Occupational welfare in Russia with special reference to health care
Relying on new empirical data, derived from a survey, and supplemented by an extensive study of available secondary material, this thesis represents the first attempt systematically to explore key issues regarding occupational welfare in Russia, with special reference to health care. The thesis is divided into three parts: a discussion of the problematic; an investigation of the evolution of policy; and an examination of primary and secondary empirical data. The fundamental theoretical problems of occupational welfare are approached in the light of research in the West, in the Soviet Union and in post-Soviet Russia with emphasis both on divergences and commonalities. It is argued that any endeavour to separate Soviet and Western experiences is artificial and ultimately unproductive. Rather, the analytical penetration of ideological barriers renders possible an examination of their fruitful interaction. On the basis of existing knowledge two perspectives of occupational welfare -- social policy and organisation -- are introduced. An attempt to formulate a general definition of the notion of occupational welfare is also made. The evolution of occupational welfare and in particular its health care component are examined in their context, from the Tsarist era, during the Soviet Union and through to post-Soviet times, with a concrete aim of elucidating any continuities in policy pathways. Contemporary issues are associated with the initial outcomes of health reforms in the 1990s that are indispensable for projecting the future prospects of occupational welfare. The empirical component of the thesis reports the results of fieldwork carried out in Moscow between 1995 and 1997. The brief was to explore the contemporary status of occupational welfare in Russia in the context of changing social policy aims and methods evolving in the course of the transformation. The attitudes of senior managers of industrial enterprises providing in-kind health services for their employees were investigated, as were employers' actual health responsibilities in the light of the introduction of compulsory health insurance legislation. It is argued that occupational welfare has a distinct sphere of operation and offers potential, not only for the survival of the service area but also for its further development in the evolving socio-political environment. The thesis is a first step towards a deeper analysis of occupational welfare in Russia: an audit of outstanding issues, although not exhaustive, completes the account as an aid to further discussion and research.