Healthcare in Russia
The Constitution of the Russian Federation provides all citizens right to free healthcare under Mandatory Medical Insurance in 1996. However, 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. In 2008, 621,000 doctors and 1.3 million nurses were employed in Russian healthcare. The number of doctors per 10,000 people was 43.8, but only 12.1 in rural areas. The number of general practitioners as a share of the total number of doctors was 1.26 percent.
- 1 Life expectancy
- 2 Major health issues
- 3 History
- 4 Pro-natal policy
- 5 Structure
- 6 Voluntary medical insurance
- 7 See also
- 8 References
- 9 External links
As of 2013, the average life expectancy in Russia was 65.1 years for males and 76.5 years for females. The average Russian life expectancy of 70.8 years at birth is nearly 6 years shorter than the overall average figure for the European Union, or the United States.
The biggest factor contributing to this relatively low life expectancy for males is a high mortality rate among working-age males from preventable causes (e.g., alcohol poisoning, stress, smoking, traffic accidents, violent crimes). Mortality among Russian men rose by 60% since 1991, four to five times higher than European average.
As a result of the large difference in life expectancy between men and women, the gender imbalance remains to this day and there are 0.859 males to every female.
Major health issues
Common causes of death
In 2008, 1,185,993, or 57% of all deaths in Russia were caused by cardiovascular disease. The second leading cause of death was cancer which claimed 289,257 lives (14%). External causes of death such as suicide (1.8%), road accidents (1.7%), murders (1.1%), accidental alcohol poisoning (1.1%), and accidental drowning (0.5%), claimed 244,463 lives in total (11%). Other major causes of death were diseases of the digestive system (4.3%), respiratory disease (3.8%), infectious and parasitic diseases (1.6%), and tuberculosis (1.2%).
The infant mortality rate in 2008 was 8.5 deaths per 1,000, down from 9.6 in 2007. Since the Soviet collapse, there has been a dramatic rise in both cases of and deaths from tuberculosis, with the disease being particularly widespread amongst prison inmates.
Russia is the world leader in smoking. According to a survey reported in 2010 by Russia’s Health and Social Development Ministry, 43.9 million adults in Russia are smokers. Among Russians aged 19 to 44 years, 7 in 10 men smoke and 4 in 10 women smoke. It is estimated that 330,000-400,000 people die in Russia each year due to smoking-related diseases.
Alcohol consumption and alcoholism are major problems in Russia. It is estimated that Russians drink 15 litres (26 pints) of pure alcohol each year. This number is nearly 3 times as much as it was in 1990. In Moscow on September 24 of 2009, Russia's interior minister Rashid Nurgaliyev cited the average intake at an estimated 18 liters a year; "In Russia, each person, including babies, accounts for about 18 liters of spirits per year. In the opinion of WHO experts, consumption of more than 8 liters per year poses a real threat to the health of the nation. Russia has long exceeded this level". It has even been reported that excessive alcohol consumption is to blame for nearly half of all premature deaths in Russia.
A recent study blamed alcohol for more than half the deaths (52%) among Russians aged 15 to 54 from 1990 to 2001. For the same demographic, this compares to 4% of deaths for the rest of the world.
HIV/AIDS, virtually non-existent in the Soviet era, rapidly spread following the collapse, mainly through the explosive growth of intravenous drug use. According to a 2008 report by UNAIDS, the HIV epidemic in Russia continues to grow, but at a slower pace than in the late 1990s. At the end of December 2007 the number of registered HIV cases in Russia was 416,113, with 42,770 new registered cases that year. The actual number of people living with HIV in Russia is estimated to be about 940,000. In 2007, 83% of HIV infections in Russia were registered among injecting drug users, 6% among sex workers, and 5% among prisoners. However, there is clear evidence of a significant rise in heterosexual transmission. In 2007, 93.19% of adults and children with advanced HIV infection were receiving antiretroviral therapy.
