Reform of the Russian Public Health System and the Value Conflicts of Professionalism

Abstract

This article how medical professionalism is being reshaped in the context of current health reform efforts in Russia and considers the value conflicts that have emerged as a result. Physicians have seen this invasion of the State and the market into the organization and content of medical work as an infringement of both the fundamental values of their profession and the rights of their patients. In various arenas of public discussion it is possible to discover symbolic battles between the proponents and opponents of the current reforms. These debates mainly focus on definitions of true medical professionalism and the values behind this. These value conflicts are not confined to pure rhetoric and ideology but have essential practical implications, which can be seen in various details of medical work such as making choices between values that may either reinforce or contradict traditional professional values with them. It is demonstrated that these value choices are directly related to changes in the social morphology of Russia’s public health care system, including not only its economic and political-administrative aspects but also how the self-perception and feelings of medical workers are being affected by the current reforms. In the various situations and circumstances that make up everyday professional activity, the new obligations in medical work that have appeared from these complex changes come into conflict with the professional self-conception of medical workers and prompt them to changes that contradict their ideal conceptions of professionalism and professional duty. On these grounds the medical workers protesting against the current reforms see it as being destructive to the Russian public health system. The results presented in this paper are based on an analysis of discussions in the specialized online pages in Facebook that emerged from the tide of protest against the current reforms (“All-Russian action ‘For accessible medical care!’” and “Against the extermination of health care”). In this research the author employs Herbert Blumer’s scheme of constructing social problems and the Chicago school-style four-dimensional (ecological-economical-political-sociopsychological) analysis of change in the organization and conditions of medical work.