Access to Healthcare in Russia: A Pilot Study in Ekaterinburg.

AIM: The aim of the study was to analyze accessibility of medical assistance in Russian polyclinics (a case study of the city of Ekaterinburg).

METHODS: The research included an anonymous survey of patients in five polyclinics of Ekaterinburg (N=500) conducted by applying a specially developed standardised interview.

RESULTS: The following factors of medical care accessibility were analyzed: the patient's financial status and administrative and managerial resources of medical institutions. Medical aid in polyclinics is provided within the framework of the Compulsory Medical Insurance Programme. 72% of the patients polled, however, had to pay for medical services. In order to pay less for medical services and to obtain services faster patients use informal payments: they either pay their doctors directly (4%) or make gifts (58%). Low-income population groups refuse to pay for medical services or to make gifts to the medical staff. They also tend not to follow their doctors' recommendations. The most significant indicators of the organizational and managerial work of a medical institution which limit accessibility are the following: queues in front of doctors' offices (41%) and difficulties with making appointments (17%).

CONCLUSIONS: To solve the problem of medical aid accessibility in the Russian state healthcare system, it is necessary to develop information and reference materials for patients available in every polyclinic listing the terms of provision of free medical aid and types of free medical services. The difficulties to obtain medical services could be resolved at the management level by using the material and human resources of the administration of medical institutions.