In April 2006, the State Council met with the Russian President to set goals for developing a strategy for responding to AIDS; improving coordination, through the creation of a high-level multisectoral governmental commission on AIDS; and establishing a unified monitoring and evaluation system. A new Federal AIDS Program for 2007 - 2011 was also developed and adopted. Federal funding for the national AIDS response in 2006 had increased more than twentyfold compared to 2005, and the 2007 budget doubled that of 2006, adding to the already substantial funds provided by the main donor organizations.
Coordination of activities in responding to AIDS remains a challenge for Russia, despite increased efforts. In 2006, treatment for some patients was interrupted due to delays in tender procedures and unexpected difficulties with customs. Additionally, lack of full commitment to an in-depth program for education on sex and drugs in schools hinders effective prevention programs for children.
In 2008, suicide claimed 38,406 lives in Russia. With a rate of 27.1 suicides per 100,000 people, Russia has one of the highest suicide rates in the world, although it has been steadily decreasing since it peaked at around 40 per 100,000 in the mid-late 90s, including a 30% drop from 2001 to 2006. In 2007 about 22% of all suicides were committed by people aged 40–49, and almost six times as many Russian males commit suicide than females.
Heavy alcohol use is a significant factor in the suicide rate, with an estimated half of all suicides a result of alcohol abuse. This is evident by the fact that Russia's suicide rate since the mid-90s has declined alongside per capita alcohol consumption, despite the economic crises since then; alcohol consumption is more of a factor than economic conditions.
Pre-reform health care
Pre-1990s Soviet Russia had a totally socialist model of health care with a centralised, integrated, hierarchically organised with the government providing free health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. On the whole, the Soviet system tended to primary care, and placed much emphasis on specialist and hospital care.
The integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The effectiveness of the model declined with underinvestment. Despite the fact that the quality of care began to decline by the early 1980s, medical care and health outcomes were on par with western standards. Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the lack of money that had been going into health was patently obvious. Some of the smaller hospitals had no radiology services, and a few had inadequate heating or water. A 1989 survey found that 20% of Russian hospitals did not have piped hot water and 3% did not even have piped cold water. 17% lacked adequate sanitation facilities. Every seventh hospital and polyclinic needed basic reconstruction. Five years after the reforms described below per capita spending on health care was still a meagre US$158 per year (about 8 times less than the average European social models in Spain, the UK and Finland, and 26 times that of the U.S. which spent US$4,187 at that time).
Reform in 1991-1993
The new Russia has changed to a mixed model of health care with private financing and provision running alongside state financing and provision. Article 41 of the 1993 constitution confirmed a citizen's right to healthcare and medical assistance free of charge. This is achieved through compulsory medical insurance (OMS) rather than just tax funding. This and the introduction of new free market providers was intended to promote both efficiency and patient choice. A purchaser-provider split was also expected to help facilitate the restructuring of care, as resources would migrate to where there was greatest demand, reduce the excess capacity in the hospital sector and stimulate the development of primary care. Finally, it was intended that insurance contributions would supplement budget revenues and thus help to maintain adequate levels of healthcare funding.
The OECD reported that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse. The population’s health has deteriorated on virtually every measure. Though this is by no means all due to the changes in health care structures, the reforms have proven to be woefully indequate at meeting the needs of the nation. Private health care delivery has not managed to make much inroads and public provision of health care still predominates.
The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.
In 2006 a national project 'Health' was launched to improve the country's healthcare system through improved funding and healthcare infrastructure. This plan helped equip hospitals and clinics with advanced, high-end equipment and ambulance systems, build new medical centers, as well as launch nation-wide vaccination programs and free health checks. The project has also been working on developing medical technology market through initiatives to blend healthcare and information technology. One of the focuses was made on salary increase of medical staff working in the primary care as well as their wider training programmes.
The project was initiated by the Russian President Vladimir Putin and coordinated by the Presidential administration. It was mostly financed by the federal budget. However regional and municipal levels have also contributed a lot to the financing of the program.
