The List: The World’s Worst Healthcare Reforms

RUSSIA

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System: Free basic medical care provided by the government, with a byzantine and under-regulated employer-based private insurance market

Reform: Before it collapsed, the Soviet Union had an enormous socialized medical system, with millions of hospital beds and hundreds of thousands of healthcare workers. The transition from that system to a public-private model, between 1989 and 1993, went, in a word, horribly.

Ninety percent of Russians are technically covered. But, doctors and hospitals extract "donations" for free care. Anyone who can afford it pays out-of-pocket for private hospitals and doctors. In theory, consumers can pick their own insurance plan. In reality, their employers generally do it for them, bought-off by the insurers.

In 2006, Vladimir Putin's government approved a $3.2 billion health care reform plan that failed to improve the system. The reform contained a hodgepodge of policy priorities, such as paying doctors to perform primary care, but did not address any of the healthcare system's structural defects.

Even with the $3.2 billion infusion, Russia still allocates only 3.4 percent of government spending to healthcare, whereas the World Health Organization (WHO) recommends 5 percent.

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