Consumer Behavior as a Factor of Change in Russian Health Care System

The paper addresses efficiency and inequality issues under the conditions of increasing competition in the health care sector in Russia. Co-existence of state-funded mandatory and market-based voluntary medical insurance as well as high proportion of direct out-of-pocket payments create the unique settings for analysis of causes and forms of competition among providers of medical services. Due to more than 10% annual growth of real income over the last six years, we can also observe tremendous changes in consumer behavior in health care and medical insurance markets. The authors make their conclusions on how all these changes effect the efficiency of health care provision and access of different groups of households to medical services. The paper is based on the results of two general public surveys and series of in-depth interviews with hospital and insurance organizations managers organized by the authors as part of Ford Foundation and USAID projects in years 2002 and 2005. The study focused on the two Russian regions with different potential for developing competition in health sector. We show that the conclusions are similar for both regions and, therefore, could be used for further development of health care sector in Russia in general. We also note that many trends are common for transition economies where health care reform is still on the agenda