Reform in 2011
Starting 2000, there was significant growth in spending for public healthcare and in 2006 it exceed the pre-1991 level in real terms. Also life expectancy increased from 1991-93 levels, infant mortality rate dropped from 18.1 in 1995 to 8.4 in 2008. Russian Prime Minister Vladimir Putin announced a large-scale health-care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billion) in the next few years to improve health care in the country. He also said that obligatory medical insurance tax paid by companies for compulsory medical insurance will increase from current 3.1% to 5.1% starting from 2011.
In an effort to stem Russia’s demographic crisis, the government is implementing a number of programs designed to increase the birth rate and attract more migrants to alleviate the problem. The government has doubled monthly child support payments and offered a one-time payment of 250,000 Rubles (around US$10,000) to women who had a second child since 2007.
In 2006, the Minister of Health Mikhail Zurabov and Deputy Chairman of the State Duma Committee for Health Protection Nikolai Gerasimenko proposed reinstating the Soviet-era tax on childlessness, which ended in 1992. So far, it has not been reinstated.
In 2007, Russia saw the highest birth rate since the collapse of the USSR. The First Deputy PM also said about 20 billion rubles (about US$1 billion) will be invested in new prenatal centres in Russia in 2008–2009. Immigration is increasingly seen as necessary to sustain the country's population. By 2010, number of Russians dropped by 4.31% (4.87 million) from the year of 2000, during the period whole Russia’s population died out just by 1.59% (from 145.17 to 142.86 million).
The healthcare system follows the administrative structure of the country and is divided into federal, regional (oblast-level) and municipal (rayon-level) administrative levels.
The administrative units at this level govern regional healthcare. Prior to the 1993 legislation establishing a mandatory medical insurance system, regional governments had full control of regional funds for healthcare. Following implementation of mandatory medical insurance, they lost a portion of this control to the newly established territorial mandatory medical insurance funds (OMS Funds). Due to the only partial implementation of the health insurance system, however, regional and local governments currently retain a significant role in its management. The regions must ensure compliance with federal programs, in particular those focused on the control of conditions and infectious diseases defined as being of high social priority, but do not have to report to the Ministry of Health. Following decentralization in the early to mid-1990s, they enjoy considerable autonomy within their administrative units.
Local (municipal) level
In many larger cities rayon authorities appear to be actively engaged in the reform process, while in rural areas the health authorities’ functions have tended to become the responsibility of central district hospital chiefs. Following the 2003 law On general principles of organization of local self-government in the Russian Federation, municipal level governments do not have to report to the federal or oblast level governments, though they do have to comply with Ministry orders. This poses a problem for health policy since raions do not have to comply with oblast level health reforms or other policies, and are only obliged to provide statutory healthcare services within their jurisdiction. In practice, many regions and raions have developed a negotiating procedure so that the local governments remain within the regional Ministry of Health sphere of influence.
Voluntary medical insurance
Voluntary medical insurance was first authorized in Russia in 1991, with further regulatory legislation the following years. DMS is provided to individuals or groups, for example the staff of an enterprise, and allows the population covered to obtain additional services beyond those included in the basic package. It is offered exclusively by private insurance companies which operate for profit. According to the Federal law on mandatory medical insurance legislation (1993), DMS may be offered by private insurers who are part of the mandatory medical insurance system. In general, it tends to be purchased mostly by employers for their staff. The legal person purchases policies for its employees that give the right for getting medical aid in established public or private institution in the volume that is foreseen in the insurance contract. Private insurance firms have tended to concentrate on the top end of the market and to offer add-on services to supplement the basic package of free medical care. Their focus has been on providing better conditions, offering patient choice of a doctor and on securing access to more prestigious institutions.
- Russian Ministry of Health
- Abortion in Russia
- List of federal subjects of Russia by incidence of substance abuse
- Russian Medical Fund
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