By Brittany Holom January 1

On Nov. 30, thousands of Muscovites marched through Samotechnaya Square against planned cuts to the citys healthcare system. Photo Credit: Brittany L. Holom

The following is a guest post byBrittany Holom,a Ph.D. candidate in the Department of Politics at Princeton University.

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On Nov. 30, medical personnel, activist groups, and political parties gathered in Moscow, the noise slowly growing louder as group after group joined the marching line, using loudspeakers to project their chants into the biting winter air. The demonstrators signs called for a moratorium on proposed reforms to the citys health-care system, with some demanding to know why there was money for war, but not for medicine. News agencies estimated that 5,000-6,000 people braved the days freezing temperatures to demand accessible, affordable medicine (dostupnaya meditsina). These protests against planned health-care reforms in Moscow marked the second event of its kind within the month; the first doctors meeting had taken place on Nov. 2. Another took place on Dec. 14, in combination with groups against education reforms. What are these reforms that have drawn such opposition, and why have these specific protests gained so much attention? What do they mean for the Putin regime, particularly in the context of the larger economic woes? Could widespread support for the welfare state prove to be a stumbling block for Putins popularity?

The recent protests are rooted in Moscow health reform plans that first emerged in mid-October, when Russian Medical Server, an online medical news site, leaked the details of the intended changes to the citys health care. To optimize the systems structure, it was reported, the government planned to close 28 hospitals and clinics in the city and lay off thousands of medical personnel. According to the groups of doctors and nurses gathered at the rallies, the planning process took place behind closed doors for months, with little to no consultation with those working day-to-day in the citys health-care system. Moscow officials later reported that the governments Research Institute of the Organization of Healthcare and Medical Management had authored the reforms.

While the specific characteristics and plans of the reforms in question are new, the push for change is not. Since the dissolution of the Soviet Union, analysts have argued that the Russian health-care system is in dire straits. It has struggled against a long history tied with alcoholism and issues of underfunding and structural imbalances linked with the legacies of the Soviet Semashko system. Nevertheless, although the goal of improvement has been constant across time and regimes in post-Soviet Russia, there has been little clear, strong direction for achieving this. Then, in his 2012 May Decrees pledges, Putin promised a full restructuring of the system to meet updated health goals. The government immediately began planning for a shift of health-care financing to single-channel funding, which will begin in 2015. In April 2014, deputies approved an update of the state program The Development of Healthcare, which laid out strategies for advancing the Russian health care system. These strategies largely followed the recommendations and goals set out by the World Health Organization (WHO). The current Moscow reforms are part of this larger drive for greater efficiency and improved health.

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Russian health-care protests continue despite Putins ...