Attitudes to reform: Could a cooperative health insurance scheme work in Russia?

As for all health systems, in Russia, the demand for medical care is greater than its health system is able to guarantee the supply of. In this context, removing services from the state guaranteed package is an option that is receiving serious consideration. In this paper, we examine the attitudes of the Russian population to such a reform. Exploiting a widely-used methodology, we explore the population's willingness to pay for cooperative health insurance. Distinguishing between socioeconomic and demographic factors, health-related indicators and risk aversion we find, consistent with other literature, positive income and risk aversion effects. We interpret the former as evidence that the Russian population is not opposed to the idea of progressive redistribution, to pool the costs of health-related risks; and the latter as evidence that risk-averse individuals demand more insurance coverage. In exploring these results further, we show that cognitive bias is important: overestimating the benefits leads to the purchase of additional insurance, while underestimating lowers demand for insurance. Our overall conclusion is that the introduction of a supplementary cooperative health insurance scheme in Russia could increase the accessibility of healthcare, lower the tendency for informal payments, incentivize the personal maintenance of good health and create a new source of funding for public healthcare.

The effect of chronic conditions and multi-morbidity on self-assessed health in Russia.

AIMS: Chronic disorders, such as cardiovascular disease, cancer, respiratory diseases and diabetes, are the leading cause of mortality globally, representing 68% of all recorded deaths. The incidence of chronic disease and multiple chronic disease is rising across the world, but relatively little is known about the impact of multi-morbidities on the life experiences of those individuals who encounter them. In this paper, we examine and quantify the relationship between chronic illness, multi-morbidity and the individual self-assessed health of the Russian population using individual-level Russian data and a novel quantitative technique. METHODS: We apply a partial proportional odds framework to a rich data set incorporating demographic, socio-economic and health indicators in Russia. RESULTS: We find that individuals with chronic conditions report significantly lower levels of health than those without chronic conditions, but that the strength of the effect is much more pronounced for males than for females (e.g. neurological disease: odds ratio [OR]=4.81 for men; OR=1.86 for women)). As the number of co-morbidities increases, there is a dramatic decrease in the likelihood of reporting good health for both males and females, but for males there is a greater increase in the likelihood of reporting bad health (OR=49.31 for males with ≥5 diseases; OR=28.05 for females). CONCLUSIONS: More than 40% of Russians currently live with multi-morbidity, and this group is at the highest risk of reporting poor self-rated health. This research adds to the body of evidence demonstrating the challenges facing health-care systems as new patterns of disease take hold in contemporary society.