Medical welfare during late Stalinism: A study of doctors and the Soviet health system, 1945--1953.

다국어 초록 (Multilingual Abstract)

This is a study of the Soviet health system in the Late Stalinist period, with special reference to doctors as welfare state personnel. I focus particularly on the emergence of a quasi-welfare state ethos that accompanied a shift towards universality in the provision of medical services. There are important limitations on the applicability of the welfare state model to the Soviet Union as it was originally developed only for non-socialist states. Nevertheless, it illuminates a significant aspect of the Late Stalinist system that is often neglected in a scholarship that concentrates primarily upon post-war economic reconstruction and Cold War mobilization.
Doctors were indispensable to the existence and development of a Soviet welfare state. Firstly, Late Stalinist medical administration was professionalized so health policy was substantially shaped by doctors in both the state and party apparatuses. Secondly, the medical bureaucracy was greatly expanded while the number of doctors overall nearly doubled over 1945–53, implying a rapid expansion of social programs. Thirdly, these quantitative changes were matched by a commitment to lesser-known qualitative improvements.
There are four serious limitations to the analysis of the Late Stalinist Soviet Union as a welfare state. Firstly, any idea of the Soviet social citizen was fractured by many special classes of patients. Secondly, de facto widening entitlements to medical services were accompanied by continued medical policing of economic production and biological reproduction. Thirdly, the Soviet medical profession was fractured with practitioners partially deflecting the aspirations of the medical administration. Finally, the process of Soviet welfare state building in the post-war years was damaged by political actions originating entirely outside it, most notoriously systematic anti-Semitism leading to the Doctors' “Plot.&rdquo.
Beyond these serious reservations, the development, principles, and kinds of Soviet medical welfare that were provided over 1945–53 parallel those used in non-socialist welfare states. Many important Late Stalinist innovations amounted to a shift in the overall orientation of health services from productionism towards universality of access. Active patient participation in the health service increased steeply due to a rising sense of entitlement. On balance, welfare state building was a significant feature of the Late Stalinist system.