Bureaucratic twists and turns following the demise of the Soviet Union have left Russia's health-care "system" -- if it can be called that -- in shambles. Russian hospitals are in a perilous state, drugs are in short supply and doctors and nurses are astonishingly underpaid -- as much as one-third below the national average.

Due to the health care crisis and falling living standards, the death rate has risen by one third to the highest rate of any major nation, and life expectancy has fallen to an average of 65.9 years for both men and women -- about 10 years less than in the U.S. and on par with Guatemala.

• By one 1999 estimate, at least 20,000 cancer patients die annually because they cannot afford medicine.

• An estimated 200,000 diabetics are unable to get insulin -- even though the government guarantees a free supply -- because local and regional governments cannot afford to buy it.

• One in 10 hospitals was built before 1914 and one in five has no running water.

Since 1990, Russia has decentralized its Soviet health bureaucracy, then tried to recentralize it. Experts report it threw the door open to private health insurers, then moved to close it. The system guaranteed free medicine to those who needed it, then limited free medicine to the neediest.

Eight different health ministers have tried to run the system during the last 10 years.

Source: Michael Wines, "An Ailing Russia Lives a Tough Life That's Getting Shorter," New York Times, December 3, 2000; Michael Wines and Abigail Zuger, "In Russia, the Ill and Infirm Include Health Care Itself," New York Times, December 4, 2000.

For New York Times text http://www.nytimes.com/2000/12/04/world/04RUSS.html