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.06 per cent.11SOCIAL POLICY UNDER PUTINThe health, education and social welfare systems inherited by thePutin administration were in a bad way.In the early 1990s theyhad been ravaged by the slump and the resultant meltdown ofstate spending, and by the determination of Yeltsin s extreme pro-marketeers to force as much as possible, as quickly as possible,into the private sector.In the late 1990s, the privatisation maniawas constrained by Parliament.But social spending stayed at a piti-fully low level, doctors and teachers real wages continued to fall respectively to about 80 per cent and 50 per cent of the averagewage  and the services continued to deteriorate.From 1999, three things changed:" As the economy improved and tax revenue increased, moremoney was directed to health, education and social welfare." The stalemate between president and Parliament that hadparalysed government during Yeltsin s second term wasbroken." The hotch-potch of policies put together by Yeltsin s govern-ments, often with unsuitable advice from the internationalfinancial institutions, was replaced by an all-round reformprogramme drawn up by a team headed by German Gref,Putin s economic development minister.The reform programme acknowledged the need to mend whatwas broken in the schools and hospitals, and was able to increasespending at least modestly.But its key principles were adaptedfrom extreme right-wing privatisation credos in the west: as much146 CHANGE IN PUTI N'S RUSSIAhealth, education and social welfare as possible was to be providedby private companies; systems of private medical insurance andprivately funded pensions would replace state-funded health andpension provision; the state s role would be to provide basics,to regulate, and to subsidise those who could not afford to pay.Welfare benefits, and housing provision, would be subject to thesame principles.12Putin s governments, conscious of public support for the Soviet-era welfare systems and of people s determination to share in thebenefits of the oil boom, trod warily.In his first term (2000 04)Parliament passed laws providing for the gradual introduction ofmedical insurance and privately funded pensions, and for somemeasure of fee paying in university education.All these measuresbegan to be introduced, but cautiously.The government fearedpopular reaction  such as the protests that erupted in January2005, in response to the reform of welfare benefits (see Chapter 9,pages 173 7).That reform was slowed down as a result, and otherswere paced gently from the start.For example, pension reform waslegislated in 2002: alongside the universal state-funded scheme,workers would be encouraged to contribute to private pensionfunds.But by 2008, fewer than 10 per cent of workers had joineda private scheme, and almost all of these were at above-averageincome levels.During Putin s second term, the government s hand was strength-ened by the huge volumes of oil money available.The damage doneto budget spending in the early 1990s at last began to be reversed.There were substantial pay increases for staff in health, educationand other public services.In 2007, a three-year budget was adopted,with priority funds earmarked for  national projects in health,education, accessible housing and the development of agriculture.But against the background of mounting social inequality describedabove, the government faced growing criticism about how the fundsthat were at long last available should be spent.In the case of the health system, the government was urgedto address widening inequalities of access.In 2008, a study byresearchers at the Independent Institute of Social Policy concludedthat the system was characterised by  deep-going differences inthe way that various categories of the population  depending ontheir level of education, income and location  seek different typesof medical help.People in the countryside made extremely littleuse of outpatient care, particularly by specialists, for example.Insome regions, usually poorer ones, the accessibility of free care PEOPLE AND MONEY: HUMAN DEVELOPMENT DILEMMAS 147was limited.There was a  striking inequality in the proportion ofhousehold income that poor people spent on medicine:  more than8 per cent of the population is compelled to shoulder  catastrophiclevels of medical expenses.The report also said that pay rises hadbeen distributed unevenly through the health service, and that thelevel of under-the-counter payments for treatment had increasedbetween 2002 and 2007.The much-vaunted  national projects willmake little difference to the profound institutional and fundingproblems, Professor Natalia Zubarevich of Moscow State Univer-sity, a leading social policy researcher, said in an interview.In thehealth sector, the  national project money comprises only 13 percent of total spending, and is poorly directed, she said.About one-third of the amounts set aside via the  national project had beenswallowed up by a pay rise for general practitioners, while surgeonsand other specialists will receive nothing; another quarter will goon flagship medical centres.Major institutional problems and theinequalities they produce had not been addressed, she warned.13Russia entered the recession of 2009 with many such problemsunresolved [ Pobierz całość w formacie PDF ]