E.M. Smirnova, PhD of Historical Science, Associate Professor
Yaroslavl State Medical University, Yaroslavl (Russian Federation)
One of the most important public health problems of Russia in the second half of the 19th to early 20th centuries was the weak development of medical services at factories. Medical care at industry enterprises was mainly of a emergency medical assistance nature and was often only on paper, and its establishment and nature depended on the decision of the owners. Adopted in 1912 under pressure from the labor movement, a package of laws on insurance should have changed the situation through a mechanism of social partnership. The law “On insuring workers in case of illness”, established the conditions and prospects for the development of medical services at factories. It was meant to become the basis for health insurance. This article deals with the formation process of health insurance in the Yaroslavl Province and its problems, primarily due to a conflict of interests between entrepreneurs seeking to minimize the cost of medicine and hired workers. The medical community saw a rational solution to improve the availability and quality of health care for workers in the transfer of medical services at factories into the hands of rural and urban municipalities, zemstvo-district doctors insisted on a full merger of factory medical services with the zemstvo districts. Recognizing this as a difficult task due to limited zemstvo-district budgets and the underdevelopment of the hospital network, zemstvo districts, if possible, chose a palliative solution to the problem and made arrangements with the owners of enterprises for the provision of hospital, outpatient and other forms of assistance, as well as the provision of drugs for workers. The problem of this single province reflected the typical situation of the central industrial region.
Keywords: Yaroslavl Province, social insurance, health insurance, medical insurance, zemstvo district medicine