• Spending overview
• Policy overview
• Diseases overview

Spending overview

According to the latest data from the World Health Organisation (WHO), total healthcare expenditure in Russia was the equivalent of 5.3% of GDP in 2006. This compares poorly with more developed economies: both the US and Germany spend well over 10% of GDP on healthcare. However, it compares more favourably with other emerging-market economies, such as China's, where expenditure is estimated at a little below 5% of GDP. From 2011 onwards, assuming a gradual recovery in the global and Russian economies, the picture should improve, but even then income growth and the government's budget position are likely to remain considerably more restricted than during the oil boom that Russia enjoyed for much of the current decade.

Healthcare funding, previously reliant on general taxation, saw a significant overhaul shortly after the end of the Soviet period, with the introduction of compulsory health insurance, paid for by employer contributions for those in employment, and by municipal governments for the rest. Less than 10% of total healthcare expenditure is covered by official central government spending, although around 70% of expenditure is considered to be public, from local governments and other state bodies. Of far greater importance is the unofficial sector, whereby patients make payments to hospitals and to healthcare staff in return for treatment. It is normal for services such as meals or laundry to be charged for. The unofficial payments have been estimated to amount to several billion US dollars per year.

Policy overview

Reforms of the Russian healthcare system, aimed at containing costs and improving efficiency, began in the early 1990s. The system has been decentralised and a compulsory health insurance scheme introduced, but many problems remain. In 2005 the then president, Vladimir Putin, announced four priority "national projects" that would benefit from increased state financing. For the first time since independence, the projects placed a much-needed focus on the areas of social policy most in need of government attention. In healthcare, the government prioritised raising healthcare workers' wages, the construction of new regional medical centres and the re-equipment of existing ones, as well as the purchase of new ambulances.

The Russian health system has traditionally been oversupplied with hospitals—although bed numbers have been falling in recent years—and undersupplied with primary care facilities and services. Russia has a high number of doctors relative to the population, but too few primary care physicians relative to specialists. It also has a low number of support staff, such as nurses. Infrastructure quality is poor, with many hospitals run-down and lacking even basic facilities. Access to healthcare is much better in cities than in rural areas. These deficiencies are unlikely to be fundamentally remedied over the medium term.

Diseases overview

Life expectancy in Russia is low, especially for men. Russian male life expectancy was just 59 in 2007, lower than in Pakistan or Bangladesh. The infant mortality rate is high by European standards, although significantly lower than in the other countries of the Commonwealth of Independent States (CIS). Since the collapse of the Soviet Union, death rates have increased sharply, with infectious diseases such as tuberculosis, hepatitis and HIV/AIDS spreading rapidly alongside traditional killers such as heart disease, cancer and alcoholism. The leading cause of death in Russia is cardiovascular disease, followed by deaths from external causes, such as accidents and homicide.

Russia faces a serious HIV/AIDS crisis. HIV entered Russia about ten years later than it reached the US and western Europe, but has since spread rapidly. Official government figures report that around 450,000 people are living with HIV/AIDS. Independent estimates put the figure at over 1m. The virus is spreading from high risk groups to the general population; rates of new infection are highest among people aged between 15 and 30. The incidence of tuberculosis is high. Although the number of those contracting and dying of tuberculosis in Russia has been on the decline in recent years, the disease still kills some 26,000 people each year, which is one of the highest rates in the world; 110,000 people contract the disease in Russia annually. The prison population and people who are HIV-positive are particularly vulnerable to tuberculosis. The number of Russian smokers is among the highest in the world, with 42% of early deaths among men aged 35-69 caused by smoking. Every year, there are over 260,000 smoking-related deaths in Russia.