Between a Rock and a Hard Place: The Question of Money at St. Petersburg Women's Clinics

Abstract

The new financing mechanisms introduced into the Russian health care system since the beginning of the 1990s have not resolved its severe financial problems. This article examines the consequences for outpatient services and the daily work of individual doctors in St. Petersburg, using women's reproductive health services as a case example. Interview and observational data reveal a constant opposition between formal rules and informal practices at both the administrative and polyclinic levels. Polyclinics for women's reproductive health services have developed various strategies as a response to insufficient financing, but many of these strategies are questionable within the current mandatory health insurance system. Ordinary doctors perceive the development as mainly negative. The results raise the question of increasing arbitrariness, from patients' perspective, in the health services provided. The study illustrates how in a post-socialist context, the past constantly permeates the present in the form of novel adaptations to the new social context.

Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study

“…Private services sometimes involve considerably higher user charges, but nevertheless they can be accessed easily if the user has the financial assets. Private services tend to be provided in more comfortable settings and they usually guarantee a higher level of privacy [15]. At the same time, distrust towards and dissatisfaction with public sector services is widespread [23-26].…”

“…More specialised services are provided by hospital in- and out-patient units. Furthermore, a number of private clinics also provide health services in St. Petersburg today, and gynaecology is one of the specialties where private services have developed most rapidly [15]. …”

Pregnancy prevention, reproductive health risk and morality: a perspective from public-sector women's clinics in St. Petersburg, Russia

“…After small revisions to the interview schedule, data collection was continued in two other women's clinics. The criteria for selecting the clinics have been described in an earlier publication (Larivaara et al 2008). Finally, four other women's clinics were visited and four gynaecologists -one in each clinic -were interviewed in order to assess whether the clinics used in the study somehow differed from other clinics in St. Petersburg.…”

“…In women's clinics, visits to gynaecologists are freeof-charge, but patients pay a listed fee for laboratory tests and other examinations such as ultrasounds. Many women's clinics also offer commercial services (for more details see Larivaara et al 2008). In addition, a number of private clinics provide reproductive health services, but they tend to be more expensive than commercial services in public-sector women's clinics.…”

“…Yet, due to the organisation of women's health services in Russian cities (Larivaara et al 2008), gynaecologists potentially have a major influence on women's contraceptive choices. Studies from other countries have shown that compliance with contraception improves with increased patient involvement and factors such as activation, facilitation of partnership, patientcentredness, responsiveness to patients' attitudes and emotions, use of empathy and positive regard, physician informativeness and review of plans (Delbanco and Daley 1996, Lipkin 1996, Fisher et al 2006, Nobili et al 2007.…”