Russian Federation
Medical Country of Origin Information Report

September 2022

Manuscript completed in September 2022. Reissued for corrigendum in June 2023.
Neither the European Union Agency for Asylum (EUAA) nor any person acting on behalf of the
EUAA is responsible for the use that might be made of the information contained within thispublication.
Luxembourg: Publications Office of the European Union, 2022
PDF

ISBN 978-92-9400-242-6 doi: 10.2847/248363 BZ-08-22-227-EN-N© European Union Agency for Asylum (EUAA), 2022
Cover photo/illustration: Moscow, Russia - January 18, 2021, ©IStock: 1375247350,(photographer: Yury Karamanenko), 06 March 2022, url: Stock Photos | Ambulance
Reproduction is authorised provided the source is acknowledged. For any use or reproduction ofphotos or other material that is not under the EUAA copyright, permission must be sought directlyfrom the copyright holders.

Acknowledgements
The European Union Agency for Asylum (EUAA) acknowledges International SOS (Intl.SOS) as
the drafter of this report.
EUAA specialists from the Medical Country of Origin Information (MedCOI) Sector, Country
Information and Guidance Unit, Asylum Knowledge Centre have reviewed the reportinternally.

4

Contents
Acknowledgements ......................................................................................................................................... 3Contents .............................................................................................................................................................. 5
Disclaimer ......................................................................................................................................................... 15
Glossary and abbreviations........................................................................................................................... 17
Introduction ..................................................................................................................................................... 24
Methodology .......................................................................................................................................... 24
Defining the terms of reference ........................................................................................... 24
Note on the usage of this report .......................................................................................... 24
Collecting information ............................................................................................................. 25
Key informant interviews ........................................................................................................ 25
Literature review ....................................................................................................................... 26
Medication and treatment prices ......................................................................................... 26
Quality control ........................................................................................................................... 26
Referencing .................................................................................................................................27
Map of the Russian Federation .................................................................................................................. 28
1.

Context ...................................................................................................................................................... 29
1.1.

Geography and demographics ............................................................................................. 29

1.2.

Political context ......................................................................................................................... 30

1.3.

Economic context ..................................................................................................................... 30

1.4.

Historical context ...................................................................................................................... 30

2. Healthcare system ....................................................................................................................................31
2.1.

2.2.

Health system organisation .....................................................................................................312.1.1.

Public sector ................................................................................................................ 32

2.1.2.

Private sector............................................................................................................... 35

2.1.3.

Impact of COVID-19 ................................................................................................... 36

Healthcare resources ............................................................................................................... 37
2.2.1.

Health financing........................................................................................................... 37

2.2.2. Healthcare infrastructure ......................................................................................... 38
2.2.3. Health workforce ........................................................................................................ 38
2.3.

Pharmaceutical sector ............................................................................................................. 42

2.4.

Patient pathways .......................................................................................................................43

3. Economic factors .....................................................................................................................................44
3.1.

Health services provided by the state/public authorities ...............................................44

3.2.

Public health insurance, national or state coverage ....................................................... 45

3.3.

Private health insurance schemes ....................................................................................... 49

3.4.

Other social security ................................................................................................................ 50
3.4.1.

Occupational diseases and work injury ............................................................... 52

3.4.2. Family allowance and benefits ............................................................................... 53
3.4.3. Old age pensions and allocations for disabled persons (and survivors) .... 53
3.4.4. Unemployment benefits ........................................................................................... 54
3.4.5. Minimum wage ............................................................................................................ 54
3.4.6. Poverty alleviation measures .................................................................................. 55
3.5.

Out-of-pocket health expenditure ....................................................................................... 55
3.5.1.

Costs of consultations............................................................................................... 56

3.5.2. Cost of medications ....................................................................................................57
3.5.3. List of useful links ....................................................................................................... 58
4. Cardiovascular diseases (CVDs)......................................................................................................... 59
4.1.

4.2.

General information ................................................................................................................. 59
4.1.1.

Epidemiological context ........................................................................................... 59

4.1.2.

National policies and programmes ....................................................................... 59

4.1.3.

Content and structure of the healthcare system for CVDs............................. 60

4.1.4.

Private healthcare ...................................................................................................... 60

4.1.5.

Example of treatment centres................................................................................. 60

Access to treatment ................................................................................................................. 62
4.2.1.

Structure and organisation in the public healthcare system .......................... 62

4.2.2. Private healthcare system........................................................................................ 62
4.2.3. Cardiovascular healthcare facilities in the public healthcare system .......... 63
4.2.4. CVD healthcare workforce in the public and private sectors ........................ 63
4.2.5. Limitations on access to treatment ....................................................................... 63
4.3.

Insurance and national programmes .................................................................................. 64
4.3.1.

Public healthcare sector ........................................................................................... 64

4.3.2. Private healthcare sector ......................................................................................... 65
4.3.3. International donor programmes ........................................................................... 68
4.4.

Cost of treatment ...................................................................................................................... 68
4.4.1.

Overview....................................................................................................................... 68

4.4.2. Methodology of data collection on treatment prices ....................................... 68
4.5.

Cost of medication ....................................................................................................................72
6

4.5.1.

Overview........................................................................................................................72

4.5.2. Methodology of data collection on drug prices .................................................. 73
4.6.

NGOs ............................................................................................................................................79

5. Endocrinology .......................................................................................................................................... 80
5.1.

5.2.

General information ................................................................................................................. 80
5.1.1.

Epidemiological context ........................................................................................... 80

5.1.2.

National policies and programmes ....................................................................... 80

Access to treatment .................................................................................................................. 81
5.2.1.

5.3.

Resources..................................................................................................................... 82

Insurance and national programmes .................................................................................. 85
5.3.1.

Private healthcare insurance .................................................................................. 85

5.3.2. International donor programmes ............................................................................ 87
5.4.

Cost of treatment ...................................................................................................................... 88
5.4.1.

5.5.

Methodology of data collection on treatment prices ....................................... 88

Cost of medication .................................................................................................................... 91
5.5.1.

Methodology of data collection on drug prices ................................................. 92

6. Infectious diseases ................................................................................................................................. 99
6.1.

6.2.

General information ................................................................................................................. 99
6.1.1.

Epidemiological context ........................................................................................... 99

6.1.2.

National policies and programmes ......................................................................100

Access to treatment ................................................................................................................ 102
6.2.1.

Overview of treatment for infectious diseases in the public healthcare
system .......................................................................................................................... 102

6.2.2. Limitations on access to treatment for infectious diseases in the publichealthcare system ..................................................................................................... 103
6.2.3. Treatment for infectious diseases offered in the private healthcare sector........................................................................................................................................ 105
6.2.4. International donor programmes .......................................................................... 106
6.2.5. Discrimination faced by patients with HIV/AIDS ............................................... 106
6.3.

Insurance and national programmes ................................................................................. 107
6.3.1.

6.4.

Cost of treatment ....................................................................................................................... 111
6.4.1.

6.5.

Methodology of data collection on treatment prices ........................................ 111

Cost of medication ................................................................................................................... 114
6.5.1.

6.6.

Private healthcare insurance ................................................................................. 108

Methodology of data collection on drug prices ................................................. 115

NGOs .......................................................................................................................................... 124

7. Psychiatry ................................................................................................................................................. 125

7.1.

7.2.

General information ................................................................................................................ 125
7.1.1.

Epidemiological context .......................................................................................... 125

7.1.2.

National policies and programmes ...................................................................... 127

Access to treatment ................................................................................................................. 131
7.2.1.

Structure of mental healthcare in the public healthcare system in Russia. 131

7.2.2. The practice of psychiatry in Russia .................................................................... 132
7.2.3. Limitations of the accessibility and quality of mental healthcare................. 133
7.2.4. Psychiatry in the private healthcare system ...................................................... 134
7.2.5. Resources.................................................................................................................... 135
7.2.6. Discrimination against “narcology” patients ...................................................... 135
7.3.

Insurance and national programmes ................................................................................. 136
7.3.1.

7.4.

Services provided by international donor programmes ................................. 140

Cost of treatment ..................................................................................................................... 140
7.4.1.

Overview...................................................................................................................... 140

7.4.2. Methodology of data collection on treatment prices ....................................... 141
7.5.

Cost of medication .................................................................................................................. 144
7.5.1.

Overview...................................................................................................................... 144

7.5.2. Methodology of data collection on drug prices ................................................ 144
7.6.

NGOs .......................................................................................................................................... 150

8. Neurology ................................................................................................................................................ 152
8.1.

8.2.

General information ................................................................................................................ 152
8.1.1.

Epidemiological context .......................................................................................... 152

8.1.2.

National policies and programmes ...................................................................... 152

8.1.3.

Key facilities for the treatment of neurological conditions ............................ 153

Access to treatment ................................................................................................................ 154
8.2.1.

Structure and organisation of neurology healthcare in Russia .................... 154

8.2.2. Resources.................................................................................................................... 156
8.3.

Insurance and national programmes ................................................................................. 158
8.3.1.

8.4.

Services provided by international donor programmes .................................. 161

Cost of treatment ...................................................................................................................... 161
8.4.1.

Overview....................................................................................................................... 161

8.4.2. Methodology of data collection on treatment prices ....................................... 161
8.5.

Cost of medication .................................................................................................................. 164
8.5.1.

Overview...................................................................................................................... 164

8.5.2. Methodology of data collection on drug prices ................................................ 165
8.6.

NGOs ........................................................................................................................................... 171
89. Nephrology .............................................................................................................................................. 172
9.1.

9.2.

General information ................................................................................................................ 172
9.1.1.

Epidemiological context .......................................................................................... 172

9.1.2.

National policies and programmes ...................................................................... 172

9.1.3.

Key facilities for the treatment of nephrological conditions in Russia ........ 174

Access to treatment ................................................................................................................ 174
9.2.1.

9.3.

Overview of nephrology in the public healthcare system ............................. 174

Overview of nephrology in the private healthcare system .......................................... 176
9.3.1.

Facilities ....................................................................................................................... 176

9.3.2. Nephrology healthcare workforce........................................................................ 176
9.3.3. Limitations on access to healthcare for nephrological conditions .............. 177
9.4.

Insurance and national programmes ................................................................................. 178

9.5.

Cost of treatment ..................................................................................................................... 180
9.5.1.

9.6.

Cost of medication .................................................................................................................. 183
9.6.1.

9.7.

Methodology of data collection on treatment prices ....................................... 181
Methodology of data collection on drug prices ................................................ 184

NGOs .......................................................................................................................................... 188

10. Pulmonology ........................................................................................................................................... 190
10.1.

General information ................................................................................................................ 190
10.1.1. Epidemiological context .......................................................................................... 190
10.1.2. National programmes and policies on healthcare for pulmonologicalconditions ..................................................................................................................... 191
10.1.3. Key facilities for the treatment of pulmonological conditions ........................ 191

10.2. Access to treatment ................................................................................................................ 192
10.2.1. Structure and organisation of the system for pulmonary healthcare in
Russia ........................................................................................................................... 192
10.2.2. Limitations to patient access to healthcare for pulmonological conditions in
Russia ........................................................................................................................... 193
10.2.3. Resources.................................................................................................................... 194
10.3. Insurance and national programmes ................................................................................. 194
10.3.1. Private healthcare insurance ................................................................................. 195
10.3.2. International donor programmes .......................................................................... 197
10.4. Cost of treatment ..................................................................................................................... 197
10.4.1. Overview...................................................................................................................... 197
10.4.2. Methodology of data collection on treatment prices ...................................... 197
10.5. Cost of medication .................................................................................................................200
10.5.1. Overview.....................................................................................................................200

10.5.2. Methodology of data collection on drug prices ................................................ 201
10.6. NGOs .........................................................................................................................................206
11. Paediatrics .............................................................................................................................................. 207
11.1.

General Information ............................................................................................................... 207
11.1.1.

Epidemiological context ......................................................................................... 207

11.1.2. National programmes and policies ..................................................................... 207

11.2.

11.1.3.

Content and structure of the paediatric healthcare system ......................... 208

11.1.4.

Main paediatric medical facilities .......................................................................... 210

Access to treatment ................................................................................................................ 214
11.2.1. Facilities and organisation ...................................................................................... 214
11.2.2. Healthcare resources ............................................................................................... 218
11.2.3. Private healthcare system...................................................................................... 223

11.3.

Insurance and national programmes ................................................................................ 224
11.3.1.

Private paediatric healthcare ................................................................................ 225

11.3.2. Paediatric programmes funded by international donors............................... 228
11.4.

Cost of treatment .................................................................................................................... 228
11.4.1.

11.5.

Methodology of data collection on treatment prices ..................................... 228

NGOs ......................................................................................................................................... 232
11.5.1. Domestic NGOs ........................................................................................................ 233

12. Patients with disabilities ...................................................................................................................... 235
12.1.

General information ............................................................................................................... 235
12.1.1. Epidemiological context ......................................................................................... 235
12.1.2. National policies and programmes ..................................................................... 236
12.1.3. Example of treatment centres............................................................................... 236

12.2. Access to treatment ............................................................................................................... 237
12.2.1. Overview of access to treatment ......................................................................... 237
12.2.2. Limitations on access to healthcare for people with disabilities................. 237
12.2.3. Rehabilitation............................................................................................................. 238
12.2.4. Private healthcare sector ....................................................................................... 239
12.3. Insurance and national programmes ................................................................................ 240
12.3.1. Private healthcare insurance ................................................................................ 240
12.4. Cost of treatment .................................................................................................................... 243
12.4.1. Methodology of data collection on treatment prices ..................................... 243
12.5. NGOs ......................................................................................................................................... 248
13. Elderly patients ....................................................................................................................................... 251
13.1.

General information ................................................................................................................ 251
10

13.1.1.

Epidemiological context .......................................................................................... 251

13.1.2. National policies and programmes ...................................................................... 251
13.1.3. Key facilities for the treatment of geriatric conditions ................................... 252
13.2. Access to treatment ............................................................................................................... 253
13.2.1. Structure and organisation of healthcare for elderly patients in the publichealthcare system in Russia .................................................................................. 253
13.2.2. Healthcare for elderly patients in the private healthcare sector in Russia254
13.2.3. Geriatric programmes funded by international donors ................................. 255
13.2.4. Geriatric health and social care resources........................................................ 255
13.2.5. Limitations on healthcare and social care for elderly patients in the publichealthcare system .................................................................................................... 256
13.3. Insurance and national programmes ................................................................................ 257
13.3.1. Private healthcare insurance ................................................................................ 258
13.4. Cost of treatment .................................................................................................................... 259
13.4.1. Methodology of data collection on treatment prices ..................................... 259
Annex 1. Bibliography ................................................................................................................................. 263
Oral sources, including anonymous sources .............................................................................. 263
Public sources...................................................................................................................................... 263

List of figures
Figure 1: Map of the Russian Federation ................................................................................................. 28
Figure 2: OOP expenditure (% of current health expenditure) 2000-2018 ................................... 56
Figure 3: 2008 structure of diabetes service in Russia according to the Federal Target
Programme .................................................................................................................................. 82

List of tables
Table 1: Anonymised key informants ........................................................................................................ 25
Table 2: Public financing for health in billions of RUB, 2020-2023 (current prices) .................... 37
Table 3: Number of hospitals and outpatient clinics and beds, 1940-2019 ................................... 38
Table 4: Workforce breakdown per specialist category, per 10 000 population, 2018. .............41
Table 5: Healthcare resources by federal district, 2019 .......................................................................41
Table 6: Federal and regional privileges holders entitled to receive free or discounted
medicines ..................................................................................................................................... 46

Table 7: Patient entitlement to free medications .................................................................................. 48
Table 8: Social assistance programmes by key income loss risks, 2019 ....................................... 52
Table 9: List of useful links .......................................................................................................................... 58
Table 10: Example facilities for the treatment of CVDs ...................................................................... 62
Table 11: Public and private healthcare insurance coverage for CVDs in Russia.........................67
Table 12: Websites consulted for drug prices ........................................................................................ 69
Table 13: Cost of treatment for CVDs in the public and private health systems in Russia .........72
Table 14: Websites consulted for drug prices ......................................................................................... 73
Table 15: Cost of drugs for CVDs in the public and private health systems in Russia ................. 78
Table 16: Endocrine conditions for which treatment is limited in Russia ........................................ 84
Table 17: Public and private healthcare coverage for endocrinology patients in Russia ............ 87
Table 18: Websites consulted for treatment prices ............................................................................. 89
Table 19: Cost of treatments for endocrine conditions in the public and private health systems
in Russia ......................................................................................................................................... 91
Table 20: Websites consulted for drug prices...................................................................................... 92
Table 21: Cost of drugs for endocrinological conditions in the public and private healthsystems in Russia ....................................................................................................................... 98
Table 22: Example facilities for the treatment of infectious diseases ............................................. 101
Table 23: Public and private healthcare coverage for patients with infectious diseases in
Russia ............................................................................................................................................. 111
Table 24: Websites consulted for treatment prices ............................................................................. 112
Table 25: Cost of treatments for patients with infectious diseases in the public and private
health systems in Russia I ........................................................................................................ 112
Table 26: Cost of treatments for patients with infectious diseases in the public and private
health systems in Russia II ....................................................................................................... 114
Table 27: Websites consulted for drug prices ....................................................................................... 115
Table 28: Cost of drugs for infectious diseases in the public and private health systems in
Russia ........................................................................................................................................... 124
Table 29: Type of mental health disorders ............................................................................................ 126

12

Table 30: Sample of psychiatric treatment centres in Russia from the public and private
healthcare sectors ................................................................ Error! Bookmark not defined.
Table 31: Public and private healthcare insurance coverage in Russia ......................................... 140
Table 32: Websites used to identify price of treatments, diagnostics and equipment .............. 141
Table 33: Cost of treatments for psychiatric conditions in the public and private health systems
in Russia I..................................................................................................................................... 142
Table 34: Cost of treatments for psychiatric conditions in the public and private health systems
in Russia II.................................................................................................................................... 144
Table 35: Websites used in initial search for drug availabilities and costs in Moscow ............. 145
Table 36: Cost of drugs for psychiatric conditions in the public and private health systems in
Russia ........................................................................................................................................... 150
Table 37: Neurology treatment centres in Russia from the public and private healthcare
sectors .......................................................................................................................................... 154
Table 38: Volume of neurosurgical equipment available in Russia ................................................ 157
Table 39: Neurology cover in the public and private healthcare system....................................... 161
Table 40: Websites consulted for treatment prices ............................................................................ 162
Table 41: Cost of treatments for neurological conditions in the public and private healthcare
sectors in Russia ........................................................................................................................ 162
Table 42: Cost of treatments for neurological conditions in the public and private healthsystems in Russia ...................................................................................................................... 164
Table 43: Websites consulted for drug prices ...................................................................................... 165
Table 44: Cost of drugs for neurological conditions in the public and private health systems in
Russia ............................................................................................................................................ 171
Table 45: Nephrology treatment centres in Russia from the public and private healthcare
sectors .......................................................................................................................................... 174
Table 46: Public and private healthcare insurance nephrology coverage in Russia ................. 180
Table 47: Websites consulted for treatment prices............................................................................. 181
Table 48: Cost of treatments for nephrological conditions in the public and private healthsystems in Russia ...................................................................................................................... 183
Table 49: Websites consulted for drug prices ...................................................................................... 184
Table 50: Cost of drugs for nephrological conditions in the public and private health systems
in Russia ....................................................................................................................................... 188

Table 51: Pulmonology treatment centres in Russia from the public and private healthcare
sectors .......................................................................................................................................... 192
Table 52: Public and private healthcare insurance coverage in Russia ........................................ 196
Table 53: Websites consulted for treatment prices ........................................................................... 198
Table 54: Cost of treatments for pulmonological conditions in the public and private healthsystems in Russia .....................................................................................................................200
Table 55: Websites consulted for drug prices ...................................................................................... 201
Table 56: Cost of drugs for pulmonological conditions in the public and private health systems
in Russia ......................................................................................................................................206
Table 57: Examples of paediatric medical and treatment centres in Russia ................................ 214
Table 58: Healthcare services provided by paediatric polyclinics in Russia................................ 217
Table 59: Paediatric healthcare workforce in Russia.........................................................................220
Table 60: Public and private healthcare insurance coverage in Russia ....................................... 227
Table 61: Websites consulted for treatment prices ............................................................................ 229
Table 62: Cost of treatments for paediatric conditions in the public and private health systems
in Russia ...................................................................................................................................... 232
Table 63: Examples of domestic Russian NGOs covering paediatric medicine ........................ 234
Table 64: Example facilities for the treatment of patients with eye disabilities .......................... 237
Table 65: Numbers of adults in residential social care in Russia ................................................... 239
Table 66: Public and private healthcare coverage for patients with disabilities in Russia ...... 243
Table 67: Websites consulted for treatment prices............................................................................ 244
Table 68: Cost of treatments for patients with disabilities in the public and private healthsystems in Russia ..................................................................................................................... 248
Table 69: Public healthcare coverage for elderly patients in Russia ............................................ 258
Table 70: Private healthcare coverage for elderly patients in Russia ........................................... 259
Table 71: Websites consulted for treatment prices.............................................................................260
Table 72: Cost of treatments for geriatric conditions in the public and private health systems in
Russia .......................................................................................................................................... 262

14

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Disclaimer
This report was written according to the EUAA Country of Origin Information (COI) Report
Methodology (2019). 1 The report is based on carefully selected sources of information. All
sources used are referenced.
0F

The information contained in this report has been researched, evaluated and analysed withutmost care. However, this document does not claim to be exhaustive. If a particular event,person or organisation is not mentioned in the report, this does not mean that the event has
not taken place or that the person or organisation does not exist.
Furthermore, this report is not conclusive as to the determination or merit of any particularapplication for international protection. Terminology used should not be regarded asindicative of a particular legal position.
‘Refugee’, ‘risk’ and similar terminology are used as generic terminology and not in the legal
sense as applied in the European Union (EU) Asylum Acquis, the 1951 Refugee Convention
and the 1967 Protocol Relating to the Status of Refugees.
Neither EUAA nor any person acting on its behalf may be held responsible for the use which
may be made of the information contained in this report.
The drafting of this report was finalised in March, 2022. Any event taking place after this dateis not included in this report. More information on the reference period for this report can befound in the Methodology section of the Introduction.
This report provides medical country of origin information (MedCOI). The Russian Federationis the largest country in the world and the delivery team has sought to report the most
relevant information within the time and resources available for this contract.
The reader should bear in mind that most of the information was collected before the Russian
invasion of Ukraine and the subsequent sanctions against Russia. These sanctions may havecaused some shortages in the availability of treatments and medications and influenced theprices. However, the general structure of the health services and health service provision isunlikely to have substantially changed. So, although caution should be applied when using thefinancial information present in this report, the general information is still considered valid. All
links present in the report have been tested and were working at the time of initial review, but
unpredictable cyber-attacks against Russian institutions may sometimes deny access to someof the web pages.

1

The 2019 COI Report Methodology can be downloaded from the EUAA COI portal, url

15

EUROPEAN UNION AGENCY FOR ASYLUM

16

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGlossary and abbreviations
Term

Definition

AF

Atrial fibrillation

AMI

Acute myocardial infarction

ANC

Antenatal care

APD

Automated peritoneal dialysis

ARAD

Arkangelsk Regional Anti-Tuberculosis Dispensary

BMS

Bristol Myers Squibb

CABG

Coronary artery bypass graft

CAPD

Continuous ambulatory peritoneal dialysis

CAT

Computerised tomography (see also CT)

CKD

Chronic kidney disease

CMI

Compulsory Medical Insurance (see also OMS)

CoVID

Coronavirus disease 2019 (SARS-CoV-2)

17

EUROPEAN UNION AGENCY FOR ASYLUM

COVID-19

Coronavirus disease 2019 (SARS-CoV-2)

CRS

Congressional Research Service

CT

Computerised tomography

CVDs

Cardiovascular diseases

DAA

Direct-acting antiviral

DALY

Disability-adjusted life year

DOTS

Directly observed treatment, short-course

DP

District internist/physician

EUAA

European Union Agency for Asylum

EAEU

Eurasian Economic Union

ECG

Electrocardiogram

EEC

Eurasian Economic Commission

EMS

Emergency medical services

ENT

Ear, nose and throat

18

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTEREmergency room

ESC

European Society of Cardiology

FAS

Federal Antimonopoly Service

FFOMSФедеральный фонд обязательного медицинского страхования
(ФФОМС) [Federal Fund OMS (Compulsory Medical Insurance)]

FMBA

Federal Medico-Biological Agency

FMF

Familial Mediterranean fever

FOD

Free of charge

FSB

Federal Security Services

GA

Ground ambulance

GBD

Global Burden of Disease

GP

General provider

HBV

Hepatitis B virus

HCV

Hepatitis C virus

HD

Haemodialysis

19

EUROPEAN UNION AGENCY FOR ASYLUM

HIV/AIDS

Human immunodeficiency virus/acquired immunodeficiency
syndrome

ICD

Implantable cardioverter defibrillator

ICU

Intensive care units

IHD

Ischaemic heart disease

INGO

International non-governmental organisations

INR

International normalised ratio

Intl.SOS

International SOS

KF

Kidney failure

KYH

Know Your Heart

MDR-TB

Multidrug-resistant tuberculosis

MedCOI

Medical country of origin information

MIS

Medical information system

MoFA

Ministry of Foreign Affairs

MoH

Ministry of Health

20

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

MRIMagnetic resonance imaging

MSM

Men who have sex with men

NATONorth Atlantic Treaty Organization

NCD

Non-communicable disease

NCO

Non-commercial organisationNGO

Non-governmental organisation

NMRI

Nuclear magnetic resonance imaging

OECD

Organisation for Economic Co-operation and Development

OMSОбязательное медицинское страхование [Compulsory Medical
Insurance (see also CMI)]OOPOut of pocket

PCI

Percutaneous coronary interventions

PD

Peritoneal dialysis

PNI

Psychoneurological Institution

PPP

Purchasing power parity

21EUROPEAN UNION AGENCY FOR ASYLUM

PCIPrimary percutaneous coronary interventions

PSG

Program of State Guarantees for Medical CarePT

Physical therapist

PTCA

Percutaneous transluminal coronary angiography

PTSD

Post-traumatic stress disorder

PVD

Peripheral vascular disease

PWID

People who inject drugs

RNMSPC

Russian National Medical Society of Preventive Cardiology

RosstatFederal State Statistics Service

RRT

Renal replacement therapy

STD

Sexually transmitted disease

STI

Sexually transmitted infection

TB

Tuberculosis

TB-DOTSTB directly observed treatment, short-course

22

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTTFOMSTerritorial Fund of Obligatory Medical Insurance

TTE

Transthoracic echocardiogram

UN

United Nations

UNAIDS

Joint United Nations Programme on HIV/AIDSUN DESA

United Nations Department of Economic and Social Affairs

UNDP

United Nations Development Programme

USHIS

Unified State Health Information System

VEDL

Vital and Essential Drugs List

VMI

Voluntary medical insurance (private healthcare insurance)

WHO

World Health Organization

XDR-TB

Extensively drug-resistant TB

23

EUROPEAN UNION AGENCY FOR ASYLUM

Introduction
Methodology
This report is produced in line with the European Union Agency for Asylum (EUAA) COI
Report Methodology (2019) and the EUAA COI Writing and Referencing Style Guide (2019). 2
1F

The purpose of the report is to provide information on access to healthcare in the RussianFederation. This information is relevant to the application of international protection statusdetermination (refugee status and subsidiary protection) and migration legislation in EU+
countries.
This report also aims to provide information about access to healthcare for specific diseases
and population groups.

Defining the terms of reference
The terms of reference for this Medical Country of Origin Information (MedCOI) Report are
based on the Belgian Desk of Accessibility’s ‘Researcher’s Guide’, developed in theframework of the MedCOI4 project. The guide includes a list of questions to be addressed in
the report (see below). The main period of research for this report was June-September 2021,
and complementary research to address peer review comments took place up until May
2022.
The report was reissued in June 2023, to correct a factual error. The incorrect sentence on
page 99 concerning hepatitis symptoms and chronic infection has been removed. The rest of
the report remains the same.

Note on the usage of this report
Since the time of research, various sanctions have impacted the situation in the RussianFederation. At the time of publication, economic sanctions have affected the national
economy and in effect, prices and availability on various goods and services. 3 Additionally,
many websites have become unavailable, either due to hacking attacks or other reasons. 4
The impact on this report is three-fold: one, the prices indicated in this report, while accurate
at the time of research and initial review, are possibly no longer indicative. Two, while
medicines are exempt from the sanctions against Russia, 5 reports on shortages began
2F

3F

4F

EUAA, EASO Writing and Referencing Guide for EASO Country of Origin Information (COI) Reports, 2019, url
PBS News Hour, How sanctions are affecting the Russian economy, 23 April 2022, url; BBC, Russia sanctions: How
the measures have changed daily life, 13 March 2022, url
4
NY Times, Russia, Blocked From the Global Internet, Plunges Into Digital Isolation, 7 March 2022, url; TRT World,
Is Russia planning to ‘log out’ of the World Wide Web?, 18 March 2022, url; Wired, Russia Is Being Hacked at an
Unprecedented Scale, 27 April, 2022, url
5
Dyer, O., Essential medicines keep flowing to Russia, but sanctions could severely effect health, 21 March 2022,
url
2
3

24

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

appearing in early March 2022. The shortages were according to reports due to stockpiling of
medication and logistical issues caused by the sanctions, not due to availability of drugs in
the country. 6 Three, many online sources used could not be checked during the final review
stages.
5F

Consequently, it was not possible to update the prices nor research which prices may havebeen changed in the past few months. It is possible other information relating to theavailability of treatments and medication have changed as well, but because of the current
limitation in information as well as the volatile situation, it is not possible to ascertain what
may differ since the time of research. For this reason, caution is advised when utilising thefindings presented in this report.

Collecting information
EUAA contracted International SOS (Intl.SOS) to manage the report delivery including datacollection. Intl.SOS recruited and managed a public health lead to author the report and alocal consultant to collect data. The public health lead was selected from Intl.SOS’ existing
pool of consultants. The consultant was selected based on their experience in leading
comparable projects, their experience working on public health issues in the RussianFederation and other former Soviet nations, and their regional experience working on the
ground in Belarus.
The research questions based on the above-mentioned ‘Researcher’s Guide’ were used todevelop the ‘Questionnaire on access to healthcare’, which included a medication andconsultation price list containing common treatment and medication questions. The
questionnaire was completed based on the knowledge of the local consultants, two medical
doctors and a research assistant in the Russian Federation, as well as a literature review.

Key informant interviews
Key informant interviews were carried out by the international consultant with local
consultants between July and September 2021. See Table 1 below.
Key informant code

Role description

Contact 1

Medical doctor and local consultant responsible for in-country data collection
for the report. The person wishes to remain anonymous for security reasons.

Contact 2

Research assistant responsible for data collection and translation of Russianlanguage sources. The person wishes to remain anonymous for security
reasons.

Table 1: Anonymised key informants

AP, Panic buying or a long-term problem? Russia suffers drug shortages amid sanctions over Ukraine war, 4 April
2022, url
625

EUROPEAN UNION AGENCY FOR ASYLUM

Literature review
The local consultants collected statistical data and health system information from official
government sources, journal papers and reports by non-governmental organisations (NGOs)
and their websites, and provided local working knowledge and an overview of the healthcare
system in Russia. The local research assistant provided an English translation of the Strategy
for Health Development in the Russian Federation until 2025. The lead consultant(international) reviewed a range of public health academic studies, international donor
reports, news agency and NGO documents and strategies, private health clinic websites, andinternational statistical datasets to collect and synthesise information on which to base thedraft sections of each report.
Sources were carefully selected following the Common EU Guidelines for Processing COI(2008) and the EUAA COI Report Methodology (2019), and are referenced in footnotes oneach page and included in the bibliography.

Medication and treatment prices
A comprehensive, although non-exhaustive, list of treatment and medication prices isprovided in each topical chapter. The data presented in these were collected by the local
consultants and research assistant in Moscow between July and August 2021. Medication andtreatment prices were reported in Euros (EUR) to make it easier for information users who are
unfamiliar with the focus country’s local currency to comprehend the costing component andcompare to other contexts where necessary.
Prices of treatments, diagnostics and equipment were gathered using an initial internet
search for their availability and costs in Moscow. The most common prices were compared,
and the median price agreed. The currency conversion from Rubles (RUB) to EUR was
performed using the OANDA Converter. 7 The prices of drugs were collected using the same
methodology, only each medication was checked against the Russian Federation’s official
Vital and Essential Drugs List, and if not found under a generic name from the internet search,
checked against the State Register of Medicines. If a medication was registered, a further
internet search for its availability was performed using its brand name. If it was not registered,a note regarding the absence of registration was added. Medicines which are only available
in the informal market were excluded. No regional variations were noted.
6F

Quality control
Quality control of the report was carried out both on content and form.
The accuracy of information included in the report was reviewed, to the extent possible,
based on the quality of the sources and citations provided by the lead and local consultants.
Form and content were reviewed by International SOS and EUAA MedCOI experts.

7

OANDA [currency conversion website], 2022, url

26

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Referencing
Recommended referencing for this report: ‘EUAA MedCOI, Medical Country of Origin
Information Report: Russian Federation, September 2022, [url].’

27

EUROPEAN UNION AGENCY FOR ASYLUM

Map of the Russian Federation

Figure 1: Map of the Russian Federation 8
7F

UNHCR (The United Nations High Commissioner for Refugees), Russian Federation - Reference map, 18 June 2018,
url
8

28

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

1. Context
Geography and demographics

1.1.

The Russian Federation (short-form country name in this report: Russia) is the largest country
in the world. It comprises a total area of 17 098 242 square kilometres and a land massof 16 376 870 square kilometres. It lies in the Northern and Eastern hemispheres. 9 Russia issituated between Eastern Europe to the west and the northern part of Asia to the east, and issurrounded by 12 seas and 3 oceans.
8F

Russia is the ninth most populated country in the world, with a 2019 projected population of
145.9 million, a 0.1 % annual rate of population change and a low fertility rate of 1.83 live births
per woman. 10 The elderly population is increasing and is predicted to reach an age-old
dependency ratio of 40 people over the age of 65 per 100 working-age people by 2100. 11
Children between 0 and 17 years account for approximately 20.8 % of the population, or
30.4 million. 12
9F

10F

11F

In 2019, life expectancy in Russia was 72.6 years, which was below the global average of
73.2 years; in 2019, life expectancy at birth was 67.1 years for men and 77.8 years for
women. 13 In 2017, the average number of children born to a Russian woman was 1.61. 14
12F

13F

In 2019, the infant mortality rate was low at 5 deaths per 1 000 live births, while under-5-year
mortality was equally low at 7 deaths per 1 000 live births. 15 Russia’s maternal mortality ratio in
2007-2017 was 10 women per 100 000 live births during pregnancy or within 42 days afterchildbirth, a drop of 28 women per 100 000 live births since the year 2000, when thematernal mortality ratio was 38 women per 100 000 live births. 16 The maternal mortality ratio
had risen to an estimated 17 women per 100 000 live births by 2019, according to the United
Nations Development Programme (UNDP) Gender Inequality Index. 17
14F

15F

16F

World Population Review, Where is Russia in the World?, n.d., url
UN DESA, Population Division, World Population Prospects 2019, Volume II: Demographic Profiles(ST/ESA/SER.A/427), 2019, url, p. 1
11Vishnevsky, A. and Shcherbakova, E., A New Stage of Demographic Change: A Warning for Economists, 9 October
2018, url, p. 233
12
Rosstat, Population of the Russian Federation by Gender and Age as of 01.01.2021 [Statistical Bulletin], 2021, url,
accessed 17 September 2021
13
UNDP, Human Development Report: Russia Dashboard, July 2021, url
14
Wrede, S. et al., Birth Systems across the World: Variation in Maternity Policy and Services across Countries,
February 2021, url, p. 5
15
UN DESA, Population Division, World Population Prospects 2019, Volume II: Demographic Profiles(ST/ESA/SER.A/427), 2019, url, p. 1
16World Bank Data, Maternal mortality ratio (national estimate, per 100,000 live births) – Russian Federation, 19852015, 2019, url
17
UNDP, Human Development Report 2020, The Next Frontier: Human Development and the Anthropocene Briefing
note for Countries on the 2020 Human Development Report Russian Federation, 2020, url, p. 6
9

10

29

EUROPEAN UNION AGENCY FOR ASYLUM

1.2.

