Health care disparity reveals Russia's income inequality crisis

Galina Nikolaeva (left), 65, thanks Nadezhda Gracheva of Sisters of Mercy at Saint Alexei Hospital in Moscow.</p>

Galina Nikolaeva (left), 65, thanks Nadezhda Gracheva of Sisters of Mercy at Saint Alexei Hospital in Moscow.

Comparing the Divide: Income dictates access to health care in the capital cities of Russia and the United States, where lawmakers debate policy mere miles from some of the country’s most underserved communities. Russia’s Gini coefficient, at 0.420, is actually better than that of Washington, D.C. at 0.435.

MOSCOW — Pensioner Galina Nikolaeva, 65, cries with affection when she recalls how she was looked after when she suffered a seizure on New Year’s Eve.

“If I hadn’t made it to this hospital, I wouldn’t be alive anymore. I’m sure of this. I believe the Lord sent me here,” says Nikolaeva, whose 8000-ruble ($264) monthly pension does not allow her to afford even low-budget state care.

Nikolaeva was admitted to Saint Alexei, a respected Moscow hospital financed by the state and the Russian Orthodox Church that provides free medical care. She doesn’t think she would have survived her latest run of bad health without what she calls the “dedication” and “love” of the medical staff.

“This isn’t empty praise,” Nikolaeva says. “I am just saying what it is like. And I am in a position to judge — I’ve been in and out of hospitals for the last 25 years.”

Russia's Constitution guarantees free health care for everyone, but many Russians say the reality is not so egalitarian. They say that health care is divided into two camps: those who can afford private clinics or paid state treatment; and those who must queue for crowded and second-rate care if they cannot draw together the necessary funds.

Since the Soviet collapse, years of unbridled western-style capitalism driven by high oil prices have transformed Russia, still the world’s largest energy exporter, but many believe it has mostly enriched the wealthiest slice of society while the majority remains little better off. Though in Soviet times personal wealth was kept well out of sight, Russia today is rife with ostentatious displays of personal riches.

The disparity in health care access reflects what analysts call a widening gulf between the rich and the poor in a country with a minimum wage of $170 a month but which has almost a hundred ‘dollar billionaires.’ Those billionaires own 30 percent of all the country's personal assets, according to the Credit Suisse Global Wealth Report.

A volunteer dries Galina Nikolaeva's hair at Saint Alexei Hospital in Moscow.
(Yuri Kozyrev/GlobalPost)

Russia’s Gini coefficient — the standard measure of income inequality — ranks Russia as more equal than the United States and the four other BRICS countries. But Russia performs well on this ranking in part because the government handed citizens their apartments in a mass privatization effort after the Soviet Union’s collapse.

In the last two decades, trust in Russia’s free health care has plummeted, spurring the rise of private clinics, some of which are world-class and have attracted foreign investors — tens and even hundreds of millions of dollars at a time.

But millions of Russians like Nikolaeva have never set foot in such a clinic.

Fearing they are left with no real safety net, poor sections of society like pensioners are thankful for charity organizations like the Sisters of Mercy who contribute staff to the Saint Alexei hospital.

They know how lucky they are to get in the door.

Sisters of Mercy 

The Sisters are an international religious movement that sprung up in the mid-1800s. But in Russia they are thought of primarily as the Orthodox Tsarist-era nurses who treated the wounded during the Crimean War, later morphing into a national movement that saw communities helping the poor, homeless and sick across the country.

These communities went underground in atheist Soviet Russia, but they have returned after the Soviet collapse just over two decades ago and operate a number of programs to treat the poor.

Their nurses, who once again wear traditional nurses’ head scarves, elicit glowing praise from patients in Saint Alexei, many of them Orthodox Christian pensioners. Svetlana Prokofeva, 74, who is recovering from stomach poisoning and pneumonia, says the hospital’s dedicated care has made her feel like “she has made it into heaven.”

But for every patient receiving top care in a reputable Moscow hospital, there are thousands facing long queues, sub-standard treatment, outdated medical equipment in the regions or not able to afford treatment at all.

Irina, an elegant 70-year-old pensioner with a shock of white hair, sporting modest makeup and a smart black coat, cut a peculiar figure behind the wheel of a taxi on Moscow’s snowy roads this month.

A widow, Irina says that cab fares are the only way she can make enough money to get treatment for her daughter. She brushes away tears with apparent embarrassment as she explains that her divorced 33-year-old daughter, a German-Russian translator, has advanced leukemia and urgently requires a blood transfusion to replace platelets in her blood stream.

“I am not getting out of this car until I have 5000 rubles,” Irina says. “That’s what it costs for a donor for a single day. They say that if she doesn’t get this blood, it will be too late and the illness will become irreversible. This is quite literally a matter of life and death.” 

Sisters of Mercy and a nurse look after patients at Saint Alexei Hospital in Moscow.
(Yuri Kozyrev/GlobalPost)

Irina gets a monthly pension of 13,000 rubles as a former civil servant who retired from the Foreign Ministry a decade ago. She says she has no one to turn to for help. 

“If anyone tries to tell me that we have good medical health care, what can I say? It is bad. Where can I get 5,000 rubles in a day? Tell me — where?”

