. In particular, this article demonstrates how both the American and Russian reforms have tried to use market incentives and the shifting to individuals some responsibility to contain costs, the use of government and non-governmental actors to provide health care and insurance, and various levels of centralization and decentralization of select services in order to address cost, quality, and access issues.

Health Care Reform in the United States and the Russia Federation: 1990-2015