Semashko model

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The Semashko model is a single-payer healthcare system where healthcare is free for everyone, and is funded from the national budget. It has been extensively modified since its introduction, and a number of ex-Soviet countries have now abandoned much of it. It was highly centralised and prescriptive in its design and had a very strong focus on specialist medicine so that family medicine and primary care was underdeveloped. The Bolsheviks began establishing the system in with a July 1918 decree, nationalizing all existing medical institutions and proclaiming healthcare being available for free for all, thus, at least nominally, establishing the world's first free and universal healthcare system. However, the actual availability of healthcare in the impoverished country after the prolonged civil war and two World Wars, especially in the more remote villages, lagged well into the 1930s, and the practical universality only got established by the 1950s. The system is named after Nikolai Semashko, a Soviet People's Commissar for Healthcare. The model is largely continued in Russia, most other post-Soviet states (exceptions are Turkmenistan, Kyrgyzstan and the Baltic states), and some other formerly Soviet-aligned states (such as North Korea and Cuba) and is regarded as one of the most influential ones.