Political context

Russia is a federal semi-presidential republic. 18 Power is shared at federal level among thepresident, the parliament, the federal government and the courts, but in practice the balanceof power is tilted towards the president. 19 The bicameral legislature, the Federal Assembly, iscomposed of the upper house, the Federation Council, and the lower house, the State Duma.
Members of each serve five-year terms.
17F

18F

1.3.

Economic context

Russia is an upper-middle-income economy with a gross domestic product (GDP) per capita
of EUR 8 708 in 2020. 20 In 2020, it was the 11th largest economy in the world. 21
19F

1.4.

20F

Historical context

The Soviet Union was formally dissolved on 31 December 1991. 22 The Russian Soviet
Federative Socialist Republic was renamed the Russian Federation. 23
21F

22F

A multiparty system emerged in the 1990s, though the 1993 constitution set up an unequal
relationship between political parties and the executive. 24 As of 2000, however, politics were
dominated by Vladimir Putin and the United Russia party. 25
23F

24F

Zaznaev, O., Understanding Semi-Presidentialism in Political Science: A Review of the Latest Debate, World
Applied Sciences Journal, url, pp. 196-197
19
European Parliament Research Service, Russia’s Constitutional Structure: Federal in form, unitary in function,
October 2015, url, p. 3
20World Bank, World Bank Country and Lending Groups, n.d., url
21
IMF, MF Datamapper, 2021, url
22
Editors of Encyclopaedia Britannica, Collapse of the Soviet Union, The end of Soviet communism, Britannica, n.d.,url
23
Editors of Encyclopaedia Britannica, Collapse of the Soviet Union, The end of Soviet communism, Britannica, n.d.,url; CVCE, From Soviet federalism to the creation of the Commonwealth of Independent States (CIS), 8 July 2016,
url, p. 7
24
European Parliament Research Service, Russia: political parties in a 'managed democracy’, December 2014, url,p. 2
25
Freedom House, Freedom in the World 2021: Russia, n.d., url
1830

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

2. Healthcare system
2.1.

Health system organisation

The Constitution of the Russian Federation guarantees to the population of Russia the rightto free-of-charge healthcare and medical assistance, financed by a health budget, insurance
contributions and other proceeds. 26 There have been several rounds of health sector
reforms, beginning with the adoption of the Constitution of the Russian Federation, which
retained the right to free healthcare and the introduction of Compulsory Medical Insurance(CMI) in 1993. 27
25F

26F

The Russian name for CMI is Обязательное медицинское страхование; thus CMI is referred
to by the anglicised acronym OMS. The managing organisation of the insurance isФедеральный фонд обязательного медицинского страхования (ФФОМС), referred to by
the anglicised acronym FFOMS. After a period of health system decentralisation to municipal
governments in the 1990s, the system was re-centralised again in the mid-2000s due to
growing inequalities in policies and funding across local areas. 28
27F

In 2014, a set of health system ‘optimisation’ measures were adopted to reduce health costs
by improving health system efficiency. 29 These included merging health centres andhospitals, increasing medical staff salaries, and providing polyclinics and hospitals with hightech equipment. 30 However, the measures unintentionally lead to a reduction of the total
number of medical providers, pushing providers into the private sector, diminishing the
primary care network, particularly in rural areas, and forcing patients from the public into theprivate system. 31
28F

29F

30F

The Strategy for Health Development in the Russian Federation until 2025, launched inJune 2019, includes disease prevention and expanding primary care and palliative services toaddress the disproportionate focus on clinical/inpatient and emergency care at the cost of
prevention, early diagnosis, rehabilitation and palliative care. 32 The current health system is,
31F

Russia, Constitution of the Russian Federation, Chapter 2: Rights and Freedoms of Man and Citizen, Article 41,
2001, url
27
Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, p. 91.
28
Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2017, url, p. 11
29
Tagaeva, T. and Kazantseva, L., Public Health and Medical Care in Russia: Status and Problems, 2017, url, pp. 174175
30
Tagaeva, T. and Kazantseva, L., Public Health and Medical Care in Russia: Status and Problems, 2017, url, pp. 175
31
Tagaeva, T. and Kazantseva, L., Public Health and Medical Care in Russia: Status and Problems, 2017, url, pp. 174175; Molchanova, E.V., Comparative Assessment of Health Systems in Russia and Finland, January 2020, url, p. 256
32
Russia, Указ Президента РФ от 6 июня 2019 г. N 254 О Стратегии развития здравоохранения в Российской
Федерации на период до 2025 года [Presidential Decree of the Russian Federation, June 6, 2019, No. 254, Aboutthe strategy of development of healthcare in the Russian Federation for the period until 2025], url, p. 926

31

EUROPEAN UNION AGENCY FOR ASYLUM

however, centralised with some management and budgetary authority devolved to regionaland municipal levels:••

Russia’s Ministry of Health (MoH) develops and implements the state’s health policy andlegislation, overseeing service delivery, pharmaceuticals, sanitary and epidemiologicalconditions, surveillance, the Federal Fund of Compulsory Medical Insurance (FFOMS),
and other activities.
Regional healthcare departments and ministries are responsible for managing regional
health programmes and services, including health protection, the health workforce andemergency services. The executive authorities have budget authority over specialised
medical care. The regions are also responsible for managing and funding primarycare. 33
Local government bodies manage the healthcare system at the municipal level,
including monitoring and analysing population health and service delivery, coordinating
healthcare activities, and implementing municipal programmes. Executive authorities
have authority to plan the costs for emergency care, primary medical care in outpatientand inpatient facilities, and medical care for women during pregnancy, in labour andafter childbirth. 34
32F

•

33F

There are significant disparities in the resources and services available between regions andmunicipalities. Regions with more economic opportunities attract more investments, resulting
in higher salaries and bigger tax revenues, enabling larger healthcare budgets. The 10
wealthiest regions have almost double the health funding compared to the poorest regions. 35
The vast territories with lower populations struggle with insufficient coverage of medical
facilities and lack of qualified staffing and equipment. 36
34F

35F

Some large state-controlled corporations also offer healthcare services. These selectively
available services are referred to as ‘departmental healthcare’ and are not run by Russia’s
MoH. Their funding comes from different sources and they have own infrastructure which
includes polyclinics, full-scale hospitals and sanatoriums. Contact 1 stated that it would be‘nearly impossible’ to obtain statistical data on this component of the healthcare system. 37
36F

2.1.1.

Public sector

Public health services are organised into primary, secondary and tertiary levels: primary careincludes general medical services, emergency care and some specialised services;secondary care includes a broader range of specialised medical care; and tertiary care offers
high-tech medical services. 38 In cities and towns, polyclinics are the key primary care
37F

Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2017, url, p. 11
34
Aksenova, E. et al., Sustainability and Resilience in the Russian Health System, March 2021, url, p. 9
35
Ulumbekova, G.E., Финансирование здравоохранения в России (2021-2024 гг.). Факты и предложения
[Healthcare financing in Russia (2021-2024). Facts and suggestions] April 2019, url
36
Molchanova, E.V., Comparative Assessment of Health Systems in Russia and Finland, January 2020, url, p. 256
37
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
38
Aksenova, E. et al., Sustainability and Resilience in the Russian Health System, March 2021, url, p. 16
33

32

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

institutions, whilst in low-populated, rural areas, feldsher-obstetric clinics (ФАП (FAP)– фельдшерско-акушерский пункт) cover primary care, obstetric and surgical careservices. 39 These small clinics house basic medical diagnostic and treatment equipment andare staffed by a feldsher (doctor’s assistant) and often a midwife. 40
38F

39F

The public health system also features an extensive network of hospitals and a high numberof providers per patient. 41 The type of hospitals available across Russia ranges from large,
well-equipped tertiary hospitals in regional capitals that cover a wide range of medical andsurgical procedures, to small, basic hospitals in rural areas which only offer healthcare forcommon fields of clinical practice. Specialised centres covering specific problems such as
cardiovascular and perinatal conditions are usually only found in regional capitals. In addition,national federal research and treatment centres that provide state-of-the-art diagnostics andtreatment, often referred to as hi-tech medical care, are predominantly located in the major
cities of Moscow or St Petersburg. 42
40F

41F

The use of telemedicine has also increased exponentially, expedited by the COVID-19
pandemic in 2020-2021. The Russian government began attempting to implement
telemedicine in response to the growth of global information technology use andconnections. 43 A component of its programme to create a Unified State Health Information
System (USHIS) is the ‘Appointment with a doctor in a digital form’ which allows, in particular,
for shortening queues in polyclinics. 44 But in practice, many institutions do not have a medical
information system (MIS). In those that do, some doctors are ambivalent about it, with somefearing that remote patient support leads to more medical errors. 45
42F

43F

44F

While current law stipulates that telemedicine can only be used for consultations on theprevention, diagnosis and monitoring of a patient's health and for assessments of the needfor a face-to-face appointment, this is being updated to cover its wider use in emergency
situations or under threat from a dangerous disease. Treatment cannot be prescribed
remotely without an initial physician’s appointment. There are no special restrictions on thetype of medicines that can be prescribed thereafter through telemedicine. Electronicprescriptions are currently only available in certain regions of Russia. As a rule, telemedicine
services are not reimbursable under state medical insurance but they can be provided on a

Russia, правительство российской федерации постановление от 28 декабря 2020 г. № 2299 «ОПрограмме государственных гарантий бесплатного оказания гражданам медицинской помощи на 2021 годи на плановый период 2022 и 2023 годов» [Government Decree #2299 of 28 December 2020, On the programof state guarantees of providing free-of-charge medical care to citizens in 2021 and in years 2022 and 2023],
2020, url; Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes toremain anonymous for security reasons40
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons41
Chubarova, T. and Grigorieva, N., How Public/Private Mix in Health Care Financing and Delivery Shape a Health
System Structure and Outcomes: a Case of Russia, 28-30 June 2017, url, pp. 8-10
42
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
43
Digital Healthcare 2021, Trends and Developments in Digital Healthcare, 30 June 2021, url
44
Rusanova, N.E., History and issues of digital healthcare in Russia, 2018, url, p. 34
45
Rusanova, N.E., History and issues of digital healthcare in Russia, The Institute of Social and Economic Problemsof Population of the Russian Academy of Sciences, 2018, url, p. 34
39

33

EUROPEAN UNION AGENCY FOR ASYLUM

free-of-charge basis if they are within the frameworks of pilot programmes which are available
in certain regions and funded from regional budgets. 46
45F

Strengths of Russia’s public healthcare system include the relative success of universal
access in urgent and emergency situations, and the availability of healthcare that is free andof good quality in many cities and regional capitals. The current population has also inherited
the Soviet health infrastructure with polyclinic and hospital premises, and medical campusesin many cities. 47
46F

Overall weaknesses in the public healthcare system encompass a lack of funding, patientorientation and user-friendliness, as well as understaffing in many places, especially in rural
areas. 48 Medical personnel regularly receive insufficient and outdated professional training,and many are poorly motivated, partially due to low wages. 49
47F

48F

Feldshers are a unique category of medical personnel employed in Russia’s public healthcare
system. The term translates as ‘physician’s assistant’. The cadre of feldshers emerged in the
18th century to serve as army medics or service providers in rural areas without physicians.
During the Soviet era and after, however, the number of feldshers declined as they have been
increasingly replaced by nurses. 50 Working primarily in rural areas, feldshers may be theprimary providers who see patients, perform physical exams, and diagnose and treat cases
while referring complicated cases to doctors. In urban areas, feldshers typically work under adoctor. Feldshers also work in ambulances, departments of sanitation and epidemiology, andlaboratories. 51
49F

50F

Referrals between primary and higher levels of care are poor. Due to limited humanresources, primary care providers are often overworked and unable to ensure a smoothtransition to the higher levels, and there is little coordination between the primary andsecondary levels. While 70 % of DPs use referral letters, it is less common for specialists tocommunicate with a referring doctor after a treatment period. 52 Furthermore, the primary careprovider can also be bypassed by paying the specialist a fee. 53
51F

52F

Another key weakness in Russia’s public health services is the introduction of paid services
within the traditionally free public setting as a result of reduced federal funding for

Tyupa, V., Shadrin, A., Digital Health Apps and Telemedicine in Russia, n.d., url
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons48
Molchanova, E.V., Comparative Assessment of Health Systems in Russia and Finland, 2020, p. 256; Tagaeva, T.
and Kazantseva, L., Public Health and Health Care in Russia, Problems in Economic Transition, 2017, url, p. 979
49
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons.
50 Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2017, url, p. 19.
51 Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, pp. 100-101.
52
Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2017, url, p. 19.
53
Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, pp. 100-101
46
47

34

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

mandatory health insurance, economic sanctions and inflation. 54 Public facilities can charge a
fee for services outside the Program of State Guarantees for Medical Care (PSG) covered by
OMS. As a result, a patient may access some procedures for free while paying for others suchas laboratory tests and diagnostics. 55 There is a procedure for patients to submit an official
complaint when public medical facilities seek to levy fees for services that are supposed to be
free of charge. 56
53F

54F

55F

A patient may also pay extra for better quality medical devices than those covered by OMS.
Fees can also be charged when the patient is not officially referred to a hospital from a healthcentre or the charge is not covered by OMS. Of concern is that patients may not beknowledgeable about what procedures they need or what is covered by OMS and may pay
unnecessary costs. Patient fees also contribute to increased inequalities as higher-income
households can pay for care that is unaffordable to lower-income households. 57
56F

2.1.2.

Private sector

The private sector is small and concentrated in urban areas, but has increased gradually,
especially for specific services including laboratories, dentistry, cosmetic/plastic surgery andobstetrics. 58 More recently, the private sector has also been making inroads into outpatientand inpatient care. 59 Demand has been driven by the lower availability of free medical carefrom the public system. Private healthcare is mainly provided in outpatient facilities, althoughprivate hospitals exist and offer a broad spectrum of procedures and surgeries. Private
facilities tend to be smaller with fewer beds and fewer visits per day, but they are usually
better equipped than state healthcare facilities and offer a more patient-centredenvironment. 60 The private sector also offers paid services such as ground ambulance(GA)/emergency medical services (EMS) in major metropolitan areas. 61
57F

58F

59F

60F

In 2010-2014, the total number of hospitals decreased whilst the number of private hospitals
increased by almost 50 % in urban areas. After 2014, growth continued to accelerate, with thenumber of private sector hospital beds reaching 17 000 in 2018. 62 NGOs play a small role in
61F

Tagaeva, T. and Kazantseva, L., Public Health and Health Care in Russia, Problems in Economic Transition, 2017,
url, p. 980
55
Tinkoff Magazine. Когда не нужно платить за лечение и куда жаловаться, если требуют денег [When you
don't have to pay for treatment and where to complain if they ask for money], 2018, url
56
Tinkoff Magazine. Когда не нужно платить за лечение и куда жаловаться, если требуют денег [When you
don't have to pay for treatment and where to complain if they ask for money], 2018, url
57
Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, pp. 26, 89, 94, 100
58
Chubarova, T. and Grigorieva, N., How Public/Private Mix in Health Care Financing and Delivery Shape a Health
System Structure and Outcomes: a Case of Russia, 28-30 June 2017, url, pp. 8, 10, 14
59
Nikulina, O. and Ratkin, A., Current state of financing health care system in Russia: regional aspect, 25 September
2020, url, p. 2
60
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
61
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
62
Nikulina, O. and Ratkin, A., Current state of financing health care system in Russia: regional aspect, 25 September
2020, url, p. 2
54

35

EUROPEAN UNION AGENCY FOR ASYLUM

health policy advocacy and service delivery, with a particular focus on infectious diseases
such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). 63
62F

Private healthcare providers are increasingly participating in obligatory medical insurance. In
2013, the percentage of private sector healthcare providers operating in the obligatory
medical insurance segment was 16 %, while in 2016 it rose to 29 %. 64 However, private
providers mainly receive out-of-pocket (OOP) payments. 65 Another type of private healthcare
insurance is the voluntary medical insurance (VMI), which is described in Section 3.3.
63F

64F

2.1.3.

Impact of COVID-19

The healthcare system has been severely impacted by the COVID-19 pandemic, with hospitalbeds in five of the most affected regions reaching almost-full capacity. 66 Healthcare workers
have been increasingly developing mental health conditions such as depression andanxiety, 67 partly due to disproportionately high COVID-19 mortality among them. 68 The healthsector experienced the highest number of job losses during 2020 despite an increase inwages, possibly due to increased mental and physical fatigue among health workers, high
COVID-19 infection rates among health workers, and/or reduced employment in public andprivate social care facilities. 69
65F

66F

67F

68F

During 2020, the Sputnik V vaccine was developed at the Gamaleya National Centre of
Epidemiology and Microbiology. 70 Mass inoculations began in December 2020, with thevaccination offered for free to all Russian citizens and legal permanent residents. 71 One
challenge to mass distribution is the cold chain required to maintain Sputnik V at -18 °C duringtransportation and storage. 72 In early 2021, two additional vaccines, EpiVacCorona and
CoviVac, were launched.
69F

70F

71F

UNRISD, Constraints on Universal Health Care in the Russian Federation: Inequality, Informality and the Failuresof the Mandatory Health Insurance Reforms, February 2015, url, p. 1164
KPMG, Private Healthcare Market in Russia: Outlook for 2017-2019, 2017, url, p. 5
65
Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2017, url, p. 9
66
Herestofa, L., The Impact of COVID-19 on Russia, 24 March 2021, url
67
Mosolova, E. et al., Stress, anxiety, depression and burnout in frontline health care workers during COVID-19
pandemic: a brief systematic review and new data from Russia, 2 January 2021, url, p. 1
68
Lifshits, M. and Neklyudova, N., COVID-19 mortality rate in Russia: forecasts and reality evaluation, 25 September
2020, url, pp. 1, 7-8
69World Bank, Russia’s Economic Recovery Gathers Pace, Says New World Bank Report, 26 May 2021, url
70
Jones, I. and Roy, P., Sputnik V COVID-19 vaccine candidate appears safe and effective, 2 February 2021, url,
p. 642
71
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
72
Davis, C.M., Readiness and resilience of the health systems of the UK and Russia during Covid-19 epidemics in2020-2021: impacts of priorities, shortages and rationing, 27 April 2021 date, url, p. 40
63

36

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

2.2.

Healthcare resources

2.2.1.

Health financing

Russia’s healthcare is financed from the public and private sectors, including the paid VMI. In
2019, public financing made up 61 % of total health expenditures, while 39 % of expenditures
came from private financing, primarily OOP payments. 73
72F

In 2020, government spending on health was 4.1 % of GDP. This percentage is expected to
decline during the next three years, as shown in Table 2. Government financing for healthcomes from budget appropriations and from the OMS. Financing through the OMS, managed
by FFOMS, is also becoming more important: between 2010 and 2018, OMS financing
increased from 24 % to 39 % of total expenditures. 74 Budget expenditures are also
increasingly shifting from the federal budget to the regional budgets, with each region or
federal subject having its own funding, including the health component. 75
73F

74F

Year

2020

2021

2022

2023

Federal budget

1 264.7

1 129.4

1 134.8

1 100.9

FFOMS

2 368.6

2 545.4

2 658.0

2 798.0

760.7

753.2

798.2

849.1

4 394.0

4 428.0

4 591.0

4 758.0

4.1 %

3.8 %

3.7 %

3.6 %

Consolidated budgets of federal subjects(oblasts, republics, districts)
Total:
GDP % share:

Table 2: Public financing for health in billions of RUB, 2020-2023 (current prices) 76
75F

Private financing for health comes from voluntary private health insurance and OOP
payments. Between 2010 and 2019, private spending increased from 1.9 % to 2.2 % of GDP. 77
This was driven by the limited availability of many medical services financed by OMS and theincreasing availability of private sector services. 78
76F

77F

OECD.Stat, Health expenditure and financing, Russia n.d., url
Aksenova, E. et al., Sustainability and Resilience in the Russian Health System, March 2021, url, p. 1475
KPMG, Private Healthcare Market in Russia: Outlook for 2017-2019, 2017, url, p. 8; Chubarova, T., Inequality ofAccess to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019, url, p. 92; Contact 1, Medical
Doctor and local consultant, email, July-September 2021. The person wishes to remain anonymous for security
reasons
76
Ulumbekova,G.E., Заключение о расходах бюджетов бюджетной системы РФ по разделу
«Здравоохранение» на 2021 год и на плановый период 2022 и 2023 годов [Conclusion on the expenditures ofthe budgets of the budgetary system of the Russian Federation in the section “Healthcare” for 2021 and for theplanning period of 2022 and 2023], ВШОУЗ [VSHOUZ], 10 October 2020, url, p. 3
77
OECD.Stat, Health expenditure and financing, Russia n.d., url
78
Molchanova, E., Comparative Assessment of Health Systems in Russia and Finland, 2020, url, p. 257
73

74

37

EUROPEAN UNION AGENCY FOR ASYLUM

2.2.2.

Healthcare infrastructure

Since the 1990s, reforms have reduced the total number of hospitals while expanding thecapacity of outpatient clinics, as shown in Table 3. Rural areas were particularly impacted bythese reductions between 2005 and 2013, as the number of health facilities in rural areas fellby 75 %. 79
78F

Year

Hospitals,
000s

Hospital beds1

Total,
000

Outpatient
clinics, 000s

Capacity of outpatient clinics,
admissions per shift

Per 10 000
population

Total, 000 Per 10 000
population

1990

12.8

2 037.6

137.4

21.5

3 221.7

217.3

2000

10.7

1 671.6

115.0

21.3

3 533.7

243.2

2010

6.3

1 339.5

93.8

15.7

3 685.1

257.9

2015

5.4

1 222.0

83.4

18.6

3 861.0

263.5

2019

5.1

1 173.6

80.0

21.2

4 072.4

277.5

Table 3: Number of hospitals and outpatient clinics and beds, 1940-2019 80
79F

Russia has a well-functioning emergency healthcare service that is staffed by doctors and GA
doctors. EMS are free and covered under the national public health system, are universallyavailable 24/7 throughout Russia, and can be contacted by dialling 03 from landline
telephones or 112 from mobile phones. 81 During the past two decades, the number of
emergency stations has been reduced by 30 %. 82
80F

81F

EMS includes general ambulance teams as well as specialised teams. A general team isusually composed of a doctor, feldsher or nurse, and a driver, although in smaller cities, towns
and most rural areas, teams are comprised of a feldsher and a nurse. 83
82F

2.2.3.

Health workforce

There were 548 800 doctors in Russia in 2018. In the same year, there were 1.2 million nurses
across the country. 84 Table 4 shows the number of health workers per specialist category.
83F

Epple, N., Russian Health Care Is Dying a Slow Death – Opinion, The Moscow Times, url
Rosstat, Российский Статистический Ежегодник 2020 [Russian Statistical Yearbook 2020], 2020, url, p. 215
81
Rodigin, A., An update on emergency care and emergency medicine in Russia, 2015, url, p. 1.; Gerden, E., EMS
Around the World: Big Changes Coming for EMS in Russia, July 2019, url, p. 1.
82 Rosstat, Российский Статистический Ежегодник 2020 [Russian Statistical Yearbook 2020], 2020, url, p. 215
83 Rodigin, A., An update on emergency care and emergency medicine in Russia, 2015, url, p. 4.; Gerden, E., EMS
Around the World: Big Changes Coming for EMS in Russia, July 2019, url, p. 1.
84 Russia, MoH, Ресурсы и деятельность медицинских организаций здравоохранения. Медицинские кадры
2018 [Resources and activity of medical healthcare organizations. Medical personnel 2018], 31 July 2019, url, p. 33
79

80

38

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Medical specialist

No. per
10 000population

Medical specialist

No. per
10 000population

Adolescent psychiatrists (15-17
years)

0.28

Neurologists

1.47

Anesthesiologists/ICU physicians

2.14

Neurosurgeons

0.20

Cardiologists

0.85

Obstetricians and gynaecologists

4.59

Clinical pharmacologists

0.05

Oncologists

0.65

Dentists

1.05

Ophthalmologists

0.90

Dermatologists/sexuallytransmitted infection specialists

0.54

Paediatric oncologists

0.11

District adolescent psychiatrists

0.17

Paediatric psychiatrists (0-14 years)

0.53

District paediatric psychiatrists

0.28

Paediatric surgeons

1.09

District paediatricians

9.20

Paediatric urologists

0.12

District physicians

3.04

Paediatricians (all)16.31

District physicians in rural clinics(ambulatories)

0.06

Palliative care specialists

0.04

District psychiatrists

0.22

Pathologists

0.21

39

EUROPEAN UNION AGENCY FOR ASYLUM

Medical specialist

No. per
10 000population

Medical specialist

No. per
10 000population

Ear, nose and throat (ENT)
specialists

0.62

Physical therapists (PT)

0.33

Endocrinologists (paediatric)

0.34

Psychiatrists (adult)

0.90

Epidemiologists

0.23

Pulmonologists

0.13

Emergency room (ER) physicians

0.29

Radiologists (X-ray and imaging
specialists)

1.15

GA physicians

0.75

Rehabilitologists (rehabilitation
specialists)

0.00

Geriatricians

0.10

Rheumatologists

0.11

Haematologists

0.10

Surgeons general

1.70

Infectious disease specialists

0.41

Transfusiologists (related to all
aspects of the transfusion of bloodand blood components)

0.15

Internal medicine physicians

5.04

Trauma surgeons/orthopaedists(orthopaedic surgeons)

0.84

Endocrinologists (adult)

0.52

Tuberculosis (TB) specialists

0.48

Neonatologists

35.04

Ultrasound diagnostics physicians

1.09

40

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Medical specialist

No. per
10 000population

Medical specialist

No. per
10 000population

Nephrologists

0.79

Urologists

0.46

Table 4: Workforce breakdown per specialist category, per 10 000 population, 2018. 85
8 4F

The health workforce is unevenly distributed across the regions, with a higher number ofresources per population in the vast and sparsely populated regions of Siberia and the Far
East, and the Northwest, as shown in Table 5.
Doctors per
10 000population

Mid-level medical
personnel per
10 000population

Hospitals

Hospital beds per
10 000population

Central

49.6

93.1

1 090

76.6

Northwestern

59.8

106.7

511

81.4

Southern

43.3

93.4

500

78.5

North Caucasus

42.9

94.3

344

71.3

Volga

46.7

106.8

1 040

78.9

Ural

46.0

112.7

434

78.0

Siberian

48.8

108.5

757

88.9

Far Eastern

53.9

109.4

454

95.7

Table 5: Healthcare resources by federal district, 2019 86
85F

Health workers are also unevenly distributed between urban and rural areas. In 2015, urban
areas had on average about 50 doctors per 10 000 population, while rural areas had only
about 12 doctors per 10 000 population. 87
86F

Private companies are employing more health workers due to the steady growth of theprivate healthcare sector. In 2005-2014, the number of private sector health workers doubled,from 4 % to 8 % of the health workforce. 88 Some doctors are migrating from the public to the
87F

Russia, MoH, Ресурсы и деятельность медицинских организаций здравоохранения. Медицинские кадры
2018 [Resources and activity of medical healthcare organizations. Medical personnel 2018], 31 July 2019, url, p. 33
86
Rosstat, Российский Статистический Ежегодник 2020 [Russian Statistical Yearbook 2020], 2020, url, p. 221
87
UNRISD, Constraints on Universal Health Care in the Russian Federation: Inequality, Informality and the Failuresof the Mandatory Health Insurance Reforms, February 2015, url, p. 20
88
Chubarova, T. and Grigorieva, N., How Public/Private Mix in Health Care Financing and Delivery Shape a Health
System Structure and Outcomes: a Case of Russia, 28-30 June 2017, url, p. 1085

41

EUROPEAN UNION AGENCY FOR ASYLUM

private sector due to lack of funding for state facilities and cumbersome reporting
requirements. 89
88F

Pharmaceutical sector

2.3.

Russia’s pharmaceutical market is growing quickly and is anticipated to soon become one of
the top 10 markets in the world. 90
89F

The majority of the pharmaceutical market (85 %) is in the private sector, while the stateprocures significantly less. 91 Only 11 % of the total pharmaceutical expenditure in 2013 wasfunded by the public sector. 92 The share of government-owned pharmacy chains in 2014 was
below 10 % of the market. 93 Furthermore, of the 2 400 enterprises manufacturing basic
pharmaceutical products and pharmaceutical preparations, 2 100 were privately owned. 94
90F

91F

92F

93F

Over 64 % of total pharmaceuticals sold in 2020 were over-the-counter products such as
cold and cough remedies and dietary supplements and vitamins. 95 Generic drugs dominate
the domestic market. 96
94F

95F

The Federal Drug Reimbursement Programme launched in 2017 provides Russian citizens
with free access to over 350 pharmaceutical products. Recent regulatory rules andlegislation have also served to tighten state control, e.g. ensuring warehouses are up to
standard, safeguarding affordability, improving medicine labelling and reducing counterfeit
drugs. 97
96F

In Russia, online pharmacies are a regular and legal way to obtain medications. 98 At the endof 2020, about 350 legal entities received permission to sell medicines online, which
represents about 110 pharmacy chains or 12 000 points of sale. 99 Prescription medications
can be ordered online, but are not allowed to be shipped to a patient’s house. They must becollected at a physical pharmacy. 100
97F

98F

99F

Molchanova, E.V., Comparative Assessment of Health Systems in Russia and Finland, January 2020, url, p. 4
Shekhar, R. et al., Regulatory Pathway for Registration of Biosimilars in Russia, 15 April 2020, url, p. 79
91
Shekhar, R. et al., Regulatory Pathway for Registration of Biosimilars in Russia, 15 April 2020, url, p. 79
92
WHO, European Health Information Gateway, Total pharmaceutical expenditure as % of total health expenditure,
6 September 2020, url
93
DSM Group, Russian Pharmaceutical Market 2014, 2014, url, p. 69
94
Federal State Statistics Service (Rosstat), Российский Статистический Ежегодник 2020 [Russian Statistical
Yearbook 2020], 2020, url, p. 327
95
Elagina, D., Pharmaceutical Industry in Russia – statistics & facts, 26 May 2021, url
96
Shekhar, R. et al., Regulatory Pathway for Registration of Biosimilars in Russia, 15 April 2017, url, p. 79
97
Shekhar, R. et al., Regulatory Pathway for Registration of Biosimilars in Russia, 15 April 2017, url, p. 80
98Адвокатская газета [Lawyer's newspaper], Аптеки теперь смогут продавать лекарства онлайн и доставлятьих на дом легально [Pharmacies will now be able to sell medicines online and deliver them to your home legally],
3 June 2020, url
99
DSM Group, Рейтинг аптечных сетей по итогам 2020 года [Rating of pharmacy chains in 2020], 5 March 2021,
url
100
Gomobile.ru, Как аптеки выходят в Digital 2021 [How pharmacies go to digital 2021], n.d., url, p.4; Garant.ru,Дистанционная продажа лекарств vs традиционные аптеки [Remote sale of drugs vs traditional pharmacies.], 21January 2022, url
89

90

42

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Drugs are placed on a priority list to determine their price, such as the Vital and Essential
Drug List (VEDL). 101 The list of drugs for the VEDL is developed and reviewed annually. The
prices are fixed, negotiated between the federal government and the drug manufacturers,
and reviewed annually. The prices for other drugs are reviewed at least once in three years.
The selling price is determined by a pharmacy network or organisation based on thecommodity invoices and price negotiation protocol from the manufacturer or wholesaleintermediary. 102
100F

101F

Patient pathways

2.4.

Patients are free to choose their own primary care provider, either a DP or GP, at an
outpatient facility. In the first instance, most will seek care from the provider they are
registered with. When a patient requires medical treatment, the provider will order treatment
or refer the patient to a specialist in an outpatient facility if necessary. If further examinationis needed, the patient will be referred for hospitalisation at a specialised inpatient facility.
After discharge, follow-up care is provided at an outpatient facility. One weakness in thissystem is that the onus is on the patient and not the doctor to complete the referrals between
facilities. 103
102F

Some facilities have introduced ‘on-duty’ DPs that patients can see instead of their regular
doctors to increase the availability of contact with a doctor. There is also a trend towardbypassing the DP/GP and directly seeking specialist care, particularly for
gynaecology/obstetrics, surgery, urology, ophthalmology, ear, nose and throat (ENT)
specialists, and dermatologists. The disadvantage of this approach is potential disruptions tocontinuity of care, as care is received from different providers. 104
103F

A second patient pathway is the emergency pathway: direct access to emergency care andurgent medical services. Patients needing emergency care or somebody on their behalf
telephones the EMS team, explains the urgent medical problem and names the patient’s
exact location. These calls are answered by medically trained dispatchers who usually only
speak Russian. Sometimes, calls are escalated to a senior duty doctor who decides on therequired response. EMS teams can give urgent care at the patient’s location or send them toan appropriate duty hospital for an immediate care review, followed by hospital admission if
necessary. 105 EMS teams will attend the site of an emergency, an outpatient clinic, or ahospital if the outpatient facility lacks the resources. 106
104F

105F

Holownia-Voloskova, M. et al., Drug Policy in the Russian Federation, 13 October 2018, url, p. 107
Holownia-Voloskova, M. et al., Drug Policy in the Russian Federation, 13 October 2018, url, p. 110
103
Aksenova, E. et al., Sustainability and Resilience in the Russian Health System, March 2021, url, pp. 6, 34
104
Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2018, url, p. 19
105
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
106
Aksenova, E. et al., Sustainability and Resilience in the Russian Health System, March 2021, url, p. 36
101

102

43

EUROPEAN UNION AGENCY FOR ASYLUM

3. Economic factors
3.1.

Health services provided by the state/publicauthorities

The Program of State Guarantees for Medical Care, PSG, ensures free medical care as
outlined in the Constitution, and guarantees uniform benefits paid through a single national
pool. 107 A Government order defines the benefits package within several parameters: 108
106F

1.
2.

3.

4.

5.

107F

List of diseases: almost all diseases in the International Classification of Diseases areincluded; treatment is free of charge.
Types of services: primary care, specialist outpatient care, day-care centre services,ambulance care, rehabilitation care, palliative care, specialist inpatient care; treatment
is free of charge.
High technology care: includes only elective care; tertiary care (highly specialised carethat involves advanced and complex treatments and procedures) can only be obtained
for specific conditions.
Waiting time limits: primary care provided by district physicians – within 24 hours;
consultations by outpatient specialists – not more than 14 days; instrumental diagnostics
and laboratory tests – 14 days; computer tomography – 30 days; ambulance care – 20
minutes after registration of a call; high technology care (tertiary care) – 30 days.
Drugs: list of outpatient drug beneficiaries and list of 788 essential drugs are specified
from 2021. 109
108F

In addition, planning and evaluation of the PSG considers utilisation targets for each type ofcare, funding per capita and unit cost target (normative) for each type of care, and criteria of
healthcare quality (there are 25 criteria for the individual types of care). 110
109F

In practice, the PSG features several limitations. It does not clearly define which services
should be used for which conditions or how, and so there is room for negotiation between
the provider and patient. 111 Furthermore, services covered by the PSG have narrowed overtime or do not meet real costs. 112 For example, in 2016, a basic blood test cost about RUB 300
110F

111F

Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 28
108
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 28
109
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 28; OMS Policy, Перечень бесплатных услуг по полису ОМС на 2022 год[List of free services under the MHI policy for 2022], 15 July 2019, url
110
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 28
111
Kaneva, M. et al., Attitudes to reform: Could a cooperative health insurance scheme work in Russia?, 22 January
2019, url, pp. 372-373
112
UNRISD, Constraints on Universal Health Care in the Russian Federation: Inequality, Informality and the Failuresof the Mandatory Health Insurance Reforms, February 2015, url, p. 27; Borgen Project, 10 Facts About Healthcare in
the Russian Federation, 18 June 2020, url
107

44

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT(EUR 3.44), but the scheduled OMS rates budgeted for only 73 to RUB 103 (EUR 0.84 to 1.18)
for a blood test depending on its complexity. The cost of a visit to a physician varied fromRUB 300 to 800 (EUR 3.44 to 9.17) across the country, while the OMS rate was RUB 108(EUR 1.24). 113 As a result, patients must pay out of pocket for the services that are not covered,including in the public sector. Finally, availability of PSG varies across regions, with richer
regions able to spend more on the PSG package available to beneficiaries. 114
112F

113F

Public health insurance, national or state coverage

3.2.

