Social Inequality and Strategies for Getting Medical Care in Post-Soviet Russia

Abstract

This article examines the relationship between social status and medical help-seeking strategies in St. Petersburg, Russia. Analysis of in-depth interviews with a cross-section of the population revealed that access to and use of medical care varied greatly across the urban social structure. Those in the highest social strata used their knowledge and connections to gain access to the best care. Their social position and understanding of the system also privileged them in interactions with physicians, enabling them to take greater advantage of "free" services. Even with similar levels of material well-being, people with less education received poorer health care. Lacking confidence in their ability to assess quality and reluctant to consider options outside the impoverished, inefficient state medical system, they bore the brunt of its inadequacies. This reinforced a long-standing, culturally based predisposition to delay treatment until health problems had become more difficult and costly to manage.

The effects of Taiwan's National Health Insurance on access and health status of the elderly

“…These results are encouraging from a policy perspective, particularly for outpatient health care. Inequality in access has been widely documented (Adamson et al, 2003;Andersen et al, 2002;Auchincloss et al, 2001;Goddard and Smith, 2001;Keskimaki, 2003;Niefeld and Kasper, 2005;Pannarunothai and Mills, 1997;Rusinova and Brown, 2003;Schoen and Doty, 2004) and providing equal access to health care is often a policy priority. Our results provide strong evidence that a national health insurance system with comprehensive coverage is an effective way to reduce access disparities.…”

Constraints on Universal Health Care in the Russian Federation: Inequality, Informality and the Failures of Mandatory Health Insurance Reforms

“…While basic health care was available to poorer and less educated Soviet citizens, it was of poor quality, rude and ineffective. Ethnographic evidence shows that many people in these strata delayed seeking care and relied on self-treatment as long as possible, though this was obviously not an option for serious health problems (Rusinova and Brown 2003). The lesson here is that health services must be not only available but decent and dignified, or people may avoid seeking care until illnesses become serious and expensive to treat.…”

“…By the 1980s the system had become outdated and increasingly ineffective, unable to modernize to provide the 1 In the 1980s less than one-half of 1 per cent of the population had access to the elite system, while about half were served in the lowest-quality, rural district system (Davis 1988). Education and social status also played important roles in health care utilization (Rusinova and Brown 2003).…”

Social Inequality and the Continuing Russian Mortality Crisis

“…But such a health care deficit is again socially structured. Financial, informational and social means to access health care vary socially (Rusinova and Brown 2003;Dubikaytis et al 2010). Treating the major causes of ill health in Russia, once they occur, is expensive.…”