An HSE expert reported on the "evolution of inequality" in access to healthcare.

Over the ten years from 2011 to 2021, the number of Russians requiring medical care but not receiving it remained virtually unchanged, according to a study by Lyudmila Zasimova, head of the Laboratory for Economic Research of the Public Sector (LEIOS) at the HSE Center for Fundamental Research. The results of the study were included in the article "The Evolution of Inequality: Socioeconomic Factors Affecting Access to Russian Healthcare," published in the journal Voprosy Ekonomiki (Issue of Economics, No. 11, 2025).

The author's findings are based on data from the International Social Survey Programme (ISSP) surveys for 2011 and 2021. A distinctive feature of the ISSP is the repeated nature of the questions and the identical data collection methodology, allowing for comparisons across countries and years, the article explains. In her study, the author used only a Russian sample and analyzed two indicators to measure inequality in access to healthcare: contact with doctors and unmet demand for healthcare services.

The results showed that in 2021, the proportion of respondents who had consulted a doctor in the previous 12 months was 65.8%, which is lower than the 70.5% in 2011. Zasimova notes that this may be due to COVID-19 restrictions and fear of infection when visiting a medical facility. At the same time, cases in which medical care was needed but for some reason was not received remained at a similarly high level – 46.1% in 2011 and 44.1% in 2021. The author points out that these figures are significantly higher than other countries participating in ISSP surveys, including Taiwan, the Philippines, Japan , and European countries. The average access to care indicator in the surveyed countries was 23.2% in 2011, and 27.9% in 2021.

Thirty-two countries participated in the International Social Survey Program (ISSP) surveys in 2011 and 30 countries in 2021. The sample size for Russia was 1,511 people in 2011 and 1,597 in 2021, with respondents ranging in age from 18 to 92. As the study notes, despite the relatively small sample sizes, the country samples are representative at the national level.

The article defines access to healthcare services as the ability to obtain healthcare services when a person has and perceives a need for them. Inequality in access refers to the uneven distribution of healthcare resources, where certain population groups face barriers in obtaining quality medical care. Thus, inequality in access to healthcare services refers to unfair and avoidable differences between different population groups, according to the study.

According to the study, women traditionally seek medical care more often than men, but are also more likely to fail to receive it. In 2021, men were 14% less likely than women to visit a doctor. The article notes that this is due to biological factors, as women are more likely to seek medical attention for reproductive health issues and also tend to live longer than men, leading to a higher prevalence of chronic diseases in old age. Furthermore, statistically, women outnumber men in Russia, especially in sectors of the economy that require annual medical checkups, meaning they are more likely to encounter financial and other barriers.

In 2021, people with disabilities or chronic illnesses were 21% more likely to be unable to obtain the healthcare they needed than other patients. In 2011, this figure was 13%. At the same time, the author notes that disabilities and poor health may require expensive and more complex treatments , which were not always available under COVID-19 restrictions.

Data also shows that those with supplementary health insurance (VHI) policies visit doctors more often. However, in 2021, even these patients faced difficulties in obtaining medical care due to the overburdened healthcare system amid the pandemic.covid-19 .

According to Zasimova, in 2021, against the backdrop of the pandemic, the influence of financial factors on access to healthcare became noticeable for the first time: if a respondent's per capita income was below the subsistence level, the likelihood of visiting a doctor decreased by 6%.

In 2011, city residents were more likely to seek medical care than those in rural areas, but in 2021, these differences were less significant. The author suggests that during the COVID-19 pandemic, city residents postponed doctor visits, scheduled treatments, and medical checkups to reduce the risk of infection. Furthermore, many moved to the countryside and sought medical care less frequently in their local areas.

Despite the unique circumstances of 2021 due to COVID-19, Zasimova's article highlights persistent inequalities in access to healthcare in Russia, which have persisted for a decade. She believes that a more thorough study is needed on the unmet needs of women and people with underlying health conditions, as these categories of Russians were at risk in 2011 and 2021.

RBC sent a request to the Ministry of Health.

As Zasimova explained to RBC, it's difficult to say without data how the situation has developed since 2021. "If we take a rough estimate, in recent years there haven't been significant investments in healthcare, comparable to national projects or large federal target programs. Meanwhile, the need for medical care after COVID has only increased due to delayed treatment, advanced cases, and the deterioration of equipment following the pandemic," she said, describing the current picture by 2025. Without targeted policies to reduce health inequalities, one can expect them to persist and even worsen, especially if healthcare spending declines and private healthcare becomes increasingly unaffordable amid rising prices, Zasimova believes.

According to Andrey Ragozin, Director of the Center for Financing, Organization, and Interregional Relations in Healthcare at the Financial University under the Government, one of the main reasons for the inequality in access to healthcare in Russia is the decentralized nature and multi-channel nature of its financing. A significant portion of responsibility has been shifted to regional budgets, whose capabilities vary, and different types of care are financed from different sources: some medical benefits are covered by the compulsory medical insurance system, others by regional or federal budgets, and childbirth and rehabilitation are covered by the Social Fund of Russia. Moreover, even within the compulsory medical insurance system, some services are covered by private health insurance companies, while others are paid directly by the Federal Compulsory Medical Insurance Fund.

Managing such a system is extremely difficult, Ragozin points out. In his opinion, based on global experience, a systemic solution could be the so-called single-payer model, which directly pays for all types of guaranteed care throughout the country. Such a solution helps mitigate inequality, improve the quality of care, and reduce administrative and transaction costs, Ragozin noted, pointing out that such a system is in place in Australia, South Korea, Iceland, and Taiwan, for example.