Access to quality health care in Russia for all still remains questionable. A comparison with Canada

Venera Zakirova^1*, David Zakus², Charles P. Larson³ and Rinad Gataullin⁴

¹Research Associate, Center for International Health, Dalla Lana School of Public Health, University of Toronto, Canada.

²Senior Program Specialist (Health Systems), International Development Research Centre (IDRC), Ottawa. And Associate Professor, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada.

³Clinical Professor, Department of Pediatrics, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

⁴Professor, Head of Department of Economic Theory and Business Organization, Eastern Economic- Humanitarian University, Ufa town, Russia.

*Corresponding author E-mail: venera1108@yahoo.com

Accepted 01 October, 2012

Abstract

Since the collapse of the Soviet Union the health of the Russian population has declined considerably as a result of social, economic and lifestyle changes. Similarly, its population has been in decline too: from 148 million in 1990 to about 142 million in 2006, caused by the duel effects of high death and low birth rates, the latter greatly influenced by high rates of abortion. Russia’s health care system is based on the old Soviet one and thus possesses its merits and problems. The major achievements of the Soviet’s system were establishing comprehensive health care services available to the entire population and it’s influence on the development of the Alma Ata approach to primary health care. However, simultaneously Soviet medical science was isolated from developments in the West. As a consequence, many ineffective treatments remained routine and innovations developed in the West were not adopted. The Soviet health care system was based heavily on basic prevention, consisting of extensive screening measures and check-ups, which generally made the healthcare system inefficient and relatively expensive. Recent economic growth has had minimal impact on key indicators of health and human welfare. Currently, Russia possesses adequate numbers of highly qualified doctors and healthcare professionals, though most of them are poorly paid and unmotivated. Medical equipment in the majority of clinics and hospitals is archaic and hygienic conditions do not even meet domestic let alone established international standards (See L.Maksimova. Healthcare Reforms in Russia: Current Status. 2006. http://commercecan.ic.gc.ca/scdt/bizmap/interface2.nsf/vDownload/ISA_5214/$file/X_6362899.DO). Since 1991 the government of the Russian Federation has initiated health care reforms based on the health systems of the United Kingdom and Nordic countries. Yet, compulsory health care insurance and public programs cover only a small portion of drug purchases and a very limited number of medical procedures or operations. Despite the declared right of citizens to have access to free drugs at in-patient clinics, the majority of essential medicines and supplies must be paid for by patients out of pocket. It is estimated that patient out of pocket expenses comprise up to 60% of total healthcare expenditures, with most of this being direct payments to doctors and nurses rather than through private insurance schemes (See ibid ). In a result, a serious barrier to quality health care for low income persons, who make up 15-20% of the population, has appeared. This article describes the current health care situation and raises questions about whether Russia’s health reform process  is able to ensure the constitutional guarantee for free universal health care for all citizens.

Keywords: Quality Health Care, Russia and Canada