Have you ever watched Michael Moore’s documentary film ‘Sicko”? It’s quite interesting as devoted to medical issues of different countries (and we, people, are always curious about different sides of living abroad, aren’t we?). Actually, I wonder if everything mentioned in that film represents the real facts, without distortion? Something seems a bit strange to me, and some facts I just can’t understand as I live in another context.
Having watched this film, I decided to write a post about the Russian health system (and to compare it with other countries). So, maybe you’ll be confused as much as me.
Before writing all this I read many sources concernig Russian health care system and… I understood the only thing – it has really difficult structure even for me. That’s why I decided not to load you up with unnecessary information and tell everything as simple as possible. If you have any questions, I’ll do my best to answer them in comments.
Let’s begin.
First of all, there are two types of medical services in Russia – gratuitous and commercial.
Gratuitous medical services in Russia
These medical services are covered by compulsory health insurance (you can get an insurance policy at no charge at one of the major Russian insurance companies). With this kind of insurance you can apply to a polyclinic according to the place of residence, state hospital or call an ambulance.
You get outpatient treatment at polyclinic:
- here you consult your general practitioner;
- then he or she determines the subsequent treatment or necessity of consulting specialized doctors like a neuropathist, ENT specialist, etc.
- if required you can undergo medical tests (urinary, blood, chemistry tests, etc.), photoroentgenography, physiotherapy treatment and, for example, receive an injection in a procedure room.
Everything is free (not absolutely free, of course, because the Russian health insurance fund gets 5,1% of our salary in the form of taxes), if you have a policy of obligatory medical insurance.
But! There are so many annoying things in these medical services…
Here, in Russia, doctors have low salary in most cases, that’s why they are not motivated to work better: they can be rude, can say that you’re in good health (even without any tests) and send you home. It was my boyfriend’s case: every time he consulted his doctor at polyclinic he was said after awhile:
a) “you are healthy”;
b) “I don’t know what’s wrong with you”.
Of course, exceptions exist and I met smart, single-minded doctors at state polyclinics, but I met him so rarely that now I prefer to apply to commercial clinics only.
Besides, you need to make an appointment to consult a doctor. In some polyclinics you can call or go to front desk to book an appointment in advance, in others (for example in mine) you should call strongly between 8 and 8:30 am the same day you want to consult a doctor. Now imagine how many people want to get an appointment every day – there are lots of them! So, every time I tried to get through I found that the phone was always busy. It seems to me something is wrong with this system.
But much earlier (10-15 years ago) it was even worse. In some polyclinics you had to come early in the morning (about 7 a.m.), join the queue and wait – maybe 30 minutes, maybe 1 hour or more – just to make an appointment. It is really Russian style!
Oh, I didn’t mention that polyclinics opened only at 8 a.m. and most of the time people waited their turn in the street. Imagine it’s winter and temperature is – 20°C. Oops!
I don’t know why, but such problems were only in some regions, and I ran into this issue after moving to Novosibirsk. It was an unpleasant surprise for me…
Besides, there exist “queues” for different types of medical testing – for example, for MRT. You may register for a test, but you will undergo it only in several months. And also there is such notion like “a referral”, and without it you won’t be able to undergo any tests “at no cost”. So, if your doctor is indifferent like my boyfriend’s is, you’ll never get a referral :)
As I have already said, having a policy of obligatory medical insurance you can call an ambulance (first aid should be provided even without it). Arrived doctor examines you, possibly makes necessary injections or offers to go to a hospital. Russian hospitals (especially in small towns) also can be different – in Novosibirsk you can find modern and good-looking ones (usually with up-to-date equipment) or dilapidated with awful treatment conditions. What hospital you’ll check into will depend on your place of residence and a presumptive diagnosis. The treatment quality will depend on your doctor, but experience has proven that the number of qualified doctors in big state hospitals is promising.
Anyway, some people have recourse to gratuitous medical services all their life… And everything is OK. Probably.
Commercial medical services
In the case of commercial clinics there are two ways of paying for a specialised medical consultation and all the subsequent tests and health screening:
1. You pay for everything yourself
The average price for a consultation is 700 rubles ($15,5*), price for tests vary, electrocardiography is about 650 rubles, magnetic resonance tomography varies from 2500 to 11 000 rubles ( from $55 to $244*) depending on its characteristics.
2. You have a voluntary health insurance policy
There are different types of voluntary health insurance in Russia which include different services and conditions. The cheapest variant that I found cost about 20 000 rubles ($445*) and included only outpatient treatment (i.e. polyclinics) and doctor’s home visits; the most expensive variant in my region cost 82 800 rubles ($1 840*) and included outpatient treatment, doctor’s home visits, dental health service, emergency inpatient care and full diagnostic services.
Here I’ll omit the problem of insurance benefits: an insurer may refuse to pay a claim, as in many other countries.
But I meet people who buy this type of policies themselves rarely, more often they are provided by an employer. Big international companies like to allure employees by such things.
Turning to commercial medical services, it must be confessed that even they have their weaknesses. For example, it’s a normal situation when doctors in such medical centers prescribe unnecessary tests believing that a patient will pay money for useless information and won’t even understand it. I came on it several times but, luckily for me, I have people with medical education to consult with :)
But if you don’t tell your money, the last issue is not a problem for you. The only thing that matters is not to meet an unqualified doctor and not to be killed by too much doctoring.
By the way, you may run into unqualified doctors everywhere, and I learnt it by my own experience (you come to a comercial medical center, pay money, regularly visit your doctor during a month, take expensive tests to hear that it’s too difficult to make out a diagnosis). And I know some tragic cases, when people died because of doctors’ carelessness.
Somehow commercial medical services in Russia aren’t perfect too. And that upsets me, because the only way out of this whole situation is to search for real opinions about doctors you are going to consult with.
So. That’s general information about our medical services. Possibly, it’s not so bad and I just overstate something… We have gratuitous medical services, anyway, and people may consult a doctor. However, sometimes they should get through a real quest to finally visit a doctor. I think this bureaucracy is slowly killing the country from the inside.
But what is more important, the commercial medicine, meant to facilitate getting medical help quickly, isn’t always able to help you. Especially, when it comes to personal benefit.
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*At the rate of 45 rubles per dollar
If you find any grammatical/stylistics errors in this text – please, let me know.
