Special Section: Global Health Research
Health Care Reform in the Former Soviet Union: Beyond the Transition
Article first published online: 23 SEP 2011
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 2, pages 840–864, April 2012
How to Cite
Balabanova, D., Roberts, B., Richardson, E., Haerpfer, C. and McKee, M. (2012), Health Care Reform in the Former Soviet Union: Beyond the Transition. Health Services Research, 47: 840–864. doi: 10.1111/j.1475-6773.2011.01323.x
- Issue published online: 8 MAR 2012
- Article first published online: 23 SEP 2011
- European Union's 7th Framework Program. Grant Number: HEALTH-F2-2009-223344
- former Soviet Union;
- health systems;
- out-of-pocket payments
To assess accessibility and affordability of health care in eight countries of the former Soviet Union.
Data Sources/Study Setting
Primary data collection conducted in 2010 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia, and Ukraine.
Cross-sectional household survey using multistage stratified random sampling.
Data Collection/Extraction Methods
Data were collected using standardized questionnaires with subjects aged 18+ on demographic, socioeconomic, and health care access characteristics. Descriptive and multivariate regression analyses were used.
Almost half of respondents who had a health problem in the previous month which they viewed as needing care had not sought care. Respondents significantly less likely to seek care included those living in Armenia, Georgia, or Ukraine, in rural areas, aged 35–49, with a poor household economic situation, and high alcohol consumption. Cost was most often cited as the reason for not seeking health care. Most respondents who did obtain care made out-of-pocket payments, with median amounts varying from $13 in Belarus to $100 in Azerbaijan.
Access to health care and within-country inequalities appear to have improved over the past decade. However, considerable problems remain, including out-of-pocket payments and unaffordability despite efforts to improve financial protection.