Decentralization of the health care system
Until the late 1980s the management of the health services in the former Soviet Union
was completely centralized. The Ministry of Health of the USSR regulated management
and resource allocation throughout the whole system via the Republican Ministries of
Health and there was little scope for customized responses to local needs. Even within
the soviet system however, this came to be seen as unsatisfactory and a number of
initiatives were mounted to test out the scope for decentralization. These pilots were still
underway at the break up of the USSR but the value of decentralization in terms of
creating incentives for efficiency and encouraging cost containment had been clearly
demonstrated. These successes, together with the emerging demand for regions to be
allowed greater autonomy and an increasing sense that centralisation was politically
unacceptable set the scene for the dispersal of power.