The OMS system is linked to place of residence and citizenship, including for those who are
unemployed. 115 The OMS has almost-full coverage (99.2 %). 116 It covers general medical
services, specialised medical care and drugs on the VEDL, except services for sociallysignificant diseases or high-tech procedures which are covered by the federal and regional
budgets. 117 Some regions have created special OMS funds to expand coverage for theirresidents. 118
114F

115F

116F

117F

Some categories of patients receive free or reduced cost medications, depending on theirstatus, whether they have specific diseases, and the duration of illness. To receive
medications for free, a patient must have a valid prescription. Table 6 lists privilege holders
who receive free or discounted medications, and Table 7 lists the conditions that entitle
patients to receive free or discounted medications from the state. 119
118F

Federal privileges holders entitled to receive free medications (or equivalent monetary value)

Heroes of the Soviet Union and Russian Federation, full Knights of the Order of Glory and, in case of
their death, some of their direct relatives

Heroes of Labour and full knights of the Order of Labour GloryChildren aged three years and underDisabled people (I, II and III groups)

Institute of Modern Russia, Russia’s Healthcare System: Current State of Affairs and the Need for Reforms. 2016,19 February 2015, url
114
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 20
115
Richardson, E., Health financing, 2014, url, p. 92
116
OECD.Stat, Health expenditure and financing, Russia, n.d., url
117
Aksenova, E. et al., Sustainability and Resilience in the Russian Health System, March 2021, url, p. 25
118
Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, p. 92
119
Russia, Official website of the Moscow Mayor, Как и где получить льготные лекарства [How and where to get
subsidised medicines], n.d., url, p. 1, accessed 17 September 2021
113

45

EUROPEAN UNION AGENCY FOR ASYLUMFederal privileges holders entitled to receive free medications (or equivalent monetary value)

Disabled children (can also receive special nutrition if appropriate)

Veterans and some of their family members if veterans passed away

Former underage concentration camp prisoners, ghetto inhabitants during World War II

People who sustained injuries from radiation

Regional privilege holders (lists of categories developed by region) who receive free medications(or equivalent monetary value) or 50 % reductions in the price of medicines

As decided by region
Table 6: Federal and regional privileges holders entitled to receive free or discounted medicines 120
119F

Patients with specific diseases entitled to all medications for free

HIV infection and AIDS

Oncological diseases (incurable patients are also entitled to free dressings materials)

Leprosy

Diabetes (additionally these patients can receive ethanol (for disinfection), insulin pens and needles,and diagnostic materials)

Psychiatric illnesses (for patients working in specialised industrial entities where they are engaged inlabour therapy, learning new professions following by employment in those entities)

Schizophrenia and epilepsy

Russia, Official website of the Moscow Mayor, Как и где получить льготные лекарства [How and where to get
subsidised medicines], n.d., url, p. 1, accessed 17 September 2021
120

46

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Gaucher disease

Cystic fibrosis

Mucopolysaccharidosis, types I, II and VI

Plastic anaemia unspecified

Hereditary deficiency of factor II (fibrinogen), VII (labile) and X (Stewart-Prower)

Patients with specific diseases entitled to free medication for that illness

Cerebral palsy

Radiation sickness

Systemic chronic skin disorders

AsthmaMyocardial infarction (first 6 months)

Multiple sclerosis

Myopathy

Pierre Marie cerebellar ataxia

Parkinson disease

Helminthiasis (for some groups of people)

Patients with specific diseases, or who have undergone specific procedures, and who are entitled
to free medicines for one year

Myocardial infarction

47

EUROPEAN UNION AGENCY FOR ASYLUM

Stroke (cerebral vascular accident; bleeding or infarction)

Coronary artery bypass graft (CABG) surgery

Coronary angioplasty and stenting

Cardiac ablation procedure

Patients with 17 additional diseases are entitled to free medicines to treat certain symptoms 121
120F

Hepatocerebral dystrophy; phenylketonuria; acute intermittent porphyria; hematological disorders:hemoblastosis (diseases with abnormal proliferation of the blood-forming tissues like leukaemia),cytopenia (diseases with a deficiency of cellular elements of the blood like granulocytopenia,
leukopenia, low platelets), hereditary haemopathies (blood diseases); brucellosis (severe); rheumatic
disorders: rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, Bekhterev's disease(ankylosing spondylitis); status post heart valves surgery; status post organs and tissues transplant;
pituitary nanism (dwarfism; persons of low stature; growth retardation); precocious sexual
development; myasthenia; chronic urological disorders; syphilis; glaucoma, cataract; Addison disease;diseases of intestines and urological disease leading to a stoma formation; and primary
immunodeficiency (for patients younger than 18 years old)
Table 7: Patient entitlement to free medications 122
121F

Funding for the FFOMS and the OMS system comes from the federal budget (requiring 57–
59 % of the consolidated budget’s expenditure on healthcare), 123 employer contributions(5.1 % of payroll) for those who are employed, and from regional budgets for those who are
not employed (including pensioners, children and people with disabilities). 124 The FFOMS
budget has fluctuated over time causing concern over accessibility and quality of care. To
balance the budget, the MoH increased the rate of obligatory health insurance contributionsin 2016 from 5.1 % to 5.9 % beginning in 2019, and unsuccessfully attempted to limit healthprofessional salaries. Such changes risk impacting the accessibility and quality of care. 125
122F

123F

124F

Non-residents, including those without legal documents, have, in life-threatening medical
situations the right to free of charge medical assistance, as provided by the Constitution,international treaties, laws, and decrees. 126 However, the laws are unclear about who should
125F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
122
Russia, Official website of the Moscow Mayor, Как и где получить льготные лекарства [How and where to get
subsidised medicines], n.d., url, p. 1, accessed 17 September 2021
123
KPMG, Private Healthcare Market in Russia: Outlook for 2017-2019, 2017, url, p. 5
124
Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, p. 92
125
KPMG, Private Healthcare Market in Russia: Outlook for 2017-2019, 2017, url, p. 8
126
Zvereva, E. and Chilingaryan, K., Linguistic and Cultural Mediation in Health Care Settings: An Overview of Russia
and Turkey, 2018, url, p. 268
121

48

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

finance emergency services for illegal or unreported migrants, which may result in lower
quality of care as the clinics themselves are forced to absorb the cost. 127 Stateless people
who have legal permanent residence in Russia have equal recourse to free medical care
unless otherwise stipulated by international agreements. 128
126F

127F

Children under the age of 14 years are provided with OMS when they present a birthcertificate and a document confirming a permanent residence of their parent(s) or guardian(s).
Where migrants do not participate in such agreements, they need to pay out of pocket. 129
128F

3.3.

Private health insurance schemes

The private health insurance system of VMI (voluntary medical insurance), predominantly
supplied by private insurance companies, emerged in the 1990s. 130 Its share of the market
barely grew in 2008-2020, and has remained at 14-16 % since 2008. 131 Only 10.3 % ofRussians purchased voluntary health insurance in 2018. 132 In 2019, 6.2 million VMI policies
were issued. 133 VMI schemes (ДМС in Russian) were only 5 % of the private healthexpenditures and only 0.1 % of all current expenditure on health in 2019. 134
129F

130F

131F

132F

133F

While VMI was originally intended to cover services excluded from the PSG (e.g. dental care),it has evolved to include supplementary coverage that allows access to better medical
technologies and facilities, expanded choices, shorter waiting lists, and better material
conditions. 135 Healthcare for holders of VMI policies is offered mostly at private medical
facilities or at public facilities, usually hospitals, that have brokered agreements with theissuing insurance companies. VMI gives policy holders broader medical coverage with ahigher quality of healthcare that is more patient-centred and user-friendly with stronger
doctor–patient communication, although costly tests and treatments regularly must be
approved by the insurance providers on a case-by-case basis. In some medical fields such as
dentistry, the quality of care is so superior to that provided by the state system that even
134F

Madyanova, V. et al., Right for healthcare for migrants, refugees and stateless persons in Russia, 17 April 2018, url,
p. 130128
Russia, Ministry for Health, Федеральный закон от 21.11.2011 г. № 323-ФЗ «Об основах охраны здоровья
граждан в Российской Федерации.» [Federal Law No. 323-FZ of 21 November 2011 ‘On the framework of healthprotection of citizens in the Russian Federation’], Article 19, 21 November 2011, url
129
Zvereva, E. and Chilingaryan, K., Linguistic and Cultural Mediation in Health Care Settings: An Overview of Russia
and Turkey, 2018, url, p. 268
130
Aistov, A. et al., Voluntary private health insurance, health‑related behaviours and health outcomes: evidence
from Russia, 23 December 2020, url, p. 282
131
RBK Magazine, Рынок частной медицины в России [Market of private medicine in Russia], 3 March 2020, url
132
Nikulina, O., Ratkin, A., Current state of financing health care system in Russia: regional aspect, 25 September
2020, url
133
Rossiyskaya Gazeta (Российская Газета), Россияне стали чаще самостоятельно покупать полисы ДМС[Russians are more likely to buy their own VHI policies], 9 December 2019, url
134OECD.Stat, Health expenditure and financing, Russia, n.d., url
135
Kaneva, M. et al., Attitudes to reform: Could a cooperative health insurance scheme work in Russia?, 22 January
2019, url, p. 273
127

49

EUROPEAN UNION AGENCY FOR ASYLUM

patients with fewer financial resources will opt for private dental clinics. 136 As a consequence,the dental market has racked up a 29.7 % share of the private sector healthcare market. 137
135F

136F

Because the cost of VMI is high, it is typically offered by larger employers (who receive tax
benefits) in urban areas, and only rarely purchased directly by individuals. 138 For example, in
Moscow and St Petersburg, corporate VMI contracts account for 95 % of the VMI market. 139
Individual policy holders are wealthier Russians and international assignees. The high cost
excludes marginalised groups such as the elderly, people with disabilities and poorer
households from purchasing VMI, particularly as VMI providers may charge them higher
premiums due to pre-existing conditions or higher health risk, or set strict limits on thebenefits. 140
137F

138F

139F

3.4.

Other social security

Social security in Russia includes both social assistance (non-contributory programmes) andsocial insurance (old-age and disability pensions), with both cash and in-kind benefits suchas free or subsidised goods and services (e.g. rent payment, house appliances, drugs,
transportation, etc.). 141 Most social assistance is allocated based on personal or household
characteristics, such as maternity subsidies, number of children, or disabilities. As a result, anestimated three quarters of the population receives some form of assistance. 142 Russia
recently announced a National Social Initiative which adopts a people-centred approach andcentres social services around the household or individual. This is expected to improve theclient experience, quality, and accessibility of social services. 143
140F

141F

142F

Excluding the programmes related to special merits and special conditions of work, Russia’ssocial assistance programmes aim to alleviate pressure from loss of income. Table 8
describes the different measures for key income loss categories.
Income riskSocial assistance measures

Long-term illness•••

Income support (federally mandated benefits for long term illness)
Additional income support in case of poor healthIn-kind benefits

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons137
RBK Magazine, Рынок частной медицины в России [Market of private medicine in Russia], 3 March 2020, url
138
Kaneva, M. et al. Attitudes to reform: Could a cooperative health insurance scheme work in Russia?, 22 January
2019, url, p. 273
139
Aistov, A. et al., Voluntary private health insurance, health‑related behaviours and health outcomes: evidence from
Russia, 23 December 2020, url, p. 284
140
Kaneva, M. et al., Attitudes to reform: Could a cooperative health insurance scheme work in Russia?, 22 January
2019, url, p. 372
141
World Bank, Towards more effective social assistance in Russia: An update of the system performance considering
new national target of halving poverty by 2024, 2019, url, p. 34
142
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 26
143
World Bank, Russia's Economic Recovery Gathers Pace, Says New World Bank Report, 26 May 2021, url
136

50

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Income riskSocial assistance measures•

Long-term disability•••

Short-term disability•••
Disability/victims of naturaland anthropogenic
disasters
•
•
•
•

•

Unemployment assistance (non-contributory allowance)•••

Poverty benefit
Means-tested housing allowance
Allowances for special conditions of work (high-risk occupations,deployment in harsh climate conditions
Rural public sector employees, e.g. teachers and health workers)
Other benefits for selected professional groups••••
Insufficient income in old
age

•
•
•
•
•

Loss of breadwinner

Disability (social) pension (for individuals not eligible for contributory
disability pension from the Pension Fund of the Russian Federation)
Additional paid leave compensation for care takers of a disabledchild (for those who are not eligible for this benefit under the social
insurance provisions)
Special one time or periodic benefits for victims of natural
disasters/catastrophes
Tax breaks
In-kind benefits

•
•
•
•
•

•
Maternity and childhood

Insufficient income fromwork

Income support in case of temporary disability (for individuals not
eligible for respective social insurance benefits)
Other programmes related to short-term disability

Maternity benefit for prenatal services registration (for women noteligible for this benefit under the social insurance scheme);
Birth grant (for those not eligible for this benefit under the social
insurance scheme)
Allowance for early childhood (up to 1.5 years) (for mothers not
eligible for this benefit under the social insurance scheme)
Foster family allowance
Means-tested allowance for families with children
Maternity capital
Allowance for orphans
Tax breaks, etc.

•

Loss of work

Income support in case of work accidents (for individuals not eligible
for respective social insurance benefits under the Social Insurance
Fund of the Russian Federation)
Medical care and rehabilitation services (for individuals not eligible
for respective social insurance benefits)
In-kind benefits•

Pensions top up (up to the minimum region-specific poverty line forpensioners);
Old-age (social) pension (for the elderly who do not qualify for an
old-age pension from the Pension Fund of the Russian federation)
Additional benefits for those with long work careers (veterans oflabour)Means-tested housing allowance
Special benefits for victims of political repression
Additional benefits for war veterans and victims of politicalrepression
Other forms of in-kind benefits, etc.
Survivors’ (social) pension (for survivors who do not qualify for asurvivors’ pension from the Pension Fund of the Russian Federation)

51

EUROPEAN UNION AGENCY FOR ASYLUM

Income riskSocial assistance measures••

Allowances for families of military personnel
Other allowances in case of a loss of a breadwinner

Note: The World Bank authors state that the source for this data is their analysis and Organisation for
Economic Co-operation and Development (OECD) classification; excluding contributory pension
insurance benefits administered by the Pension Fund of the Russian Federation and contributorysocial insurance benefits administered by the Social Insurance Fund of the Russian federation.
Table 8: Social assistance programmes by key income loss risks, 2019 144
143F

The programmes have a range of strategies to identify beneficiaries. For example, people
with disabilities are registered with the Ministry of Social Support. Health insurers have theirown registries. The programme for drug benefits registers invalids and people withdisabilities, veterans and people with specific illnesses. Most programmes are not means
tested, nor are there registers to identify the poor. 145
144F

Access to the different programmes is influenced by variation in regional budgets and theuneven capacity of delivery systems across the regions. Some of the poorest regions do nothave enough resources to support their poor, while other regions have over three times theneeded resources. 146
145F

3.4.1.

Occupational diseases and work injury

Occupational health and safety are enshrined in key documents of Russia. As described by
the International Labour Organisation (ILO), Article 37 of the Constitution stipulates the rights
of citizens to work in environments meeting occupational safety and health requirements, toa minimum rate of remuneration for work established by the federal government, andprotection from unemployment. The 1993 Basic Law on Labour Protection contains provisions
ensuring workers’ rights to protect their health. 147
146F

In a 2016 review of Russian social security programmes it was noted that work injuries arecovered by the social assistance programme for employed persons, including both
permanent and temporary residents (with the exception of self-employed persons). Funding
for the programme comes from employer contributions. Medical services due to occupational
injury or disease are covered by the OMS. 148 Occupational health services are provided inseveral settings: public hospitals and polyclinics, and private hospitals or polyclinics at large
enterprises. 149
147F

148F

World Bank, Towards more effective social assistance in Russia: An update of the system performance
considering new national target of halving poverty by 2024, 2019, url, p. 46
145
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 26
146
World Bank, Russia's Economic Recovery Gathers Pace, Says New World Bank Report, 26 May 2021, url
147
ILO, Labour Protection in the Russian Federation: Law and Practice, 11 February 2011, url
148
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
149
ILO, Labour Protection in the Russian Federation: Law and Practice. Protection of workers’ health, 11 February
2011, url
144

52

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Benefits for temporary disability cover 100 % of earnings during rehabilitation and areadministered by the Social Insurance Fund (http://fss.ru/). Pensions for permanent disability
depend on the degree of disability, with a requirement of a 10 % loss in working capacity, andare assessed annually. The benefit was set by the Social Insurance Fund and is administeredby the Pension Fund of the Russian Federation (http://www.pfrf.ru). Death due to workplace
injury or occupational disease results in a survivor pension and a death grant. In someregions, additional assistance programmes for occupational diseases and work injury areavailable. 150
149F

3.4.2.

Family allowance and benefits

Family allowances include maternity benefits and the maternity capital programme, as well
as family allowances. The maternity capital programme is the second-largest social
assistance programme in Russia. The maternity capital programme provides annualmaternity capital payments to mothers for the birth of their third child, as well as othersubsequent children. 151 It is financed through employer contributions and federal and local
government budgets, and administered by the Pension Fund of the Russian Federation andits regional bodies. 152
150F

151F

Maternity benefits cover 100 % of the insured person’s gross earnings in the last 24 months,
paid for 70 days before and 70 days after childbirth. In addition, the local government pays alump-sum childbirth grant. If the pregnancy is registered within the first 12 weeks, the family
receives a pregnancy registration supplement. Childcare benefits are paid until the child is 18
months old and cover 40 % of the parent’s average wage in the last 24 months. Maternity
benefits are financed by employers, with additional funds from federal and local governments,
and administered by the Social Insurance Fund and regional social insurance funds, including
for unemployed and nonworking citizens. 153
152F

Family allowances also include benefits for children up to age 18 years (23 years for full-timestudents). Child allowances are paid to families below a minimum subsistence level. Single
parents receive a double amount of allowance, and additional supplements are paid if aparent fails to pay alimony. The allowance varies across the regions. 154
153F

3.4.3.

Old age pensions and allocations for disabled persons (andsurvivors)

Pension benefits are available for older adults (age 60 years for men and 55 for women),people with disabilities, and survivors. The amount available from an old-age pension
depends on the person’s number of contributions and length of insurance record. Pension
reform started in 2019, as per Federal Law #350-FZ, which raised the pensionable age

US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, urlWorld Bank, Towards more effective social assistance in Russia: An update of the system performance considering
new national target of halving poverty by 2024, 24 June 2019, url, pp. 45-46
152
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
153
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
154
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
150
151

53

EUROPEAN UNION AGENCY FOR ASYLUM

slightly. From 2021, women have the right to claim pension benefits when they reach age
56.5 years, and men from age 61.5. 155
154F

People with disabilities can receive a monthly disability insurance pension based on loss ofworking capacity and need for attendance. In addition, people disabled during World War II,
military service, or a major industrial accident receive state disability pension. Individuals
eligible for monthly survivor pension include a dependent, nonworking family member caring
for a child younger than age 14 or disabled; children, brothers, sisters and grandchildren up to
age 18 (age 23 for students, no limit for those who have been disabled since childhood); andwidow(er)s, parents or grandparents aged 60 or older (men) or aged 55 or older (women) or
disabled. 156
155F

Additional social assistance programmes help meet the gaps in the pension insurance
coverage, including top-ups of pensions that fall short of the region-specific poverty line forpensioners, and pensions to individuals with disabilities, old age or survivorship who areotherwise not covered. 157 The Pension Fund of the Russian Federation and its regional bodies
administer benefits and collect contributions. 158
156F

157F

3.4.4.

Unemployment benefits

The 2016 review of social programmes in Russia also states that unemployment benefits areavailable to anyone who is registered with an employment office, has 26 weeks of full-time
employment in the last 12 months, and is willing and able to work. The benefits cover 75 % of
the previous average monthly wage for the first three months, 60 % for the next four months,
45 % for the next five months, and thereafter (for a further 12 months) the local minimum
subsistence level increased by a factor that varies according to region. 159
158F

3.4.5.

Minimum wage

The national minimum wage from 1 January 2021 is RUB 12 792, established by Federal Law
No. 473-FZ from 29 December 2020, a 22 % increase from 2019. 160 The Labour Codedecrees that the minimum wage is equal to the subsistence level of the working population,
159F

Russia, Administration of the Russian President, Внесены изменения в отдельные законодательные актыРоссийской Федерации по вопросам назначения и выплаты пенсий [Changes have been made to certain
legislative acts of the Russian Federation on the appointment and payment of pensions], 3 October 2018, url,
accesses 25 November 2021
156
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
157
World Bank, Towards more effective social assistance in Russia: An update of the system performance
considering new national target of halving poverty by 2024, 24 June 2019, url, p. 44
158
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
159
US ORDP, Social Security Programs Throughout the World: Europe, 2016, Russia, 2016, url
160Countryeconomy.com., National Minimum Wage: 2020, 2021, url; Russia, Федеральный закон от 29.12.2014 г.
№ 473-ФЗ. О территориях опережающего социально-экономического развития в Российской Федерации
[Federal Law No. 473-FZ of 29.12.2014 On the Territories of Advanced Socio-Economic Development in the RussianFederation], 29 December 2014, url
155

54

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

based on the subsistence minimum of the working population during the second quarter ofthe previous year (Federal Law No. 421-FZ of 28 December 2017). 161
160F

3.4.6.

Poverty alleviation measures

Approximately 13 % of Russia’s population is considered poor, ranging from less than 1 % toover 50 %, depending on the region. 162 Many are poor due to low salaries that are below thepoverty line: as many as two thirds of the poor live in households where at least one member
is working. 163
161F

162F

While the majority of the poor, 79 % in 2017, receive some form of social security,
programmes do not prioritise the poor, nor are the benefits enough to bring them out ofpoverty. 164 Most social security programmes select beneficiaries based on socio-demographic
categories, providing equal benefits regardless of actual need. 165
163F

164F

Out-of-pocket health expenditure

3.5.

The majority of private expenditures on health consist of OOP payments, or direct and nonreimbursable payments by private households to healthcare providers at the time of service.
In 2019, OOP spending amounted to 2.1 % of expenditure on health, 95 % of all private
expenses. 166 OOP expenditures have increased significantly since 2000 (see Figure 2), andare dominated by outpatient drugs. 167 In 2018, about half of OOP payments went topharmaceutical products and medical items, followed by paid medical services and a small
proportion for paid health resorts services. 168
165F

166F

167F

Russia. Федеральный закон "О внесении изменений в отдельные законодательные акты Российской
Федерации в части повышения минимального размера оплаты труда до прожиточного минимума
трудоспособного населения" от 28.12.2017 N 421-ФЗ (последняя редакция) [Federal Law "On Amendments to
Certain Legislative Acts of the Russian Federation to Raise the Minimum Wage to the Minimum Living Wage for theWorking Population" of 28 December 2017 No. 421-FZ (latest revision)], url
162World Bank, Russia's Economic Recovery Gathers Pace, Says New World Bank Report, 26 May 2021, url
163
World Bank, Towards more effective social assistance in Russia: An update of the system performance
considering new national target of halving poverty by 2024, 24 June 2019, url, p. 12
164World Bank, Human Capital Project: 2020 Country Brief, October 2020, url
165 World Bank, Russia's Economic Recovery Gathers Pace, Says New World Bank Report, 26 May 2021, url
166
OECD.Stat, Health expenditure and financing, Russia, n.d., url
167
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 12
168
Ulumbekova, G.E., Финансирование здравоохранения в России (2021-2024 гг.). Факты и предложения
[Healthcare financing in Russia (2021-2024). Facts and suggestions] April 2019, url
161

55

EUROPEAN UNION AGENCY FOR ASYLUM

Figure 2: OOP expenditure (% of current health expenditure) 2000-2018 169
168F

Per capita OOP spending, particularly on inpatient care, is higher among people with higher
incomes and those living in wealthier cities such as Moscow and St Petersburg. However,
OOP spending on outpatient drugs and services is increasing more quickly among thepoor. 170 The percent of households spending more than 10 % of their income on medical carereached 5 % in 2014. 171 One of the procedures causing catastrophic spending is surgical care,which devastated almost 20 % of households’ budgets in 2014. 172 Catastrophic expenditures
are higher among the wealthy. 173
169F

170F

171F

172F

3.5.1.

Costs of consultations

According to health information websites for expatriates in Russia, the cost of a consultation
with a GP or a specialist is generally EUR 21.27 to 91.88, a dental consultation is EUR 42.54 to
62.11, an overnight at a hospital is EUR 42.54 to 85.11, and an individual private room is up to
EUR 463.68. 174
173F

World Bank, Data: Out-of-pocket expenditure (% of current health expenditure – Russian Federation, Source:
WHO, Global Health Expenditure database, 2000-2018, url
170
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 33
171
World Bank, Human Capital Project: 2020 Country Brief, October 2020, url, p. 2
172
World Bank, Risk of catastrophic expenditure for surgical care (% of people at risk) – Russian Federation, 20032020, url
173
Somanathan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, World Bank Group, 2018, url, p. 32
174
Expat Assure, An expat guide to healthcare and health insurance in Russia., n.d., url; Expatica, Healthcare in Russia:
the Russian healthcare system explained. Private healthcare in Russia, 11 June 2021, url
169

56

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTOOP spending is used to supplement OMS or VMI coverage or by patients without insurance.
OOP spending can be both official payments in the public or private sector, or informal
payments in the public sector in order to receive a particular treatment or as a gratuity. In
2015, 3 % of patients paid more often informally than formally, and more often in the publicthan the private sector (29 % versus 22 % respectively). The decline from 7 % in 2007
suggests that informal payments are gradually decreasing. 175
174F

3.5.2.

Cost of medications

The medications in the VEDL, as well as drugs for people with seven high-cost classificationsof diseases, are free for some categories of patients but not all. Prices for medications
included in the VEDL are strictly controlled by the state at all levels from manufacturers topharmacies. 176 Drugs are fully reimbursed for specific groups, as outlined in Table 6. 177
175F

176F

Drugs for life-threatening and chronic progressive rare diseases (‘orphan drugs’) may be free
in some regions, depending on the regional budget. However, only 4 % of the population iscovered by these drug programmes. 178 The cost of the orphan drugs is high and presents anincreasing burden to regional budgets: between 2012 and 2016, the total expenses for
medicinal provision for citizens suffering from rare (orphan) diseases increased fromRUB 2.13 billion (EUR 24.4 million) to RUB 15.5 billion (EUR 177.61). This takes up a quarter ofthe regional costs on medicines (including incoming federal transfers). 179
177F

178F

The general population must pay for their own medicines. 180 This is especially the case in
outpatient care. 181 About half of OOP spending goes to pharmaceutical products and medical
items. 182 The availability of drugs also remains uneven. Procurement and distribution of
medical supplies are unreliable, resulting in drug shortages or rampant price changes. 183 The
causes of this problem include political sanctions that limit imports and the subsequent shift
from imported to domestic pharmaceuticals. 184
179F

180F

181F

182F

183F

Chubarova, T., Inequality of Access to the Health System in Russia: The Case of Out-of-Pocket Payments, 2019,url, p. 98
176
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019
№ 2406-р Об утверждении перечня жизненно необходимых и важнейших лекарственных препаратов длямедицинского применения на 2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of thelist of vital and essential drugs for medical use for 2020’], 12 October 2019, url
177
Holownia-Voloskova, M. et al. Drug Policy in the Russian Federation, 13 October 2018, url, p. 108
178
Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, 2017, url, p. 13
179
Holownia-Voloskova, M. et al. Drug Policy in the Russian Federation, 13 October 2018, url, p. 107
180
Kamenschikova, A. et al., Obligatory medical prescription of antibiotics in Russia: Navigating formal and informal
health-care infrastructures, February 26 2021, url, p. 357
181
Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, 2020, url, p. 5
182
Ulumbekova, G.E., Финансирование здравоохранения в России (2021-2024 гг.). Факты и предложения
[Healthcare financing in Russia (2021-2024). Facts and suggestions] April 2019, url
183
Shekhar, R. et al., Regulatory Pathway for Registration of Biosimilars in Russia, 15 April 2020, url, p. 80
184
Borgen Project, 10 Facts About Healthcare in the Russian Federation, 18 June 2020, url
175

57

EUROPEAN UNION AGENCY FOR ASYLUM

3.5.3.

List of useful links

Organisation

Short description

Web address

Russian MoH

Ministry overseeing public healthinitiatives and advising thegovernment on medical andhealth policy

https://minzdrav.gov.ru/en

Rosstat

Official Russian health statistics

https://rosstat.gov.ru/folder/13721

RosstatA selection of official Russian
health statistics in English

https://eng.rosstat.gov.ru/

State Register ofMedicines

Official registry of medicines in
Russiahttps://grls.rosminzdrav.ru/default.as
px

OECD

Data from OECD countries, aswell as selected non-OECD
countries including the Russia
Federation

https://stats.oecd.org/

WHO/Europe

A data warehouse facilitating
access to multiple healthdatabases with data from Europe

https://dw.euro.who.int/

WHO/Europe

An information gateway to healthdata from Europe

https://gateway.euro.who.int/en/

World Bank

Open data, including a on a
range of health indicators

https://data.worldbank.org/

Table 9: List of useful links

58

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

4. Cardiovascular diseases (CVDs)
4.1.

General information

CVDs are a group of disorders of the heart and blood vessels, including coronary heartdisease (e.g. heart attacks, cardiomyopathy, congenital heart conditions), cerebrovasculardisease (e.g. stroke) and peripheral arterial disease. 185 In the context of this report, CVDs referto hypertension, myocardial infarction, heart failure and heart rhythm disorders.
184F

4.1.1.

Epidemiological context

There is limited publicly available epidemiological data on prevalence and incidence rates of
CVD in the Russian Federation yet the Global Burden of Disease (GBD) study has shown that
Russia has one of the highest burdens of CVDs in the world. 186 According to Russia’s Federal
State Statistics Service, the estimated annual prevalence of CVDs was 36 548.9 cases with anestimated prevalence rate of 24 891.9 cases per 100 000 population in 2018. In the same
year, the estimated annual incidence was 4 783.7 cases with an incidence rate of 3 258 cases
per 100 000 population. 187
185F

186F

Ischaemic heart disease ranked as the leading cause of death in Russia with cardiomyopathy,
myocarditis and endocarditis are in fourth place. 188
187F

4.1.2.

National policies and programmes

In response to the high epidemiological rates of CVDs (especially ischaemic heart disease
and stroke), the Russian government has taken several actions since 2006 to improvehealthcare for CVD patients and those with other non-communicable diseases (NCDs). 189 A
national priority project entitled ‘Health’ was started in 2006. From 2018 to 2024, thegovernment launched its ‘Vascular Programme’ aimed at reducing mortality from CVDs. 190
188F

189F

WHO, Cardiovascular Diseases (CVDs), n.d., urlKontsevaya, A. et al., The management of acute myocardial infarction in the Russian Federation: protocol for astudy of patient pathways, 25 September 2017, url, p. 1
187
Rosstat, Здравоохранение в России. 2019: Статистический сборник [Healthcare in Russia – 2019 Statistical
Yearbook], 2019, url, p. 29
188
WHO, Global Health Observatory, Deaths, DALY, and population in Russian Federation for both sexes aged allages, n.d., url
189
Russia,MoH,Национальные
проекты
«Здравоохранение»и«Демография»[National Projects ‘Healthcare’ and ‘Demography’], 11 July 2019, url; Министерство здравоохранения РФ,Федеральный проект «Борьба с сердечно-сосудистыми заболеваниями» [Federal Project ‘Fight against
cardiovascular diseases’], 20 July 2021, url
190
Russia,MoH,Национальные
проекты
«Здравоохранение»и«Демография»[National Projects ’Healthcare’ and ’Demography’], 11 July 2019, url
185

186

59

EUROPEAN UNION AGENCY FOR ASYLUM

Around this time, several activities were conducted in the field of preventive medicine for
CVD patients, notably improving primary healthcare and state-of-the-art care aimed
predominantly at acute myocardial infarction and strokes. 191
190F

Since 2008, the government has adopted health promotion strategies on healthy lifestyles
and noncommunicable disease (NCD) prevention highlighting CVDs. 192 Mobile health centres
were used to visit remote and rural areas to offer preventive care. 193
191F

192F

4.1.3.

Content and structure of the healthcare system for CVDs

In emergency situations, such as in case of a suspected heart attack, patients call a public
GA team, and an initial assessment, including an ECG, is performed by this team. The patientis then dispatched to a hospital that is most appropriate for her/his needs. Urgent andemergent care and non-urgent care are provided free to all eligible patients. If the patient’s
symptoms are life threatening, then the patient will be transferred to the nearest public
hospital with adequate care facilities, including primary percutaneous coronary interventions(pPCIs), intensive care units (ICUs) units and so on. People residing in rural and remote areas
face a disadvantage in that view because transport to the most suitable hospital may takelonger to arrive or be unavailable due to road and weather conditions. 194
193F

4.1.4.

Private healthcare

The private healthcare sector for CVD treatment and care consists mainly of private hospitals
centred in Moscow that charge patients fees for treatments and drugs paid for throughprivate health insurance, including VMI, or by the patients themselves. Like all private
healthcare in Russia, CVD treatment in this sector is limited to Russian citizens and residents
with higher incomes, international assignees and medical tourists. 195
194F

4.1.5.

Example of treatment centres

Table 10 shows a sample of example CVD treatment centres in Russia from the public andprivate healthcare sectors, based on those identified through a search of their websites, withclaims to be leading centres corroborated against a variety of other sites:

Pogosova N. and Sokolova O., Governmental efforts for cardiovascular disease prevention efforts in the RussianFederation, 27 February 2017, url, p. S49
192
Lipman, H. M., Health and medicine in Russia, 22 June 2013, url, pp. 2163-2164
193
Pogosova N. and Sokolova O., Governmental efforts for cardiovascular disease prevention efforts in the RussianFederation, 27 February 2017, url, p. S50
194
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
195
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
191

60

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Facility type

State or city

Facility name1

Moscow

Bakoulev Centre
for cardiovascularsurgery, Moscow

X
MoH

CSIC, the largest public researchbody in Spain, gives it hospitalworld ranking 291

2

Moscow

National Medical
Research Centreof Cardiology

X
MoH

World rank 511

PublicPrivateSpecialisms/comment

Declared best multi-speciality clinic
in Moscow; and received agovernment grant for innovation
and advanced technologies

3

Moscow

Botkin Hospital

X

4

Moscow

Central Clinical
HospitalX

5

Moscow

City Clinical
Hospital №1
named after N.I.
Pirogov

X

6

Moscow

Myasnikov
Cardiology Centre

X

Treats all types of CVDs

5

Moscow

European Medical
Centre (EMC)

X

World rank 1065

6

MoscowPremier Medica
MoscowX

Private Clinic

7

Moscow

JSC Medicina
ClinicX

Private clinic

8

St
Petersburg

City Hospital
no. 40

X

–

9

Tomsk

Scientific ResearchInstitute
Cardiology

X

Provides specialised care topatients from the Urals to Sakhalin;world rank 954

61

X Treats
VIPs

Considered best in Russia

Regional vascular centreEUROPEAN UNION AGENCY FOR ASYLUM

10State or city

Facility name

Urals:
KhantyMansi

Yugra Cardiology
andCardiovascular
Surgery Centre

Facility type
PublicX

PrivateSpecialisms/comment–

Table 10: Example facilities for the treatment of CVDs

4.2.

Access to treatment

4.2.1.

