Nursing prof. joins Soviet roundtable

Nursing and Sociology Professor Linda Aiken was one of six delegates chosen to represent the United States at a roundtable discussion about health care in the former Soviet Union. The roundtable was part of the Gore-Chernomyrdin commission, dedicated to the examination of a series of matters having to do with health, social and economic issues in Russia. Aiken said last week's discussion, the first she has attended, was dedicated to issues of health care and policy and centered on finding solutions to Russia's health care problems. The U.S. delegation members, along with Secretary of Health and Human Services Donna Shalala and Vice President Al Gore, met with Russia's minister of health, first deputy of health and varied heads of state health care. Aiken, who also serves as Director of the Center for Health Services and Policy Research at the University, explained that the U.S. health care system served as a model for instruction. "Since communism has died out, there is a new emphasis on how Russia can change based on what the U.S. has done right and wrong," she said. The Center for Health Services and Policy Research is internationally known for its work on health work force policy. And Aiken said that is one of the major problems in Russia's health care system. "They have too many doctors who are poorly trained and too many hospitals [where] the care is inadequate," she said. Aiken said Russian officials are concerned about the continually rising mortality rate. Currently, Russia is the only country with an increasing rate, rather than a decreasing one. "The infant mortality rate is very high," she said. "And they have higher mortality at every age group." The Russian government spends only four percent of the country's gross national product on health care, as compared to the U.S.'s 14 percent. And, according to Aiken, with the country's depressed economy, the four percent does not add up to much. "80 percent of the health resources in Russia go to hospital care," she said. "More money should be invested in care at the community level. The challenge is how to spend the money in the best possible way." Because of the fall of communism, Russia is currently changing from a centralized government to one which is decentralized, giving more power to governmental structures in individual states. And the new power has left individual state health officials wondering how to engineer the much needed changes. Aiken said officials expressed interest in "bringing over U.S. state health commissioners to help" with the changes. She also said the other area which seems to warrant improvement is the training and integration of nurses in Russia's health system. Russian nursing students enter a two-year training program after they have completed their eight years of basic schooling. "This means that most of them are starting when they are 14 years old," Aiken said. "A major goal is to upgrade nurses' training to levels [equivalent to those] in the U.S. or England." Nurses also do not have an influential role in health care organization, Aiken said. And this is "detrimental" because nurses provide the most care, but do not have a role in policy and management discussions. But Aiken went on to say that, for nurses to have a more active role, more education and training is needed. She also said that there is a need for using more nurses to provide services outside of the hospital. The school of nursing at the University has examined the practice of sending nurses to homes of patients, thereby allowing patients to be released earlier but still have their recovery monitored. "The outcomes are better and it costs less," Aiken said. She said that nursing was one of the key solutions to the Russians' health care problems, adding that it is "the way to best spend the money they have." Aiken said that the next discussion is already being planned, this time to be held in Washington D.C. Since this is an ongoing initiative, Aiken said she will probably be meeting with the delegation again or will "make other recommendations" for the spot.

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