Window on Eurasia: More than Half of Russians Can’t Afford Medical Care

Paul Goble

Baku, February 28 – Fifty to seventy percent of Russians – some 70 to 100 million people -- do not get the medical care they need because they lack insurance or sufficient funds to pay for it, with many now not able to afford the most basic drugs and some forced to sell their homes to pay for the treatment they need.
Those are just some of the grim figures in a new report released by the Russian Society for Evidence-Based Medical Research (ORDM, http://www.ordm.ru), one described by journalist Irina Aleksandrova in an extensive article in the Moscow newspaper Gazeta last week (http://www.gzt.ru/health/2008/02/20/220320.html).
Despite Russia’s economic successes, its poor and especially their children, rural residents, those confined in the penal system, and the homeless are hurting badly in this respect, the report says. And their numbers set Russia’s problem in this area “at odds with the situation in many other countries of the world” – including in the United States.
“In all relatively well-off states, it is these groups which are the first in line to receive special benefits and access to medical help,” Aleksandrova writes. “Even in the U.S., where health care is based on individual and collective insurance, for pensioners and those with especially serious illnesses … there is a national program” of financing.
But in Russia that is not the case. There except for those suffering from diabetes or tuberculosis, no one can be absolutely certain that he will not have to come up with his own money for the treatment of illnesses, from the most mundane to the most serious and life-threatening.
Those who become victims of cancer and diseases of the nervous or circulatory system often have “to sell their residences in order to pay for the necessary medical help. Indeed, the report notes, Russians now pay 30 to 60 percent of the costs of health care out of pocket, a far higher percentage than almost anywhere else.
This imposes both enormous suffering on the population and greater costs on the society because many illnesses that could have been cured if they had been treated early on become much worse and only then addressed by specialists, a pattern that exacerbates a serious misallocation of resources.
Aleksandrova cites the conclusions of Moscow sociologist Sergei Shishkin who found that “approximately ten percent of the poorest households are forced to spend up to 30 percent of their incomes for treatment” and that “more than two percent” of them spend more than 50 percent.”
But as bad as Russia’s healthcare delivery system is for the general population both urban and rural, there are two groups where its failures hit Russians especially hard. Those who are in the penal system seldom get the medications they need, are given outdated drugs, and often leave jail sicker than when they went in.
And the estimated 4.5 million homeless people in the Russian Federation are seldom given any medical help at all, not only seriously reducing the life chances of these people but ensuring that in all too many cases, they spread diseases to the broader population rather than regain the health they need to reenter social life.
As it often does, “Gazeta” asked various people to comment about this appalling situation. And as is often the case, those close to the government explained it away as either being the fault of rising costs generally or the failure of regional governments to do what they are supposed to.
But others, less closely tied to the Kremlin establishment are far more critical: Oksana Dmtriyeva, a Just Russia Duma deputy, said that the situation had become “unbearable,” noting that during a recent visit outside of Moscow, there were no medicines and hence no possibility of treatment available to Russian people.