Structure and organisation in the public healthcare system

Patient healthcare for CVDs in the public health system is mostly provided through public
hospitals or outpatient facilities. Primary prevention activities for patients at risk include
advising on lifestyle modification, treating high blood pressure and using medication to
improve lipid profiles. 196 Primary care activities consist of CVD-related visits to GPs, as well as
GP visits to patients’ homes. 197
195F

196F

A typical patient pathway is encompassed in the following description of how patients accesshealthcare for CVD in the public health system. The first port of call for patients withsuspected non-acute CVD is at primary care level, where usually the patient is examined by
GPs at the local polyclinic. 198 The GPs will order specific tests, such as rest ECG and lipid
profile tests, then they will usually refer the patient to a specialist cardiologist at a polyclinic or
outpatient facility. The latter decides upon further tests, such as the 24-hour ECG and bloodpressure monitoring, and tests for stress, echocardiography, ultrasound and arteryexamination. 199
197F

198F

4.2.2.

Private healthcare system

Healthcare for CVD is provided in some private hospitals, which signed an agreement (socalled state-private partnership) with regional or local health authorities to provide thisPetersen, J. et al., Primary care use and cardiovascular disease risk in Russian 40-69 year olds: a cross-sectional
study, 14 April 2020, url, p. 692
197
Kontsevaya, A. et al., The Economic Burden of Cardiovascular Diseases in the Russian Federation, SeptemberOctober 2013, url, p. 200
198
Russia, MoH, Федеральный закон от 21.11.2011 г. № 323-ФЗ «Об основах охраны здоровья граждан вРоссийской Федерации.» [Federal Law No. 323-FZ of 21 November 2011 ‘On the framework of health protection of
citizens in the Russian Federation’], 21 November 2011, url
199
Russia, MoH, Федеральный закон от 21.11.2011 г. № 323-ФЗ «Об основах охраны здоровья граждан вРоссийской Федерации.» [Federal Law No. 323-FZ of 21 November 2011 ‘On the framework of health protection of
citizens in the Russian Federation’], 21 November 2011, url
196

62RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

care. 200 In the private healthcare sector, patients go directly to a cardiologist to be assessed,
rather than first seek primary care consultations. 201
199F

200F

4.2.3.

Cardiovascular healthcare facilities in the public healthcare
system

According to Pogosova and Sokolova, following the healthcare reforms of the 2000s, various
health centres have emerged. By 2015, there were 806 health centres comprising 501 healthcentres for adults, 219 paediatric health centres, 23 mixed health centres for families, and 63
mobile health centres for use in rural areas. 202 The number of hospitals able to perform pPCI,
which is the most suitable treatment for myocardial infarction, rose from 144 in 2010 to 260 in
2015. 203 One academic study conducted in 2020 aimed at evaluating the geographic andtemporal trends in expansion of services uncovered uneven progress in the distribution of the
new facilities. For example, facilities in the Northern Caucasus achieved very limited progresscompared to Moscow and larger cities, which attained similar rates of treatment to developed
countries. 204
201F

202F

203F

4.2.4.

CVD healthcare workforce in the public and private sectors

The main burden of treatment for CVD falls on GPs in Russia. There are more than 10 000
cardiologists in Russia, with approximately 90 % being female and working in hospitals in the
public healthcare system. 205 In 2018, there were 11 321 cardiologists, or an estimated annual
rate of 0.97 cardiologists per 10 000 of the adult population for the whole of Russia, with thelowest numbers of cardiologists in Vologda region (0.49 cardiologists per 10 000 adult
population), Pskov region (0.52 per 10 000 adult population) and Nenetz Autonomous District(0.63 per 10 000 adult population). In the same year, there were 1097 paediatric cardiologists,
or an estimated annual rate of 0.36 paediatric cardiologists per 10 000 children acrossRussia. 206
204F

205F

4.2.5.

Limitations on access to treatment

The screening programme ‘Dispansertisation’ for CVD patients and high-risk patients, which
was initiated in 2013 and strengthened in 2019, theoretically provides equal access toContact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
201
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
202
Pogosova N. and Sokolova, O., Governmental efforts for cardiovascular disease prevention efforts in the RussianFederation, 27 February 2017, url, p. S50
203
Pogosova N. and Sokolova, O., Governmental efforts for cardiovascular disease prevention efforts in the RussianFederation, 27 February 2017, url, p. S52
204
Vlassov, V. et al., Quality improvement in hospitals in the Russian Federation, 2000–2016: a systematic review,
4 October 2019, url, p. 408
205
Galyavich, A., Cardiology Practice in the Russian Federation, What is the situation of Private Practice Cardiologists
in the Russian Federation?, n.d., url
206
Russia, MoH, Ресурсы и деятельность медицинских организаций здравоохранения Москва, 2019
[Resources and activity of medical healthcare organizations Moscow, 2019], 2019, url
200

63EUROPEAN UNION AGENCY FOR ASYLUM

screening for people in urban and rural areas. 207 In practice, the programme has been lessaccessible to patients in rural areas. 208
206F

207F

While Russia’s urban populations experience relatively good access to healthcare andtreatment for CVDs, especially in urgent cases, this does not always stand for patients inrural areas. In the latter areas, facilities are limited and patients are often required to travel tothe nearest town, city or even their region’s capital. Although the care itself is free under the
public health system, travel expenses are not covered by the OMS. Travel expenses arehigher in some remote areas, such as Russia’s Far East, where travel encompasses long
distances and is, therefore, unaffordable for some. 209 People in different geographic regionsof Russia also have unequal and timely access to pPCI facilities when required. 210
208F

209F

Other general barriers to access include unaffordable medicines that are paid out of pocket,
although there are exceptions for prescription medicines for some groups, like pensioners
and veterans. 211 Other barriers are underfunded polyclinics with resulting long waiting times,
under-provision of services, insufficient diagnostic capacity and inadequate infrastructure. 212
210F

211F

4.3.

Insurance and national programmes

4.3.1.

Public healthcare sector

Reports from 2011 and 2013 state that hospital inpatient care was funded by the OMS while
cardiovascular surgery and pPCIs were funded from the federal budget under the auspicesof the framework of the federal high-tech and expensive medical care programme or directly
financed by the patient. 213 Some drugs for CVDs are on Russia’s VEDL. 214
212F

213F

When treatments are not available in Russia, it is theoretically possible for Russian citizens tobe sent abroad for treatments funded by the federal budget. Cases are examined by theFederal Agency for High Technology Medical Assistance. However, this function is frequentlyДиспансеризация и общественное здоровье в России. Доклад 2: Здоровье населения и организация
профилактических медицинских осмотров [The dispanserization and public health in Russia. Report 2: The
dispanserization technique as a tool of prevention approach in public health], May-June 2011, url, pp. 4-7
208 Petersen, J. et al., Primary care use and cardiovascular disease risk in Russian 40-69 year olds: a cross-sectional
study, 14 April 2020, url, pp. 693-696
209
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
210
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Pogosova, N. and Sokolova, O., Governmental efforts for cardiovascular disease
prevention efforts in the Russian Federation, 27 February 2017, url, p. S52
211
Richardson, E., et al., Pharmaceutical care, 2014, url, p. 153
212
Sheiman, I., et al., The evolving Semashko model of primary health care: the case of the Russian Federation, 2018,
url, p. 213
213
Kontsevaya, N. et al., The Economic Burden of Cardiovascular Diseases in the Russian Federation, SeptemberOctober 2013, url, p. 200; Popovich, L. et al., Russian Federation: health system review, 8 October 2011, url, pp. 7576
214
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Petersen, J. et al., Primary care use and cardiovascular disease risk in Russian 4069 year olds: a cross-sectional study, 14 April 2020, url, p. 692
207

64

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

suspended for several months and passed to other government agencies whenreorganisations take place. The number of Russians who have been granted treatments
overseas is small, according to a source from 2011. 215
214F

4.3.2.

Private healthcare sector

Holders of private healthcare insurance, including VMI, can access medical care and disease
management support for CVD at a choice of private hospitals and clinics, many of which are
in Russia’s capital, Moscow. See Table 11, which was compiled by Contact 1 (Medical Doctor
and local consultant) and supplemented with additional information. 216
215F

Popovich, L. et al., Russian Federation: health system review, 8 October 2011, url, p. 78
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
215

216

65

EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

CVD services
coveredMandatory
public healthinsurance(OMS)

Russian citizens
and permanent
residents,
includingreturning Russian
migrants.

1. Public/Federal

Covers healthcare
benefits for all
people eligible for
OMS

Services included:

Migrants from exSoviet countries
can obtain an
OMS policy
through theiremployers if theemployer agrees.

2. Employers
finance OMS
through
contributions, 23 % of salary goes
into social tax, apercentage of
which is paid into anational Russian
healthcare fund.
Once paid, theemployee has theright to free
medical care frompublic Russian
healthcare clinics.
3. People who
cannot work anddo not contributeto OMS (e.g.
unemployed,
pensioners,
children, sickpeople) can still
access free basic
healthcare. 217

1. Outpatient/preventive care (e.g.
screening andpreventive
counselling) 218
2. Most prescribeddrugs as containedin the VED List 219
3. Inpatient andoutpatient care 220
4. Pharmaceuticalcare and diagnostic
tests
217F

218F

219F

Services excluded:
1. Consultation withspecialists(cardiologists/
cardiac surgeons)
2. Tertiary care
3. Advanced
technology care 221
220F

21 6F

4. Recipients mustalso have a legal
address within
RussiaExpatica, Healthcare in Russia: the Russian healthcare system explained, n.d., url
Pogosova, N. and Sokolova. O., Governmental efforts for cardiovascular disease prevention efforts in the RussianFederation’, 27 February 2017; url, pS48
219
Popovich, L. et al., Russian Federation: health system review, 8 October 2011, url, pp. 75-76
220
Popovich, L. et al., Russian Federation: health system review. 8 October 2011, url, pp. 75-76
221
Popovich, L. et al., Russian Federation: health system review. 8 October 2011, url, pp. 75-76
217

218

66

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Government
healthinsurance
programmes
for employeesof specialist
agencies, e.g.
law
enforcement

Employees of
selected
government
agencies andcompanies

Requirements

Private sector
healthinsurance,
including VMI

Scope ofcoverage

CVD services
coveredFor the registeredindividual andsometimes theirfamilies

No publicly
available information

For the registeredindividuals and/or
their family (if an
employerpurchases VMI for
an employee, it
usually only
covers that
individual and nottheir family)

Available services
depending on thehospital or medical
facility that theinsurance covers.
An example list for
facilities in Moscow
is as follows:
•
•
•
•
•
•
•
•
•

angioplasty;
stenting;
aortocoronary
shunting;skin closing ofan ear of the left
auricle;implantation ofpacemaker;
radio-frequency
ablation
replacement ofvessels andvalves;heart transplantation;
removal oftumours.

Table 11: Public and private healthcare insurance coverage for CVDs in Russia 222
221F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
22267EUROPEAN UNION AGENCY FOR ASYLUM

4.3.3.

International donor programmes

The search conducted for this MedCOI report found no evidence of medical care or disease
management support for CVD being provided by international donors.

4.4.

Cost of treatment

4.4.1.

Overview

There is a difference between the costs charged for treatments available for CVDs at public
and private medical facilities in Russia, with private facilities charging between 10 % and 30 %more. There is also a geographic disparity, with prices in high-income regions, such as thecities of Moscow and St Petersburg, being higher than those charged in low-income regions.
There is limited availability of treatments in rural areas, especially invasive procedures. Most
patients in these areas are referred to specialists in nearby cities or towns. It is reported thatpublic facilities must adhere to official published prices while prices charged by private
facilities are regulated by the private sector health market. Private facilities working undercontract with regional funds supplied by the OMS are paid for costs which are negotiatedbetween the fund and the facility, which mostly leads to facilities accepting the conditions set
by the fund as they receive large volumes of patients and guaranteed payments. Private
facilities that work independently of government funding charge prices determined by theprivate sector market for medical care. 223
222F

4.4.2.

Methodology of data collection on treatment prices

The prices of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. The websites used are shown in Table 12.
The most common prices were compared and the median price agreed and included in Table
13: Cost of treatment for CVDs in the public and private health systems in Russia.
Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
223

68

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTName and url of website

Subject matter for prices

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)https://www.krasotaimedicina.ru/

Aggregator of prices and availability of the medical services(surgery, diagnostics, etc.) in Moscow from a lot of private clinics

https://gemotest.ru
Costs of laboratory tests and some diagnostics
https://www.invitro.ru/

https://market.yandex.ru/

Cost of equipment: Russian Market place – overview and accessto offers from many online and offline shops (including medical
equipment, orthopaedic supplies, rehabilitation devices, etc.)

Table 12: Websites consulted for drug prices

Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Cardiologist

FOC

FOC

1 752

N/A

No reimbursement

Cardiac surgeon

FOC

FOC

3 254

N/A

No reimbursement

Laboratory test of
blood; INR e.g. incase ofacenocoumarol
anticlotting

FOC

FOC

417

417

No reimbursement

Laboratory test for
cardiac biomarker;
creatinekinase MB (CK-MB)

FOC

FOC

501

501

No reimbursement

Specialist

Laboratory tests

69

EUROPEAN UNION AGENCY FOR ASYLUM

Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

FOC

FOC

1 085

1 085

No reimbursement

Angiography (=arteriography)

FOC

FOC

35 96635 966

No reimbursement

Electro cardiogram
(ECG)

FOC

FOC

1 168

1 168

No reimbursement

Holter monitor/
ambulatory ECG
device (cardiology)

FOC

FOC

3 171

3 171

No reimbursement

Ultrasound of theheart (=
echocardiography =echocardiogram =transthoracic
echocardiogram(TTE))

FOC

FOC

2 336

2 336

No reimbursement

FOC

N/A

5 424

No reimbursement

Laboratory test for
cardiac biomarker;
troponin

Medical imaging

Treatment

Hospital stay/admission

Hospital
stay/admission fee in
cardiology
department (dailyrates)*FOC

70

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Treatment price RUB

Hospital
stay/admission fee in
cardiac surgery
department (dailyrates)*

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

FOC

FOC

N/A

4 590

Reimbursement/
specialprogramme/free/comments

No reimbursement

Intervention possibilities in case of (high risk of) myocardial infarction

Cardiac surgery;cardiaccatheterisation

FOC

FOC

N/A

6 700 –
30 041

No reimbursement

Cardiac surgery;
Coronary artery
bypass grafting(CABG), bypass

FOC

FOC

N/A

177 412

No reimbursement

Cardiac surgery;
PTCA/PCI; coronary
angioplasty including
follow up

FOC

FOC

N/A

92 294

No reimbursement

Intervention possibilities in case of severe heart rhythm disorders

Cardiology,
placement/insertionof pacemaker**

FOC

FOC

N/A

67 176

No reimbursement

Cardiology,
maintenance andfollow-up of
pacemaker***

FOC

FOC

N/A

6 008

No reimbursement71EUROPEAN UNION AGENCY FOR ASYLUM

Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Cardiology,
placement/insertionof implantablecardioverter
defibrillator (ICD)

FOC

FOC

N/A

70 931

No reimbursement

Cardiology, follow-up
of ICD by cardiologist

FOC

FOC

4 172

5 007

No reimbursement

Notes
FOC:

Free of charge to eligible patients.

* Daily rate includes bed and food only, everything else is an extra (laboratory and imaging tests,
physician consultations, medications and procedures)** Cost includes procedure only, without cost of device*** Cost for 1 visit
Table 13: Cost of treatment for CVDs in the public and private health systems in Russia

4.5.

Cost of medication

4.5.1.

Overview

The medications listed below are generally available although their availability is better inlarge cities and regional capitals. Poorer regions have equivalently worse access to
medications. Pharmacies, especially inter-hospital pharmacies, make the effort to stockpile
medications to mitigate possible shortages. 224
223F

All medications must be registered in Russia to be used at public and private facilities. Only
those produced or legally imported are prescribed. All the main medications used to treat
CVDs are registered in Russia. Most are featured on the VEDL and their prices are strictly
controlled by the state with price deviations deemed legally unacceptable. The registration
process for drugs is a complex issue because the process is different for different

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
224

72

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

medications. For most medications, registration needs to be completed within 160 working
days, and can limit the availability of medicines developed abroad. 225 Patients in the publichealth system are not entitled to broad medication coverage. 226
224F

225F

4.5.2.

Methodology of data collection on drug prices

The prices of drugs for cardiovascular disease were collected using an initial Internet search
for their availability and costs in Moscow. The websites used for the initial search are shownin Table 14:
Name and url of website

Subject matter for prices

https://aptekamos.ru/ 227

Aggregator of prices and availability of the medications in
Moscow pharmacies

226F

https://www.eapteka.ru/
Big online pharmacy with option of ordering medications thatare rarehttps://apteka.ru/

Big online pharmacy with option of ordering medications thatare rarehttps://grls.rosminzdrav.ru/grls.aspx

State Register of Medicine

Table 14: Websites consulted for drug prices

The most common prices were compared, and the median price agreed and included inTable 15. Each medication was checked on the VEDL. 228 If it was not found under a genericname from the Internet search, it was checked against the State Register of Medicines. If it
was registered, a further Internet search for its availability was performed using its brand
name. If it was not registered, a note regarding the absence of registration was added toTable 15.
227FФедеральный закон от 12.04.2010 г. № 61-ФЗ Об обращении лекарственных средств [Federal Law No. 61FZ
from 12 April 2010 ‘On the circulation of pharmaceutical products’], 2010, url
387
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 260-261
227
Note from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
228
Russia, Government of the Russian Federation, 3Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 260-261
225

73

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
Name

Brand
name

DosageForm

Numberof units incontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

Anti-hypertension

Amlodipine

Norvasc®

5 mg/10 mg

Tablet30

151

Pharmacy

Includedin VEDL

Amlodipine +valsartan +hydrochlorothiazide

Exforge
HCT®

10 mg/
160 mg/12.5 mg

Tablet28

3 096

Pharmacy

N/A

Atenolol

Atenolol®

50 mg

Tablet30

113

Pharmacy

Includedin VEDL

123

Pharmacy

Includedin VEDL

2.5 mg/
5 mg/
10 mg

Bisoprolol

Bumetanide

Can beorderedfromabroadCandesar-tan

Carvedilol

Doxazosin

Carvedilol®

1 mg

50

5 674

Pharmacy

N/A

16 mg/
32 mg

28

242

Pharmacy

N/A

30

176

Pharmacy

Includedin VEDL30

186

Pharmacy

Includedin VEDL6.25 mg/12.5 mg/
25 mg

Tablet

2 mg/
4 mg

74

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
Name

Brand
name

Enalapril

Eplerenone

Inspra®,Enspiro®

Furosemide

Furosemide®

Numberof units incontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

5 mg/
10 mg/
20 mg

28

63

Pharmacy

Includedin VEDL

25 mg/
50 mg

30

809

Pharmacy

N/A

Tablet50

102

Pharmacy

Includedin VEDL

Tablet20

95

Pharmacy

Includedin VEDL

Dosage40 mg,
solution

Form

20 mg

Hydrochlorothiazide

Hydrochlorothiazide®

25 mg/
100 mgIndapamide

1.5 mg/
2.5 mg30

223

Pharmacy

Includedin VEDL

Irbesartan

150 mg/3
00 mg

28

479

Pharmacy

N/A

Lercanidipine

10 mg/
20 mg

30

426

Pharmacy

N/A

Lisinopril

Lisinopril®

10 mg

Tablet20

83

Pharmacy

Includedin VEDL

Lisinopril +hydrochlorot
hiazide(comb.)

Lisinopril®
/ Hydrochlorothiazide®

10 mg/
12.5 mg

Tablet28

360

Pharmacy

N/A

75

EUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

Generic
Name

Brand
name

DosageForm

Numberof units incontainer

Losartan

Losartan®

25 mg

Tablet30

120

Pharmacy

Includedin VEDL

Losartan

Losartan®

50 mg

Tablet30

154

Pharmacy

Includedin VEDL30

267

Pharmacy

Includedin VEDL

25 mg/
50 mg/
100 mgMetoprolol

Nifedipine

Nifedipine®

10 mg

Tablet100

100

Pharmacy

Includedin VEDL

Nifedipine

Nifedipine®

20 mg

Tablet30

100

Pharmacy

Includedin VEDL

Olmesartan

10 mg/
20 mg/
40 mg

Tablet28

684

Pharmacy

N/A

Perindopril

8 mg

Tablet30

334

Pharmacy

Includedin VEDL

Propranolol

Propranolol®

40 mg

Tablet50

42

Pharmacy

Includedin VEDL

Spironolactone

Spironolactone®

50 mg

Tablet28

167

Pharmacy

Includedin VEDL

28

195

Pharmacy

N/A

Telmisartan

40 mg/
80 mg

76

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
Name

Brand
name

Dosage5 mg/10 m
gTorasemide

30 mg
UrapidilValsartan

Form

Ebrantil®

Diovan®

5 mg/ml,
5 ml

40 mg/
80 mg/
160 mgNumberof units incontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

20

336

Pharmacy

N/A

CapsulesIncludedin VEDL

709
Solution

Tablet30

441

Pharmacy

N/A

25 mg/
75 mg

40

611

Pharmacy

N/A

Antiplatelet aggregation

Dipyridamole

Prasugrel

Effient®

5 mg/10 m
g

28

3421

Pharmacy

N/A

Ticagrelor

Brilinta®

60 mg/
90 mg

56

4 267

Pharmacy

Includedin VEDL

Captopril

Chlortalidone

Available
only with
Atenolol®
+ Chlortalidone®

50 mg

Tablet40

25

Pharmacy

Includedin VEDL

50 mg +
12.5 mg

Tablet28

167

Pharmacy

N/A

77

EUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

Generic
Name

Brand
name

DosageForm

Numberof units incontainer

Methyldopa

Dopegit®

250 mgTablet50

300

Pharmacy

Includedin VEDL

Minoxidil

60ml 5 %

Spray

1

793

Pharmacy

N/A

Moxonidine

0.2 mgTablet28

551

Pharmacy

Includedin VEDL

Quinaprilhydrochloride

25 mg

Tablet20

79

Pharmacy

Includedin VEDL

Ramipril

5 mg

Tablet28

401

Pharmacy

N/A

Atorvastatin

20 mg

Tablet30

401

Pharmacy

Includedin VEDL

Rosuva-statin

10 mg

Tablet30

350

Pharmacy

N/A

Simvastatin

20 mg

Tablet30

83

Pharmacy

Includedin VEDL

Isosorbide
dinitrate

40 mg

Tablet50

209

Pharmacy

Includedin VEDL

Isosorbide
mononitrate

40 mg

Tablet30

184

Pharmacy

Includedin VEDL

Table 15: Cost of drugs for CVDs in the public and private health systems in Russia

78

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

NGOs

4.6.

There is little evidence on international donor or NGO support for patients with CVDs in
Russia. 229
228F

Petersen, J. et al., Primary care use and cardiovascular disease risk in Russian 40-69 year olds: a cross-sectional
study, 14 April 2020, url, p. 691
229

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EUROPEAN UNION AGENCY FOR ASYLUM

5. Endocrinology
5.1.

General information

Endocrinology is a branch of medicine that specialises in the study of the hormones. 230 The
endocrine system is a group of endocrine glands (e.g. hypothalamus, thyroid, pancreas,ovaries or testes) responsible to produce hormones important for reproduction and sexual
differentiation; development and growth; maintenance of the internal environment; andregulation of metabolism and nutrient supply. 231 In the context of this report, endocrinology
refers to the following diseases: Diabetes, Hypo/hyperthyroidism, thyroid cancer and Cushingdisease.
229F

230F

5.1.1.

Epidemiological context

According to Russia’s Federal State Statistics Service, the estimated annual prevalence ofendocrinology-related diseases was 12 168 100 cases in 2018 and the estimated annual
incidence was 2 117 000 cases in 2018. These figures are comprised of aggregated data for
the following diseases: endocrine system diseases, eating disorders and metabolic disorders(diabetes mellitus, obesity, etc.). 232 The World Bank estimated that in 2019, the population
prevalence of people in Russia with type 1 or type 2 diabetes mellitus was 6.1 % of Russia’s
total population aged 20 to 79 years old. This figure was calculated by adjusting to a standard
population age structure. Data was sourced from the International Diabetes Federation,
Diabetes Atlas. 233 According to WHO, Diabetes mellitus ranks as the 17th cause of death inRussia with an estimated annual death rate of 12.6 deaths per 100 000 population andresponsible for 672.3 disability-adjusted life years (DALYs) per population, both in 2019. 234
231F

232F

233F

5.1.2.

National policies and programmes

There is some information available about government policies and programmes aimed attreating endocrine diseases, but there is little evidence of the results of policy
implementation. 235 Between 1996 and 2012, Russia’s government ran two federal
programmes named ‘Diabetes Mellitus’ and ‘Prevention and Control of Socially Significant
234F

Society for Endocrinology, What is endocrinology?, n.d., url
Nussey, S., and Whitehead, S., Endocrinology: An Integrated Approach - Chapter 1, 2001, url,
232
Russia, Rosstat, Заболеваемость населения по основным классам болезней. Заболеваемость населенияпо основным классам болезней в 2000 - 2020 гг (зарегистрировано заболеваний у пациентов с диагнозом,установленным впервые в жизни). болезни крови, кроветворных органов и отдельные нарушения,вовлекающие иммунный механизм [Dataset: Morbidity by major classes of diseases. Population devices in themain classes of difficulties in 2000 – 2020 (registered illnesses in patients diagnosed for the first time in their lives).
Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism], 30 November
2020, url
233
World Bank, Diabetes prevalence (% of population ages 20 to 79) - Russian Federation, n.d., url
234
WHO, Global Health Observatory, Deaths, DALY, and population in Russian Federation for both sexes aged allages (2019), n.d., url
235
Author’s interpretation based on experience of the research process.
230
231

80

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Diseases’. 236 Between 2002 and 2009, diabetes was added to the government’s target list of
diseases. An organised diabetes health service was initiated by the EndocrinologicalResearch Centre of the Russian Academy of Medical Sciences. 237 The programmes helped toreorganise and restructure the diabetes services 238
235F

236F

237F

5.2.

Access to treatment

There is almost no scholarly literature on endocrinology practice in Russia. 239 Patients withendocrine diseases are mostly treated in the primary healthcare sector via their GP at
smaller polyclinics, and at secondary (specialised endocrinology care) and tertiary (hi-tech
medical care) healthcare centres. 240 They receive treatment for the most part in the primarysector from their GP at smaller polyclinics. 241 Patients can also be treated by an
endocrinologist at larger polyclinics with endocrinology units with outpatient clinics and daycare settings. Endocrinology outpatient units can be subdivided into three units: diabetic foot,diabetic retinopathy and diabetic schools. Treatment in the secondary healthcare sector isprovided at hospitals. 242
238F

239F

240F

241F

Patients receive more advanced specialised care at regional endocrinology institutes with
regional diabetes centres in regional capital cities and at federal centres in Moscow and St
Petersburg. 243 These centres contain specialist units that provide care for diabetic footdisease, and feature ophthalmology units and renal haemodialysis departments for managing
patients with end-stage diabetic nephropathy. Patients requiring hi-tech specialised care,such as surgeries and invasive procedures, are referred to federal centres according toregional quotas. These centres have expertise in using hi-tech methods to predict, diagnose
and treat vascular complications from diabetes. 244
242F

243F

Urgent care is provided at emergency departments as well as endocrinology departments
and at the ICUs at hospitals. Although access to treatment is universal, people living in large

Healthy Life Project, New Paradigm of Healthcare: Responding to Global Challenges - Type 2 Diabetes: A Key
Focus of Public Responsibility, 27 October 2020, url
237
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1129-1130
238
Healthy Life Project, New Paradigm of Healthcare: Responding to Global Challenges - Type 2 Diabetes: A Key
Focus of Public Responsibility, 27 October 2020, url
239
Author’s interpretation based the research process
240
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1129-1130
241
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1124
242
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
243
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
244
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1129-1130
236

81

EUROPEAN UNION AGENCY FOR ASYLUM

cities have better access to qualified specialists and equipment. There are insufficient
resources to treat endocrine patients in some of Russia’s regions and territories. 245
244F

5.2.1.

Resources(a) Facilities

Figure 3 shows the structure of diabetes service in Russia in 2008. 246 There is no data on thecurrent total number of medical facilities offering specialist diabetic care in Russia.
245F

Figure 3: 2008 structure of diabetes service in Russia according to the Federal Target Programme 247
246F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
246
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1130
247
Doničová et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes Specialists
in Eastern European Countries, 1 September 2021, url, p. 1130. The table is adapted from Dedov, Shestakova, andSounstov, 2008 (original source no longer available).
245

82

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTThe key national institution for endocrinology is the Endocrinology Research Centre, which isa federal state academic medical institution. 248
247F(b) Staff
In 2016, Pigarova noted an apparent shortage of medical personnel in the field of
endocrinology. 249 The Russian health authorities advocate for one
endocrinologist/diabetologist per 50 000 population, while the number of specialists whotreat people with diabetes has been estimated as 5 000. In 2011, Doničová et al. explained
this shortage by pointing to the need for clinicians to self-fund specialist training at qualified
centres and to the fact that their incomes did not cover this cost. 250
248F

249F

(c) Limitations on access to healthcare for endocrine conditions
Treatment for endocrine disorders conditions face limited access in Russia. Table 16 shows
the specific conditions where patients face restricted access and some details of the natureof the restrictions.
Name of disease

Limitation: treatment and/or medications

Leukodystrophy Е75.2

Treatment is limited

Cystic fibrosis (mucoviscidosis) E84

Treatment and medications have limited access, but areavailable for free via the state fund Circle of Good

Tumour necrosis factor receptor-associated As above
periodic syndrome (TRAPS), E85.0
Familial Mediterranean fever (FMF), E85.0

As above

Lysosomal acid lipase deficiency, E75.5

As above

Mucopolysaccharidosis IVA, E76.2

As above

Disorders of phosphorus metabolism(hypophosphatasia), E83.3

As above

Neuronal ceroid lipofuscinosis type 2, E75.4 As above
Glycogen storage disease type II (Pompedisease) E74.0

As above

Acromegaly and pituitary gigantism E22

Treatment has limited access and medications are notincluded in OMS (state insurance programme) either
federal or regional

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Author’s interpretation based on experience of the research process; Russia, ФГБУ«НМИЦ эндокринологии» Минздрава России [National Medical Research Centre of Endocrinology of the Ministryof Health], Структура центра [Structure of the Centre], n.d., url
249
Pigarova, E.K., Organisation, problems and development prospects of endocrinology care and specialist training,
22 September 2016, url, p. 4
250
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1134
248

83

EUROPEAN UNION AGENCY FOR ASYLUMName of disease

Limitation: treatment and/or medications

Acromegaly, E22.0;

As above

Urea cycle disorders, E72.2

As above

Biotinidase deficiency, E53.8

As above

Rickets-like diseases

As above

Familial hypercholesterolemia (homozygous As aboveform) Е78.0
Transthyretin amyloid cardiomyopathy
E85.4 + I43.1*+E85.8

As above

Transthyretin familial amyloid
polyneuropathy E85.1

As above

Table 16: Endocrine conditions for which treatment is limited in Russia 251
250F(d) Geographic and economic limitations on access to endocrinology
healthcare
Access to treatment is limited in rural and/or scarcely populated remote areas, although it
was reported in the 2011 study of diabetic care in Russia that mobile healthcare units offering
basic diabetic care did visit remote rural areas in some parts of the country. 252 Patients inrural areas may need to travel to regional capitals or large cities, such as Moscow and St
Petersburg, to get the care they need. With some exceptions for certain categories of the
population, travel-related expenses are not covered under OMS, which puts additionalburden on patients with low incomes. People with mobility impairments are also at a
disadvantage as most services are delivered at stationary medical facilities and they may
have challenges using transport, especially those living in rural areas. Poorer regions havefewer healthcare resources and offer a lower standard of healthcare. 253
251F

252F

All-Russian Union of Patients, Опрос: доступность государственных гарантий в сфере оказания медицинской
помощи и лекарственного обеспечения 2019 год [Survey: availability of state guarantees in the field of medicalcare and drug provision 2019], 23 December 2019, url, pp. 19-30; Circle of Kindness Foundation, Перечень тяжелых
жизнеугрожающих и хронических заболеваний, в том числе редких (орфанных) заболеваний [List of severe
life-threatening and chronic diseases, including rare (orphan) diseases], 29 July 2021, url; Kaishauri N., В России этоне лечат [This is not treated in Russia], Miloserdie, 22 January 2018, url
252
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1135
253
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
251

84

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

5.3.

Insurance and national programmes

Healthcare for endocrine diseases is available and covered by the OMS policy or Russian
citizens and legal residents upon registration at a polyclinic. 254 In practice, patients are
reimbursed from budgets in Moscow and St Petersburg, but elsewhere in Russia, regional
funding is required. 255 Non-urgent care is provided under the OMS to eligible patients whileurgent and emergent care is provided to anyone who seeks it while in Russia, including
foreigners and stateless people. 256 The OMS generally covers medication in inpatientsettings, such as public hospitals. There is no universal medication coverage per se, but
certain categories of patients are entitled to subsidised or reduced prices, and some are also
entitled to free medications. 257
253F

254F

255F

256F

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the conditions that entitle patients to receive free or discounted
medications from the state.
Oncology patients, including those with thyroid cancer and those with incurable cancers, areentitled to free dressings. 258 Diabetes patients receive glucose-lowering medications free ofcharge, which requires significant government resources. 259 Ethanol (for disinfection), insulin
pens and needles, and diagnostic materials are all provided for free. Patients at increased riskof acute metabolic complications, such as children, teenagers and pregnant women, getauthorised to receive genetically engineered human insulin or insulin analogues. Test strips
are only reimbursed in Moscow and St Petersburg. Patients have to self-fund several newer
treatment methods, DPP-4 inhibitors and GLP-1 agonists. 260
257F

258F

259F

5.3.1.

Private healthcare insurance

Different forms of private medical insurance, including VMI, are available to those able toafford them, and enable those patients to receive healthcare at private healthcare facilities
or paid-for-service departments of public health facilities. Stateless people are obliged to pay
for private healthcare as they are not covered by the OMS policy. However, chronic illnesses,

Tchokhonelidze, I. and Zemchenkov, E., Current status, challenges, and the role of ISN in advancement ofnephrology in the Newly Independent States and Russia region, 26 February 2019, url, p. 50; Contact 1, Medical
Doctor and local consultant, email, July-September 2021. The person wishes to remain anonymous for security
reasons
255
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1132
256
Russia, MoH, Приказ Минздрава России от 12 ноября 2012 г. N 899н “Порядок оказания медицинской
помощи взрослому населению по профилю ‘эндокринология’” [Order No. 899н of 12 November 2012 ‘The
procedure for providing medical care to the adult population in the specialty area of endocrinology’], 17 June 2013,
url
257
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
258
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons259
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
260
Doničová, V. et al., Health Care Provision for People with Diabetes and Postgraduate Training of Diabetes
Specialists in Eastern European Countries, 1 September 2021, url, pp. 1132
254

85

EUROPEAN UNION AGENCY FOR ASYLUM

including chronic endocrine conditions, are often considered as pre-existent conditions andare not covered under many VMI policies. 261
260F

Table 17 shows the services that endocrine patients get free from the state and thoseavailable through the private healthcare sector.
Programme

Focus

Mandatory
public healthinsurance(OMS)

Requirements

Scope ofcoverage

Endocrinology services
coveredRussian
1. Public/Federal
citizens and
2. Employers financepermanent
OMS throughresidents,
contributions, 2including
3 % of salary goesreturning
into social tax, aRussianpercentage of
migrants.
which is paid into a
Migrants fromnational Russian
ex-Soviet
healthcare fund.
countries canOnce paid, theobtain an OMS
employee has thepolicy throughright to freetheir
medical care from
employers if
public Russian
the employer
healthcare clinics.
agrees.
3. People who
cannot work anddo not contributeto OMS (e.g.
unemployed,
pensioners,
children, sickpeople) can still
access free basic
healthcare. 262

Covershealthcare
benefits for all
people eligible
for OMS

Services included:• Non-urgent
healthcare for
endocrine disorders• Urgent healthcare for
endocrine disorders• Inpatient medications• Glucose-lowering
medications• Medical devices for
self-administration ofdiabetes medications• Test strips• Oncology medications
for thyroid cancer anddressings
Services excluded:• Outpatient
medications (withsome exceptions)

Employees of
selected
government
agencies andcompanies

For theregisteredindividual andsometimes
their families

Information not publicly
available

26 1F

Government
healthinsurance
programmes for
employees of
specialist
agencies, e.g.
law
enforcement
Private sector
healthinsurance,
including VMI

For theregisteredindividual
and/or their

Available services
depending on the hospitalor medical facility that theContact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
262
Expatica, Healthcare in Russia: the Russian healthcare system explained, n.d., url
261

86RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Requirements

Scope ofcoverage

Endocrinology services
coveredfamily (if an
employerpurchases VMI
for anemployee, it
usually only
covers that
individual andnot their family)

insurance covers. An
example list from the paid
services list of the Botkin
Hospital, Moscow is asfollows:••

Scheduled andoutpatient medical
care
Diagnostics of
endocrine systemdiseases and theircomplications

Tests:• All laboratory andinstrumental methodsof diagnosis areavailable:• All types of hormonaland biochemical
blood and urine tests• Ultrasound• Puncture biopsy of
thyroid nodes• Osteodensitometry of
the lumbar spine• Proximal femur• Radius
Treatment:
Insulin pumps are installedin patients with type 1 and2 diabetes who are on
insulin therapy
Table 17: Public and private healthcare coverage for endocrinology patients in Russia 263
262F

5.3.2.

