Management
One of the aims of the reform process and indeed of Soviet experiments with the New
Economic Mechanism was to ‘liberalize’ management. Previously the planning and regulation
systems determined the framework within which services would be delivered and management,
at whatever level, was responsible for enacting the stated specifications. The system was
administered rather than managed and individual managers had very little leeway for
independent action. Local government officials were appointed centrally and hospital and
polyclinic directors were working within such clearly prescribed constraints that there was little
scope for effective management intervention.
The Kemorovo experiment was among the first to attempt to empower individual hospital
mangers allowing them the discretion to adjust staffing levels, hire and fire, negotiate pay and
bonus packages and make demands of staff in terms of performance. They were also given a
degree of financial autonomy and allowed to income generate and retain profits within the
hospital or polyclinic. This approach while it is allowed for within the new insurance scheme is
not the basic model advocated, rather insurance funds are to make purchasing decisions
independently of providers. However, the shift in managerial role has been widely generalized
and has been transferred from the soviet context into the new Russian setting.