Russia. Healthcare system overview.

Russia has a very low standard of compulsory state funded healthcare compared to Western Standards. Medical staff are adequately trained; however their talents cannot be fully used due to the lack of funds and medical equipment available. All citizens are entitled by law to equal access to healthcare, but old Soviet ways still prevail leading to inequality. Healthcare is free and is available to all citizens and registered long-term residents. Private healthcare is also available in the country, which is highly recommended. The Russian government oversees the health service and is trying to equalise the way that healthcare is given.

The State System
For the state healthcare fund employees and employers pay around 2 to 3 percent of wages to a social tax and then a small percentage of that money goes into the healthcare fund. Dependant family members are covered by the contributions paid by employed family members. The unemployed, old age pensioners and people on long-term sickness benefit are also entitled to free health, with the state covering their contribution. Vulnerable groups are not exempt from fees payable directly to doctors, which again makes healthcare virtually impossible, for them. The self employed must pay their own contributions in full. Foreigners immigrating to Russia without jobs must produce proof of private health insurance in order to obtain their residence permit.

Private Healthcare
The state fund covers a basic healthcare package; however citizens who can afford private insurance can ensure that they receive the best medical care available. Private medical services include treatment by specialists, hospitalisation, prescriptions, pregnancy and childbirth and rehabilitation.
Few can afford this option and those in dire need of good medical care may be forced to take out private insurance; for example a retired pensioner, is entitled to free health care in at least one institution. If the treatment given in that institution is not satisfactory, he must decide whether to spend five years of pension allowance on a single year of healthcare.

Fees
Russian citizens are all untitled to free healthcare from the state but most doctors will ask for extra payment or take a bribe for their services because medical professionals are often very poorly paid.

Doctors and Health Centres
Doctors are known as vratch and are the first point of contact with the state health system. Citizens can register with the doctor of their choice; however, people seeking state medical care must make sure that their doctor is contracted into the medical scheme. When you visit the doctor, you need to present your insurance cover, to determine the level of medical care available to you.

Health centres are known as polyklinika or polyclinics. The polyclinics may or may not be associated with a hospital. They employ GPs (called therapists) and various specialists. Doctors are qualified to give out prescription medicine, but they often want additional payment.

If you need a doctor out of the normal practice hours, you will have to visit a duty doctor.
Waiting times to see doctors vary and it is recommended that you make an appointment in advance. If you need urgent help, you may go to the doctors surgery on speculation, but be prepared for a long wait.

Consultants
Consultants are senior doctors who have completed a higher level of specialised training. Consultants charge each patient a fee, which is very expensive and beyond the reach of most citizens. There is often a long waiting list to see consultant doctors.

Hospitals
Hospitals and clinics exist in all major towns and cities of Russia. Patients are admitted to hospital either through the emergency department or through a referral by their doctor. Once a patient is admitted treatment is controlled by one of the hospital doctors. The conditions in most of the states hospitals are very bad, it is estimated that over one third of the country's hospitals and clinics lack hot water and some of them have no running water at all. There are also clinics and hospitals which are not linked to a waste disposal system and many of both categories have no central heating. Even in the more advanced hospitals, many medical staff do not regularly wash their hands and surgical apparatus is not always disinfected; thus, rates of infection are exceptionally high. The quality of hospital rooms varies according to the quality of a person’s health insurance scheme. Often, patients must buy their own drugs, from the doctors. Even hospital food is in short supply, leaving family and friends to provide for the patients from home. The waiting lists for hospital admissions are extremely long.

Emergency Care
Emergency treatment is provided at the emergency room of all hospitals. Emergency departments are open non-stop all year. You may use their services if you need immediate attention, or if your GP refers you to them, or if there is no GP service available. Emergency care is available free for everyone, however, once your condition is stabilised you will need to show proof of your insurance status. You will also have to pay a fee directly to all of the doctors who have treated you.

Private Clinics
There are private practices in Russia. The premises, equipment and personnel are funded by private insurance contributions, but it is used only by a small minority of people, often as a top up to the basic state healthcare and to cover them for the services deemed non-essential.

Dentists
Dental care in Russia is expensive, and most citizens cannot afford the treatment. Dentists are known as zubnoiy vratch which means ‘tooth doctor’. Citizens must pay themselves for dental treatments including routine checkups.

Pharmacies
Dispensing chemists known as apteka sell medicines in Russia. A prescription is known as a retsept can only be prescribed by doctors and consultants; however basic medical advice can be given from the pharmacist. Prescription medicine is only available from a qualified and registered chemist or from a hospital pharmacy. In rural areas, the supply of medicine is particularly dire; usually there is only one pharmacy in each large village and villagers often queue for their medicine all day without knowing if the pharmacy has the required medicine in stock.
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