HEALTHCARE FOR EVERYONE: A MONITORING STUDY: VCIOM: Russia Public Opinion Research Center

HEALTHCARE FOR EVERYONE: A MONITORING STUDY

Every second Russian has paid additional health services when using mandatory health insurance. However, most of Russians are confident that paying for services through mandatory health insurance is unacceptable.

01.11.2023

IN BRIEF

• 95% of Russians reach out for medical help using mandatory health insurance (+6 p.p. compared to 2017).;

• 43% believe that at many hospitals and outpatient clinics people have to pay the services which are supposed to be free through mandatory health insurance (45% in 2015), 34% are confident that such services must be provided fully free of charge (45% in 2015).;

• 28% report they have faced refusal when they reached out for treatment using their mandatory health insurance.;

• More than half of Russians (56%) paid additional services when they sought medical help through their mandatory health insurance.;

• 76% consider it unacceptable to introduce paid health services within mandatory health insurance.

MOSCOW, 1 November 2023. Russian Public Opinion Research Cetner (VCIOM) presents the findings of a survey devoted to mandatory health insurance.

General situation

Mandatory health insurance provides people with free and quality health services at state health institutions.
An overwhelming majority of Russians seek medical help (95%). They include 61% of those who did it less than a year ago (+8 p.p. compared to 2017) and 20% of those who did it one or two years ago (20%).

Women are more likely to seek healthcare through mandatory health insurance (70%) compared to men (49%).

However, four out of ten Russians say they pay for a number of health services which are supposed to be free through the mandatory health insurance scheme (43%). This opinion has been quite stable over the recent eight years (45% in 2015). Every third respondent is confident that today treatment covered by the mandatory health insurance system is completely free for patients (34% vs 45% in 2015); a decline is due to an increased share of the undecided (10% in 2015; 23% in 2023).

The younger the Russians, the more often they say that free health services are guaranteed by mandatory health insurance (45% of those aged under 25; 31% of those aged over 45).

Those who have sought treatment covered by their mandatory health insurance over the recent year tend to report that the services provided by the basic health service package are free of charge — 39% (vs. 34% of total respondents and 27% of those who reached out for treatment 3-5 years ago).

The level of income also influences opinions on the situation in free healthcare. Respondents with good income tend to be more optimistic - 44% of them think that the services provided by mandatory health insurance is free of charge (vs. 25% of those with poor income). Every second Russian with low income says such services are paid (55% vs. 32% of those with good income).

The urbanization rate impacts public views on the services provided by mandatory health insurance. Residents of both capitals and large cities are inclined to think that such services are fully free (Moscow, St Petersburg — 40%, million-plus cities — 37%, cities with a population of 950-500 thousand inhabitants — 41% vs. 30-33% of those living in rural area and small cities with under 100 thousand inhabitants. Half of rural area inhabitants and those who live in the cities with under 100 thousand inhabitants believe that most of the services through mandatory health insurance are provided for fee (44% and 48% vs. 37-40% of those in large cities and both capitals).

…personal experience

Seven out of ten Russians have not faced situations where they did not receive free health services provided by mandatory health insurance (67%). A quarter says they have faced such situations (28%), including 9% who faced it many times and 19% once or several times. They are mainly those who have low level of income (39% vs. 21% of those who have good income).

Half of Russians had to pay for additional services not covered by mandatory health insurance (56%), 37% had to pay when they sought treatment for themselves; 19%, for their relatives. Every third respondent has not reached out for paid health services when using mandatory health insurance — 35% (41% of those aged 60+).

Women paid for the additional services when they sought treatment for themselves (41% vs. 32% of men), whereas men did it when they sought treatment for their relatives (22% vs. 16%).
Respondents with low income had to pay for the additional health services when using mandatory health insurance (64% vs. 46% of those who have good income).

Although commercial health services are in demand, most of Russians consider it unacceptable to introduce paid services as part of mandatory health insurance (76%).

VCIOM-Online Russian nationwide survey was conducted October 17-18, 2023. A total of 1,708 Russians aged 18+ were surveyed. Survey method: online survey, probability-based stratified random sample. The data were weighted for socio-demographic characteristics. Panel participants were recruited in the course of the Sputnik daily all-Russian telephone survey (CATI) using RDD selection of mobile phone numbers from a complete list of phone numbers in use in Russia. The data were weighted for socio-demographic characteristics. The margin of error at a 95% confidence level does not exceed 2.5%. In addition to sampling error, minor changes to the wording of questions and different circumstances arising during the fieldwork can introduce bias into the survey.

