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p When we speak of the state character of public health we mean, in the first place, that medical aid is administered to the entire urban and rural population regardless of social, political, racial and all other factors. This, in its turn, implies that the medical aid is free and that the state provides for the population a sufficient number of medical institutions and skilled medical personnel.

Free and generally available medical aid is ensured by state allocations for public health. The funds provided by the state budget of the USSR for medical aid and the development of public health institutions are growing every year. Table 6 gives some idea of the USSR state budget outlays for public health.

Table 6 Allocations for public health Years Sums allocated by the state budget in millions of rubles Expenditures per capita (in comparable prices) (in rubles) 1913 14.5 0.91 1940 860.0 4.70 1955 3,490.6 17.22 1960 4,759.0 22.60 1965 6,610.7 28.59 1966 6,997.0 29.86 1967 7,350.0 31.22 49

p In 1972 the state allocations for public health and physical culture exceeded 9,700 million rubles. Not only are the absolute allocations for public health increasing, but also their share in the state budget has increased.

p In addition to the above appropriations medical institutions receive large sums of money from their lunds from various industrial enterprises, collective farms, co-operatives and other establishments. These sums exceed, in tot, 1,000 million rubles a year.

p No small part of the funds allocated for social maintenance and social insurance is also used for health protection. These allocations exceeded 21,000 million rubles annually in recent years. They were spent among other things on allowances for temporary disablement, quarantine and to working mothers caring for their sick children, on grants to pregnant women for maternity leave, on the maintenance of sanatoriums, kindergartens, creches and Young Pioneers’ camps, etc. Taken together the share of all expenditures on public health defrayed by the social consumption funds reaches 25 per cent of these funds.

p Besides the aforesaid expenditures on public health we must also take into consideration the considerable state expenditure on the development of medical science and medical education, which are not included in the public health and physical culture item, but come under science and education in the state budget.

p The situation is different in a number of capitalist countries where only a comparatively small part of the cost of health protection is defrayed by the state budget. In these countries the working people pay the bulk of the expenses on medical aid. The personal expenditure of U.S. citizens on medical treatment exceeds two-thirds of all the funds used for health protection. Despite all attempts to introduce various systems of public aid, including the so-called Medicare and Medicaid systems, the patients or their families have to pay large sums of money to medical institutions or medical personnel for the aid rendered. Suffice it to say that, according to official data, the price of one day’s hospitalisation in the USA now exceeds 50 dollars, a visit to a general practitioner costs 6 to 10 dollars, the expenses on obstetric aid range from 150 to 400 dollars, the price of filling a tooth is 5 to 10 dollars, etc. Even U.S. presidents have repeatedly referred to the exorbitant "cost of health”.

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p The general availability of medical aid in the USSR is also ensured by the extensive material and technical base of public health and medical science. Had not a sufficient number of hospitals, polyclinics, dispensaries, research institutions, medical schools, etc., been built under the Soviet Government, the general availability of medical aid, as a clear expression of the state’s responsibility for public health, would have been an empty phrase.

p We have already noted that before the October Revolution Russia was at the bottom of the list as regards the number of medical institutions and medical personnel. For example, in 1913 the country had 13 hospital beds per 10,000 population. In the outlying national districts there were either no hospitals at all or there were very few, and only in the towns. Thus on the territory of the present-day Republics of Turkmenia, Uzbekistan, Kirghizia and Kazakhstan there were no more than 1-3 hospital beds per 10,000 population and only 28,100 doctors, that is, 1.8 per 10,000 population. The bulk of the rural population had practically no skilled medical aid at all.

p According to the 1970 figures, the USSR had 26,500 various hospitals with a total of 2,663,300 beds, i.e., 109.2 beds per 10,000 population. Soviet Union is now one of the world’s leading countries in providing hospital accommodation. As regards the so-called somatic beds, i.e., hospitals for the treatment of all patients, except mental cases, the Soviet Union is ahead of the USA, Great Britain, France and other economically developed countries.

p A veritable army of doctors has been trained in the country in Soviet times; in 1970 it numbered nearly 675,000, i.e., 27.6 per 10,000 or one per 400 population. The USSR has more doctors than any other country in the world.

p The number of medical workers with a secondary medical education (nurses, technicians and surgeons’ assistants) has also increased severalfold. Today this number exceeds 2 million.

p Particularly great changes in health protection have taken place in Russia’s former outlying national regions. For example, in the Uzbek SSR the number of doctors increased from 139 in 1913 to 21,100 in 1968. In Kirghizia the number of doctors increased from 21 in 1913 to 5,700 in 1968, in Turkmenia (during the same period)—from 70 to 4,400 and in the Tajik SSR—from 19 to 4,300.

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At the present time even the remotest towns and villages in all the republics have their own hospitals, polyclinics, dispensaries, pharmacies and oilier medical institutions which administer highly-skilled medical aid. Table 7 presents some of the main indices of the development of health protection, i.e., figures attesting the building up and expansion of the material and technical base of the public health system.

Table 7 Number of doctors and hospital beds (at the end oi the year) 1913 1940 1950 I960 1965 1970 Number of doctors of all specialities, in thousands 28.1 155.3 265.0 431.7 554.2 679 Number of doctors per 10,000 population 1.8 7.9 14. G 20.0 23.9 27.6 Number of hospital beds in thousands 208 791 1,011 1,739 2,226 2,663.3 Number of hospital beds per 10,000 popu– lation 13 40.2 56 80.5 96 109.2