Opportunities and limitations of patient choice: the case of the Russian Federation

Abstract

While many countries have increased the opportunities for patient choice of provider, there is debate to what extent this has had positive effects on efficiency and quality of healthcare provision. First, some conditions should be met to exercise such choice, of which the most important is the provision of reliable data on providers' performance to both patients and physicians as their agents, as well as increasing primary health care (PHC) providers' involvement in realization of patient choice. Second, expanding patient choice does not always lead to efficient allocation of resources in a healthcare system. This article explores these controversial developments by using empirical evidence from the Russian Federation. It shows that choice indeed has value for patients, but there are many areas of inefficient choice, which leads to misallocation of healthcare recourses. Thus, health policy in this area should be designed to ensure a reasonable balance between objectives of expanding choice and promoting more efficient organization of healthcare provision. Political rhetoric about unlimited patient choice may be useless and even risky unless supported by well-balanced programmes of supporting and managing choice.

The use of medical care and out-of-pocket payments in Russia

“…Russian patients today have greater choice of medical facilities and providers compared to Soviet (uSSR) patients [1]. They may receive care in public and quasi-public health care institutions 1 as well as private hospitals and outpatient clinics.…”

Patient Choice in the Post-Semashko Health Care System

“…However, unlimited, and unregulated patient choice leads to a misallocation of resources in the health care system (Sheiman, et al, 2013). Due to information asymmetry between consumers and providers of health services, the latter have the opportunity to provide redundant services.…”

“…It can lead to a less efficient allocation of resources, aggravate the fragmentation of service delivery, and increase costs (Enthoven and Tollen, 2005;Thomson and Dixon, 2004;Sheiman et al, 2013). The policy of enhancing patient choice may have an ambivalent impact on access to health care and on equity in the utilization of medical services (Dixon and Le Grand, 2006).…”

“…The deficit in public health funding had a destructive impact on the referral system connecting different levels of health care services. A referral system has survived but is impaired in most administrative areas of Russia (Sheiman et al, 2013). The availability of a referral from a public outpatient facility for examination and treatment in a diagnostic center or a hospital ceased to be a guarantee of free access to the required care.…”

Effects of patients’ motives in choosing a provider on determining the type of medical institution

“… 10 In addition, the motives in choosing a provider are important with regard to efficiency. 11 Although studies on patient motives in choosing a provider are mostly related to their choice of primary care clinic or general practitioner, 12 , 13 they also include topics such as obstetrics–gynecology, 14 , 15 surgery, 16 , 17 and public–private institutions. 18 …”