International donor programmes

There is no evidence of endocrine healthcare being provided by international donor
programmes or foundations.

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons263

87EUROPEAN UNION AGENCY FOR ASYLUM

5.4.

Cost of treatment

Endocrinology healthcare is provided free of charge under the OMS to all eligible patients in
Russia. Treatment prices are 30 % to 50 % higher in the private sector. Costs are also higher
in wealthier regions. These statements are based on treatment prices in public facilities for
non-eligible patients. Public facilities must adhere to official published prices (‘tariffs’)
determined by the regional OMS funds in settlements with Territorial Fund of Obligatory
Medical Insurance (TFOMS, ТФОМС) and other public facilities. When public healthcare
facilities provide services to patients who are not eligible to receive OMS coverage, prices are
regulated by the private healthcare market, as are treatment prices ordinarily at private sector
healthcare facilities. 264
263F

5.4.1.

Methodology of data collection on treatment prices

The prices of treatments, diagnostics and equipment were collected using an initial internet
search for their availability and costs in Moscow. Websites used are shown in Table 18:
Websites consulted for treatment prices.

Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)https://www.krasotaimedicina.r Aggregator of prices and availability of the medical services (surgery,u/diagnostics, etc.) in Moscow from a lot of private clinics

https://gemotest.ru

Costs of laboratory tests and some diagnostics

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
264

88

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTName and url of website

Subject matter for prices

https://www.invitro.ru/

https://market.yandex.ru/

Cost of equipment: overview and access to offers from many online
and offline shops (including medical equipment, orthopaedic supplies,
rehabilitation devices, etc.)

Table 18: Websites consulted for treatment prices

The most common prices were compared, and the median price agreed and included inTable 19: Cost of treatments for endocrine conditions in the public and private health systems
in Russia.
Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Consultation by aninternal specialist(internist)

FOC

FOC

1 669

1 669

No reimbursement

Consultation by an
endocrinologist

FOC

FOC

2 503

2 503

No reimbursement

Consultation by anophthalmologist

FOC

FOC

2 921

2 921

No reimbursement

Consultation by aneurologist

FOC

FOC

2 086

2 086

No reimbursement

Consultation by ageneral practitioner

FOC

FOC

4 590

4 590

No reimbursement

Specialist

89EUROPEAN UNION AGENCY FOR ASYLUM

Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

FOC

FOC

3 338

3 338

No reimbursement

Blood glucose(including blood
glucose:HbA1C/glyc.Hb)

FOC

FOC

1 253

1 253

No reimbursement

Laboratory test of
thyroid function (TSH,
T4, T3)

FOC

FOC

1 752

1 752

No reimbursement

FOC

N/A

1 001

N/A

No reimbursement

FOC

N/A

834/50stripsN/A

No reimbursement

N/A

FOC **

N/A

4 590

No reimbursement

Consultation by
vascular surgeon(e.g. for diabetic foot)Laboratory tests

Devices

Blood glucose meterfor self-use by patient

Blood glucose selftest strips for use by
patient

Treatment

Hospital
stay/admission fee ininternal or
endocrinology
department (dailyrates) *90

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Treatment price RUB

Laser treatment ofdiabetic retinopathy

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

N/A

FOC **

N/A

29 207

Reimbursement/
specialprogramme/free/comments

No reimbursement

Notes
FOC: Free of charge to eligible patients* Daily rate includes bed and food only, everything else is an extra (laboratory and imaging tests,
physician consultations, medications and procedures)** In some cases, there are quotes for hospitalisation under OMS policy and, if the condition is notcritical, the patient might be in the queue for hospitalisation from 1-2 months up to 1 year
Table 19: Cost of treatments for endocrine conditions in the public and private health systems in Russia

5.5.

Cost of medication

Medicines for endocrine conditions are, in theory, accessible across the Russian federation,
but availability is better in urban and particularly metropolitan regions. Low-income regions
have poorer access to medicines, especially imported and expensive ones. Pharmacies,
particularly inter-hospital pharmacies, stockpile medicines to mitigate specific shortages. 265
264F

The major endocrinology medicines are registered in Russia and only registered drugs can belegally produced or imported into the country. Those which are not controlled or restricted
may be brought into Russia. 266 Some medicines for endocrine diseases are included on thenational VEDL. 267 Prices for medications on the VEDL are regulated and strictly controlled by
265F

266F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
266
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
267
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов на 2020 год, а также перечней
лекарственных препаратов для медицинского применения и минимального ассортимента лекарственных
препаратов, необходимых для оказания медицинской помощи [Decree No. 2406-p of 12 October 2019 ‘Onapproval of the list of vital and essential medicines for 2020, as well as the lists of medicines for medical use andthe minimum range of medicines necessary for the provision of medical care’], 12 October 2019, url, pp. 260-261
26591

EUROPEAN UNION AGENCY FOR ASYLUM

the state at every step of the supply chain, from production to patient, and cannot exceed theformal prices it sets. 268 Most endocrine medicines are only available on prescription. 269
267F

268F

The drugs registration process is lengthy, expensive and cumbersome and it may limit theavailability of newer medications developed in other countries. 270
269F

5.5.1.

Methodology of data collection on drug prices

The prices of drugs for endocrine disorders were collected using an initial internet search fortheir availability and costs in Moscow. The websites used for the initial search are shown in
Table 20.

Name and url of website

Subject matter for prices

https://aptekamos.ru/ 271

Aggregator of prices and availability of the medications in

270F

Moscow pharmacies

https://www.eapteka.ru/

Big online pharmacy with option of ordering medications that arerare

https://apteka.ru/

Big online pharmacy with option of ordering medications that arerare

https://grls.rosminzdrav.ru/grls.aspx State Register of Medicine
Table 20: Websites consulted for drug prices

The most common prices were compared, and the median price agreed and included inTable 21. Each medication was checked on the VEDL. If medication was not found under ageneric name from the internet search, it was checked against the State Register ofMedicines. If it was registered, a further internet search was performed using its brand name.

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
269
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
270
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons271
Note from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
268

92

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Brand
name

DosageForm

Numberof units inthe container

CanagliflozinИнвокана®/Invokana®

100 mg,
300 mgTablets30

2 503

Pharmacy

N/A

DapagliflozinФорсига®/Forsiga®

5 mg,
10 mg

Tablets30

2 336

Pharmacy

N/A

EmpagliflozinДжардинс®
/Djardins®

10 mg,
25 mg

Tablets30

2 920

Pharmacy

N/A

GlibenclamideМанинил®/Manynil®

5 mg

Tablets120

83

Pharmacy

N/A

Gliclazide

30 and60 mg

Tablets30

167

Pharmacy

Included in
VEDL

Glimepiride

1, 2, 3,
4 mg

Tablets30

295

Pharmacy

Generic
Name

Diabetes

Glucagon

GlucaGen®
Hypokit

1 mg

Powder

1

659

Pharmacy

Included in
VEDL

Insulin,premixed:
aspart(rapidacting) andaspartprotamine(intermediat
e acting)
like®Novomix

NovoRapid®
Penfill
NovoMix®
Penfill

100 IU/m
l 3 mlSol orsuspensi
on

1

1 502

Pharmacy

Included in
VEDL

93

EUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ freePharmacy

Included in
VEDL

Generic
Name

Brand
name

DosageForm

Numberof units inthe container

Insulin,premixed:
combinatio
n of lispro(rapidacting) andinsulinlisproprotamine(intermediat
e acting)

Humalog®
Humalog®
Mix 25
Humalog®
Mix 50100 IU/m
l 3 mlcartridge

Susp

5

1 418

Insulin,premixed:
combinatio
n of regular(shortacting) andinsulinisophane(intermediat
e acting)
like Mixtard

Mixtard®
30 Flexpen

100 IU/m
l 3 mlSusp

5-Insulin,premixed:
NPH 70/30
combinatio
n of rapid
andintermediat
e acting
insulin

Humulin M3

100 IU/m
l 3 ml

Susp

5

834

Pharmacy

Included in
VEDL

Insulin,subcutaneo
us infusion,by selfcarried
pump

Apidra®

100 IU/m
l 3 ml

Sol

5

2 003

Pharmacy

Included in
VEDL

94

Included in
VEDLRUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Generic
Name

Brand
name

DosageForm

Numberof units inthe container

Insulin:combinatio
n of insulin
degludec(extra-longacting) andinsulinaspart(rapidacting)Ryzodeg®
FlexTouch100
IU/ml 3
ml

Sol

5

3 338

Pharmacy

Included in
VEDL

Insulin:intermediat
e acting [1224 hr];insulin
NPH/isopha
ne like®Insulatard

Protaphane®
PenFill
Humulin®
NPH
Insuman®
Basal GT

100 IU/m
l 3 ml

Sol

5

751

Pharmacy

Included in
VEDL

Insulin:long-acting[24 hr];insulindetemir

Levemir®
FlexPen100
IU/ml 3
ml

Sol

5

1 669

Pharmacy

Included in
VEDL

Insulin:long-acting[24 hr];insulinglarginelike ®Lantus

Lantus®
Toujeo100 IU/m
l 3 ml

Sol

5

3 338

Pharmacy

Included in
VEDL

Insulin:rapid acting[2-5 hr];insulinaspart like
®Novorapid

NovoRapid®
Penfill

100 IU/m
l 3 ml

Sol

5

1 418

Pharmacy

Included in
VEDL

95

EUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Generic
Name

Brand
name

DosageForm

Numberof units inthe container

Insulin:rapid acting[2-5 hr];insulinglulisine

Apidra®

100 IU/m
l 3 ml

Sol

5

2 003

Pharmacy

Included in
VEDL

Insulin:rapid acting[2-5 hr];insulinlisproHumalog®

100 IU/m
l 3 ml

Sol

5

1 585

Pharmacy

Included in
VEDL

Insulin:short acting[7-8 hr];bovine,porcine or
human
regularinsulin like
Actrapid

Actrapid®

100 IU/m
l 3 ml100 IU/m
l
10 ml

Sol

5 or 1

501

Pharmacy

Included in
VEDL

Insulin: ultra
long-acting[42hr];
insulindegludec

Tresiba®
FlexTouch

100 IU/m
l 3 ml

Sol

5

3 504

Pharmacy

Included in
VEDL

LinagliptinТражента®/Traz-henta®

5 mg

Tablets30

1 502

Pharmacy

N/A

500,
850,
1 000
mg

Tablets60

167

Pharmacy

included in
VEDL

15,
30 mg

Tablets30

Pharmacy

N/A

Metformin

PioglitazoneАстрозон®
/Astrozon®

96

Very
limitedRUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
Name

Brand
name

DosageNumberof units inthe containerFormПиоглар/Pioglar®

Saxagliptinhydrochloride

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ freeavailability orderonlyОнглиза®/5 mg

Tablets30

1 836

Pharmacy

N/A

100 mgTablets28

1 669

Pharmacy

N/A

50 mg

Tablets28

751

Pharmacy

N/A

Tablets100

167

Pharmacy

included in
VEDL

0.1 mgTablets20

125Pharmacy

included in
VEDLCortisone

25 mg

Tablets80

1 168

Pharmacy

N/A

Dexamethasone

0.5 mg,
4 mg/ml

Tablets,inj

56 tabs,
25 amp

167

Pharmacy

included in
VEDL

Ongliza®

Янувия®/Sitagliptin
Yanuviya®

Vilda-gliptinГалвус®/Galvus®

Hypo/hyperthyroidism

50, 75,100, 125,
150
mcg

Levothyroxine (=L-thyroxine)

Corticosteroids

Fludrocortisone
acetateКортинефф®/Kortineff®

97EUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

DosageForm

Numberof units inthe container

Hydrocortisone

25 mg/
ml 1 ml

Susp,
oint

1 amp ortube

334

Pharmacy

Included in
VEDL

Prednisolone

30 mg/
ml 2 ml,
5 mg
pills

Sol,
tablets

1 amp

417

Pharmacy

Included in
VEDL

Desmopressin

Antiqua®
Rapid/
Minirin®/Nativa®

60 or
120
mcg

Tablets30

2 253

Pharmacy

Included in
VEDL

Testosterone
undecanoate

Omnadren®
Sustanon®

250 mg/ml 1 ml

Sol

1

834

Pharmacy

Included in
VEDL

Generic
Name

Brand
name

Specific hormones

Table 21: Cost of drugs for endocrinological conditions in the public and private health systems in Russia

98

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

6. Infectious diseases
General information

6.1.

Infectious diseases are caused by infectious organisms such as bacteria, viruses, fungi, or
worms. 272 HIV is a virus whose infection attacks the body’s immune system weakening it
against other pathogens. 273 Hepatitis is an inflammation of the liver caused by a viral infection
which can be caused by different types of hepatitis viruses, for example hepatitis A, hepatitis
B or hepatitis C. 274 In the context of this report special attention will be given to HIV/AIDS and
Hepatitis B and C.
271F

272F

273F

6.1.1.

Epidemiological context

According to Russia’s Federal State Statistics Service, the estimated annual prevalence of
HIV was 747 400 cases with an estimated annual prevalence rate of 509.2 patients per
100 000 population in 2019. 275
274F

The Moscow Times reported that more than 1.2 million people were living with HIV in Russia
in 2019. 276 There was also a record estimated annual total of 37 000 deaths from thedisease in that year. 277
275F

276F

WHO reported in 2019 that HIV/AIDS was the 14th leading cause of death in Russia, whichmeans that it ranks lower than at the global level where HIV/AIDS was recorded as the 11th
leading cause of death (calculated for the Global Burden of Disease Study of 2019). 278
Russia’s death rate in 2019 from HIV/AIDS was 14.6 deaths per 100 000 population, and thedisease was responsible for 763.8 DALYs lost. 279
277F

278F

The estimated annual incidence of acute hepatitis B was 800 cases in 2019, with anestimated incidence rate of 0.6 cases per 100 000 population. The incidence of acutehepatitis C was 1 500 cases with an estimated annual incidence rate of 1 case per 100 000
population in the same year. 280
279F

WHO, Infectious diseases, n.d., urlWHO, Regional Office for Europe, HIV/AIDS, n.d., url
274
CDC, The ABCs of Hepatitis – for Health Professionals, 2020, url, p. 2
275
Russia, MoH, Заболеваемость- СОЦИАЛЬНО ЗНАЧИМЫЕ ЗАБОЛЕВАНИЯ НАСЕЛЕНИЯ РОССИИ В 2017ГОДУ [Statistics of Prevalence, Socially significant diseases of the Russian Population in 2017], 5 July 2018, url, pp.
9-10
276
ILO, Getting to Zero, url
277
Moscow Times, Russia's HIV Epidemic is Growing, Affecting Older Citizens – Watchdog, 4 July 2019, url
278
GBD 2019 Diseases and Injuries Collaborators, Global burden of 369 diseases and injuries in 204 countries andterritories, 1990–2019, 17-23 October 2020, url, p. 1210
279
WHO, Global Health Observatory, Deaths, DALY, and population in Russian Federation for both sexes aged allages (2019), n.d., url
280
Russia, Federal State Statistics Service, Заболеваемость - Заболеваемость населения социально-значимыми
болезнями-2019 [Statistics of Incidence, Socially significant diseases- 2019], 30 November 2021, url
272
273

99

EUROPEAN UNION AGENCY FOR ASYLUM

6.1.2.

National policies and programmes

Russia first introduced legislation on HIV response between 1980 and 1990 at the start of thecountry’s HIV epidemic. In 2016, the Federal Government approved a State Strategy to
Combat the Spread of HIV in Russia until 2020 and beyond. It acknowledges that current
legal regulation for HIV prevention does not meet current needs but fails to specify what
legislation should be changed or amended. The strategy is funded by the federal andregional healthcare budgets and other sources, and states that Russia’s federal subjects
should provide additional funding for HIV testing antiretroviral therapy (ART) to increase theircoverage. The strategy identifies that improvements are needed in the management, logistics
and staffing of specialists at medical organisations that deliver services to people living withHIV to facilitate access to healthcare of a good standard, but does not specify who these
healthcare providers are. 281
280F

The strategy was criticised by several sources, including the Kommersant and The Moscow
Times, for not fully complying with the WHO guidelines that recommend condom use andlubricant as a prevention measure, and for taking a largely moralistic approach to disease
prevention. 282 Another criticism made by Avert, an online news service covering HIV globally,
noted that although the strategy refers to the necessity of rehabilitation and social support for
key affected populations, it neglects to outline any future national programmes to support theimplementation of this. 283 Its moralistic conceptual framing around conservative and family
values also disallows sex education in schools, key messaging around safe sex throughcondom usage, protection programmes and the inauguration of substitution therapy for
PWID. 284
281F

282F

283F

A federal targeted programme for socially significant diseases for 2007–2012 included
funding specifically for HCV activities. However, the programme combined the indicators forhepatitis B and C, which creates a challenge to monitoring and programme evaluation, as
each type of viral hepatitis impacts different populations and requires different efforts (e.g.
there is a vaccine for HBV, but not HCV). 285
284F

Table 22 shows a sample of treatment centres in Russia with specialised programmes or
facilities for patients with infectious diseases from the public and private healthcare sectors,
based on those identified through a search of their websites, with claims to be leading
centres corroborated against a variety of other sites. 286
285F

Government of the Russian Federation, State Strategy to Combat the Spread of HIV in Russia through 2020 andbeyond, 20 October 2016, url, p. 3
282
Kommersant, Без презервативов и лубрикантов - Минздрав подготовил проект стратегии по борьбе с ВИЧ
до 2030 года [Without condoms or lubricants: the Ministry of Health prepares a draft strategy to combat HIV until2030], 11 June 2020, url; Moscow Times, Russia’s HIV Prevention Strategy Ignores Global Guidelines – Kommersant,12 June 2020, url
283
Avert, HIV and AIDS in Russia, n.d., url
284
Moscow Times, HIV Cases in Russia Surpass 1 Million – State Watchdog, 2 December 2019, url
285
Ocheret, D. et al., Current situation regarding access to hepatitis C treatment in Eastern Europe and Central Asia,
Eurasian Harm Reduction Network, 2013, url, p. 22
286
Author interpretation based on her experience of the research process.
281

100

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTState or city

Facility name1

St
Petersburg

Clinical infectious diseases
hospital. S.P. Botkin

2

MoscowSpecialised ScientificHepatology Centre

3

Astrakhan

Alexandro-MariinskayaState Budgetary Clinical
Hospital of the Astrakhan
RegionFacility typeSpecialisms

PublicPrivateInfectious diseases

X

Paidservices
available

Hospital capacity is 1 147
beds or over 48 000
patients per year. The
outpatient department
does around 80 000
consultations a year. Each
year, 4 000 patients with
HIV infection are
hospitalised; this includes
deliveries of children fromHIV-positive women.
Departments include
intensive care, infectious
surgical and obstetricaldepartments, endoscopy,
outpatients. Free treatment
for Russian citizens
referred by a doctor, alsooffers paid services.

X

Founded in 2000,
specialised scientific centre
in Moscow for the study ofliver diseases, anddiagnosis and treatment ofviral hepatitis.

Paid
services
available

Has a newly equipped
infectious diseases hospitalthat opened in 2020.
Provides free medical careto the Russian citizens on
the territory of theAstrakhan region, alsooffers paid services.

X

Table 22: Example facilities for the treatment of infectious diseases

101EUROPEAN UNION AGENCY FOR ASYLUM

6.2.

Access to treatment

6.2.1.

Overview of treatment for infectious diseases in the publichealthcare system

Healthcare for patients with HIV infection and chronic hepatitis is provided in the secondary
healthcare sector at specialised centres. 287 By law, each federal subject (territory) within the
Russian Federation is required to have at least one specialised HIV centre that treatspatients living with HIV. These are usually situated in the main cities and/or regional capitals.
They also run regional registries of patients with HIV and chronic hepatitis. 288
286F

287F

As of 2013, the centres offered monitoring services and laboratory testing for diseases(including CD4 and viral load tests), conducted medical research, prescribed and monitored
highly active ART and delivered psychosocial counselling to provide mental health support topatients. 289 Those who do not require urgent care and/or admission or isolation are regarded
as outpatients and are treated at polyclinics by GPs. Larger polyclinics have infectious
disease units which are usually comprised of an infectious disease specialist (a specialist who
diagnoses and manages infections in patients), an epidemiologist (a specialist who studies
the distribution and determinants of health-related states and events in the population) andnurses. Some patients receive care in day care centres. Urgent care is initiated via the public
GA service. 290
288F

289F

(a) Vaccinations
All eligible patients receive vaccinations free of charge in Russia, including the HBVvaccination for viral hepatitis as part of the National Vaccine Calendar. Babies born in Russia
have received this inoculation since 1998. Following the introduction of the vaccine
programme, the incidence of HBV steadily declined. 291 Since 2004, approximately 95 % of
290F

Russia, MoH, Приказ Министерства здравоохранения РФ от 8 ноября 2012 г № 69н «Об утверждении
порядка оказания медицинской помощи взрослому населению при заболевании, вызываемом вирусом
иммунодефицита человека (ВИЧ-инфекции)» [Order of the Ministry of Health and Social Development of theRussian Federation No. 69n of 31 January 2012 ‘On approval of the procedure for the provision of medical care toadult patients with infectious diseases’], 12 November 2015, url, p. 3
288
Russia, MoH, Приказ Министерства здравоохранения и социального развития Российской Федерации от
31 января 2012 г. № 69н "Об утверждении Порядка оказания медицинской помощи взрослым больным приинфекционных заболеваниях” [Order of the Ministry of Health and Social Development of the Russian Federation
No. 69n of 31 January 2012 ‘On approval of the procedure for the provision of medical care to adult patients with
infectious diseases’], 31 January 2012, url, pp. 5-6
289
Ipsos Healthcare, HIV Management in Russia: Examining the infrastructure of the Russian and USA healthcare
systems with respect to the management of HIV patients, 2013, url, p. 6
290
Russia, MoH, Приказ Министерства здравоохранения и социального развития Российской Федерации от
31 января 2012 г. № 69н "Об утверждении Порядка оказания медицинской помощи взрослым больным приинфекционных заболеваниях” [Order of the Ministry of Health and Social Development of the Russian Federation
No. 69n of 31 January 2012 ‘On approval of the procedure for the provision of medical care to adult patients with
infectious diseases’], 31 January 2012, url, pp. 5-6
291
Russia, MoH, National prophylactic vaccinations calendar [Национальный календарь профилактических
прививок], n.d., url; Klushkina, V. W. et al., Impact of Universal Hepatitis B Vaccination on Prevalence, InfectionAssociated Morbidity and Mortality, and Circulation of Immune Escape Variants in Russia, 9 June 2016, url, p. 1
287

102

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

infants have been vaccinated against HBV. By 2019, HBV vaccination coverage was up to
97 %. 292
291F(b) Treatment facilities
Infectious diseases treatments are provided in specialist institutions, through the infectious
diseases departments of standard hospitals, and at HIV centres. The leading national
treatment centre for HIV is St Petersburg's AIDS Centre. 293
292F(c) Staff
According to Ipsos Healthcare, in 2013 there were around 10 000 infectious disease
specialists in Russia, but only a small number (between 500 and 700 physicians) werepractising at 85 HIV centres. It is noteworthy that all physicians who treated HIV patients weretrained infectious disease specialists and likely had high caseloads. 294
293F

6.2.2.

Limitations on access to treatment for infectious diseases in
the public healthcare system(a) General limitations

Whilst treatment for infectious diseases is hypothetically available across Russia, access may
be harder in rural or scarcely populated, remote areas. Patients often need to travel at theirown cost to the nearest town or regional capital for treatment. While some individuals, suchas HIV-infected children, may qualify for free transportation to treatment facilities, travel andaccommodation on the way to hospital facilities are not generally covered by the state
healthcare insurance policy, the OMS. 295
294F(b) People living with HIV
Several sources report that patients in Russia experience problems with access to ART
medicines for HIV. Dr Pokrovsky, Head of the Federal Research Centre for AIDS Prevention
and Control in Moscow, stated that there are more than 1 million patients in Russia who are
documented as living with HIV and that half of these patients cannot access appropriate
antiretroviral medications. 296 A policy on the substitution of imported drugs has prevented
295F

WHO, WHO vaccine-preventable disease: monitoring system, 2020 global summary, 15 July 2020, url
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons294
Ipsos Healthcare, HIV Management in Russia: Examining the infrastructure of the Russian and USA healthcare
systems with respect to the management of HIV patients, 2013, url, p. 7
295
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
296
Politico, The epidemic Russia doesn’t want to talk about, 11 May 2020, url
292
293

103

EUROPEAN UNION AGENCY FOR ASYLUM

the availability of more modern antiretroviral drugs produced in Western countries and only
licensed drugs produced in Russia. 297
296F

Russia’s present State Strategy on HIV Prevention stated that 37.3 % of registered HIV
patients received ART and were put under medical observation in 2015. 298 Specific key
affected populations may be particularly impacted by limitations on access to drugs.
According to a 2014 UNAIDS report, less than half of men who have sex with men (MSM) –gay man and others – living with HIV said that they had received ART in Russia, and just 4 %of PWID living with HIV had access ART in 2013. 299
297F

298F

Another problem is late diagnostic testing. According to Ipsos Healthcare, in 2013 Russianpatients were usually diagnosed with high CD4 counts (above 400/mm³), but due to the flaws
in the healthcare and bureaucratic systems, the waiting time to begin therapy wasapproximately three years. By that time, patients’ CD4 counts were substantially lower. 300
UNAIDS found that many people who required ART did not receive it due to late testing, andthat rates of late diagnosis of HIV remained high. 301
299F

300F

There were also sociocultural limits on resources to treat patients, especially key populations,
including MSM and sex workers, and limitations on access to non-medical/auxiliary support
services. Legal support and/or support groups were only available through federal HIV
centres. Physicians could withhold information about services provided by NGOs frompatients and failed to discuss these options with them in spite of often being aware that
support from this sector existed. 302
301F

As of 2014, Russia did not support the evidence on the effectiveness of harm reduction. The
rates of HIV infection among people who inject drugs in the country were among the highest
in the world. 303 There is a lack of alignment with WHO recommendations on methadone
substitution therapy. Although WHO/UNODC/UNAIDS champion substitution maintenancetherapy as one of best ways of treating opioid addiction and an effective strategy for reducing
HIV risk behaviours, the Russian government has historically vetoed this line of treatment. 304
Substitution therapy has been illegal in Russia since 1998 and carries a 20-year prison
sentence. 305
302F

303F

304F

Twigg, J. and Rendelman, M., Center for Strategic and International Studies (CSIS), A Turning Point for Russia andHIV?, 11 March 2020, url; PBS News Hour, 1 million Russians are HIV-positive, but only a third get treatment, 12 June
2018, url
298
Russia, Government of the Russian Federation, State Strategy to Combat the Spread of HIV in Russia through2020 and beyond, 20 October 2016, url, p. 50
299
UNAIDS, The Gap Report, 2014, url, p. 107-108300
Ipsos Healthcare, HIV Management in Russia: Examining the infrastructure of the Russian and USA healthcare
systems with respect to the management of HIV patients, 2013, url, p. 7; UNAIDS, The Gap Report, 2014, url, p. 108
301
UNAIDS, The Gap Report, 2014, url, p. 108
302
Ipsos Healthcare, HIV Management in Russia: Examining the infrastructure of the Russian and USA healthcare
systems with respect to the management of HIV patients, 2013, url, p. 8
303
UNAIDS, The Gap Report, 2014, url, pp. 108-110
304
WHO, UNODC and UNAIDS, Substitution maintenance therapy in the management of opioid dependence andHIV/AIDS prevention, 2004, url, pp. 1-2; Parfitt, T., Russia's health promotion efforts blossom, 27 June 2009, url, p. 2;
Harm Reduction International, The Global State of Harm Reduction: 6th edition, 2018, url, p. 50
305
Politico, For Crimea’s drug users, a Russian death sentence, 15 May 2017, url
297

104

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT(c) Viral hepatitis
Prior to HCV drug advances in 2013, the best treatment options were a combination of
peginterferon and ribavirin, which are known to have significant side effects. Therefore,
patients in Russia not only struggled to afford treatment for hepatitis C, but there were alsofinancial challenges around diagnostic costs and treatments for side effects for the HCV
medications. Despite the advances of direct-acting antivirals (DAAs) which have been
available in Russia since 2015, many patients in the country have difficulties in accessing
modern HCV treatment. 306
305F

In 2017, only 0.2 % of the total estimated patients with hepatitis C received treatment. 307
306F

According to WHO, an estimated 20 000 people received HCV treatment in 2018. However,with approximately 5 million people estimated to be living with HCV in the RussianFederation, this reflects a significant gap. While Russia makes HCV testing and treatment
available free of charge in the public sector, there are access issues as product registration isfor originators only, there is no inclusion in licensing agreements for DAAs, and no generic
local production. 308
307F

There are significant barriers based on cost and drug development policies. Daclatasvir ismanufactured by a local generic manufacturer under exclusive licence from the originator
Bristol Myers Squibb (BMS). Access to DAAs is rationed in the public healthcare system.
Additionally, Russia is not included in the voluntary licensing agreement with Gilead, and as aresult is not able to import or locally develop generic versions of DAA treatments (also noagreement with Bristol-Myers Squibb or AbbVie). HCV treatment costs in Russia are muchhigher than in the United States and elsewhere. 309
308F

PWID are disproportionately impacted by HCV and HIV coinfection; facing higher infection
rates with low rates of treatment access. In a 2016 study of 349 HIV-infected individuals witha history of injection drug use, 98.9 % tested positive for HCV, yet only 3.3 % received
treatment. 310 Despite the high rates of viral hepatitis infection among PWID, as recently as
2013, the Russian viral hepatitis programme did not include PWID as a target group. 311
309F

310F

6.2.3.

Treatment for infectious diseases offered in the private
healthcare sector

There is an information deficit on availability of healthcare for infectious diseases patients inthe private healthcare sector. Remote consultations are available mostly in private settings

WHO, Accelerating access to hepatitis C diagnostics and treatment, 27 January 2021, url, p. 16
AFEW International, Invisible epidemic of Hepatitis C in Russia, 13 July 2018, url
308
WHO, Accelerating access to hepatitis C diagnostics and treatment, 27 January 2021, url, p. 52
309
WHO, Accelerating access to hepatitis C diagnostics and treatment, 27 January 2021, url, p. 52
310
Tsui, J. I. et al., Insights on the Russian HCV care cascade: minimal HCV treatment for HIV/HCV co-infected PWID
in St Petersburg, 11 October 2016, url, p. 1
311
Ocheret, D. et al., Current situation regarding access to hepatitis C treatment in Eastern Europe and Central Asia,
Eurasian Harm Reduction Network, 2013, url, p. 6
306
307

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EUROPEAN UNION AGENCY FOR ASYLUM

and not covered under OMS policy. Private healthcare facilities almost never accept patientswith confirmed or suspected infectious diseases. 312
311F

6.2.4.

International donor programmes

There is evidence of international donor activity which has been compromised by thegovernment’s approach to prevention and management of infectious diseases. 313
312F

6.2.5.

Discrimination faced by patients with HIV/AIDS

The Fundamentals of Legislation of the Russian Federation on Healthcare and the Federal
Law on the Fundamentals of the Care for Health of the Citizens in the Russian Federation
both contain anti-discrimination norms. However, neither of these specifically address sexual
orientation or gender identity. 314 In general, there is low acceptance of same-sex
relationships in Russia. 315
313F

314F

Lack of education and services puts people at risk from sexually transmitted infections.
Legislation from 2012 bans “propaganda of non-traditional sexual relationships amongminors”, which means awareness-raising activities for young people on lesbian, gay, bisexualand transgender (LGBT) issues, including in schools, is forbidden. NGOs who try to organisesuch events find it extremely difficult to obtain authorisations. 316 As of 2011, programmes on
prevention of sexually transmitted diseases and HIV/AIDS among MSM did not receive
government funding and relied on support from NGOs funded by foreign grants.
315F

A 2011 publication from the Russian LGBT Network confirmed that transsexual people had
difficulty in accessing medical services due to a lack of up-to-date knowledge andqualifications in the field among most medical professionals, especially in rural areas. This has
led some to self-medicate, using loopholes in the rules to buy hormones without
prescriptions. 317
316F

Stigma associated with both substance abuse and HIV result in higher likelihood of poor
general access to healthcare for both groups, especially outside major cities. 318 One
infectious diseases doctor who specialises in HIV treatment and care said that it is common
317F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
313
Author interpretation based on the sources discussed
314Inter-Regional Social Movement ‘Russian LGBT Network’, Discrimination on grounds of sexual orientation andgender identity in health care, education, employment and social security in the Russian Federation, May 2011, url,
p. 16
315
ECRI, ECRI report on the Russian Federation (fifth monitoring cycle), 5 March 2019, url, p. 38
316
ECRI, ECRI report on the Russian Federation (fifth monitoring cycle), 5 March 2019, url, p. 38
317
Inter-Regional Social Movement ‘Russian LGBT Network’, Discrimination on grounds of sexual orientation andgender identity in health care, education, employment and social security in the Russian Federation, May 2011, url,
p. 16
318
Vetrova, M.V., HIV and Substance Use Stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in
Russia, AIDS and Behavior, 28 January 2021, url, p. 2815; UNAIDS, Training the next generation of Russian doctors
on HIV-related stigma and discrimination, 30 October 2018, url
312

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

for HIV-positive patients to be denied admission to a hospital. 319 Another group impacted bystigma are HIV positive prison inmates, only 5 % of whom receive ART. 320
318F

319F

Women who inject drugs are stigmatised because of gender norms about drug use, as wellas in some cases their ability to care for their children or for their engagement in sex work. 321
According to UNAIDS, there is discrimination towards pregnant women who inject drugs.
These women face substantial barriers to services for prevention of mother-to-childtransmission — more barriers compared to other women who are living with HIV but not
involved in injection drug use. In a 2014 study conducted by Elizabeth King et al., female sex
workers articulated further barriers for these women - poverty, a lack of official
documentation, no anonymity in testing and the official registration system. Available services
were not enough to guarantee successful treatment. Women sex workers in St Petersburg
reported that stigma from conventional healthcare service providers towards sex workers
living with HIV had more of an impact that the stigma associated with sex work. This has kept
some female sex workers from getting tested for HIV at all. 322
320F

321F

6.3.

Insurance and national programmes

Like healthcare for the population at large, healthcare for adults and children with infectious
diseases is provided under the OMS upon registration at a polyclinic. Urgent care, including
admission is provided free of charge to all patients needing it in Russia. Non-urgent care isprovided to Russian citizens, permanent legal residents or long-term visa holders and/or
legally employed people who hold an OMS policy and have a registered address in Russia.
Returning Russian migrants and foreign migrants to Russia are covered by OMS once they
are registered as legal residents. 323 Insufficient funding remains a serious problem: thegovernment health spending is still below 6 % (the WHO-recommended minimum) and is stillaround 4 % of GDP. 324
322F

323F

UNAIDS, Training the next generation of Russian doctors on HIV-related stigma and discrimination, 30 October
2018, url
320
Avert, HIV and AIDS in Russia, n.d., url
321
King, E. et al., Women who inject drugs in Russia: stigma as a barrier in access to HIV and drug treatment services,
30 September 2020, url, p.v272
322
King, E.J et al., The influence of stigma and discrimination on female sex workers’ access to HIV services in St
Petersburg, Russia, 2013, url, pp. 4-8
323
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons324
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
319

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EUROPEAN UNION AGENCY FOR ASYLUM

Treatment for HIV and tuberculosis (TB) is free to all patients, as established in Russia’sFederal Law. 325 People with HIV/AIDS are entitled to free or discounted prescription
medications for outpatient care, depending on approval from federal authorities. 326
324F

325F

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 shows patients with HIV/AIDS as being entitled to receive free
medications from the state.