Can you recall when was the last time you sought health care at state health care institutions through your mandatory health insurance? (close-ended question, one answer, % of total respondents)
	2017	2018	2019	2023
Less than 1 year ago	53	56	61	61
1-2 years ago	20	18	16	20
3-5 years ago	9	11	10	9
6 years ago or more	7	7	6	5
I don’t use mandatory health insurance	6	4	5	3
I don’t have mandatory health insurance	3	2	2	1
Don’t know	2	2	<1	1

Can you recall when was the last time you sought health care at state health care institutions through your mandatory health insurance? (close-ended question, one answer, % of total respondents)
	Total	Men	Women	Ages 18-24	25-34	35-44	45-59	60 +
Less than 1 year ago	61	49	70	59	56	59	57	69
1-2 years ago	20	23	17	23	26	21	19	15
3-5 years ago	9	12	6	13	10	9	10	6
6 years ago or more	5	7	4	0	4	4	7	6
I don’t use mandatory health insurance	3	5	2	5	2	2	5	2
I don’t have mandatory health insurance	1	2	<1	<1	1	1	1	1
Don’t know	1	2	1	<1	1	4	1	1

In your opinion, what is the situation at hospitals and outpatient clinics when people go there to get services provided by their mandatory health insurance? (close-ended question, one answer, % of total respondents)
	2015	2023
… services are fully free	45	34
… or many services which are supposed to be free have to be paid	45	43
Don’t know	10	23

In your opinion, what is the situation at hospitals and outpatient clinics when people go there to get services provided by their mandatory health insurance? (close-ended question, one answer, % of total respondents)
	Total	Men	Women	Ages 18-24	25-34	35-44	45-59	60 +
… services are fully free	34	34	35	45	39	35	31	31
… or many services which are supposed to be free have to be paid	43	44	42	34	44	44	45	43
Don’t know	23	22	23	21	17	21	24	26

In your opinion, what is the situation at hospitals and outpatient clinics when people go there to get services provided by their mandatory health insurance (close-ended question, one answer, % of total respondents)
	Total	Can you recall when was the last time you sought health care at state health care institutions through your mandatory health insurance?
	Total	Less than 1 year ago	1-2 years ago	3-5 years ago	6 years ago or more	I didn’t use mandatory health insurance	I don’t have mandatory health insurance	Don’t know
… services are fully free	34	39	30	27	24	18	<0	12
… or many services which are supposed to be free have to be paid	43	42	45	45	38	50	68	52
Don’t know	23	19	25	28	38	32	32	36

Have you faced a situation when you were not provided with the service free of charge through your mandatory health insurance, or not? (close-ended question, one answer, % of those who used mandatory health insurance to get health services)
	Total	Men	Women	Ages 18-24	25-34	35-44	45-59	60 +
Yes, I faced it many times	9	8	10	7	11	8	10	10
Yes, I faced it once or twice	19	17	21	16	19	19	20	19
No, I haven’t faced it	67	71	64	71	65	67	65	68
Don’t know	5	4	5	6	5	6	5	3

Have you faced a situation when you were not provided with the service free of charge through your mandatory health insurance, or not? (close-ended question, one answer, % of those who used mandatory health insurance to get health services)
	Total	Can you recall when was the last time you sought health care at state healthcare institutions through your mandatory health insurance?
	Total	Less than 1 year ago	1-2 years ago	3-5 years ago	6 years ago or more	Don’t know
Yes, I faced it many times	9	10	9	8	5	6
Yes, I faced it once or twice	19	20	19	19	11	13
No, I haven’t faced it	67	66	67	68	76	72
Don’t know	5	4	5	5	8	9

Over the recent 3-5 years have you or your relatives had to pay additional health services when getting treatment through your mandatory health insurance? (close-ended question, up to 2 answers, % of total respondents)
	Total	Men	Women	Ages 18-24	25-34	35-44	45-59	60 +
Yes, when I need treatment myself	37	32	41	38	41	33	37	38
Yes, when my relatives needed treatment	19	22	16	16	21	22	19	16
No, I haven’t	35	32	37	23	24	38	34	41
Don’t know	9	14	6	23	14	7	10	5

In your opinion, is introduction of paid health services within mandatory health insurance likely acceptable, or not? If yes, in what cases? (open-ended question, up to 3 answers, % of total respondents, answers that gained at least 1%)
As part of additional package of services / if the patient asks for it; without ordinance	3
To improve efficiency / to facilitate the provision of services	2
In case the service cannot be provided through mandatory health insurance (including lack of specialists / medicines / equipment etc.)	2
For better quality / more detailed treatment	1
In case of a complicated / occupational disease	1
If there is a long queue to get a free service	1
Acceptable for non-mandatory health services (plastic surgery / beauty procedures, etc.)	1
When more comfortable conditions are desired	1
For dental prosthesis	1
When high-cost/high-tech medical devices are needed to provide health services	1
In no cases is it acceptable	76
Other	3
Don’t know	11

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