The Specifics of Financing Healthcare in the Perm District in the 1920-s

The object of research in this article is healthcare in the Perm District during the 1920-s, and the subject is the specific features of its financing. The materials from the Perm archives, statistical publications, and periodicals from that time served as the basis for writing this work, which used general scientific methods and a system-structural approach in its research. The twenties of the 20th century were marked by a huge shortage of public funds in Russia. This was due to the serious upheavals of the previous decade. Under these circumstances, the Soviet government had to abandon its original ideological plans and implement large-scale changes with a "touch" of market reforms to close a wide gap in the budget. Some of these changes included the reform of local budgets, coupled with territorial and administrative changes within the country, as well as the introduction of cost accounting and new insurance principles. In the course of the study, the authors explored new principles of local budget formation: sources of its replenishment and cost structure. They noted a shift in the ratio of the latter in total budgets at the union, republic, regional, district, and city levels. This led to a lack of funds for healthcare needs, which was partly compensated by the health insurance fund. Low wages caused turnover, a shortage, and an overburden on medical personnel, which in turn affected the quality of the services they provided. Cost savings led to slow development of a network of medical and preventive institutions that did not correspond either to the dynamic growth of the population or to ideological attitudes concerning the availability of healthcare. The financial deficit resulted in a fiasco with regard to the preventive nature of health care. The main conclusions of the article can also be used in scientific research on the history of medicine and in the development of educational courses on History of Medicine for students of medical universities