A planned transition to insurance medicine in Russia was based on the implementation of three basic principles: decentralization to the local level of all financing and administrative regulations; establishment of economically independent, self-financing medical facilities for preventive and curative care; and the formation of a more rational structure to the delivery of medical care. Ryan (1991) indicates that two regions in Russia, Kuibyshev and Kemerovo, began to apply these rudimentary principles in demonstration projects of insurance medicine in 1990.