Association for Public Policy Analysis & Management

Russian health care system offers a tax-financed universal public health insurance, which was supposed to grant the population access to the health services and improve the nation's health. However, statistics show quite the opposite – the average life expectancy is significantly shorter than the OECD average. About 72% of the individuals claim in the surveys that they do not address their new health concerns and do not seek help from the physicians and the specialists. Currently, there also exists an opportunity to receive a supplemental private health insurance, which is mainly provided by the employer. This supplemental private health insurance covers the same services and procedures as the public insurance, but also has a broader provider network which can include private providers, and preferential access to treatment. In this paper, I examine whether having such supplemental private health insurance affects the utilization of following medical services: doctor visits in response to a new health concern, inpatient care, regular physical exams and preventive visits.

Study Design:

Fixed-effects model and the nearest-neighbor matching methods were used in the process.

Population Studied:

I use the data from the 2012-2016 nationally representative Russia Longitudinal Monitoring Survey (RLMS) and focus on the employed individuals of the legal working age who either have or do not have the supplemental health insurance. To reduce the self-selection issue, I do not include individuals who purchased their own private health insurance, rather limit the privately insured to those whose insurance policy was provided by the employer.

Principal Findings:

The results show that when having a supplemental health insurance men are more likely to respond to a new health problem by visiting a doctor (7.2 pp), while this is not the case for women. There is also a significant positive impact of having a supplemental health insurance policy on the occurrence of the regular physical exams and preventive visits for both men (4.5 pp) and women (5.8 pp).

Conclusions:

Taking into consideration similar coverage provided by the universal and supplemental insurance and the presence of some positive and significant results, I can conclude that one of the possible reasons why the individuals in Russia tend to ignore their health problems is a desire to avoid poor-quality service, lack of provider selection (usually limited to only one approved clinic) and long wait-lists in the public clinics and hospitals.

Implications for Policy or Practice:

The increase in the probability of preventative and routine examinations may potentially increase the chances to diagnose and treat diseases at the early stage, but examining of the relation between the supplemental health insurance and the health status is still questionable.