6.3.1.

Private healthcare insurance

Different forms of private medical insurance, including VMI, are available to those who canafford them, and enable those patients to receive general healthcare at private healthcare
facilities. However, stateless people are obliged to pay for private healthcare as they are notcovered by the OMS policy. Private healthcare facilities almost never accept patients withconfirmed or suspected infectious diseases. 327
326F

Table 23 shows the infectious diseases healthcare services that are covered by OMS andprivate medical insurance, including VMI.
Programme

Focus

Mandatory
public healthinsurance(OMS)

Russiancitizens andpermanent
residents,
includingreturning
Russianmigrants.
Migrants
from exSoviet
countries canobtain an
OMS policy
through their

Requirements

1. Public/Federal
2. Employers financeOMS throughcontributions, 2-3 %of salary goes intosocial tax, apercentage of whichis paid into a national
Russian healthcare
fund. Once paid, theemployee has theright to free medical

Scope ofcoverage

Infectious diseases
coveredCovershealthcare
benefits for all
people eligible
for OMS

Services included:• Inpatient andoutpatient medical
treatment• Medications for HIV insome regions• Consultation byinternist (orinfectiologist)• Consultation by HIV
specialist• Consultation by agastroenterologist• Laboratory test HIV:viral load

Russia, Government of the Russian Federation, Федеральный закон № 149-ФЗ О внесении изменений вотдельные положения Федерального закона № 38-ФЗ О предупреждении распространения в Российской
Федерации заболевания, вызываемого вирусом иммунодефицита человека (ВИЧ) [Federal Law No. 149-FZ
amending certain provisions of Federal Law No. 38-FZ, On the prevention of the spread in the Russian Federationof a disease caused by the human immunodeficiency virus (HIV)], 2016, url, Art. 4.1; Russia, Government of theRussian Federation, Федеральный закон № 149-ФЗ от 23 мая 2016 года "О внесении изменений в отдельные
положения Федерального закона от 18 июня 2001 года № 77-ФЗ "О предупреждении распространения
туберкулеза в Российской Федерации" [Federal Law No. 149-ФЗ of 23 May 2016 amending certain provisions ofFederal Law No. 77-FZ of 18 June 2001 ‘On the prevention of the spread of tuberculosis in the Russian Federation’],2016, url, Art. 7 Para. 1
326
Russia, Official website of the Moscow Mayor, Как и где получить льготные лекарства [How and where to get
subsidised medicines], n.d., url, accessed 30 August 2021
327
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
325

108

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Scope ofcoverage

Requirements

employers if care from public
the employer Russian healthcare
agrees.
clinics.
3. People who cannot
work and do notcontribute to OMI(e.g. unemployed,
pensioners,
children, sickpeople) can still
access free basic
healthcare. 328
32 7F

Infectious diseases
covered
•
•

•

•
•
•
•
•

•
•
•

Laboratory test HIV:CD4 countLaboratory test:
resistance test for
antiretroviral drugs.
HCV testing:Laboratory test ofhepatitis B antibodies;
HBsAb, HBeAb,
HBcAb;
Laboratory test ofhepatitis B antigens;
HBsAg, HBeAg;
Laboratory test of HBVDNA testing in case ofhepatitis B;
Laboratory test of HCV
RNA test;
Laboratory test of liverfunction (PT, albumin,bilirubin,transaminases: ASAT(= SGOT), ALAT(= SGPT) etc.);
Diagnostic imaging bymeans of ultrasound (ofthe liver);
Diagnostic
investigation, in theform of liver biopsy;
Diagnostic
investigation: transient
elastography; test forliver fibrosis (e.g.
fibroscan)Services excluded• Medications purchasedby the patient in
outpatient settings• Lack of information
available. See sections
6.2.2 Limitations onaccess to treatment for
infectious diseases in
the public healthcare
system andExpatica, Discover how the Russian healthcare system works and how to find a Russian pharmacy, doctor, or
hospital in the country, n.d., url
328

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EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Scope ofcoverage

Requirements

Infectious diseases
covered6.2.5 Discrimination

faced by patientswith HIV/AIDS
Government
healthinsurance
programmes
for
employees of
specialist
agencies, e.g.
law
enforcement

Employeesof selected
government
agencies andcompanies

For theInformation not publicly
registeredavailable
individual andsometimes theirfamilies

Private sector
healthinsurance,
includingvoluntary
medicalinsurance(VMI)

For theregisteredindividual
and/or theirfamily (if an
employerpurchases VMI
for anemployee, it
usually only
covers that
individual andnot their family)

110

Available services
depending on the hospitalor medical facility that theinsurance covers. An
example list is:• Consultation byinternist (orinfectiologist (EUR 28)• Consultation by HIV
specialist (EUR 40)• Consultation by agastroenterologist(EUR 40)• Laboratory test HIV:viral load (EUR 75)• Laboratory test HIV:CD4 count (EUR 75)• Laboratory test:
resistance test for
antiretroviral drugs(EUR 350)• Hospital stay extra
charges (laboratory
and imaging tests,
physicianconsultations,medications andprocedures)• Laboratory test ofhepatitis B antibodies;
HBsAb, HBeAb, HBcAb(EUR 32)• Laboratory test ofhepatitis B antibodies;
HBsAb, HBeAb, HBcAb(EUR 28)• Laboratory test of HBVDNA testing in case ofhepatitis B (EUR 12)

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Scope ofcoverage

Requirements

Infectious diseases
covered••••Laboratory test of HCV
RNA test (EUR 8)
Laboratory test of liverfunction (PT, albumin,bilirubin,transaminases: ASAT(= SGOT), ALAT(= SGPT) etc.) (EUR 38);
Diagnostic imaging bymeans of ultrasound (ofthe liver) (EUR 17);
Diagnostic
investigation, in theform of liver biopsy(EUR 230); Diagnostic
investigation, in theform of liver biopsy(EUR 40)

Table 23: Public and private healthcare coverage for patients with infectious diseases in Russia 329
328F

Cost of treatment

6.4.

Healthcare for patients with infectious diseases is provided free of charge under the OMS to
all eligible patients in Russia on an inpatient or outpatient basis. Treatment prices are 30 % to50 % higher in the private sector in urban areas than the public health system. Costs are also
higher in wealthier regions than in poorer ones. Public facilities must adhere to official
published prices whilst prices in private facilities are regulated by the private healthcare
market. 330
329F

6.4.1.

Methodology of data collection on treatment prices

The price of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. The websites used are shown in Table 24.
Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
330
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
329

111

EUROPEAN UNION AGENCY FOR ASYLUMName and url of website

Subject matter for prices

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)https://www.krasotaimedicina Aggregator of prices and availability of the medical services (surgery,.ru/
diagnostics, etc.) in Moscow from a lot of private clinics
https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/
https://market.yandex.ru/

Cost of equipment: overview and access to offers from many online
and offline shops (including medical equipment, orthopaedic supplies,
rehabilitation devices, etc.)

Table 24: Websites consulted for treatment prices

The most common prices were compared, and the median price agreed and included inTable 25 and Table 26.
Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Consultation byinternist (orinfectiologist)

FOC

FOC

2 425

2 425

Prices in Moscow

Consultation by
HIV specialist

FOC

FOC

3 464

3 464

Prices in Moscow

Consultation by agastroenterologist

FOC

FOC

3 464

3 464

Prices in Moscow

Specialist

Table 25: Cost of treatments for patients with infectious diseases in the public and private health systems in Russia
I

112

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Publictreatment
price

Privatetreatment price
RUB

Reimbursement/special
programme/free/comments

Laboratory test HIV: viral load

FOC

6 495

Prices in Moscow

Laboratory test HIV: CD4 count

FOC

Within viral load
test, that is 6 495

Prices in Moscow

Laboratory test: resistance test for
antiretroviral drugs

FOC

30 310Prices in Moscow

FOC

Limitedplaces 5 196

Prices in Moscow

Laboratory test of HBV antibodies;
HBsAb, HBeAb, HBcAb

FOC

2 771

Prices in Moscow

Laboratory test of hepatitis B
antigens; HBsAg, HBeAg

FOC

2 425

Prices in Moscow

Laboratory test of HBV DNA

FOC

1 039

Prices in Moscow

Laboratory test of HCV RNA

FOC

693

Prices in Moscow

Laboratory test of liver function (PT,albumin, bilirubin, transaminases:
ASAT (= SGOT), ALAT (= SGPT) etc.)

FOC

3 291

Prices in Moscow

FOC

1 472

Prices in Moscow

Laboratory tests

Treatment

Hospital stay/admission fee ininternal/infectious disease department(daily rates) *Laboratory tests for hepatitis B and C

Diagnostics for hepatitis

Diagnostic imaging by means ofultrasound (of the liver)113

EUROPEAN UNION AGENCY FOR ASYLUM

Publictreatment
price

Privatetreatment price
RUB

Reimbursement/special
programme/free/comments

Diagnostic investigation, in the form ofliver biopsy

FOC

19 918

Prices in Moscow

Diagnostic investigation: transient
elastography; test for liver fibrosis(e.g. fibroscan)

FOC

3 464

Prices in Moscow

FOC

Limitedplaces 5 196

Prices in Moscow

Treatment

Hospital stay/admission fee ingastroenterology department (dailyrate) *

Notes
FOC:

Free of charge* Daily rate includes bed and food only, everything else is an extra (laboratory and imaging tests, physician
consultations, medications and procedures)
Table 26: Cost of treatments for patients with infectious diseases in the public and private health systems in
Russia II

6.5.

Cost of medication

Medicines for infectious diseases conditions are generally accessible across the whole of theRussian Federation in theory, but availability is much better in urban and particularly
metropolitan regions. Low-income regions have relatively poorer access to medicines,
especially imported and expensive ones. Pharmacies, particularly inter-hospital pharmacies,
stockpile medicines to mitigate specific shortages. The major infectious diseases medicines
are registered in Russia and only registered drugs can be legally produced or imported into
the country. Those which are not controlled or restricted may be brought into Russia for
personal use. 331 Many infectious diseases medicines are included on the VEDL. 332 Prices for
330F

331F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
332
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов на 2020 год, а также перечней
лекарственных препаратов для медицинского применения и минимального ассортимента лекарственных
препаратов, необходимых для оказания медицинской помощи [Decree No. 2406-p of 12 October 2019 ‘Onapproval of the list of vital and essential medicines for 2020, as well as the lists of medicines for medical use andthe minimum range of medicines necessary for the provision of medical care’], 12 October 2019, url, pp. 260-261
331

114

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

medications on this list are regulated and strictly controlled by the state and cannot exceed
the formal prices it sets. The drugs registration process is lengthy, expensive andcumbersome and it may limit the availability of newer medications developed in othercountries. In recent years, considerable efforts have been made by the state to encourage
medications production in Russia and limit dependency on imports. 333
332F

6.5.1.

Methodology of data collection on drug prices

The prices of drugs for infectious diseases were collected using an initial Internet search fortheir availability and costs in Moscow. The websites used for the initial search are shown in
Table 27.
Name and url of website

Subject matter for prices

https://aptekamos.ru/ 334

Aggregator of prices and availability of the medications in
Moscow pharmacies

https://www.eapteka.ru/

Big online pharmacy with option of ordering medications that arerare

https://apteka.ru/

Big online pharmacy with option of ordering medications that are
rare

333F

https://grls.rosminzdrav.ru/grls.asp State Register of Medicinex
Table 27: Websites consulted for drug prices

The most common prices were compared, and the median price agreed and included in T.
Each medication was checked on the VEDL. 335 If medication was not found under a genericname from the Internet search, it was checked against the State Register of Medicines. If it
was registered, a further Internet search for its availability was performed using its brand
name.
334F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons334
Note from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
335
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов на 2020 год, а также перечней
лекарственных препаратов для медицинского применения и минимального ассортимента лекарственных
препаратов, необходимых для оказания медицинской помощи [Decree No. 2406-p of 12 October 2019 ‘Onapproval of the list of vital and essential medicines for 2020, as well as the lists of medicines for medical use andthe minimum range of medicines necessary for the provision of medical care’], 12 October 2019, url, pp. 1-40
333

115

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/freeSingle antiretrovirals/ARVs

Abacavir

Olitid®

600 mgTablets30

1 819

Pharmacy

Included in
VEDL

Atazanavir

Simanod®

300 mgCapsule30

2 425

Pharmacy

Included in
VEDL

400 mgTablets60

2 944

Pharmacy

Included in
VEDL

Darunavir

Dolutegravir

Tivikai®

50 mg

Tablets30

8 400

Pharmacy

Included in
VEDL

Efavirenz

Regast®

600 mgTablets30

866

Pharmacy

Included in
VEDL

Emtricitabine

Emtritab®

200 mgTablets30

2 338

Pharmacy

As separate
medication not includedin VEDL

Lamivudine (bothfor HBV
and HIV)

Zeffiks®

100 mgTablets28

1 472

Pharmacy

Included in
VEDL

Raltegravir

Isentress®

400 mgTablets

60

24 248

Pharmacy

Included in
VEDL

Pharmacy

As separate
medication not includedin VEDL

Rilpivirine

Edurant®

25 mg

Tablets

30

116

12 557

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

Ritonavir

Tenofovir
alafenamide(both forhepatitis band HIV)

Vemlidi®

Tenofovir
disoproxil(both for
HBV andHIV)

DosageForm

Number ofunits
in thecontainer

100 mgTablets

30

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/free

2 165

Pharmacy

Included in
VEDL

25 mg

Tablets30

8 833

Pharmacy

Tenofovir
included in
VEDL

300 mgTablets30

433

Pharmacy

Tenofovir
included in
VEDL

N/A

N/A

Combination with 2, 3 or 4 ARVs

Atripla®
(combination ofefavirenz/emtricitabine/
tenofovir
disoproxil)

Biktarvy®
(combination of
bictegravir/
emtricitabine/
tenofovir
alafenamide)

Atripla®

600 mg+ 200
mg +245 mgTablets30

15 241

Pharmacy(only at 2
pharmacies in
Moscow asof July 2021

Biktarvy®

50 mg +
200 mg+ 25 mg

Tablets

30

37 411

Pharmacy117

EUROPEAN UNION AGENCY FOR ASYLUM

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/freeGeneric
name

Brand
name

Descovy®
(combination of
emtricitabine/
tenofovir
alafenamide)

Notregisteredin Russia

RussianMedi-cations
Registry

Epzicom®
notregisteredin Russia Kivexa® isregistered

Pharmacy

RussianMedi-cations
Registry
Combination of
abacavir andlamivudine isincluded in
Essential
Drugs List

Pharmacy

Combination of
emtricitabine/
rilpivirine/
tenofovir is
included in
VEDL

Epzicom®
Kivexa®
(combination of
abacavirandlamivudine)

Eviplera®
(combination of
emtricitabine/
rilpivirine/
tenofovir
disoproxil)

Eviplera®

Juluca®
(combination of
dolutegravir andrilpvirin)

Notregisteredin Russia

Kaletra®
(combination of

Kaletra®

Dosage600 mg+
300 mg

200 mg+25 mg +
300 mgForm

Tablets

30

Tablets

30

3 724

21 823

RussianMedi-cations
Registry

100 mg+ 25 mg;
200 mgTablets
solution

120
tab-

118

8 400
7 881

Pharmacy

Combination oflopinavir/

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

lopinavir/
ritonavir)

DosageNumber ofunits
in thecontainerForm+ 50 mgsolution
80 mg +
20 mg 6
0 ml

Price
per
box,
RUB

Place
(Pharmacy,
hospital)lets
5 vials

Reimbursement/
specialprogramme/freeritonavir is
included in
VEDL

Odefsey®
(combination of
emtricitabine/
tenofovir
alafenamide/
rilpivirin)

Notregisteredin Russia

RussianMedi-cations
Registry

Stribild®
(combination ofelvitegravir/
cobicistat/tenofovir
disoproxil/
emtricitabine)Notregisteredin Russia

RussianMedi-cations
Registry

Triumeq®
(combination of
abacavir/
dolutegravir/
lamivudine)Notregisteredin Russia

RussianMedi-cations
Registry

Truvada®
(combination of
emtricitabine/

Truvada®

200 mg+
245 mgTablets

30

119

14 635

Pharmacy

N/AEUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

DosageNumber ofunits
in thecontainer

Form

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/freetenofovir
disoproxil)

Medication for opportunistic infections (e.g. antibiotics, antivirals and antifungals)

Aciclovir

200 mg,
400 mgTablets20260

Pharmacy

Included in
VEDL

Amphotericin B

50 000IU

Inject-ions

143

Pharmacy

Included in
VEDL

1g

Powder

1

1 732

Pharmacy

N/A

1g

Powder50

1 212

Pharmacy

Included in
VEDL

1g

Powder

1

520

Pharmacy

Included in
VEDL

Dapsone

50 mg

Tablets

100

1 472

Pharmacy

Included in
VEDL

Doxycycline

100 mgCapsule20

26

Pharmacy

Included in
VEDL

Fluconazole

150 mgCapsule1

35

Pharmacy

Included in
VEDL

Aztreonam

Aznam Dj®

Cefotaxim

Ceftriaxone

Rocefin®

Ganci-clovir

Tsimeven®

500 mgLyophilisate

1

1 559

Pharmacy

Included in
VEDL

Itraconazole

Orungal®

100 mgCapsule14

9 613

Pharmacy

N/A

120

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

Nystatin

DosageForm

Number ofunits
in thecontainer

500 00
0IU

Tablets10173

Pharmacy

Included in
VEDL

Pharmacy

N/A

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/freePentamidine

Pentakarinat®

300 mgPowder

1

4 850
(upon
order
only)

Posaconazole

Noxafil®

40 mg/
ml 105ml

Suspension

1

38 970

Pharmacy

Included in
VEDL

Valganciclovir

Tsivalgan®

450 mgTablets

60

32 042

Pharmacy

Included in
VEDL

150 mgCapsule16

173

Pharmacy

Included in
VEDL

0.5 g +
0.5 g

Powderfor
injections

1

346

Pharmacy

Included in
VEDL

1g

Powderfor
injections

1

866

Pharmacy

Included in
VEDL

100 mgCapsule20

1 039

Pharmacy

N/A

Other antibiotics

Clindamycin

Imipenem

Imipemen®
+
Tsilastatin®

Meropenem

Minocyclinehydrochloride

Minoleksin®

121

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainer

Nitrofurantoin

Furadonin®

50 mg

Tablets

20

87

Pharmacy

N/A

Tetracycline

100 mg,3%

Tablets,
ointment

20,
15 g

87

Pharmacy

Included in
VEDL

TrimethoprimAND
sulfametho
xazole(Cotrimoxazole)

480 mgTablets

1026

Pharmacy

Included in
VEDL

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/free

Hepatitis B medication

Adefovir

Notregisteredin Russia

Entecavir

Baraklud®

Telbivudine

RussianMedi-cations
Registry

1g

Tablets

30

10 825

Pharmacy

Included in
VEDL

Pharmacy

Included in
VEDL

Pharmacy

Included in
VEDL

600 mgTablets

30

6 062
(per
order
only)

60 mg

Tablets

28

47 630Hepatitis C medication

Dacla-tasvir

Daklinza®

122

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

Ledi-pasvir

Notregisteredin Russia

DosageNumber ofunits
in thecontainer

Form

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/free

No separate
medication

Pharmacy price foundin only one
pharmacyin Moscow
as ofJuly 2021

N/A

158 736

PharmacyThis combination is
included in
VEDL

60

606

Pharmacy

Included in
VEDL

Ledi-pasvir+ sofosbuvir(combination)

Harvoni®

90 mg +
400 mgOmbi-tasvir+ paritaprevir +ritonavir(combination)

ViekiraPak®, also
includesdasabuvir

250 mgand12.5 mg+
75 mg +
50 mg

Tablets112

200 mgCapsuleRibavirin

Price
per
box,
RUB

Tablets

28

170 254

Sime-previr

Sovriad®

150 mgCapsule28

48 496

Pharmacy

Included in
VEDL

Sofos-buvir

Sovaldi®

400 mgTablets

28

86 59
9

Pharmacy

Included in
VEDL

Sofosbuvir+
velpatasvir(combination; eg
Epclusa®)

Epclusa®

400 mg+
100 mgTablets

28

153 973

Pharmacy

Included in
VEDL

Both hepatitis B and C (classic medication)

123

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainerInterferonalfa 2bViferon®

1 000
000 IU

Suppositories

10

606

Pharmacy

Included in
VEDL

Pegasis®

180mсg/
0.5 mlInjection

1

5 889

Pharmacy

Included in
VEDL

Peg interferon alfa
2a

Price
per
box,
RUB

Place
(Pharmacy,
hospital)

Reimbursement/
specialprogramme/freeTable 28: Cost of drugs for infectious diseases in the public and private health systems in Russia

6.6.

NGOs

The state of NGOs working in the field of HIV/AIDS is a particularly complex one since theprohibition in 2016 of foreign-based organisations offering involvement and financial support.
NGO networks in Russia formerly received substantial support from internationalorganisation: UNAIDS, for example, assisted in the creation of the Russian Association of
People Living with HIV and the National Forum of AIDS-service NGOs in Russia. 336
335F

In 2012, Russian NGOs receiving foreign funding were subject to harassment under a ‘foreign
agents’ law so that the global community which had been active in HIV prevention from thelate 1990s on was largely forced out. 337 The epidemic has historically been viewed as theresult of harmful influences from the West which led to Russia departing from evidence-based
approaches to HIV in favour of ‘traditional values’, e.g. engaging in healthy lifestylepromotion. 338 Only a few Russian service providers remain. 339 In 2019, a host of imported
medicines disappeared from pharmacies and doctors treating diseases, such as HIV and viral
hepatitis, were left with few satisfactory alternatives. 340 Small Russian non-profit organisations
and civil societies, such as Patient Control, Eurasian Women’s Network on AIDS and the
E.V.A. Association struggle to get backing from the Russian government. 341
336F

337F

338F

339F

340F

Межрегиональная общественная организация "Сообщество людей, живущих с ВИЧ” [Interregional Public
Organisation, ‘Community of People Living with HIV’], Об организации [About the organisation], n.d., url
337
Twigg, J. and Rendelman, M., Center for Strategic and International Studies (CSIS), A Turning Point for Russia andHIV?, 11 March 2020, url
338
Pape, U., Framing the Epidemic: NGOs and the Fight Against HIV/AIDS in Russia, 8 November 2018, url, pp. 501502
339
Twigg, J. and Rendelman, M., Center for Strategic and International Studies (CSIS), A Turning Point for Russia andHIV?, 11 March 2020, url
340
Moscow Times, People Could Lose Their Lives, 12 February 2020, url
341
Borgen Project, 10 Facts About Healthcare in the Russian Federation, 18 June 2020, url
336

124

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

7. Psychiatry
7.1.

General information

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention ofmental, emotional and behavioural disorders. 342 Psychiatry in this report refers to mental
health conditions, such as mood disorders such as depression; anxiety disorders such as
post-traumatic stress disorder (PTSD); psychotic disorders such as schizophrenia, bipolar
disorder, sleeping disorders; and addiction problems, such as alcohol and opioid addiction.
341F

7.1.1.

Epidemiological context

According to Russia’s Federal State Statistics Service, the estimated annual prevalence of
psychiatric and behavioural disorders was 2 661 cases with a prevalence rate of 1 8123 cases
per 100 000 population. The estimated annual incidence was 612 045 cases and a rate of
417 cases per 100 000 population in 2017. 343
342F

These figures are comprised of aggregated data for the following psychiatric conditions, as
listed by the Federal State Statistics Service, as show in Table 29.
Type of mental health disorders

Psychoses and states of dementia (schizophrenia, schizoaffective psychoses, schizotypal disorder,
affective psychosis with non-congruent delusions)

Mental disorders of a non-psychotic nature (includes: organic non-psychotic disorders, including
those related to epilepsy; effective non-psychotic disorders, including bipolar disorder, anxiety,dissociative, stress-related, somatoform and other nonpsychotic mental disorders; other nonpsychotic disorders, behavioural disorders in children and adolescents, and unspecified nonpsychotic disorders)Disorders of adult personality and behaviour;‘Mental retardation’ 344
343F

American Psychiatric Association, What is Psychiatry?, n.d., urlFederal State Statistics Service, Статистика Официальная статистика Население Здравоохранение
Заболеваемость населения социально-значимыми болезнями? [Statistics of Incidence, Morbidity, Sociallysignificant diseases], 2018, url
344 ‘Mental retardation’ is still used in Russian instead of the more appropriate term “neuropsychological developmental
difficulties”.
342
343

125

EUROPEAN UNION AGENCY FOR ASYLUM

Number of patients receiving consultative and medical assistance (mixed group, hard to categorise– but patients who sought professional psychiatric help and received consultation, treatment orboth)

Alcoholism and alcoholic psychoses

Addiction and substance abuse
Table 29: Type of mental health disorders 345
344F

Stigma, lack of adherence to ICD10 guidelines, reluctance on reporting and reluctance on
seeking treatment suggest regarding these figures with care. 346
345F

According to WHO, the top 5 psychiatric conditions leading to deaths and DALYs lost in 2019
were, in order of magnitude, self-harm, alcohol abuse disorders, drug abuse, interpersonal
violence and eating disorders. 347 See Table 29b:
346F

Contact 2, Research Assistant, email, July-September 2021. The person wishes to remain anonymous for security
reasons; Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
346
Martynikhin I.A., The Use of ICD-10 for Diagnosing Mental Disorders in Russia, According to National Statistics
and a Survey of Psychiatrists' Experience, 2021, url, p. 35; Contact 1, Medical Doctor and local consultant, email, JulySeptember 2021. The person wishes to remain anonymous for security reasons
347 WHO, Global Health Observatory, Deaths, DALY, and population in Russian Federation for both sexes aged allages, n.d., url
345

126

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

PsychiatricdisorderNo. of deaths per
year per 100 000
population, 2019

No. of DALYs per
100 000 population,
2019

Rank in order of leading
causes of death in Russia if in
the top 20

Self-harm

25.1

1 097.4

9th

Alcohol use
disorders19.2

1 173.9

12th

Interpersonal
violence

7.8

439.8

–

Eating disorders

6.3

4 4695–

Drug use

6.2

549.7

–

Table 29b: Number of deaths and DALYs attributed to psychiatric disorders in 2019 348
347F

7.1.2.

National policies and programmes

Access to mental healthcare and the rights of individuals are enshrined in Russian federallaw, which applies to all Russian citizens and foreign nationals present in Russia. 349 Article 16of the Law on Mental Healthcare and the Guarantees of the Citizens’ Rights in the Course ofCare Provision includes a list of mental health services and social support measures
guaranteed by the state:
348F

•
•
•
•
•
•
•
•

emergency mental healthcare;consultation for diagnostic, treatment, psychopreventive and rehabilitation services at
inpatient and outpatient facilities;
all forms of psychiatric examination that cause temporary disability;
social support and employment assistance for people with mental health conditions;resolution of custody-related problems;
legal consultations and other types of legal aid are provided at mental andpsychoneurological facilities;
social care and nursing for disabled and elderly people with mental health conditions;education for people with disabilities and children with mental health conditions;

WHO, Global Health Observatory, Deaths, DALY, and population in Russian Federation for both sexes aged allages, n.d., url
349
FCDO, Guidance Support for British Nationals experiencing mental health Issues in Russia, 2021, 26 March 2021,
url
348

127

EUROPEAN UNION AGENCY FOR ASYLUM•

psychiatric support in the event of natural disasters and catastrophes. 350
349F

To provide mental healthcare and social support for those who need it, the state has
established mental healthcare inpatient and outpatient facilities, and has located themwhere possible near patients’ homes. It has also arranged general and vocational education
for children with mental health conditions. 351
350F

There are reports which suggest that the situation on the ground regarding accessing mental
healthcare and support services is less favourable than the legal framework suggests, 352 as
the sections in this report will unpack.
351F

In a 2015 publication, Neznanov and Vasileva stated that mental healthcare in Russia wasorganised at both the state and federal levels. At the federal level, specialised medical
facilities for mental healthcare were listed and approved of by the Russian government. In
each of the 85 other federal subjects, including republics, cities of federal importance,autonomous oblasts and other entities, specialised medical facilities for mental healthcare
were listed and approved by the subjects. 353
352F

There were three federal programmes for the reform of mental healthcare from the 1990s to
2000s. 354 The state has since lessened its role in mental healthcare, except for forensic
psychiatry. More of the care is funded at the regional level but is hampered by a lack offunding, undeveloped facilities and the absence of help from NGOs and civil society
organisations. The quality, variety and availability of care remains poor. Yet the state retains
command of the mental health system. 355
353F

354F

The mental health system remains concentrated on secondary and tertiary care via
hospitalisations and inpatient care at psychiatric hospitals staffed by psychiatrists, with
outpatient care at psychoneurological dispensaries and departments for rehabilitation andoccupational therapy. 356 In 2014, the number of outpatient clinics was very low. 357 There is
still a distinct lack of cooperation with other healthcare professionals than psychiatrists, or
those from private practices and NGOs. Drug and alcohol abuse, a field of psychiatric
medicine called “narcology” in Russia, is handled independently with its own distinct service.
It has, for example, a separate network of dispensaries from other psychiatric services. The
355F

356F

Russia, State Duma of the Russian Federation, Закон Российской Федерации «О психиатрической помощи игарантиях прав граждан при ее оказании» от 02.07.1992 г. №3185-I Russia, [Law of the Russian Federation No.
3185-I of 2 July 1992 ‘On mental healthcare and guarantees of the citizens’ rights in the course of care provision’], 2
July 1992, url
351
Neznanov, N.G. and Vasileva, V., Legal Regulation of Mental Healthcare Provision in Russia, February 2015, url,
p. 18
352
Savenko, Y.S. and Perekhov, A.Y., The State of Psychiatry in Russia, in: Psychiatric Times, Vol. 31, Issue 2,
13 February 2014, url
353
Neznanov, N.G. and V. Vasileva, V., Legal Regulation of Mental Healthcare Provision in Russia, February 2015,
url, p. 18
354
Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, p. 117
355
Kolpakova, S.V., A journey through Russian mental health care: a review and evaluation, 19 May 2019, url, p. 126
356
Kolpakova, S.V., A journey through Russian mental health care: a review and evaluation, 19 May 2019, url, pp. 120,
126
357
Savenko, Y.S. and Perekhov, A.Y., The State of Psychiatry in Russia, in: Psychiatric Times, Vol. 31, Issue 2,
13 February 2014, url
350

128

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

overall psychiatric system has shied away from addressing key topics within modern mental
healthcare practices, such as challenging stigma, social inclusion, and facilitating
independent living. 358
357F

Key facilities for the treatment of psychiatric conditions from both the public and private
healthcare sectors are shown in Table 30. These were identified through a search of theirwebsites, and each has a claim to be a leading centre, corroborated against a variety of otherwebsites.

Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, pp. 116,
124
358

129

EUROPEAN UNION AGENCY FOR ASYLUM

Facility type

S.
No.

State orcity

1

Moscow

Private Psychiatric Clinic:
psychiatric clinic"Preobrazhenie"

2

Moscow

Psychiatric Hospital no. 1
Named after N.A.
Alexeev

X

3

Moscow

Psychiatric Hospital
no. 15

X

4

Moscow

Psychiatric Hospital
no. 22

X

5

Moscow

Moscow: The Serbsky
State Scientific Centre
for Social and Forensic
PsychiatryX

6

Moscow

GMS Clinic Yamskaya,

5

St
Petersburg

Psychiatric Hospital ofSpecialised Type With
Intense Observation

X

6

St
Petersburg

Psychiatric Hospital no. 1
named after P. P.
Kashchenko

X

7

St
Petersburg

Bechterev Centre

Specialisms/comment

Facility namePublicPrivateXFirst private medical centre in
Moscow focused on psychiatry

Psychosis, brain trauma,
alcoholism, drug addiction

X

Separate department formental healthWith intense observation

X

Addiction clinic (alcoholism,
drugs, gambling, etc.); networkof clinics in 20+ areas

Table 30: Sample of psychiatric treatment centres in Russia from the public and private healthcare sectors 359
358F

359 Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain anonymous forsecurity reasons

130

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

7.2.

Access to treatment

7.2.1.

Structure of mental healthcare in the public healthcare system
in Russia

A chief psychiatrist is responsible for the organisation of psychiatric care in each region of
Russia, i.e. oblast, republic, etc., and ensures the coordination of psychiatric care, its
continuity and general oversight. 360 Psychiatric care is offered through the secondary andtertiary facilities previously described. 361 Diagnosis and treatment provision in the primary
healthcare sector are now rare. 362
359F

360F

361F

Urgent psychiatric care is provided by the public GA service. There are specialised
psychiatric GA teams in large cities comprised of a psychiatrist and feldsher (physician’s
assistant) or nurse. In rural areas, general GA teams provide urgent psychiatric care. There
are separate psychiatric departments for acute and stable conditions, paediatric, adolescentand adult patients. Large psychiatric hospitals also have ICUs, somatic, infectious and TB
wards, as well as sanatoriums. Specialist facilities offer care for patients with non-psychotic
disorders; for example, ‘narcological hospitals’ and dispensaries treat ‘narcology’ problems,
including alcohol abuse. 363
362F

Patients who are unable to perform activities of daily life, who require around-the-clock care,
who have no relatives having possibility to assist are transferred to psycho-neurological“internats” - long-term facilities that operate 24 hours a day, seven days a week. Non-urgent
care is provided in psycho-neurological dispensaries staffed by 5 or more psychiatrists or at
psychiatric outpatient units in regular outpatient facilities at polyclinics. 364 Other units ofoutpatient care include day care and night care facilities, therapeutic labour workshops,
specialised units in factories and dormitories. 365
363F

364F

360 Contact

1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reason
361
Cook, S. et al., Prevalence of symptoms, ever having received a diagnosis and treatment of depression andanxiety, and associations with health service use amongst the general population in two Russian cities,
12 November 2020, url, p. 2
362
Cook, S. et al., Prevalence of symptoms, ever having received a diagnosis and treatment of depression andanxiety, and associations with health service use amongst the general population in two Russian cities,
12 November 2020, url, p. 2; Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person
wishes to remain anonymous for security reasons
363
Russia, MoH, Министерство Здравоохранения И Социального Развития Российской Федерации Приказ от
17 мая 2012 г. N 566н. Об утверждении порядка оказания медицинской помощи при психических
расстройствах и расстройствах поведения, [Ministry of Health Order No. 566n of 17 May 2012 On Approval of theProcedure of Medical Care for Mental and Behavioural Disorders], 2012, url
364
Russia, MoH, Министерство Здравоохранения И Социального Развития Российской Федерации Приказ от
17 мая 2012 г. N 566н. Об утверждении порядка оказания медицинской помощи при психических
расстройствах и расстройствах поведения, [Ministry of Health Order No. 566n of 17 May 2012 On Approval of theProcedure of Medical Care for Mental and Behavioural Disorders], 2012, url
365
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons131EUROPEAN UNION AGENCY FOR ASYLUM

Criticism has been levelled at mental healthcare in the public system (see also ‘Limitations of
the accessibility and quality of mental healthcare’). 366 During the third wave of mental healthreform, a government framework was created as guidance. It pointed to poor use ofpsychosocial therapies, a lack of multidisciplinary mental health teams, and the tendency tofrequently hospitalise patients for long periods due to a lack of mental healthcare coverage inthe primary sector, interagency collaboration and aftercare services in marginal areas. 367
Standard diagnostic techniques, the clinical interview, communication with the patient andobservation were replaced with simplified, rapid procedures and questionnaires, which has
lowered the quality of care, given that psychiatrists’ patient loads have been increased. 368
365F

366F

367F

7.2.2.

