Is Corruption the Best Medicine? Russia’s Informal Market for Health Care

Abstract

The constitution of the Russian Federation guarantees free health care coverage for all of its citizens. However, since the establishment of the current health care system in 1993, an informal market for health care has operated within the walls of the public health system. Informal payments are notorious for their role in increasing the unaffordability and inaccessibility of health care. However, in the absence of other options, they also function as a means of securing quality health care for those who are able and willing to pay. Previous studies have demonstrated that Russia’s informal market for health care has substituted for deficient public funding and has impacted access to care, especially for low-income populations. This paper addresses the role of the informal health care market in the Russian Federation and the impact that it has had on the health of the population. An analysis of health care policy and its manifestations in Russia’s 83 regions highlights the reasons for which informal payments have been able to creep into the system. The Czech health care system is contrasted with that of the Russian Federation to show that poor and irregular government regulation and patient empowerment in Russia have rendered informal payments the most viable form of procuring good health care. A quantitative study of survey data shows that the informal market neither affects the health of the Russian population nor one’s decision to seek medical treatment. The prevalence of the informal market in the Russian health care system is a symptom of deeper issues that lie both at the core of Russia’s bureaucratic infrastructure and in its tacit continuation of egalitarian ideologies. Though it does not directly hurt the health of the population, the Russian government should recognize and address the existence of the informal market, as under-thetable activity erodes trust in public authority. Temporary measures such as the formalization of informal payments might be useful, but to truly put an end to the informal market, the government must identify and confront its root causes.