She declines to give her surname or be photographed out of apparent shame for herself and her daughter. “I’m not healthy either," she says. "I am disabled and I have problems with my lungs. And I’m driving  I’m earning money. I’m ashamed. I’m so unbelievably ashamed. When you see a woman of my age driving a taxi… it is shame. Pure shame.” 

"I really wish care wasn’t so expensive," says Lyubov Mitichkina, a Sister of Mercy and senior nurse at Saint Alexei. “The vulnerable section of society really need the government’s help as they can only receive free care to a very limited extent.”

Queues and corruption 

Alexander Saversky, head of the Patients' Rights Protection League, said the health care system is increasingly focused on paid treatment. He says that state hospitals offer paid services in parallel with free services, which he claims makes it profitable for doctors to pressure patients into paying for treatment.

“We have queues because the top doctors want to earn more money and create queues so that for patients get to treatment they have to pay money,” said Saversky.

He explained that the health care system has not recovered from the lows of the turbulent 1990s that followed the Soviet collapse. He pointed to the World Health Organization’s 2000 report that ranked Russia in 130th. He said Russia’s system had deteriorated faster than its post Soviet neighbors Kazakhstan and Belarus, which ranked 64th and 72nd respectively.

Research from the ROMIR center found last year that 65 percent of Russians paid for medical services and 20 percent of patients made informal payments to doctors. One estimate put these shadow patients at $5.5 billion last year.

Natalya Bondarenko of the Levada Center said that every year there is a larger portion of Russians who say the health care situation is worsening. In 2012, polls showed it was a bigger national bugbear than corruption, one of the main drivers of the last year of street protests against President Vladimir Putin.

"It is a larger concern than the problem of corruption and improvement of the police force. That's a pretty significant indicator,” said Bondarenko.

Fewer Russians who can afford to go private, risk going to state-funded services, according to Elena Prikhodova, 44, the executive director of a fund that allocates health cover for personnel at JSC Medicina.

“Free health care in Russia doesn’t exist,” says Prikhodova. “The range of medicines that are available for free are probably not enough. You need more. If you want to be healthy, then you have to pay.”

Pirkhodova holds medical insurance at JSC Medicina, an award-winning private clinic in the elite Mayakovskaya district of Moscow established in 1990.

A first-time consultation with the doctor costs between $80 and $100.

A Maserati is parked outside and a harp player strums in the foyer as receptionists guide patients through spacious, wood-paneled corridors. These lead into immaculate clinics with state-of-the-art equipment.

Elena Prikhodova lies down for a check-up on her leg, which she bruised badly, at JSC Medicina. Located in the center of Moscow, JSC Medicina is one of the most prestigious hospitals in Russia.
(Yuri Kozyrev/GlobalPost)

Prikhodova says she recently injured her leg when she slipped while making her children’s beds at home. She says she was rapidly seen by a doctor, X-rayed quickly and received top-class treatment. She squeezed in a subsequent check-up during her lunch break.

“Of course,” she says, “a main problem is avoiding long queues.”

The clinic has a bustling commercial marketing department, which did not allow GlobalPost to interview patients apart from Prikhodova.

It forwarded kitschy promotional images of expansive hotel-style recovery rooms featuring planted patients relaxing in large quilted beds beside faux antique telephones. Its clientele are top managers, cultural figures and politicians, as well as middle managers.

“Haggling” for health

The Sisters of Mercy operate a nightly bus of volunteers who reach out to the homeless with shelter, food and treatment during Moscow’s bitter winters. It also helps poor families raise funds for expensive medical care.

Without such charity financing, there is every chance wheelchair-bound 12-year old Dasha Smirnova would not have survived 2012. She was born with cerebral palsy and her mother Polina was told that she would die unless she received risky corrective surgery on her spinal cord.

But Russia’s top state institute for this surgery declined to perform the operation, leaving what looked like only one option — to use inexperienced surgeons in Moscow.

“I asked them whether they had ever done the operation and they openly admitted that they had only done it twice over a matter of years. Dasha is my only child – I decided to try different options.”

Polina Smirnova, 37, is not poor by any stretch in terms of property and income, She owns a 9-floor apartment which she inherited from the mass post-Soviet housing privatization and she earns 40,000 rubles a month ($1,320) as an assistant at a jewelry company.

But, she says, the operation, wheelchair, medicine and rehabilitation for her daughter far surpass her insurance coverage.

Smirnova applied to various charity support schemes and raised 1.6 million rubles through the Sisters of Mercy, which allowed her to fly Dasha to Germany for the operation. It also afforded her a German-made wheelchair.

Polina knows how lucky she has been to find charity help. Every year thousands of children are handed over to orphanages as parents see health complications such as cerebral palsy as an insurmountable challenge.

“The state does not pay for medicine for disabled children. So I have to buy medicine,” said Polina, adding that up to $200 a month goes to stocking up on a pages-long shopping list of medicines. She says she feels abandoned by the state.

Saversky of the Patients' Rights Protection League sums up the health care landscape for Muscovites:

“The patient is constantly haggling,” he says. “Do you want the pills that work or do you want the ones that could maim you? Do you want the prosthetic limb that becomes rusty or do you want the one that will last your whole life? The system is always bearing down on the patient.”

This story is presented by The GroundTruth Project.