Financial Risk Protection and Unmet Healthcare Need in Russia

Document Type : Original Article


Department of Health Policy, London School of Economics and Political Science, London, UK


Achieving universal health coverage (UHC) includes financial risk protection. To date, catastrophic healthcare expenditure (CHE), the impoverishing effect of out-of-pocket (OOP) healthcare payments, and unmet healthcare need are the most widely used indicators for assessing the financial risk protection of a healthcare system. This study aimed to estimate the Russian healthcare system’s financial risk protection by focusing on CHE, OOP and unmet healthcare need.
The study used eight waves of the Russia Longitudinal Monitoring Survey (RLMS) (2010-2017) to analyze the financial risk protection of the Russian healthcare system. Commonly used indicators – CHE, both incidence and intensity, the impoverishing effect of CHE and unmet need –were used.

We found low incidence and intensity of CHE in the Russian Federation. Our results are robust to various definitions of CHE (eg, as a share of total household expenditure or total household income). Furthermore, the impoverishing effect of OOP healthcare payments remains limited, despite the most recent economic slowdown (2014–2016). This could be explained by a noticeable reduction in CHE during the crisis years, as postponing healthcare was adopted as a coping mechanism, particularly among households heavily affected by the crisis.
As stressed by the UHC framework, our findings suggest that CHE only partly captures inefficiencies and inequities in coverage, because one tenth of households forwent medical care for medicines and certain services. As spending on medicines and dental care are the main drivers of CHE, policy interventions should focus on extending coverage for pharmaceutical and dental care and target financial barriers to seeking care, particularly for the poor and vulnerable.


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Volume 11, Issue 9
September 2022
Pages 1715-1724
  • Receive Date: 11 December 2020
  • Revise Date: 08 April 2021
  • Accept Date: 22 June 2021
  • First Publish Date: 14 July 2021