The distributive fairness of out-of-pocket healthcare expenditure in the Russian Federation

Pavitra Paul

doi:10.1007/s10754-019-09268-9

Abstract

This article examines the effects of socioeconomic position and urban–rural settlement on the distribution of out-of-pocket expenditure (OPE) for health in the Russian Federation. Data comes from 2005 to 2016 waves of the Russian Longitudinal Monitoring Survey. Concentration index reflects changes in the distribution of OPE between the worse-off and the better-off Russians over a 12-year period. Finally, unconditional quantile regression—a recentred influence function approach estimates differential impacts of covariates along the distribution of OPE. OPE is concentrated amongst the better-off Russians in 2016. Urban settlements contribute to top end OPE distribution for the richest and town settlements, at the median for the richest and the poorest. Our model for the analysis is unique in the context of study population, as it marginalises the effect over the distributions of other covariates used in the model.

Highlights

Following the disintegration of the United Soviet Socialist Republics, the Russian healthcare system underwent significant changes: decentralisation of management, introduction of a mandatory health insurance system and institutionalisation of user fees for certain healthcare services in addition to or instead of free-of-charge services (Popovich et al 2011)
The result of test of independence showed that incomplete secondary school level education did not have statistically significant visit frequency to a doctor but visit frequency(s) to a doctor was statistically significant for respondents with completed secondary school and respondents with higher education
The inflation-adjusted income gap between the richest and the poorest were at its peak (98%) in 200614 but we found no difference in mean OPE for the richest and the poorest quintiles at any quantile of OPE, denial of access to healthcare services attributable to financial affordability was higher among the better-offs

Summary

Introduction

Following the disintegration of the United Soviet Socialist Republics, the Russian healthcare system underwent significant changes: decentralisation of management, introduction of a mandatory health insurance system and institutionalisation of user fees for certain healthcare services in addition to or instead of free-of-charge services (Popovich et al 2011). The manifestation is an obvious, to varying degrees, form of private financing in which citizens pay out of pocket (OPE) for healthcare services that they receive from the public system (Gaal and McKee 2004). A source of revenue that has grown in importance is OPE, including both formal co-payments and informal, under-the-table payments (Preker et al 2002). The boundaries between free and chargeable health services are blurred. Regions in the Russian Federation impose different payment schemes in which, that formal and informal payments may substitute for one another (Aarva et al 2009). There has been an implicit response taking the form of allowing capacity to wither and tolerating an increasing gap between population entitlement and capacity to provide healthcare services (Balabanova et al 2012)

Results

Discussion

Conclusion