Russian medical care in the 1990s: A user's perspective

Abstract

Abstract:This article examines medical utilization patterns and attitudes toward the medical care system among the citizens of Russia's second largest city, St. Petersburg. It focuses upon the extent to which both attitudes towards and usage of medical care institutions have changed in the immediate post-Soviet period. A particular concern has been to determine the degree to which utilization and perceptions vary across the socioeconomic status hierarchy. The data were collected in two stages: a mass survey (N = 1500) conducted in mid 1992 and intensive follow-up interviews (N = 44) conducted in late 1994. The findings indicate that urban Russians were very critical of their medical care system at the end of the Soviet period. Most feel that the system has deteriorated even further since the end of 1991, and they are particularly worried about the emergency care system and about hospital conditions. Although people believe that the system now includes more alternatives, very few have changed their medical utilization patterns to take advantage of these new possibilities. This is more a product of their perceived high cost than of principled opposition to "pay" medicine. The analysis also demonstrates the extent to which medical utilization differs by socioeconomic status. Lower status individuals tend to utilize the formal medical care system. High status individuals seek help from a variety of sources and, in particular, rely much more heavily on informal connections to the medical care system. The medical helpseeking strategies of higher status groups have proven to be reasonably adaptable to the post-Soviet medical marketplace, while for others finding good quality medical care remains more problematic.Key words: Russian medical care, medical utilization, health attitudes, socioeconomic status INTRODUCTION This paper examines recent developments in the medical care system of Russia, focusing on how the system is perceived by the ordinary Russian citizens who utilized the medical system before the Soviet Union ceased to exist in late 1991 and who continue to utilize it now. The data for this analysis were collected in St. Petersburg, Russia, between 1992 and 1995. While the attitudes and experiences of Peterburgtsy may not typify those of all Russians, it is our contention that examining the perspectives of an urban population which has traditionally been provided with better than average medical care is an important step in understanding how the population as a whole is responding to the current situation.

Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector

“…Year of publication 1991-1998 7 English: [18,22,24,32,33,44] Russian: [19] [21]. The priorities of the reforms still appear depend on the Heads of the Ministry of Healthcare and corroborate a principle that was and still is put into practice -"new lords, new laws".…”

“…Inter-regional variation in access could be related to regional variations in healthcare financing and stages of implementation of healthcare reforms among regions [16,43]. For example, there were variations of costs per service and ability-to-pay for services among regions upon comparison of prices, both formally and informally [22,44]. However, inter-regional inequalities could be also caused by geographical remoteness from the capital and the fact that a limited number of highly specialized hospitals are mainly located in the largest cities [45].…”

“…Consumers perceived quality of care as "poor" and were "rather dissatisfied" with their quality of care. This was due to several factors: long waiting time and queues [33,47]; limited availability of modern medical equipment and medication, dissatisfaction with the quality of medical personnel, concern about doctors' competence and qualification [44]; high costs of medicine, lack of necessary medicines and equipment, bad nutrition, insufficient quality of doctors, bad sanitary conditions and others [40,43]; expensive drug treatment, violation of patients' rights, propensity of under-the-table payments, and poor conditions of healthcare facilities [48]; necessity to pay for a more convenient and better quality of care [41]. Other quality-related issues were a lack of evidence-based approaches in clinical decision-making, over-hospitalization, over-diagnosis and overmedication [49].…”

“…This could be partially explained by the fact that at the beginning of the OMS implementation respondents from the general population were not sure that the reforms would improve the quality of care [33] and few expressed anxiety (even fear) about the situation [44].…”

Implementation of an emergency and disaster medical response training network in the Commonwealth of Independent States

“…One reason for this is that ambulances would sometimes double as freelance taxis to earn extra money, thereby causing delay in emergency response (4). One study looking at views about the healthcare system among the general population in St. Petersburg found that one of the most frequently mentioned worries was about the emergency care system and its ability to provide adequate care for patients with sudden and unexpected life-threatening illness or accidents (7). There is no formal training in either adult or pediatric emergency medicine throughout most of the Commonwealth of Independent States (CIS) (8 -10).…”