Russians prefer public healthcare to private healthcare

Russians tend to have a negative assessment of the healthcare system, but prefer to be treated in public clinics rather than in private medical organizations. This data was shown by a survey by the Platform center. At the same time, the share of those who are satisfied with domestic medicine is also high – more than 40%. The Ministry of Health indicates that this is the result of a national healthcare project and a number of other initiatives of the president and government. Researchers admit that a “low base effect” may be at work here, where citizens are satisfied with any noticeable improvements.

The Center for Social Design “Platform” and the company “Online Interviewer” conducted a survey in November on how Russians assess the performance of the healthcare system in the country. 1.2 thousand respondents over 18 years old took part in it. Of these, 44% are “rather satisfied”, and 54% are “rather dissatisfied” with the situation in this area. The researchers point out that the results cannot be called a stable critical position. To one degree or another, a critical attitude towards state medicine is a global trend, the authors of the survey note.

The number of “satisfied” and “dissatisfied” men turned out to be almost the same (49% to 48%), but 59% of women are rather dissatisfied with Russian healthcare. They probably visit medical organizations more often, including in connection with caring for children, the researchers explain: the wider the experience of interaction, the higher the likelihood of encountering negative situations.

There is also a generational difference: complaints increase with age. In the category from 18 to 24 years old, as many as 64% were “satisfied”, and among respondents 55 years and older – only 36%. Older people are more likely to encounter health problems, the survey authors state, and the worse the respondent’s self-assessment of health, the more critically he assesses the healthcare system. In addition, the assessment may be influenced by the memory of Soviet times and the stereotype “it was better before,” sociologists say.

Regionally, the North Caucasus Federal District stands out: 65% of the population there are satisfied with medicine, and only 31% are dissatisfied. Researchers suggest that the “low base effect” is at work here: any improvement attracts attention and leads to a good rating. However, improvements in the healthcare system are primarily noticed by Moscow residents (57% are satisfied; 37% believe that the system has changed for the better in recent years). This is the result of the active reconstruction of city clinics and the development of electronic services, according to the authors of the survey.

The dynamics of improvements are most pronounced in the digitalization of Russian medicine (61% noted electronic recording as a positive change) and infrastructure renewal (57% – renovation of clinics and hospitals, 46% – improvement of technical equipment). The most noticeable deterioration for citizens is the increase in prices for medicines (83%), as well as a shortage of personnel and a decrease in their qualifications (65% and 54%, respectively).

42% of respondents believe that corruption in healthcare is widespread, 46% – that it occurs sometimes. More than a third of respondents (39%) claim to have encountered it personally. The founder of the Platform, sociologist Alexey Firsov, calls this an interesting phenomenon. “Most people believe the industry is corrupt. But they talk much less about personal experience related to corruption in medicine, or about the experience of those around them,” comments Mr. Firsov. “It turns out that there are strong stereotypes that dominate the industry and certainly hinder it.”

When choosing a medical institution, respondents more often give preference to public clinics. And only about a quarter of respondents (23%) choose private medicine. This trend can be seen in all regions – both large and small cities. The main supporters of state medicine are residents of the Urals – 84% would rather go to a state clinic in case of illness. Private medical services are slightly more often preferred in the Southern Federal District (there only 61% choose public medicine). At the same time, public clinics are equally often chosen by both those who are satisfied with their condition and those whose condition leaves much to be desired. However, the assessment of the healthcare system plays a role here: the lower the level of satisfaction, the more respondents are inclined to choose private organizations. Material well-being is also one of the significant factors: those who can afford it often turn to private specialists. And yet, in general, there is a fairly stable choice in favor of public clinics, the researchers state. This may be explained by the general socio-economic background and the growing cost of voluntary health insurance.

Expectations for the future of medicine in Russia are unclear: 30% of respondents believe that the healthcare system will improve, 27% – that it will worsen, 33% – that it will remain unchanged. Young people are more optimistic: among the 18–24 year old group, 46% expect further improvements. Geographically, there are more optimists in the Caucasus (44%) and Moscow (39%).

Director of the HSE Institute of Health Economics Larisa Popovich believes that the level of people choosing public medical institutions reflects the sum of the population’s subjective and objective attitudes towards the state system: “Our state medicine has become better in terms of the provision of equipment and the quality of work of doctors. On the other hand, this speaks about the solvency of the population: during periods of crisis, people always save. And also that private clinics have reduced their marketing activity.”

Assistant Minister of Health of the Russian Federation Alexey Kuznetsov sees a steady trend towards increasing citizens’ satisfaction with medical care. He points out that before the pandemic this figure was about 30%, at the end of 2022 it was 41.4%, and this year, according to a number of studies, it has increased significantly, amounting to about 46% in the first half of the year. According to Mr. Kuznetsov, this indicates the demand for programs that are being implemented within the framework of the national project “Healthcare” and “other initiatives of the president and government.” “It is expected that the survey results demonstrate the high degree of trust that citizens have in the public health care system. After all, it is the medical workers of our hospitals, clinics, and medical and obstetric centers who selflessly work to preserve the lives and health of Russians, providing the necessary medical care,” concluded Alexey Kuznetsov. (On measures to protect the rights of doctors, nurses and ambulance workers receiving social benefits, see material.)

Natalia Kostarnova