‘Free’ healthcare in Russia has cost

When Karen Papiyants lost his leg in a road accident last year, his medical nightmare was only beginning.

Although like any Russian he was entitled to free treatment, he says the doctors strongly suggested he pay $4,500 into their St. Petersburg hospital’s bank account, or be deprived proper care -- and perhaps even of survival.

Faced with that choice, the truck driver’s relatives scrambled to scrape together the money. But Papiyants said that didn’t stop nurses from leaving him unattended for most of the night and giving him painkillers only after he screamed in agony.

“It’s nothing but blackmail and extortion on the part of doctors,” said Papiyants, 37.

In theory, Russians are supposed to receive free basic medical care. But patients and experts say doctors, nurses and surgeons routinely demand payments -- even bribes -- from those they treat. And critics say the practice persists despite Russia’s booming economy and its decision to spend billions to improve the healthcare system.

Medical care in Russia is among the worst in the industrialized world. A 2000 World Health Organization report ranked Russia’s health system 130th out of 191 countries, on a par with nations such as Peru and Honduras.

This is one of the few nations in the world where life expectancy has declined sharply in the last 15 years. The average Russian can expect to live to age 66 -- at least a decade less than in most Western democracies, according to a 2005 World Bank report. For men, the figure is closer to 59 -- meaning many Russian men die before they can start collecting their pension at age 60.

Compounded by alcoholism, heart disease claims proportionately more lives than in most of the rest of the world. Death rates from homicide, suicide, auto accidents and cancer also are especially high.

Russia’s population has dropped precipitously in the last 15 years, to less than 143 million in what President Vladimir V. Putin calls “the most acute problem of contemporary Russia.”

In 2004, according to the Organization for Economic Cooperation and Development, Russia spent $441 per capita on healthcare, about a fifth of what the Europeans spend. Over the last two years the government has more than doubled healthcare spending to some $7 billion, but that still works out to about 3.4% of all government spending; the World Health Organization recommends at least 5%.

Experts here say new spending does little if it fails to tackle corruption.

The state covers all Russians under a standardized medical insurance package, while well-heeled citizens can buy extra insurance and be treated privately.

In the Soviet era, patients occasionally rewarded doctors with money or gifts but were largely guaranteed free treatment. The Soviet Union’s public health system was, for a time at least, considered among the world’s best.

But the system failed to keep up with Western medicine, and after the Soviet collapse, went into decline. Today, many who can’t afford to pay or bribe may never receive proper care.

Some experts say this has helped drive up death rates.

“Corruption in healthcare is a threat to Russia’s national security in the broadest sense of the word,” said Yelena Panfilova, head the Russian branch of Transparency International, a global corruption watchdog.

According to a summer 2006 study commissioned by the group, 13% of 1,502 respondents who had sought medical help during the previous year had to pay an average of $90 under the table, out of wages averaging $480 a month. The poll had a margin of error of 2.6 percentage points.