Mending the Human Motor 29to the Commission for Help to Scientists) and fi ve rest homes, along with sev-
eral tourist camps. In addition to patients registered with these institutions,
there was an increasing fl ow of patients without reservations. Given the site’s
lack of hotels, pansions, or central medical clinic, these patients lodged with
private residents and practiced their own health regimen without the benefi t
of medical advice.^46The Putevka and How to Get It
The voucher, or putevka (pronounced poo-TYOV-ka), entitled the recipi-
ent to a course of treatment, food, and lodging at a designated institution for
a particular period of time. This piece of colored paper possessed a monetary
value that represented the sum total of food and services to be provided,
but the acquisition of a putevka was rationed by criteria other than price.
Scarce spaces in sanatoria, pansions, and rest homes belonged fi rst of all
to those who needed them most. Offi cially, these were persons with medi-
cal conditions whose treatment would best benefi t from the assigned health
institution. Beyond this, industrial workers received offi cial priority in the
allocation of putevki, paid for by the country’s health insurance fund or by
individual enterprises. Yet this system of planned and rational distribution
existed in permanent tension with a system in which money and connections
counted as much as industrial labor and medical status. This tension would
persist to the end of the Soviet era.
In the 1920s and 1930s, health resorts operated on a quasi-commercial
basis: putevki carried a price based on costs, but they were distributed—not
“sold”—through a network of kurort bureaus or by arrangement with enter-
prises or institutions.^47 The process began with a visit to the doctor, who
would recommend the appropriate destination for the patient’s condition.
With the proper medical certifi cate, the prospective patient would then apply
to his or her local factory committee, and if recommended for a subsidized
course of treatment, the applicant would appear before a local kurort selec-
tion commission for fi nal authorization. If the commission determined that
the course of treatment was necessary, the patient would receive a free pute-
vka and transport, with forgone salary paid by the state insurance system. If
a patient wished to pay for the putevka out of pocket, a medical certifi cate or
permission from the selection commission was still required.^48
Rest home putevki were allocated through trade unions, who received
spaces based on the harmful health consequences of their industry’s work
- GARF, f. A-483, op. 2, d. 41 (Main Kurort Administration conference, November
1939), ll. 163–74. - Kurorty Abkhazii , 146–147; GARF, f. A-483, op. 1, d. 31 (kurort director conference,
December 1923), l. 32. - Gol'dfail' and Iakhnin, Kurorty, sanatorii i doma otdykha , 452–453; GARF, f. 9493,
op. 1, d. 30 (materials on supply of putevki, 1935), ll. 11–13.