The article describes the attempts of the government in the late XIX - early XX centuries to implement health care reform in Russia. The government commissions established under the Ministry of Interior based the draft laws on the establishment of an independent Central health management body, tighter control over the medical and sanitary activities of local selfgovernment health authorities and departmental medicine, and streamlining of medical legislation. The medical community, fearing the bureaucratization of medical and sanitary assistance to the population, did not support the projects of the commissions. The Commission headed by academician G. E. Rein worked most effectively, as a result of which in 1916 the Main Department of public health was created - the world’s first Ministry of health. © 2019, Stavropol State Medical University. All rights reserved.