The practice of psychiatry in Russia

The Russian psychiatric system has been criticised by several sources. 369 Psychology is notconsidered a medical speciality in Russia and there is an important distinction between
psychologists and clinical psychologists. Clinical psychologists are educated at medical
universities and work in medical institutions alongside psychiatrists. Psychologists are
permitted neither to make a diagnosis nor to prescribe treatment. They are educated at nonmedical universities and they do not qualify as medical doctors. 370 There is no law in Russia
to regulate the activities of psychologists and no reliable statistics on the number ofpractising psychologists. Diagnostic observations or recommendations made by other typesof doctors are only seen as preliminary evidence. Neznanov and Vasileva state that Russian
law emphasises that admission to a specialist institution should be used only for the purposesof treatment. 371
368F

369F

370F

People who commit dangerous acts may be involuntarily committed to a hospital under the
Criminal Code of the Russian Federation with court agreement and the required evidence.
Extreme patient cases are admitted to a secure psychiatric institution and re-evaluated by apsychiatric commission every six months, at which point further decisions about the need andtype of treatment are recommended if necessary. 372
371F

In practice, outpatient psychiatric clinics avoid involuntary admissions due to their legal
complexity and prefer to commit patients to hospital straight away, citing them as an
immediate danger. As noted by Russian psychiatrists, upon arrival, patients diagnosed withpsychosis or dementia face coercion into signing consent forms for hospitalisation andAuthor interpretation based on the sources discussed.
Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, pp. 119120, p. 123; Sørgaard, K.W. et al., Treatment Needs, Diagnoses and Use of Services for Acutely Admitted PsychiatricPatients in Northwest Russia and Northern Norway, 14 January 2013, url, p. 2
368
Savenko, Y.S. and Perekhov, A.Y., The State of Psychiatry in Russia, in: Psychiatric Times, Vol. 31, Issue 2,
13 February 2014, url
369
Author interpretation based on the sources discussed.
370
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
371
Neznanov, N.G. and Vasileva, V., Legal Regulation of Mental Healthcare Provision in Russia, February 2015, url,
p. 17
372
Neznanov, N.G. and Vasileva, V., Legal Regulation of Mental Healthcare Provision in Russia, February 2015, url,
p. 18
366
367

132

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

treatments. Yet, around 20 % are incapable of providing informed consent so their consent isfalsified. 373
372F

7.2.3.

Limitations of the accessibility and quality of mental
healthcare

Patients in some regions have very limited access to mental healthcare as most facilities arein urban areas and are much scarcer in remote and sparsely populated areas, whilst otherregions house just day care hospitals and rehabilitation departments. 374 In some regions,
there are virtually no psychiatric facilities. Patients residing in rural and/or remote areas often
have to travel to the nearest town or regional capital to access appropriate care at their own
expense. Lower-income regions have fewer healthcare resources and therefore may provide
a lower quality of care. 375
373F

374F

There has been a persistent decline in the availability of outpatient facilities; for example, thenumber of outpatient dispensaries dropped from 173 in 2005 to 92 in 2015 and 74 in
2020. 376 Psychotherapy offices were reduced from 1 095 in 2005, to 727 in 2013, to 676 in
2015. In 2012-2013, there were 150 rehabilitation services planned for 83 of Russia’s 85
federal subjects, yet 56.7 % of them were still under development by 2015, with 43.3 % that
had been operational before the 3rd wave of mental healthcare reforms but under different
names. 377
375F

376F

As of 2014, another challenge linked to the lack of outpatient care was the need forpsychiatric patients to have social support from their families to live independently. Those
without family support were placed in so-called ‘internats’. Such placement can impact
patients residing in rural and/or remote and scarcely populated areas. Orphans and solitary
people without social support or who experience homelessness can have major difficulties
accessing care. 378
377F

Savenko and Perekhov reported in 2014 in the Psychiatric Times that one third of patients at
psychiatric hospitals in Russia stay in unsanitary conditions, with 15 people in one room withbars on the windows and no dividers or poor access to a toilet. They also claim that an

Savenko, Y.S. and Perekhov, A.Y., The State of Psychiatry in Russia, in: Psychiatric Times, Vol. 31, Issue 2,
13 February 2014, url
374
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Kolpakova, S.V., A journey through Russian mental health care: A review andevaluation, 19 May 2019, url, p. 120
375
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons376
Rosstat, Здравоохранение в России. 2021: Статистический сборник [Healthcare in Russia – 2021 Statistical
Yearbook], 2021, url, p. 92
377
Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, p. 120
378
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
373

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EUROPEAN UNION AGENCY FOR ASYLUM

estimated figure of around 90 % of patients fail to receive accurate information about theirdiagnosis or treatment and receive no access to their medical records. 379
378F

Savenko and Perekhov also maintain that it is possible that patients with criminal convictions
tend to repeatedly reoffend and be readmitted leading to penalisation of the case associatedpsychiatrist. In 2021, more than 50 % of such patients were readmitted. In 2014, the year when
their article was published, the MoH had axed 50 000 inpatient beds to achieve a rate of just
104.8 beds per 100 000 population, with no provision of new outpatient facilities andservices. 380 The rate which had dropped to 90.9 inpatient beds per 100 000 population andjust 4.7 specialised forensic psychiatry beds by 2017. 381
379F

380F

7.2.4.

Psychiatry in the private healthcare system

Public mental healthcare facilities can offer paid private services that are primarily foroutpatients, including home visits. 382 In one study of mental health prevalence rates in
Arkhangelsk and Novosibirsk, the cost of private treatment was reported as unaffordable forthe majority of Russian citizens. 383
381F

382F

Below are two Moscow-based examples, both of which offer inpatient and outpatient
services.
•

The Mental Health Clinic offers outpatient treatments for personality disorders, mooddisorders, schizophrenia, obsessive-compulsive disorder, self-harm and suicidality,
sexual dysfunctions, geriatric psychiatry and some aspects of counselling for alcohol
problems, cognitive behavioural therapy, dialectical behaviour therapy, schema
therapy, family therapy, couples’ therapy and emotionally focused therapy. 384
The Minutko Mental Health Center advertises diagnostic testing, including for severe
psychiatric illness, using blood testing, hormone and immune system tests, EEG
testing, EEG monitoring, and Doppler ultrasound, diagnostic treatment and nursing forpatients with severe mental health states, a care package for older age psychiatricpatients, and other treatments for adolescent eating disorders, obsessive-compulsive
disorder, addiction, severe depression, attention deficit hyperactivity disorder, andautism. 385
383F

•

384F

Savenko, Y.S. and Perekhov, A.Y., The State of Psychiatry in Russia, in: Psychiatric Times, Vol. 31, Issue 2,
13 February 2014, url
380
Savenko, Y.S. and Perekhov, A.Y., The State of Psychiatry in Russia, in: Psychiatric Times, Vol. 31, Issue 2,
13 February 2014, url
381
Mundt, A. et al., Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe andCentral Asia from 1990-2019: a retrospective database analysis, August 2021, url, p. 5
382
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
383
Cook, S. et al., Prevalence of symptoms, ever having received a diagnosis and treatment of depression andanxiety, and associations with health service use amongst the general population in two Russian cities,
12 November 2020, url, p. 2
384
Mental Health Centre, Наши преимущества [Our advantages], n.d., url
385
Minutko Mental Health Centre, Стационар и амбулаторный центр [Hospital and outpatient centre], n.d., url
379

134

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

7.2.5.

Resources(a) Staff

There has been a gradual decline in the number of mental health professionals in Russia: in
2015, there was a rate of 8.479 psychiatrists per 100 000 population, and 4.638
psychologists and 2.404 social workers per 100 000 population. 386 There was an estimatedrate of 0.10 psychotherapists per 10 000 population in 2015 387 and 0.09 per population in
2018. 388 In 2013, 1 659 psychotherapists were employed in Russia, whilst this number
decreased to 1 440 in 2015 and 1 357 in 2018. Similarly, the number of social workers
servicing psychiatric facilities dropped from 1 637 in 2013 and to 1 559 in 2015, but the
number of psychologists increased at both inpatient and outpatient facilities. 389
385F

386F

387F

388F

An American NGO that addresses extreme poverty, The Borgen Project, has stated thatpsychologists and social workers are not found in thirteen Russian regions. 390
389F(b) Facilities
The federal budget funds forensic psychiatric hospitals and partly federal level facilities. It
pays for three psychiatric research institutes, two paediatric sanatoria and nine psychiatrichospitals, out of which only one is outside the forensic psychiatry system. Other psychiatricfacilities are paid for out of regional grants and subsidies funded by regional or local
government based on what services they offer. An official report on a third wave of mental
health sector reforms in the 1900s-2000s, that was carried out in 2007-2012, states thatwhilst new or reconstructed forensic hospitals were built, there was no other building activity
for other types of psychiatric with one exception. It was an occupational therapy department
at one psychiatric dispensary in one city. Just a few Federal Research Institutions of
Psychiatry were built. 391
390F

7.2.6.

Discrimination against ‘narcology’ 392 patients
391F

It was reported in a commentary article written by Canadian authors that “narcology”
patients (patients with drug addictions) are ‘punished’ due to a Russian government attitudeof ‘social intolerance’ that legitimises ill treatment of users. In practice this means that thispatient group faces varying and systematic human rights violations, for example, being

WHO, Human Resources Data by Country, 25 April 2019, url
Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, p. 123
388
Russia, MoH, Ресурсы и деятельность медицинских организаций здравоохранения, Часть I, Медицинские
кадры [Resources and activity of medical organisations, Part I, Medical personnel], 31 July 2019, url, p. 88
389
Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, p. 123;
Russia, MoH, Ресурсы и деятельность медицинских организаций здравоохранения, Часть I, Медицинские
кадры [Resources and activity of medical organisations, Part I, Medical personnel], 31 July 2019, url, p. 88
390
Borgen Project, 10 Facts About Healthcare in the Russian Federation, 18 June 2020, url
391
Kolpakova, S.V., A journey through Russian mental health care: A review and evaluation, 19 May 2019, url, p. 118
392Drug and alcohol abuse, a field of psychiatric medicine, is called ‘narcology’ in Russia
386
387

135

EUROPEAN UNION AGENCY FOR ASYLUM

entered into drug prevention methods and treatments which are scientifically unsound andideological, and also having essential medications and health services withheld from them. 393
392F

7.3.

Insurance and national programmes

Like healthcare for the population at large, mental health coverage is provided under statefunded health insurance system, the OMS. Access to urgent psychiatric care, including
hospital admissions, is provided free to all patients in need. Non-urgent care is provided to
Russian citizens, permanent legal residents or long-term visa holders, and/or legally
employed people who hold an OMS policy and have a registered address in Russia.
Returning Russian migrants and foreign migrants to Russia are covered by OMS once they
are registered as legal residents. 394
393F

Mental healthcare is funded at the federal level but also regional level, and in theory,
includes free prescription medications. In practice, medicines are free for inpatient stays inpublic hospitals, but not in outpatient settings where patients have to self-fund the costs. 395
394F

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the conditions that entitle patients to receive free or discounted
medications from the state. This includes some psychiatric patients, such as those withschizophrenia and some in outpatient settings.
Most psychiatric medications are included in the VEDL. 396 However, reimbursement forprescriptions is purportedly so difficult to get that many patients have to self-fund it. 397
Insufficient funding remains a serious problem today: the government health spending is still
below 6 % (the WHO recommended minimum) and is around 4 % gross domestic product. 398
395F

396F

397F

Different forms of private medical insurance, including VMI, are available to those able toafford them. However, stateless people and internally displaced people are obliged to pay for
private healthcare as they are not covered by the OMS policy. People on low incomes areforced to rely on the public mental healthcare system out of lack of choice. 399
398F

Golichenko, M. and Ka Hon Chu, S., Human rights in patient care: drug treatment and punishment in Russia, 2018,
url, p. 4
394
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
395 Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
396
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019
№ 2406-р Об утверждении перечня жизненно необходимых и важнейших лекарственных препаратов длямедицинского применения на 2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of thelist of vital and essential drugs for medical use for 2020’], 12 October 2019, url, pp. 260-261
397
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
398
Baranov, A. et al., Paediatrics in Russia: Past, Present and Future, 2017, url, p. 776
399
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
393

136

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Table 31 shows the psychiatric services that are covered by OMS and private medical
insurance, including VMI.
Programme

Focus

Requirements

Mandatory
public healthinsurance(OMS)

Russiancitizens andpermanent
residents,
includingreturning
Russianmigrants.

1. Public/Federal

Migrants fromex-Soviet
countries canobtain an
OMS policy
through theiremployers if
the employer
agrees.

2. Employers financeOMS throughcontributions, 2-3 %of salary goes intosocial tax, apercentage of whichis paid into a national
Russian healthcare
fund. Once paid, theemployee has theright to free medicalcare from public
Russian healthcare
clinics.

Scope ofcoverage

Paediatric services
coveredCovershealthcare
benefits for all
peopleeligible for
OMS

Services included:

3. People who
cannot work and do
not contribute toOMI (e.g.
unemployed,
pensioners, children,
sick people) can still
access free basic
healthcare. 400
39 9F

400

Expatica, Healthcare in Russia: the Russian healthcare system explained, n.d., url

137

•
•

•
•

Emergency mental
healthcare
Non-urgent mental
healthcare services,
includingconsultation for
diagnostic,
treatment,
psychopreventive
and rehabilitation
services at inpatientand outpatient
facilities
Inpatient
medications
Outpatient
medications forpatients withschizophrenia andthose with mental
illnesses engaged inlabour therapy• social support
andemployment
assistance forpeople withmental healthconditions• resolution ofcustody-related
problems• legalconsultations
and other typesof legal aid areprovided atmental andpsychoneurologi
cal facilities• social care andnursing fordisabled andEUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

Paediatric services
covered••elderly people
with mental
healthconditions
education forpeople withdisabilities andchildren withmental healthconditions
psychiatricsupport in theevent of natural
disasters andcatastrophes

Services excluded:••

Government
healthinsurance
programmes
for employeesof specialist
agencies, e.g.
law
enforcement

Employees of
selected
government
agencies andcompanies

For theregisteredindividual andsometimes
their families

138

Outpatient
medications
Treatment for mildand moderatemental healthconditions

Information not publicly
available

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Private sector
healthinsurance,
including VMI

For theregisteredindividual
and/or theirfamily (if an
employerpurchases
VMI for an
employee, it
usually only
covers that
individual andnot theirfamily)Available services
depending on thehospital or medical
facility that the insurance
covers.
An example list is:
•

•

•

•
•
•
•
•

139

Outpatient
treatments for
personality
disorders, mooddisorders,schizophrenia,
obsessivecompulsive disorder,
self-harm andsuicidal behaviour,
sexual dysfunctions,old age
psychiatry/geriatrics
and some aspects ofcounselling foralcohol problems
Cognitive
behavioural therapy,
dialectical behaviour
therapy, schema
therapy, family
therapy, couples
therapy andemotionally focused
therapy
Diagnostic testing,including for severe
psychiatric illness,
via blood testing,hormone andimmune systemtests
EEG testing
EEG monitoring
Doppler ultrasoundelectroconvulsive
therapy
Transcranial
magnetic stimulation(a procedure where
magnetic fields areused to stimulate
nerve cells in thebrain) and care foryoung patients with
autism,EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

Paediatric services
coveredschizophrenia andeating disorders
Diagnostic treatment
and nursing areoffered for patientswith severe mental
health states
a comprehensive
care package forolder age psychiatricpatients (geriatrics)
other treatments foradolescent eating
disorders,obsessivecompulsive disorder(OCD), addiction;
severe depression,
attention deficit
hyperactivity
disorder, and autism

•

•

•

Table 31: Public and private healthcare insurance coverage in Russia 401
400F

7.3.1.

Services provided by international donor programmes

The search conducted for this MedCOI report found no evidence of psychiatric services
being provided by international donors.

7.4.

Cost of treatment

7.4.1.

Overview

Mental healthcare is provided free of charge under the OMS to all eligible patients in Russia.
Treatment prices are 30-50 % higher in the private sector. Costs are also higher in wealthierregions than poorer ones. Public facilities must adhere to official published prices whilst
prices in private facilities are regulated by the private healthcare market. 402
401F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons402
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
401

140

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

7.4.2.

Methodology of data collection on treatment prices

The price of treatments, diagnostics and equipment were collected using an initial internet
search for their availability and costs in Moscow. The websites are shown in Table 32.
Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

https://zoon.ru/

Aggregator of information on prices for various services(including medical)

https://www.krasotaimedicina.ru/

Aggregator of prices and availability of the medical services(surgery, diagnostics, etc.) in Moscow from a lot of private clinics

https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/

https://market.yandex.ru/

Cost of equipment: overview and access to offers from many
online and offline shops (including medical equipment,
orthopaedic supplies, rehabilitation devices, etc.)

Table 32: Websites used to identify price of treatments, diagnostics and equipment

The most common prices were compared, and the median price agreed and included inTable 33 and Table 34.

Treatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price RUB

Privateinpatienttreatment
price RUB

Reimbursement/
specialprogramme/free/comments

Consultation by
psychiatrist

FOC

FOC

6 928

6 928

-

Consultation by
psychologist

FOC

FOC

3 897

3 897

-

141

EUROPEAN UNION AGENCY FOR ASYLUM

Treatment

Publicoutpatient
treatment
price

Publicinpatienttreatment
price

Privateoutpatient
treatment
price RUB

Privateinpatienttreatment
price RUB

Reimbursement/
specialprogramme/free/comments

Note
FOC:

Free of charge to eligible patients

Table 33: Cost of treatments for psychiatric conditions in the public and private health systems in Russia I

Reimbursement/
specialprogramme/
free/ comments

Treatment

Public treatment
price

Private treatment
price RUB

Public outpatient
treatment price
RUB

Psychotherapy
session withcognitive
behaviouraltherapy

FOC

FOC

658

-

Psychotherapy
session with
EMDR

Not available

103 919

N/A-

Admission in
psychiatric clinic(daily rates) for
acute situation[includes initial
review by
specialist, bed
and food,
treatment:
medications,
psychotherapy]

FOC

6 928 per day

4 632

-

142

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Treatment

Public treatment
price

Private treatment
price RUB

Public outpatient
treatment price
RUB

Reimbursement/
specialprogramme/
free/ comments

Admission in
psychiatricinstitution for
long-term stay
(monthly and/or
daily rates) [Daily
rate includes
bed and food,entertainment,
medicalsupervision by
nurse and GP,
rehabilitation.
Medications,consultation by
specialists –extra]

FOC

56 289 permonth / 22 perday

868 580-

Consultation by(psychiatric)
nurse at home(hourly and dailyrates)

Not available

6 062 per visit

1 665

-

Psychiatrictreatment of
alcohol drug
addiction in
specialized clinic(detox.); daily
admission rate

FOC

From 5 196 per
day

4 632

-

Psychiatrictreatment ofdrug addiction ina specialized
clinic (rehab.);daily admission
rate

FOC

From 2 165 per
day

463

--

143

EUROPEAN UNION AGENCY FOR ASYLUM

Treatment

Public treatment
price

Private treatment
price RUB

Public outpatient
treatment price
RUB

Reimbursement/
specialprogramme/
free/ comments

Psychiatrictreatment ofdrug addiction;
outpatient care;consultation rate

FOC

2 944

658

-

Table 34: Cost of treatments for psychiatric conditions in the public and private health systems in Russia II

7.5.

Cost of medication

7.5.1.

Overview

Psychiatric medicines are generally accessible across the whole of the Russian Federation intheory but availability is much better in urban and particularly metropolitan regions.
Pharmacies, particularly inter-hospital pharmacies, stockpile medicines to mitigate specificshortages. The major psychiatric medicines are registered in Russia and only registereddrugs can be legally produced or imported into the country. Some but not all are included on
the VEDL. 403 Prices for medications on the VEDL are regulated and strictly controlled by thestate, and those prescribed in psychiatric facilities cannot exceed the formal prices. The
registration process is lengthy, expensive and cumbersome and it may limit access to newer
medications developed in other countries. In recent years, considerable efforts have been
made by the state to encourage medications production in Russia and limit dependency on
imports. 404
402F

403F

7.5.2.

Methodology of data collection on drug prices

The prices of drugs for psychiatric conditions were collected using an initial internet search
for their availability and costs in Moscow. The websites used for the initial search are shownin Table 35.

Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 260-261
404
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
403

144

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTName and url of website

Subject matter for prices

https://aptekamos.ru/ 405

Aggregator of prices and availability of the medications in
Moscow pharmacies

https://www.eapteka.ru/

Big online pharmacy with option of ordering medications thatare rarehttps://apteka.ru/

Big online pharmacy with option of ordering medications thatare rarehttps://grls.rosminzdrav.ru/grls.aspx

State Register of Medicine

404F

Table 35: Websites used in initial search for drug availabilities and costs in Moscow

The most common prices were compared, and the median price agreed and included inTable 36. Each medication was checked on the VEDL. 406 If medication was not found under ageneric name from the internet search, it was checked against the State Register ofMedicines.
405F

DosageForm

Number ofunits
in thecontainer

Amitriptyline

25 mg

Tablets50

52

Pharmacy

Includedin VEDL

Citalopram

10 mg,
20 mg

Tablets30

346

Pharmacy

N/A

Generic Name

Brand
name

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

AntidepressantsNote from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 260-261
405

406

145

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Clomipramine

Anafranil®

25 mg

Tablets30

303

Pharmacy

Includedin VEDL

Duloxetine

30 mg,
60 mg

Tablets

28

3464

Pharmacy

N/A

Escitalopram

10 mg

Tablets28

866

Pharmacy

N/A

Fluoxetine

20 mg

Capsule20

87

Pharmacy

Includedin VEDL

Fluvoxamine

Fevarin®

50 mg,
100 mgTablets15

866

Pharmacy

N/A

Imipramine

Melipramin®

25 mg

Tablets50

390

Pharmacy

Includedin VEDL

20 mg

Tablets30

433

Pharmacy

Includedin VEDLParoxetine

Sertraline

Zoloft®

100 mgTablets28

606

Pharmacy

Includedin VEDL

Trazodone

Trittiko®

150 mgTablets

20

779

Pharmacy

N/A

Tablets30

866

Pharmacy

Includedin VEDL

Medication off-label use for PTSD

Alfuzosin (alsowith prostatecomplaints)

Dalfaz®

10 mg

146

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

DosageForm

Number ofunits
in thecontainer

Lamotrigine(also
antiepileptic)

100 mgTablets30

693

Pharmacy

N/A

Topiramate(also
antiepileptic)

25 mg

Capsule,tablets60

693

Pharmacy

Includedin VEDL

Generic Name

Brand
name

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Antipsychotics; classic

Amisulpride

Solian®

200 mgTablets30

3 984

Pharmacy

N/A

Chlorpromazine

Aminazin®

25 mg

Tablets10173

Pharmacy

Includedin VEDL

5 mg

Tablets50

61

Pharmacy

Includedin VEDL

2mg

Tablets50

87

Pharmacy

Includedin VEDLHaloperidol

Zuclopenthixol

Сlopixol®

Antipsychotics; modern atypicalClozapine

100 mgTablets50

1 472

Pharmacy

N/A

Olanzapine

10 mg

Tablets28

2 511

Pharmacy

Includedin VEDL

Quetiapine

25 mg

Tablets60

1 039

Pharmacy

Includedin VEDL

2 mg

Tablets20

346

Pharmacy

Includedin VEDL

Risperidone

Rispolept®

147

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Depot injections with classic antipsychotics

Flupentixol
decanoate
depot injection

20 mg/
ml

Inject-ions

10

1 819

Pharmacy

Includedin VEDL

Fluphenazine
decanoate
depot injection

25 mg/
ml

Inject-ions

5433

Pharmacy

Includedin VEDLHaloperidol
decanoate
depot injection

50 mg/
ml

Inject-ions

5346

Pharmacy

Includedin VEDL

200 mg/
1 ml

Inject-ions

1260

Pharmacy

Includedin VEDL

Zuclopenthixol
decanoate
depot injection

Fluanxol®

Clopixol®

Depot injections with modern atypical antipsychotics

Paliperidone
palmitate
depot injection

Xeplion®;Trevicta®

50 mg/0.5 ml

Suspension for
injection

1

9 959

Pharmacy

Includedin VEDL

Risperidone
depot injection

Rispolept® Consta®

50 mg

Powderfor
injections

1

4 590

Pharmacy

Includedin VEDL

0.5 mgTablets30

87

Pharmacy

Includedin VEDL

Anxiolytics

Clonazepam

148

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric Name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Lorazepam

Lorafen®

1 mg

Tablets25

216

Pharmacy

Includedin VEDL

Medication for bipolar disorder/ manic depression

Carbamazepine (alsoantiepileptic)

Lithiumcarbonate

Sedalit®

200 mgTablets50

173

Pharmacy

Includedin VEDL

300 mgTablets

50

73

Pharmacy

N/A

Medication for sleeping disorder; sedatives

Melatonin

3 mg

Tablets30

433

Pharmacy

N/A

Nitrazepam

5 mg

Tablets

20

87 (byorder
only)

Pharmacy

Includedin VEDL

7.5 mgTablets20

173

Pharmacy

Includedin VEDL

Zopiclone

Somnol®

Medication to treat side effects of antipsychotics/ anti parkinsonism

Biperidene

Akineton®

2 mg

Tablets100

260

Pharmacy

Includedin VEDL

10

not
found

None foundon sale in
Moscow

Includedin VEDL

Medication for opioid addiction / substitution therapy

Buprenorphine

Bupranal®

0.3
mg/ml

Injections

149

EUROPEAN UNION AGENCY FOR ASYLUMGeneric Name

Buprenorphine +naloxone

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Bupraxon®

0.216
mg +
0.222 mg

Tablets

10

not
found

None foundon sale in
Moscow

N/A

Medication for alcohol addiction

Disulfiram

Teturam®

150 mgTablets50

303

Pharmacy

N/A

Nalmefene

Selinkro®

18 mg

Tablets14

3 984

Pharmacy

N/A

5 %, 1 ml

Inject-ions

1043

Pharmacy

Includedin VEDL

Vitamin B1(thiamine)

Table 36: Cost of drugs for psychiatric conditions in the public and private health systems in Russia

7.6.

NGOs

Whilst the search conducted for this MedCOI report found no evidence of large INGOs orfoundations having programmes to support mental health patients in Russia, there isevidence of plentiful domestic Russian NGO and non-commercial organisation (NCO) activity
around mental illness. They typically get involved in the provision of care to psychiatricpatients who are either institutionalised, or outpatients who require support as their needs are
not fully met. 407 Their help rarely includes the provision of medications because mostpsychiatric medicines medications are only available on prescription and/or are strictly
controlled and/or restricted. 408 Some examples of NGOs are listed below.
406F

407F

The Regional Society of Disabled People Perspektiva was established in 1997, is based in
Moscow and covers 15 regions. It supports families and children with severe mental healthdisabilities in all areas of daily life, including at State Orphanage No. 4 for the Disabled in

Author interpretation based on the sources here.
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
407

408

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Pavlovsk. It provides help with job placements, inclusive education, sports activities and legal
assistance. 409
408F

Outsiderville is a non-profit organisation helping artists with mental disabilities through art
and art therapy. Working with art studios and therapists within psychiatric institutions,specialist schools and elsewhere, their aim is to promote social rehabilitation andindependence through art exhibitions and projects aimed at raising awareness of mental
health issues to create a more tolerant society. They also run lectures on topics, such as the
dialogue of talent and ‘madness’. They supply artistic tools, including paper, brushes andpaint and support talented artists to be financially sustainable through promotion and sale oftheir work. Artists regularly take part in local and international exhibitions. 410
409F

Anton Tut Ryadom (Anton’s Right Here) helps adults with autism spectrum disorder.
Founded in 2013 it is the only social formation, education and creative activity centre for
adults with autism spectrum disorder. It offers a culinary workshop to help students develop
their cooking skills. 411 After the outbreak of the pandemic it launched a meal delivery service,
Kitchen’s Right Here, preparing simple healthy food and sent free meals to doctors working
with COVID-19 patients in Moscow’s Botkin Hospital. Proceeds help finance the centre andprovide students with a place to go during and after the pandemic. 412
410F

411F

In 2020, the Union for Mental Health Russia launched a 2-month company to support NGOs
in coping with the consequences of the COVID-19 pandemic. The aim was to give information
on a weekly basis about non-profit organisations helping people with mental disorders as wellas to provide essential goods, art materials, medicines and payment of utility bills. 413
412F

Perspektiva, Russian Disability NGO ‘Perspektiva’, n.d., url
Outsiderville, About, n.d., url
411
Wilson Center, Russian NGOs on the Covid-19 Frontlines, 26 May 2020, url
412
Covid-19 Action Hub, The Culinary Workshop at the Russian Organisation Anton Tut Ryadom Donates Meals to
Medical Staff at Botkin Hospital, n.d., url
413
World Psychiatric Association, Union for Mental Health, III Congress on Mental Health, Meeting the Needs of the
21st Century, October 2021, url
409
410

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EUROPEAN UNION AGENCY FOR ASYLUM

8. Neurology
General information

8.1.

Neurology is a part of medicine that specialises in the study, diagnosis, treatment andprevention of diseases of the nervous system. 414 In the context of this report, neurology refers
to epilepsy, cerebral vascular accident such as stroke (e.g. a blocked artery: ischaemic strokeor leaking or bursting of a blood vessel: haemorrhagic stroke), multiple sclerosis andParkinson’s disease.
413F

8.1.1.

Epidemiological context

There are very few official epidemiological statistics available on the burden of neurologicalconditions in Russia. According to Rosstat, Russia’s Federal State Statistics Service, theestimated annual prevalence of neurological disorders was 8 568 900 cases with anestimated prevalence rate of 5 836 cases per 100 000 population in 2018. There was an
estimated annual incidence of 2 167 700 cases and an estimated incidence rate of 1 465
cases per 100 000 population in 2018. 415 These figures are comprised of aggregated data for
the following diseases: Diseases of the nervous system: Epilepsy, status epilepticus;
Inflammatory diseases of the central nervous system; Systemic atrophies, affecting mainly thecentral nervous system; Extrapyramidal and other movement disorders; Other degenerative
diseases of the nervous system; Demyelinating diseases of the central nervous system;
Multiple sclerosis; episodic and paroxysmal disorders; transient cerebral ischaemic attacks
and related syndromes; and Cerebral palsy and other paralytic syndromes. 416
414F

415F

8.1.2.

National policies and programmes

There is little published information on national policies and programmes for neurology inRussia. 417 The federal government started a project in 2016 called ‘Stop Stroke’, which was
supported by the MoH. It comprised primarily of a health education programme for physicians
and the general public. 418 A government initiative, the Russian Federal Vascular Disease
Control Project was foreseen to run from October 2018 until December 2024 according to
416F

417F

UR Medicine, Highland Hospital, What is a neurologist?, n.d., url
Rosstat, Здравоохранение в России. 2019: Статистический сборник [Healthcare in Russia – 2019 Statistical
Yearbook], 2019, url
416
Contact 2, Research Assistant, email, July-September 2021. The person wishes to remain anonymous for security
reasons
417
Author interpretation based on experience of the research process.
418
Russia, MoH, Федеральный проект «Стоп-Инсульт»: жизнь и здоровье людей – главный приоритет [Federal
project ‘Stop-Stroke’: life and health of people is the main priority], 25 April 2016, url
414

415

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Russia’s MoH. 419 It was confirmed active in 2021. 420 It funded a number of specialist Vascular
Disease Centres across the country. 421
418F

419F

420F

The Strategy for Development of Healthcare in the Russian Federation until 2025 identifies
the current high prevalence of neurodegenerative diseases as a public health threat tonational security. 422
421F

8.1.3.

Key facilities for the treatment of neurological conditions

Table 37 lists some neurology treatment centres from both the public and private healthcare
sectors.
State or city

Facility nameFacility type
Public1

MoscowSpecialisms

PrivateNational Medical
X
Research Centre forwith paid
Neurosurgery named
services
after N.N.
Burdenko/Burdenko
Neurosurgery Institute

Largest neurological clinic in
Russia (world ranking 478), leading
research
centre in neurology andneuroscience in Russia and thelargest neurological clinic in
Russia with 780 academic andmedical staff.
Extensive range of neurological
specialisms. 423
422F

2

Tyumen(Urals)Federal Centre of
Neurosurgery

3

Moscow

European Medical
Centre4

StPetersburg

Institute of
Neurosurgery

X

X

Multidisciplinary clinic

Russia, MoH, Федеральный проект «Борьба с сердечно-сосудистыми заболеваниями» [Federal project ‘Fightagainst cardiovascular diseases’], 20 July 2019, url, p. 1
420
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons421
Shendyapina, M. et al., Cognitive assessment and rehabilitation tools for stroke and dementia: An online surveyof Russian speaking clinicians, 16 April 2020, url, p. 7
422
Russia, Administration of the Russian President, Указ Президента Российской Федерации №254 от
06.06.2019 «О стратегии развития здравоохранения в Российской Федерации на период до 2025 года»[Decree of the President of the Russian Federation No. 254 of 6 June 2019 ‘On the Strategy for Development of
Healthcare in the Russian Federation until 2025’], 2019, url
423Научный центр неврологии [Scientific Centre of Neurology], Neurology and Neurosurgery Clinic, n.d., url
419

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EUROPEAN UNION AGENCY FOR ASYLUMState or city

Facility nameFacility type
PublicSpecialisms

Private5

Moscow

Moscow City Hospital
No. 12

X

Outpatient epilepsy service;
management of newly diagnosedand chronic epilepsy patients

6

Moscow

Russian Medical State
University in Moscow

X

Houses a neurological centre for alarge district of Moscow with apopulation of about 1 million.
Outpatient department for
movement disorders, provides
care for patients with idiopathic
Parkinson’s disease. 424
423F

Table 37: Neurology treatment centres in Russia from the public and private healthcare sectors 425
424F

8.2.

Access to treatment

8.2.1.

