Rural Russia in Transition: What Determines Access to Health-Care Services?

Abstract

Three German economists analyze the determinants of access to health care in rural Russia and ask whether income and ability-to-pay, emerging as the major determinants of access in urban areas, have begun to govern rural populations' access to health-care services. Using household data from a survey conducted in the year 2000 (N=321 households) in two regions of Russia-Oryol and Leningrad Oblasts-the authors examine how the reduced role of the state and the concomitant decentralization of policy-making have affected access of the rural populace to health services. Broader policy implications and suggestions for ensuring future access to services in rural areas are offered.

Hospitalization in Tajikistan: determinants of admission, length of stay, and out‐of‐pocket expenditures. Results of a national survey

“…This finding is similar to the results for Kazakhstan, which demonstrated the positive relationship between ability to pay and the likelihood of hospital admission (Thompson et al, 2003). In contrast, in relatively more prosperous Russia, the ability to pay is not a significant predictor of healthcare utilization (Lohlein et al, 2003).…”

What determines healthcare utilization and related out-of-pocket expenditures in Tajikistan? Lessons from a national survey

“…This study uses a two-stage sequential model 1,10 . The detailed definitions of dependent and independent variables included in the model, together with descriptive statistics, are shown in Table 1.…”

“…Since the beginning of transition, the countries of the former Soviet Union have experienced significant drops in public spending with regard to the healthcare sector, a considerable rise in out-of-pocket expenditures, ineffectiveness of healthcare delivery and a growing inequality in terms of the accessibility and affordability of healthcare utilization [1][2][3][4] . Among the worst affected was the healthcare sector in Tajikistan.…”

The inequity in out-of-pocket expenditures for healthcare in Tajikistan: evidence and implications from a nationally representative survey

“…Furthermore, regional variation was found to be more substantial than was rural-urban variation. This is an interesting finding since most of the previous studies on spatial variation in OPE have considered only rural-urban differences Lohlein et al 2003;Sari et al 2000), while regional variation has often been neglected. Yet, if left unaccounted for, regional inequalities in OPE further reinforce not only inequalities in other health domains, but also general socio-economic inequalities and hence, prevent effective economic growth and poverty reduction (O'Donnell et al 2008).…”

“…Several studies on the middle-income countries of Eastern Europe and the western republics of the former Soviet Union show that private OPEs have functioned as the primary means of filling the gap in funding for healthcare, which emerged as a result of the continuing economic constrains in public financing (Aarva et al 2009;Cockcroft et al 2008;Szende and Culyer 2006;Lohlein et al 2003). The situation is even more dire in the transitional countries of the Caucasus and Central Asia, where money coming from OPEs have become the major source of healthcare financing, and where OPEs far exceed public levels of funding (Balabanova et al 2004;Bonilla-Chacin et al 2005;Gotsadze et al 2005;Belli et al 2004;Sari et al 2000;McKee et al 1998).…”