In October, Russia's Health Minister announced that all Russians will enjoy free medical care. The announcement aroused debate in China, where healthcare reform has been far from satisfactory. Chinese state newspaper, the People's Daily, published a series of articles arguing that Russia's free healthcare is just an illusion. Despite all the criticism, China and Russia have a lot in common and there is a lot we can learn from the Russians in pushing forward China's healthcare reform.

Just an illusion?

Free healthcare still has a long way to go in Russia, principally because healthcare reform relates to a large system that demands more than money.

A big pocket is definitely an important prerequisite, but even with money, reform will not be easy. There have been fierce debates in Russia about whether the government can raise taxes to pay for increasing health expenditures. President Putin's economic advisor has argued for more government spending while political heavyweights like the former finance minister have take the opposite position. It takes time to train enough medical professionals to cope with the reform process. Though it may not be difficult to increase the health budget, it will take much longer, perhaps 20 years, to expand the coverage of public hospitals and increase the number of much needed medical health practitioners. Russia is an unevenly populated country which means medical resources may be slanted towards large cities, while residents in the sparsely populated far east and Siberia will prefer private clinics. Given this situation, free healthcare is putting too much of a burden on Russia's economy.

A difference in mindset: Pragmatism vs. dogmatism

China and Russia have taken different approaches to health reform from the start, largely because of differences in mindset between the two countries. China prefers a pragmatic approach, because there are no existing models applicable to China's conditions. China therefore has to "cross the river by groping the stones".

On the contrary, Russia took a much bolder approach. Russian reformers chose to copy existing models and prioritize institution building. In the past 20 years, Russia has put more emphasis on institution building than on practical needs.

When it comes to free healthcare in Russia, the same logic applies. Free healthcare is an overarching aim in Russia and requires endless efforts. However, Chinese pragmatic wisdom will not allow for a basic framework without solid accomplishments.

For all their differences, China and Russia are both committed to providing high-level medical services to the whole of their populations. It is too early to judge which reform approach is better because the two countries are both undergoing social transformation and face equally daunting challenges. It is therefore naïve and ill-timed to introduce "free healthcare" in Russia. In fact, Russia encourages private healthcare services, which will remain dominant for the long term due to their extensive coverage and high-level services.

What does China have to learn from the Russian healthcare reform? Russians are good at strategic planning. Once they set a goal, they keep working towards it. By "crossing the river by groping the stones", China is likely to waver in its path. For years, we have put forward many proposals that have not been followed through. Pragmatism leaves room for flexibility but may slow down our reform.

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