Access and Quality of Russian Healthcare

Key Insights

• Russia has universal constitutionally guaranteed healthcare.
• Russian healthcare outperforms 70% of the world’s systems in terms of quality and access.
• Globally higher healthcare spending tends to be financed by non-voluntary sources. Higher spending is associated with better quality and access.
• As percentage of all healthcare costs, Bulgaria and Russia spend more than any other country in the world on pharmaceuticals.

The Russian Federation has a universal publicly-funded healthcare system. Article 41 Paragraph 1 of the Russian Constitution (1993) guarantees free access to healthcare for all citizens of Russia in state and municipal publicly-funded healthcare organizations. In general, Russian healthcare could be divided into three categories: state, private and municipal healthcare. The system is providing broad coverage to a population of 144.5 million. It has significantly evolved over time since the collapse of the Soviet Union as new management methodologies were implemented, procurement processes improved and funding expanded.

Global Standing

According to a systematic analysis on healthcare access and quality (HAQ) Russia is ranked 58th among 195 countries studied, which places Russian healthcare system in eighth decile along with other Eastern European countries such as Latvia, Lithuania, Hungary and Bulgaria (Fullman et al, 2018). Comparing subnational data from the United States we can see an outlier: the state of Mississippi falls in the same decile as the Russian Federation in terms of healthcare access and quality, even though USA as a country was in the ninth decile. Most Western European countries had the highest scores, Canada and Australia were also in the tenth decile.

Healthcare Spending and Quality

The study has also indicated positive correlation between per capita healthcare spending in purchasing power parity and HAQ index. According to OECD (2020) data, in 2018 Russia spent 1 514 US Dollars per person on healthcare, 42,9% of which was voluntary payment. In Finland per capita spending was almost three times higher – 4 228 US Dollars. However, voluntary payment as a percentage of that money was a much smaller 24,7%. Another interesting example is Croatia, which occupies 30th place in the HAQ index, just one place lower than the United States with 10 586 US Dollars per capita expenditure. However, in terms of spending Croatia has a similar GDP per capita spending as Russia – 1 716 US Dollars with only 16,4% of that money being paid voluntarily. If we look at the proportion of financing coming from compulsory and voluntary sources, we see that most of the countries have relatively similar voluntary spending but countries with high healthcare expenditure tend to be driven by an increase in compulsory spending. Hence, countries with highest per capita healthcare spending get most of the funding from mandatory insurance or taxation. Even the United States of America, which is frequently referred to as a country with capitalist free-market healthcare, only pays for 15,5% of its healthcare voluntarily.

Doctors and Beds

Other important healthcare indicators include the number of doctors and hospital beds per 1 000 inhabitants. According to OECD (2020), Russia has really good standing in both indicators: as of 2017 it ranks 7th in the world by number of doctors (4 per 1 000 inhabitants), and 3rd by number of beds  (8.1 per 1 000 inhabitants). It is especially important in times of COVID-19 pandemic, since the healthcare system experiences severe pressure and having a lot of specialists and capacity is crucial for managing the crisis. By contrast, Sweden has nearly half the number of beds (2.2) but an almost identical number of doctors as Russia (4.1) per 1 000 inhabitants, while the United Kingdom has only 2.9 doctors and 2.5 beds per 1 000 inhabitants.

Spending on Pharmaceuticals

An important point to consider here is percentage of healthcare spending that goes into pharmaceuticals. In the United States drug prices is a topic for frequent political debate and protest; people go from the US to Canada to acquire cheaper drugs, especially insulin (Financial Times, 2019). In America 25% of patients find it hard to afford prescription drugs (KFF, 2019). Despite all the media attention, the USA doesn’t have the highest percentage of healthcare spending going into pharmaceuticals. OECD (2020) data indicates that the two countries with highest proportion of pharmaceutical spending are Bulgaria with 41.2% and Russia with 29% as of 2017. This indicator doesn’t include pharmaceutical spending in hospital setting. In 2010 – 2014 only 20% of all drugs were procured and distributed in hospital setting in Russian Federation (Deloitte, 2015).

Bibliography

1. Deloitte (2015). Development  Trends  and  Practical  Aspects  of  the  Russian  Pharmaceutical Industry. [online].
2. Financial Times (2019). Why prescription drugs cost so much more in America. [online].
3. Fullman, Nancy (2018). Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016, The Lancet, Volume 391, Issue 10136, Pages 2236-2271. [online].
4. KFF (2019). Poll: Nearly 1 in 4 Americans Taking Prescription Drugs Say It’s Difficult to Afford Their Medicines, including Larger Shares Among Those with Health Issues, with Low Incomes and Nearing Medicare Age. [online].
5. OECD (2020). Data on Health Spending. [online].
6. OECD (2020). Pharmaceutical Spending. [online].
7. Russian Constitution (1993). [online].