Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status general and specific for health education, health care, diagnosis, monitoring, management, and research. During the last ten years, telemedicine in Russian Federation (RF) has become more common, despite the fact that all publications are developmental reports without studies of outcomes evaluation and effectiveness. Information on social-economic impact is lacking. Although telemedicine in Russia can be expected to have social and economic implications for communities, healthcare providers, patients and others, most available publications to this date focused on its feasibility, estimation of cost saving, and some reference to social benefits. Russian and English language literature searches were used to encompass telemedicine evidence in terms of the social aspects, and economic performance for populations and individuals. The main benefits we looked for are access to healthcare services, cost resources, cost-effectiveness, education, social isolation, health outcomes, quality of care, and quality of life. For better understanding of telemedicine's place in society, we also present an overview of both the Russian healthcare system and telemedicine.
I. Healthcare system in Russia
With the establishment of the Soviet Union its healthcare system developed based on healthcare principles articulated by Nikolay Semashko : (1) governmental responsibility for health, (2) a close relationship between medical practice and the findings of science, (3) highly trained professionals and high quality professional care, (4) coordination of health promotion, medical treatment, and rehabilitation, (5) universal and free access to services, and (6) a preventive approach to "social diseases". The results of this approach led to the assertion that the Soviet health care system was one of the USSR's greatest achievements .
Using these principles, health care was provided by personnel who were employees of, paid by, and who received their medical supplies from the state which centralized control of the healthcare system. Thus, the system which was financed by government revenues could be an asset in the pursuit of economic and social development plans. The focus was on increasing the numbers of both hospital beds and medical personnel, improving community prevention, urban sanitation, hygiene, and promoting routine medical check-ups. Beginning in the 1920s, a network of facilities was built in order to reach even remote settlements and provide basic health coverage to the entire population . Quality of care varied, was better in urban than in rural areas, but was a significant improvement over what had existed previously .
Unfortunately, with time there was deterioration of it adherence to these principles. That resulted in less effective healthcare, and were diverging of the health status of the Russian and Western populations [1, 5]. Specifically, the paternalism inherent in Soviet philosophy allowed the failed development and/or atrophy of individual responsibility for crucial life-style issues recognized in the West such as diet, obesity, and use of alcohol and tobacco . Officials relied on growth of heath care facilities, resources, supplies and manpower, but neglected quality or effectiveness of care. Individuals saw themselves embraced in State medical facilities that shouldered the entire responsibility for an individual's health, reducing or absolving them of individual responsibility and encouraging their consumption of health care services without regard to cost.
Further, political separation between the West and the Soviet Union, abetted by the arms race, isolated Soviet medical science from Western advances in medical technology, knowledge and treatments, including new pharmaceuticals. With a stagnating economy in 1980s, the system could not afford the treatments that were coming on line in the West . …