Better health service availability and quality are declared policy priorities in Russia, and a series of large-scale public health reforms have been undertaken in recent years designed to improve diagnostic capabilities, shorten patient waiting time for both outpatient and inpatient care, enhance health workers' performance, etc.
However, opinions differ on whether the reforms have been successful. Russian patients who are the end users of health services are perhaps in the best position to judge whether changes to the health care system have been positive.
In a study undertaken as part of the HSE Basic Research Programme in 2013 and 2014, Shishkin, Kochkina and Krasilnikova examined public satisfaction with access to healthcare and its quality generally and, more specifically, the opinions of certain socio-demographic groups about certain healthcare components, such as health checkups, being able to make medical appointments online, changes in primary, secondary (both inpatient and outpatient), emergency, and dental care, and the restructuring of the entire system of health service delivery.
They used the data from two national surveys commissioned by the HSE and conducted by the Levada Center in 2013 and 2014 on samples of 3,302 and 4,503 respondents, respectively, and a national poll conducted by Roszdravnadzor in 2008 on a sample of 39,141 respondents.
Shiskin, Kochkina and Krasilnikova reported their findings in the paper Health Care Availability and Quality as Assessed by the Russian Public.
The Russian public has a generally positive view of the recent changes in clinics and hospitals, according to the researchers. Thus, 42% of respondents in the 2014 survey report an improvement in medical service delivery, while 29% believe that things have got worse; notably, those who accessed medical services in the year prior to the survey were more likely to report deterioration (32%) than those who did not seek health care (19%), while people with chronic diseases were even more likely to hold negative opinions of short-term changes in healthcare delivery – 41% reported deterioration vs. 35% reporting improvement.
According to Shishkin, Kochkina and Krasilnikova, "We can conclude that the image in the public mind – propagated mainly by mass media – of Russia's health care system tends to be better than the actual experience of those who have accessed its services and who need them more than others."
Russians tend to rank diagnostic and dental care facilities higher than other types of health services; nine out of ten respondents were happy with their dental care providers and did not wish to change them, even when given a choice; 52% of those who answered questions about dental care accessed these services at a public (municipal) clinic, 2% used departmental (in-house) facilities, and 46% received care from a private dentist.
The respondents also appreciated the option of making medical appointments online; the number of respondents reporting the availability of online appointments in their local clinic increased by 7% between 2013 and 2014 and reached 47%. Most respondents (90%) in Moscow and St. Petersburg reported having this option, compared to just one third of respondents in rural areas; most users of the system (60%) appreciated the convenience.
Despite the overall optimistic assessment, comparing the data from the 2013 and 2014 Levada surveys with the data from the 2008 Roszdravnadzor survey reveals a gradual decline in public satisfaction with both outpatient and inpatient care in terms of access to free healthcare in a timely manner and the providers' professional skills.
At least 80% of respondents in all population groups are convinced that in the event of illness, they would not be able to access free medical care to the extent needed.
Even though most Russian patients are entitled to free healthcare, an increasing number of patients pay medical providers.
Such out-of-pocket payments are particularly common in dental and in-patient care; a quarter of the recently surveyed hospital patients reported having to pay for some types of services and almost half (47%) reported having to buy their own medicines while in hospital.
Many Russians choose to pay for access to limited healthcare resources which are supposed to be free for the patient; more than a third of the patients who paid for ostensibly free services did so to get treatment from the doctor or clinic of their choice, to get prompt access to care, to motivate healthcare workers to pay more attention to the patient, and to thank the providers.
Russians tend to be sceptical about doctors; almost two thirds of respondents believe that most doctors in the country do not have sufficient professional skills (58%) and are more concerned about their income than their patients (60%).
In particular, respondents were dissatisfied with outpatient care; while 41% reported having accessed an outpatient clinic in the prior 12 months, they denied seeing any improvement of their health as a result, and the proportion of those unhappy with outpatient care increased by 9% between 2013 and 2014.
Generally, Russians are satisfied with ambulance services, except with reported delays that could cost a patient their life; one in five respondents (one in ten in Moscow and St. Petersburg) who reported having called an ambulance encountered problems such as a refusal to send an ambulance, a long wait, or other similar issues.
Satisfaction with inpatient care is quite high at 82% as a national average, including 33% who are are fully satisfied and 49% who are rather satisfied. Most people satisfied with inpatient care (87%) are those with higher incomes; according to the study's authors, the reason may be that they can afford to pay for extra care and a more comfortable environment.
The surveys quoted above provide feedback on the main dilemma of Russia's healthcare delivery reform, i.e. access vs. quality. Most Russians are prepared, to a certain degree, to sacrifice geographical access for better quality of care.
"Thus, creating well-staffed and highly-equipped medical facilities at the inter-district level, in particular by pooling the resources of clinics and hospitals as it is done today in Moscow, is a potential healthcare reform solution likely to be accepted by most Russians," concludes Shishkin.