ИСТИНА

At the turn of the 1990's Russia stepped on a transition from a planned to a market economy and democracy. Transformation affected all the shpere of societal life, led to dramatiuc changes in ideology, values, aims, methods of development and implementation of social and health policy. In such a situation iinternational experience inevitably had a very powerful impact on decision makers in Russia. To be precise in search for a new model Russia has to look for ideas and practices in countries with developed market economy and democratic institutions. The paper considers the successes and failures of health care reform policies in the Russian Federation within the frame woks of dissufions approach. Diffusion approach seems to be a useful framework to conseptualise changes in Russian social and health policy. We use it as an umbrella term to define a general situation when social institutions that successfully operate in one country are transferred to another country. In many states health care programmes are based on practicies borrowed from other countries. It is also neccessary to distingish between direct transfer or adaptation, voluntary or coeircive. Diffusion does not have negative connotation per se, however a number of problem remains, the main being how approprietae are transferred institutions for local conditions and generally uncritical diffusion is not welcomed. In the era of globalisation when international exchange of ideas is accelerated it is important to understand how general diffusion trends are formed, why some ideas and institutions are more “popular” than others on internation arena. It is argued in the paper that diffusion should be considered as an important factor of social and health policy development in post Soviet Russia. Modern health policy during the transition was formed under the two main influencies namely dominant western ideas and practices, on one hand, and enthusiasm of Russian elite at a time for liberal political ideology, on the other hand. Here the influence of international organizations that provide a lot of advices to the Russian government on social policy issues, first of all World Bank should not be inderestimated. Much less attention was paid on how well introduced institutions sitted with Russian economic, social and cultural realities. Especially taking into account a long tradition of state-led free medicine in the country. As a result changes introduced caused very high social costs in terms of population live expectancy, mortality and morbidity rates and contribute to creation of health system Russain expirience of (re)forming social and health policy is instructive as it demonstartes that diffusion in the context of rapid societal change is a poweful tool of shaping systemic characteristc of a new model.