Overall, Russians tend to be satisfied with their country's health care
system, particularly when they do not need to deal with it; however, those with
recent first-hand experience of healthcare often complain about the lack of
professionalism and the decline in free medical services, according to Sergey
Shishkin, Head of HSE's Department of Health Care Administration and Economy,
and Natalia Kochkina and Marina Krasilnikova, sociologists with the Levada
Centre, in their paper Health Care
Service Availability and Quality as Assessed by the Russian Public.
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
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
Happy at a Distance
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%
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
Diagnostics and Dental Care Particularly Liked
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
Free Health Care Gradually Disappearing
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.
Money Matters More Than Patients?
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.
Quality More Important Than Proximity
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.
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.