Structure and organisation of neurology healthcare in Russia(a) Public healthcare system

There is a severe shortage of published material describing Russia’s neurology healthcare
system. 426 Neurology is predominantly practised, and neurological conditions treated, in thetertiary healthcare sector. According to a 2015 study, there were several specialised vascular
centres that catered for cerebral vascular operations, as well as urgent neurosurgicalprocedures for patients with head injuries. 427
425F

426F

Non-urgent care is provided by neurologists through the primary healthcare sector in local
polyclinics. In rural areas, patients go to their general practitioner (GP) or feldsher (physicians’
assistant) in the first instance, and are then referred to a specialist neurologist if necessary.
Neurologists are located in many public polyclinics. As they are not necessarily affiliated witha hospital or inpatient centre, patients may seek a consultation with one directly. 428 Oncepatients receive a diagnosis and require treatment or ongoing monitoring for a diagnosed
427F

Winter, Y. et al., Costs of Illness in a Russian Cohort of Patients with Parkinson’s Disease, 17 September 2012, url,
p. 572425
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons426
Author interpretation based on experience of the research process.
427
Konovalov, A. and Potapov, A. A., Neurosurgery in Russia and USSR, 28 March 2015, url, p. 3
428
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
424

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

chronic neurological condition, they may be seen at specialised outpatient clinics/hospitals. 429
Hospital admissions are limited to acute and intensive disease management. 430
428F

429F

A range of neurological diagnoses and treatments are available in Russia. 431 As of 2015, theseincluded urgent neurosurgical care for patients with head injuries, cerebral vascular disease(e.g. ischaemic and haemorrhagic strokes), subarachnoid parenchymatous haemorrhages(bleedings) caused by arterial aneurysms and brain arteriovenous malformations andothers. 432 Evidence from 2005 found that patients with epilepsy were sometimes treated,voluntarily or involuntarily, within the psychiatric healthcare system, and were categorically
included under the statistical classification of ‘mental disorders of a non-psychotic nature’and sub-category of ‘organic non-psychotic disorders’ for the purposes of disease
surveillance. 433
430F

431F

432F

As with healthcare for other disease groups in Russia, critiques have been levied at some
aspects of neurological healthcare due to systematic flaws, for example in primary
healthcare with the intense focus on hospital treatments for neurological conditions. 434 An
Internet survey from 2016 of 171 DPs and GPs in 14 Russian regions found that DPs did notoffer patients sufficient follow-up care after leaving hospital, resulting in a lack of continuity ofcare in the case of strokes and major traumas. 435 Stroke patients are entitled to rehabilitative
care under the Russian state’s PSG, its universal coverage programme, considering thatstroke holds first place in a list of causes that lead to a primarily disability. 436 Over 1 million
people in Russia have had a stroke, with one third being of working age and just 25 %returning to employment/work after their stroke. 437 Even so, rehabilitation care for stroke
patients regularly fails to emerge. 438
433F

434F

435F

436F

437F

(b) Private healthcare system
Patients with private health insurance, including VMI, can choose from a range of private
hospitals to receive treatments and services for neurological conditions. 439 Two examples
are European Medical Centre in Moscow, which offers a range of paid services, including
functional neurosurgery, diagnostics of memory deficits and diagnostics of multiple sclerosis,
438F

Mizinova, M. et al., The direct costs of epilepsy in Russia. A prospective cost-of-illness study from a single centerin Moscow, 26 October 2011, url, pp. 125-126; Winter, Y. et al., Costs of Illness in a Russian Cohort of Patients with
Parkinson’s Disease, 17 September 2012, url, p. 572
430
Mizinova, M. et al., The direct costs of epilepsy in Russia. A prospective cost-of-illness study from a single centerin Moscow, 26 October 2011, url, p. 123
431
Author interpretation based on the sources discussed.
432
Konovalov, A. and Potapov, A. A., Neurosurgery in Russia and USSR, 28 March 2015, url, p. 3
433
WHO, Fostering Epilepsy in Care in Europe, n.d., url, p. 17; Contact 1, Medical Doctor and local consultant, email,July-September 2021. The person wishes to remain anonymous for security reasons434
Author interpretation based on the sources discussed.
435
Sheiman, I. and Shevski, V., Two Models of Primary Health Care Development: Russia vs. Central and Eastern
European Countries, Higher School of Economics, 2017, url, p. 8436
Somanthan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, June 2018, url, p. 35
437
Piradov, M.A. et al., Инсульт Пошаговая Инструкция [Stroke, Step by Step Instruction], 2019, url, p. 1
438
Somanthan, A. et al., Universal Health Coverage in Russia: Extending Coverage for the Poor in the Post-Soviet
Era, June 2018, url, p. 35
439
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
429

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EUROPEAN UNION AGENCY FOR ASYLUM

and the paid services component of the National Medical Research Centre for Neurosurgery
named after N.N. Burdenko/Burdenko Neurosurgery Institute. 440
439F

8.2.2.

Resources(a) Neurology facilities

In 2021, there were 151 Regional Vascular Centres with 16 097 beds in total across all of
Russia’s federal subjects except for two - Nenetz and Chukotskiy autonomous districts. 441 A
2017 review of neurosurgical facilities states that in that year there were 334 neurosurgicaldepartments in Russia, out of which 49 at federal neurosurgical centres (15 %) and 285 inregional hospitals (85 %). Together, these facilities offered 13 208 patient beds, with 1 271
beds (10 %) in federal centres and 11 937 (90 %) in regional hospitals. 442 While neurology
treatment is accessible in all of Russia’s regions, not all patients have equal access,particularly those residing in rural or remote and scarcely populated areas. 443
440F

441F

442F

The volume of medical equipment at neurosurgical clinics around Russia is shown in Table
38. The number of neurosurgical beds per unit of equipment at federal centres proved to be
1.5-2 times less than in regional hospitals. 444
443F

Number available in Russia,
2017

Item of equipment
Computed tomographs (CT scanning)

501

Magnetic-resonance imaging tomographs (MRI scanning)

298
209

Serialographic units (serial radiography: the technique of making
radiographs in rapid sequence for the study of high-speed
phenomena, such as the flow of blood through a brain artery)
Surgery microscopes

305

Navigation systems

171

Endoscopy tables

201

Stereotactic instruments

37

European Medical Centre, Hospital treatments, n.d., url; Национальный медицинский исследовательский
центр нейрохирургии имени академика Н.Н.Бурденко [National Medical Research Center for Neurosurgery
named after Academician N.N. Burdenko], Платные услуги [Paid services], n.d., url
441
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons442
Krylov, V.V. et al., Neurosurgery in the Russian Federation: The current state of neurosurgical service in the
Russian Federation, 2017, url, p. 4.
443
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons444
Krylov, V.V. et al., Neurosurgery in the Russian Federation: The current state of neurosurgical service in the
Russian Federation, 2017, url, p. 4
440

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Number available in Russia,
2017

Item of equipment
C-arm equipment (a C-arm is an imaging scanner intensifier and is usedprimarily for fluoroscopic intraoperative imaging during surgical andemergency care procedures. The devices provide high-resolution Xray images in real time, thus allowing the physician to monitor progress
and immediately make any corrections)

295

Table 38: Volume of neurosurgical equipment available in Russia 445
444F(b) Healthcare staff
In Konovalov and Potapov’s older account from 2015, there were 2 900 neurosurgeons
working actively in Russia. 446 By the time of the review of neurosurgical facilities in 2017, thishad diminished to 2 487 neurosurgeons, with 239 neurosurgeons (10 %) at federal centres
and 2 248 (90 %) at regional hospitals. Of these, 78 % were employed at neurosurgicaldepartments. In addition, the number of beds per one neurosurgeon in federal and regional
hospitals was similar. 447 Government statistics indicated that there were 28 610 neurologists
and 21 959 psychiatrists in Russia at the close of 2018.
445F

446F

(c) Limitations on access to healthcare for patients with neurologicalconditions
Patients on low incomes must rely on the availability of treatment on the public healthsystem. If they live in rural or remote, scarcely populated areas, they often have to travel
distances to access appropriate care with travel expenses not covered by OMS. There arefewer healthcare resources, and the quality of care is lower. People with low incomesstruggle to afford medicines. Poorer regions have worse access to medications, particularly
imported and expensive ones. 448
447F

Patients experiencing several specific conditions face restricted access totreatments/medications, which are not funded by the government: those with amyotrophic
lateral sclerosis encounter limited access to treatment. 449 Those with spinal muscular atrophyand Duchenne myodystrophy can face barriers to accessing treatment and medications (suchas waiting lists), but can receive them for free from the state-funded Circle of Kindness
Foundation. Patients with Devic’s disease (Optic Neuromyelitis), Huntington's disease, or
448F

Krylov, V.V. et al., Neurosurgery in the Russian Federation: The current state of neurosurgical service in the
Russian Federation, 2017, url, p. 4.
446
Konovalov, A. and Potapov, A.A., Neurosurgery in Russia and USSR, 28 March 2015, url, p. 3447
Krylov, V. V. et al., Neurosurgery in the Russian Federation: The current state of neurosurgical service in the
Russian Federation, 2017, url, p. 4
448
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
449
All-Russian Union of Patients, Опрос: доступность государственных гарантий в сфере оказания
медицинской помощи и лекарственного обеспечения 2019 год, 23 December 2019, url, pp. 19-30; Circle ofKindness Foundation (Фонд «Круг добра»), Перечень тяжелых жизнеугрожающих и хронических заболеваний,в том числе редких (орфанных) заболеваний[List of severe life-threatening and chronic diseases, including rare(orphan) diseases], 29 July 2021, url
445

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EUROPEAN UNION AGENCY FOR ASYLUM

transthyretin familial amyloid polyneuropathy face limited access to treatment andmedications that are not included under the OMS at state or federal level. 450
449F

It is reported by Mizinova et al. (2016) that many patients with epilepsy have low access to
hospital facilities in spite of the severity of their illness. 451 A survey of public perceptions ofpeople with epilepsy conducted in Moscow and published in 2017, with a sample of 1 167
adult permanent residents revealed the stigma and prejudice that around half of respondents
attached to the disease. 452
450F

451F

A critical Russian-language article from 2019 pointed out that the main flaw in neurology inRussia is the poor quality of neurological training delivered at medical schools and in
neurology residencies, presumably at hospitals. 453 Additionally, a paper on patients withprimary progressive multiple sclerosis indicated that patients do not receive up-to-datetreatment and medications used were low in efficacy. 454
452F

453F

8.3.

Insurance and national programmes

Like healthcare for the population at large, neurology healthcare coverage is provided understate-funded health insurance system, the OMS. Healthcare is provided to Russian citizens,
permanent legal residents or long-term visa holders and/or legally employed people who
hold an OMS policy and have a registered address in Russia. Returning Russian migrants arecovered by OMS once they are registered as legal residents. Urgent care is universallyprovided for free. 455
454F

The OMS covers medication in inpatient settings, such as public hospitals, but not medicinesprescribed in outpatient settings. There is no universal medication coverage per se, but
certain categories of patients are entitled to subsidised or reduced prices if in receipt of avalid prescription, and some are also entitled to free medications. Insufficient funding
remains a serious problem today: government spending on health remains below 6 %—theWHO recommended minimum—and are still around 4 % gross domestic product. 456
455F

All-Russian Union of Patients, Опрос: доступность государственных гарантий в сфере оказания
медицинской помощи и лекарственного обеспечения 2019 год, 23 December 2019, url, pp. 19-30; Circle ofKindness Foundation (Фонд «Круг добра»), Перечень тяжелых жизнеугрожающих и хронических заболеваний,в том числе редких (орфанных) заболеваний [List of severe life-threatening and chronic diseases, including rare(orphan) diseases], 29 July 2021, url
451
Mizinova, M. et al., The direct costs of epilepsy in Russia. A prospective cost-of-illness study from a single centerin Moscow, 26 October 2011, url, pp. 125-126
452
Guekht, A. et al., Attitudes towards people with epilepsy in Moscow, 18 April 2017, url, p. 122
453
Petrukhin, A.S., Неврология в России: реальность и стремление к идеалу [Neurology in Russia: reality andstriving to ideal], 2019, url, pp. 7-10
454
Vlasvoc, Y.V. et al., Primary-progressive multiple sclerosis in Russia: a medical-sociological study involving
patients and neurologists, url, pp. 1-7
455
Russia, MoH, Основные показатели здравоохранения 2018 [Key health indicators 2018], 2018, url; Russia, MoH,Ресурсы и деятельность медицинских организаций [Resources and activities of medical organisations], 2018, url
456
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
450

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the specific neurological conditions that entitle patients toreceive free or discounted medications from the state.
Different forms of private medical insurance, including VMI, are available to those able toafford them, and enable those patients to receive healthcare at private healthcare facilities.
However, stateless people and internally displaced people are obliged to pay for private
healthcare as they are not covered by the OMS policy. People on low incomes are forced torely on the public healthcare system for neurological healthcare out of lack of choice. 457
Table 39 shows the healthcare services available for neurology patients via the OMS andprivate sector health insurance.
456F

Programme

Focus

Mandatory
public healthinsurance(OMS)

Russiancitizens andpermanent
residents,
includingreturning
Russianmigrants.

Requirements

1. Public/Federal
2. Employers financeOMS throughcontributions, 2 %to 3 % of salarygoes into social
tax, a percentageof which is paid
into a national
Migrants from
Russian healthcare
fund. Once paid,
ex-Soviet
the employee has
countries can
the right to freeobtain an OMS
medical care frompolicy throughpublic Russian
theirhealthcare clinics.
employers if
3. People who cannot
the employer
work and do notagrees.
contribute to OMI(e.g., unemployed,
pensioners,
children, sickpeople) can still
access free basic
healthcare.

Scope ofcoverage

Neurology services
coveredCovershealthcare
benefits for all
people eligible
for OMS

Services included:
Diagnostic tests:
CT, MRI, ultrasounddiagnosis.
Neurosurgery available(some through the OMS‘high-tech care package’:• Microneurosurgery• Endoscopic
techniques• Endovascularinterventions• Intraoperative
navigation andneurophysiologicalmonitoring• Paediatric• Vascular• Spinal• Functional andreconstructive
neurosurgery
And• Cerebral vascularpathology is also
widely treated (ongeneral care)• Treatment for
emergencies (such ashead injuries)• Treatment ofischaemic andhaemorrhagic strokes,
subarachnoid

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
457

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EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

Neurology services
coveredparenchymatous
haemorrhages causedby arterial aneurysms
and AVMs and otherServices excluded:• Outpatient
medications

Government
healthinsurance
programmes
for employeesof specialist
agencies, e.g.,
law
enforcement

Employees of
selected
government
agencies andcompanies

Private sector
healthinsurance,
includingvoluntary
medicalinsurance
(VMI)

160

For theregisteredindividual andsometimes
their families

Information not publicly
available

For theregisteredindividual
and/or theirfamily (if an
employerpurchases VMI
for anemployee, it
usually only
covers that
individual andnot theirfamily)Services available
depending on the hospitalor medical facility that theinsurance covers. An
indicative list is:• Dry spine traction• Epidural block• Kinesio taping• Manual therapy• Paravertebral
block• Physiotherapy• Underwater spine
traction• Brain tumour
removal• Corpectomy• Decompression• Craniotomy• Deep brain
stimulation
surgery• Discectomy• Excision ofMorton’s
Neuroma• Facial nerve
plasty• Facetectomy• Herniated discsurgery• Implantation ofbrain
neurostimulator• Neurosurgeon
consultation

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Requirements

Scope ofcoverage

Neurology services
covered•••Nucleoplasty(=minimallyinvasive, imageguided therapy
used to treat backpain and leg pain
caused byherniated discs)
Spinal fusion
Vertebroplasty

Table 39: Neurology cover in the public and private healthcare system 458
457F

8.3.1.

Services provided by international donor programmes

No information was found during the course of research on neurology healthcare provided
by international donors.

8.4.

Cost of treatment

8.4.1.

Overview

Neurology healthcare is provided free of charge under the OMS to all eligible patients in
Russia. Treatment prices are 30 % to 50 % higher in the private sector. Costs are also higher
in wealthier regions than poorer ones. Public facilities must adhere to official published prices
while prices in private facilities are regulated by the private healthcare market. 459 Table 41
and Table 42 show the cost of all relevant treatments for neurological conditions.
458F

8.4.2.

Methodology of data collection on treatment prices

The price of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. Websites used are shown in Table 40.
Name and url of website

Subject matter for prices: costs of consultations, diagnostics

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
459
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
458

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EUROPEAN UNION AGENCY FOR ASYLUM

Aggregator of information on prices for various services (including
medical)https://zoon.ru/

https://www.krasotaimedicina Aggregator of prices and availability of the medical services (surgery,.ru/
diagnostics, etc.) in Moscow from a lot of private clinics
https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/
https://market.yandex.ru/

Cost of equipment: overview and access to offers from many online
and offline shops (including medical equipment, orthopaedic supplies,
rehabilitation devices, etc.)

Table 40: Websites consulted for treatment prices

The most common prices were compared, and the median price agreed and included inTable 41 and Table 42.
Treatment price, EUR

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Consultation byneurologist

FOC

FOC

26

26

Consultation byneurosurgeon

FOC

FOC

70

70

Consultation byrehabilitation
medicine specialist

FOC

FOC

23

23

Reimbursement/special
programme/free/comments

Specialist

Note
FOC:

Free of charge to eligible patients

Table 41: Cost of treatments for neurological conditions in the public and private healthcare sectors in Russia

162

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Reimbursement/
specialprogramme/ free/comments

Publictreatment
price

Private treatment
price
RUB

Laboratory test: medication level inthe blood (e.g. for antipsychotics/for
antiepileptics and/or for lithium
carbonate)FOC

3 464 each
medication

Laboratory test of blood; INR e.g. incase of acenocoumarol anticlotting

FOC

693

Diagnostics by means of EEG

FOC

3 984

Diagnostics by means of computed
tomography (CT scan)

FOC

6 928 - brain CT
scan

**

Diagnostics by means of MRI

FOC

5 023 - brain MRI**

Diagnostics by means of electro
myography

FOC

6 928 - 1 hand orleg (all nerves)**

Diagnostics by means ofangiography (=arteriography) of
cerebral arteries

FOC

19 918**(Spinal tap) lumbar puncture

FOC

15 588

**

FOC

5 196

Laboratory tests

Medical diagnostic procedures

Treatment

Hospital admission in neurology
department (daily rates) *163

EUROPEAN UNION AGENCY FOR ASYLUM

Hospital admittance in neurosurgery
department (daily rates) **

FOC

5 196

**

Hospital admittance in (neuro)
rehabilitation department (daily rates)
*

FOC

5 196

**

Consultation by physical therapist

FOC

1 992

Notes
FOC:

Free of charge to eligible patients* Daily rate includes bed and food only, everything else is extra - tests - labs and imaging,physicians' consultations, medications and procedures** Queues and quotations foreseen in public sector
Table 42: Cost of treatments for neurological conditions in the public and private health systems in Russia

8.5.

Cost of medication

8.5.1.

Overview

Medicines for neurological conditions are generally accessible across the whole of Russia intheory but availability is much better in urban and particularly metropolitan regions.
Pharmacies, particularly inter-hospital pharmacies, stockpile medicines to mitigate specificshortages. The major medicines for neurological diseases are registered in Russia and only
registered drugs can be legally produced or imported into the country. Medications that are
not restricted or controlled in Russia can be brought (or delivered) to Russia for personaluse. 460 Many are included on the VEDL. 461 Prices for medications on the VEDL are regulated
and strictly controlled by the state. The registration process is lengthy, expensive andcumbersome and it may limit the availability of newer medications developed in othercountries. 462
459F

460F

461F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
461
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р, 12 October 2019,url, pp. 260-261
462
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
460

164

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTIn recent years, considerable efforts have been made by the state to encourage medications
production in Russia and limit dependency on imports. 463
462F

8.5.2.

Methodology of data collection on drug prices

The prices of drugs for neurological conditions were collected using an initial Internet search
for their availability and costs in Moscow. The websites used for the initial search are shownin Table 43.
Name and url of website

Subject matter for prices

https://aptekamos.ru/ 464

Aggregator of prices and availability of the medications in

463F

Moscow pharmacies
https://www.eapteka.ru/

Big online pharmacy with option of ordering medications that arerare

https://apteka.ru/

Big online pharmacy with option of ordering medications that arerare

https://grls.rosminzdrav.ru/grls.asp State Register of Medicinex
Table 43: Websites consulted for drug prices

The most common prices were compared, and the median price agreed and included inTable 44. Each medication was checked on the VEDL. 465 If medication was not found under ageneric name from the Internet search, it was checked against the State Register ofMedicines. If it was registered, a further Internet search for its availability was performed using
its brand name.
464F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons464
Note from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
465
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 2-261
463

165

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Antiepileptics (e.g. to reduce frequency of attacks)

Carbamazepine

200 mgTablets50

129

Pharmacy

Includedin VEDL

Clonazepam

0.5 mgTablets30

87

Pharmacy

Includedin VEDL

Gabapentin

Gabapentin®,
Convalis®,
Neurontin®

300 mgTablets50

693

Pharmacy

N/A

Lacosamide

Vimpat®

100 mgTablets14

1 126

Pharmacy

Includedin VEDL

Lamotrigine

Lamolept®;
Lamitor®

100 mgTablets30

779

Pharmacy

N/A

Levetiracetam

Levetinol®;
Konvilept®

1 000
mg

Tablets30

1 212

Pharmacy

Includedin VEDL

Oxcarbazepine

Trileptal®

150 mgTablets50

433

Pharmacy

Includedin VEDL

Phenytoin

Difenin®

117 mgTablets

20

61

Pharmacy

Includedin VEDL

75 mg

Capsule14

260

Pharmacy

Includedin VEDL

500 mgTablets30

260

Pharmacy

Pregabalin

166

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

Valproicacid ORvalproateOR
Depakine®

Convulex®;
Depakine®

Vigabatrin

Notregisteredin Russia,
but allowed
to useDosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ freeIncludedin VEDL

500 mgTablets

100

9 959

Pharmacy

N/A

Antiepileptics to treat acute attacks / status epilepticus

Diazepam(i.v.
injection for
epileptic
attacks)

5 mg/ml,
2 ml

Injections

587

Pharmacy

Includedin VEDL

Lora-zepam(i.v.
injection for
epileptic
attacks)

1 mg

Tablets25

216

Pharmacy

Includedin VEDLMidazolam(i.m.
injection for
epileptic
attacks)

5 mg/
ml, 3 ml

Injections

5

Not
found

Hospital

Includedin VEDL

100 mg/ml, 5 ml

Injections

5

1 559

Pharmacy

Includedin VEDL

ValproateOR
Depakine®
(i.v.
injection for

Convulex®;
Depakine®

167

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

Form

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

500 mgTablets

20

26

Pharmacy

Includedin VEDL

Dosageepileptic
attacks)

Anti-blood clotting medicines

Acetylsalicylicacid(Aspirin®)

ApixabanEliquis®

5 mg

Tablets60

2 598

Pharmacy

Includedin VEDL

Clopidogrel

Plavix®;
Clopidex®

75 mg

Tablets90

953

Pharmacy

Includedin VEDL

Dabigatran

Pradaxa®

110 mgCapsule60

3 291

Pharmacy

Includedin VEDLСlexan®

8 000
anti-ha
IU/0.8ml

Injections

10

3 637

Pharmacy

Includedin VEDL

5 000
IU/ml 5ml

Injections, gel

5

1 559

Pharmacy

Includedin VEDL

Enoxa-parin

Heparin

Prasugrel

Effient®

10 mg

Tablets28

4 157

Pharmacy

N/A

Rivaroxaban

Xarelto®

10 mg

Tablets28

3 291

Pharmacy

Includedin VEDL

2.5 mgTablets100

173

Pharmacy

Includedin VEDL

Warfarin

168

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

Medication for multiple sclerosis

Alemtuzumab

Lemtrada®

10
mg/ml 1.
2 ml

Injections1

348 128

Pharmacy

Includedin VEDL

Dimethyl
fumarate

Fluterio®;
Eumileo®

240 mgCapsule56

69 626

Pharmacy

Includedin VEDL

0.5 mgCapsule28

79 671

Pharmacy

Includedin VEDL

Fingo-limod

Glatiramer
acetateTimexon®

20
mg/ml 1ml

Injections

28

23 815

Pharmacy

Includedin VEDLInterferonbeta-1aTeberif®;
Rebif®

44 mcg /5 ml

Injections3

14 722

Pharmacy

Includedin VEDLInterferonbeta-1b

Infibeta®

9 600 000 IU
0.3 mg0.54 %
1.2 mlPowderfor
injecttions

15

16 887

Pharmacy

Includedin VEDLNatalizumab

Tizabri®

20
mg/ml 1
5 ml

Injections

1

32 908

Pharmacy

Includedin VEDL

500
mg/50
ml

Injections

1

67 547

Pharmacy

Includedin VEDL

Rituximab

Medication for Parkinson’s disease169

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainer

Amantadine

Midantan®;
Amantadine®

100 mgTablets30

286

Pharmacy

Includedin VEDLBromocriptine
mesilate

Abergin®

2.5 mgTablets30

346

Pharmacy

Bromocrip
tine

Levodopa +benserazide

Bensiel®;Madopar®

100 mg+ 25 mg

Capsule100693

Pharmacy

Includedin VEDL

Levodopa +carbidopa

Syndopa®;
Nakom®

250
mg + 25mg

Tablets50

199

Pharmacy

Includedin VEDL

Levodopa +carbidopa +entacapone

Stalevo®

100 mg
+ 200
mg +
25mg

Tablets30

3 810

Pharmacy

N/APramipexole

Mirapex®

1 mg

Tablets30

1 212

Pharmacy

Includedin VEDL

Rasagiline
mesilate

Azilect®

1 mg

Tablets30

6 495

Pharmacy

Includedin VEDL

Ropinirole

Requipmotutab®

4 mg

Tablets

28

779

Pharmacy

N/A

Safinamide

Not
registeredin Russia

170

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric
name

Brand
name

DosageForm

Number ofunits
in thecontainer

Selegilinehydrochloride

Yumex®;
Segan®

5 mg

Tablets

50, 60

Price
per
box,
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/ free

3 897

Pharmacy

N/A

Table 44: Cost of drugs for neurological conditions in the public and private health systems in Russia

8.6.

NGOs

There is no evidence of neurology healthcare being provided by international donors. Somedomestic NGOs provide assistance to such patients. 466
465F

Author interpretation based on experience of the research process; ORBI Stroke Foundation, Коронавирус(COVID-19): информация для тех, кого коснулся инсульт [Coronavirus (COVID-19): information for those affectedby a stroke], 26 March 2020, url
466

171

EUROPEAN UNION AGENCY FOR ASYLUM

9. Nephrology
General information

9.1.

Nephrology is a branch of medicine that studies kidney disease epidemiology, diagnosis andtreatment. 467 Nephrology in this report refers to kidney diseases: renal failure, e.g., withtreatment by dialysis.
466F

9.1.1.

Epidemiological context

Information about the prevalence of nephrological conditions in Russia is scarce, andindividual epidemiological studies of specific regional populations report different rates, as
partially explained by regional variations in healthcare infrastructure. 468 Additionally, one
study from 2018 claims that difficulty assessing the prevalence is due to the absence of aproperly organised and live surveillance system observing chronic kidney disease (CKD) andbecause rates are underestimated by health service staff in terms of ‘national passive
surveillance’. In tandem, official statistical reports do not employ a CKD code as a cause of
mortality in Russia despite the fact that the lack of CKD as a comorbid condition in diagnoses
is regularly noted in patients’ medical records. 469
467F

468F

Russia’s Federal State Statistics Service provides an estimated annual incidence rate of 4 480
cases of diseases of the urogenital system per 100 000 population in 2017. 470
469F

9.1.2.

National policies and programmes

There is a lack of information about Russia’s national policies and programmes covering
nephrology. 471
470F

The failure to acknowledge chronic kidney disease as a cause of mortality due to the lack of
a CKD code has resulted in the omission of a high-quality nephrological disease surveillance

Britannica, Nephrology, n.d., url
Bikbov, M.M. et al., Chronic kidney disease in Russia: the Ural eye and medical study, 25 May 2020, url, pp. 2, 6
469
Milchakov, K.S. et al., Management of chronic kidney disease in the Russian Federation: a critical review ofprevalence and preventive programmes, 4 April 2018, url, pp. 322-323
470
Rosstat, Население. Здравоохранение. Заболеваемость. Заболеваемость населения по основным
классам болезней [Population. Healthcare. Morbidity. Morbidity by major classes of diseases], 30 November 2021,
url
471
Author interpretation based on her experience of the research process and the resources discussed; Zakharova,E., History, Current Advances, Problems and Pitfalls of Nephrology in Russia, 31 August 2018, url, pp. 242, 244
467

468

172

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

system. There is also inadequate access to renal replacement therapy, see section Limitations
on access to healthcare for nephrological conditions. 472
471F

Milchakov, K.S. et al., Management of chronic kidney disease in the Russian Federation: a critical review ofprevalence and preventive programmes, 4 April 2018, url, pp. 322-323; Tchokhonelidze, I. and Zemchenkov, A.,
Current status, challenges, and the role of ISN in advancement of nephrology in the Newly Independent States andRussia region, 26 February 2019, url, p. 50
472

173

EUROPEAN UNION AGENCY FOR ASYLUM

9.1.3.

Key facilities for the treatment of nephrological conditions in
RussiaTable 45 lists some nephrology treatment centres in Russia from both the public and private
healthcare sectors.
State or city Facility nameFacility type
Public1

Moscow

Moscow City
Hospital No. 52(Moscow City
Clinical andScientific Centreof Nephrology
and Kidney
Transplant
Pathology)

Specialisms

PrivateThe first and largest nephrology centre
in Russia with a full cycle of patient,offering the following services:X

Provides management, diagnoses andtreatment of a range of kidney diseases
and complications; manages patients
after kidney transplants.
24/7 department of HD, department ofPD, kidney transplant pathology, kidney
immunopathology, nephrologicalresuscitation department.
ICU for patients with kidney diseases

2 Moscow

Botkin HospitalX

Has database of disease spectrum inthe nephrology centre, performs kidney
biopsies and kidney- and tissuetransplants.

3

St
Petersburg

St Petersburg City
Nephrology
CentreX

4

Moscow

Russian Children’sClinic Hospital

X

Federal institution performs paediatrickidney transplants

5 Moscow

Sklifosovsky
Research Instituteof Emergency
Medicine

X

Kidney transplants

Table 45: Nephrology treatment centres in Russia from the public and private healthcare sectors 473
472F

9.2.

Access to treatment

9.2.1.

Overview of nephrology in the public healthcare system

In theory, patients with suspected nephrological conditions are first seen by a district internist
doctor or a GP who performs routine diagnostic tests, such as analysis of urine, complete

174

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

blood count, decreased creatinine clearance, creatinine and electrolytes, and/or a renal
ultrasound. If a diagnosis is unclear or unconfirmed, then the patient is referred to a specialist
nephrologist for further tests in an outpatient setting, or if for a kidney biopsy, to a day care
centre or inpatient setting. Eligible patients living in cities are usually referred to a consulting
polyclinic, while those residing in rural areas are sent to either an inter-district consultative
centre or a regional polyclinic which is part of a regional hospital. Mobile health clinics also
visit rural, remote and scarcely populated areas to reach out to more patients. Increasingly,
digital consultations are also used by healthcare practitioners working in remote areas for
consultations with senior specialists in cities and regional capitals. 474
473F

Patients who live in places where direct observation and care by a nephrologist are notavailable or impractical, remain under care of their GPs or DPs with regular input from a
consulting nephrologist. They may experience waiting times for a consultation with anephrologist and a biopsy, but this rarely exceeds weeks. 475
474F

If the referring nephrologist deems that hospital admission is necessary, the patient isadmitted to either an internal medicine department or the nephrology department of atertiary city or regional hospital. Patients with severe refractory disease or an unclear
diagnosis may be referred further to federal medical centres located in Moscow and St
Petersburg. Acute renal failure is treated in ICUs. If dialysis is needed for patients with endstage renal disease, the patient is referred to one of the specialised chronic or programme
dialysis centres which are found throughout Russia. 476
475F

In practice, healthcare for nephrology is primarily delivered through the tertiary sector in
Russia. Primary and secondary prevention leading to early detection and management ofdisease progression is not emphasised in the public healthcare system. Instead, national
programmes tend to focus on increasing dialysis rates. Furthermore, shortage of suitably
qualified medical staff, delayed primary diagnosis of CKD has resulted in a high prevalence ofend-stage CKD. 477 This has implied an enormous cost to the government for hi-tech treatment
options with little government budget left to fund early diagnosis and/or prevention. 478 As of
476F

477F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons474
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
475
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
476
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
477
Milchakov, K.S. et al., Renal replacement therapy in the Russian Federation: a 20-year follow-up, 6 August 2020,
url, p. 2; Milchakov, K.S. et al., Management of chronic kidney disease in the Russian Federation: a critical review ofprevalence and preventive programmes, 4 April 2018, url, pp. 322-323
478
Milchakov, K.S. et al., Renal replacement therapy in the Russian Federation: a 20-year follow-up, 6 August 2020,
url, p. 2; Milchakov, K.S. et al., Management of chronic kidney disease in the Russian Federation: a critical review ofprevalence and preventive programmes, 4 April 2018, url, pp. 322-323; Tchokhonelidze, I. and Zemchenkov, A.,
Current status, challenges, and the role of ISN in advancement of nephrology in the Newly Independent States andRussia region, 26 February 2019, url, p. 50
473

175

EUROPEAN UNION AGENCY FOR ASYLUM

2018, care provision to CKD patients was extremely low, and rates as two to seven times
lower than in Europe and the United States of America. 479
478F

A study which looked at Dialysis Outcomes and Practice Patterns Study (DOPPS) data
indicated that unsuitable treatment and inadequate supplies of medication arecommonplace in most HD clinics covered by the universal healthcare policy. 480
479F

9.3.

Overview of nephrology in the private healthcare
systemPrivate clinics advertise selected nephrology treatments (see Table 45). People insured
through VMI policies can see a specialist directly without a referral from their GP. About 75 %to 80 % of patients receive HD at private facilities, which can reclaim the cost of patients’treatments via territorial funds provided under the OMS, so patients do not pay
themselves. 481
480F

9.3.1.

Facilities

In 2019, there were 628 renal replacement therapy (RRT) departments across the RussianFederation. These comprised 571 HD centres, 120 PD centres with (12 being strictly PD
centres) and 46 kidney transplant centres. The number of HD departments increased by
39 % from 2014 until 2018. The number of patients requiring HD increased by 11.5 % every
year between 2003 and 2013. Figures demonstrate that the demand for treatment is higher
than the available supply. Russian Dialysis Society data show that there were 54 953 patientson RRT, including 45 206 on dialysis (both HD and PD combined) in 2018. The rate of patients
receiving RRT was 374.4 patients per million population for the whole of Russia. 482
481F

9.3.2.

Nephrology healthcare workforce

In 2010, Russia’s MoH claimed that there were 1 782 nephrologists, or a rate of 0.12
nephrologists per 10 000 population which is less than half from what is considered to be an
optimal supply of 2.5 nephrologists per 100 000 population. 483 The availability ofnephrologists varies in different regions of Russia. The regions with the lowest number of
482F

Milchakov, K.S. et al., Management of chronic kidney disease in the Russian Federation: a critical review ofprevalence and preventive programmes, 4 April 2018, url, pp. 322-324
480
Bikbov, B. et al., Hemodialysis practice patterns in the Russia Dialysis Outcomes and Practice Patterns Study(DOPPS), with international comparisons, 27 October 2016, url, pp. 399, 402
481
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons482
Andrusev, A.M. et al., Заместительная терапия терминальной хронической почечной недостаточности в РФ
2014-2018 гг [Replacement treatment of terminal renal failure in RF 2014-2018], 2018, url; Apolikhin, O.I. et al., Анализ
некоторых аспектов обеспечения ЗПТ и гемодиализов в РФ [Analysis of some aspects of RRT and hemodialysis
availability in RF] Experimental and clinical urology #3, 2010, url, pp. 4-10483
Apolikhin, O.I. et al., Анализ некоторых аспектов обеспечения ЗПТ и гемодиализов в РФ [Analysis of some
aspects of RRT and hemodialysis availability in RF], Experimental and clinical urology #3, 2010, url, pp. 4-10
479

176

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

nephrologists per 10 000 population are: Nenetzkiy Autonomous District, Kamchatskiy Krai,
and Chukotskiy Autonomous District where there are none, respectively. In Yamalo-Nenetzkiy
Autonomous District, Sakhalin Oblast, Altai Region, and Murmansk Oblast, there are 0.04
nephrologists each. In each of these regions, the availability of nephrologists is equal to orless than 50 % of those at renal facilities on average. 484 These figures suggest that patientsliving in rural, remote and scarcely populated areas are at a disadvantage regarding accessto nephrologist consultations. 485
483F

484F

9.3.3.

Limitations on access to healthcare for nephrologicalconditions

It is widely reported that there are severe limitations on access to healthcare and treatment
for nephrological conditions relating to their cost, in particular RRT. National programme
oversight of dialysis programmes is purported to be lacking. 486 Other sources reveal
deficiencies in access to HD and PD, the cost of equipment, and access problems related todrug therapy for end-stage CKD patients. 487
485F

486F

There are geographic differences in access to diagnoses and treatments that affect thesurvival times of patients, with a general lack of nephrologists and dialysis centres,
particularly in remote and rural areas who may need to travel to access appropriate
healthcare. 488 For example, in 2018, there were no HD units in Nenetzkiy and Chukotskiy
Autonomous Districts, where in total 93 492 people live in a territory of 898 291 square
kilometres. 489 Public health budgets may cover the cost of patients’ dialysis but do not fundthe costs of transport to dialysis sessions or medications. 490 The quality of dialysis treatments
varies considerably between treatment centres. 491 Poorer regions have less healthcare
resources and therefore lower quality of care. Patients face limited sessions, reduced
treatment times, poor vascular access, and the use of refurbished machines and dialysis,
water and dialysate purity with no technical specifications. 492
487F

488F

489F

490F

491F

Russia, MoH, Статистический сборник 2018 год. Ресурсы и деятельность медицинских организаций
здравоохранения, Часть I, Медицинские кадры 2018 [Statistical compendium 2018. Resources and activity of
medical organisations, Part I, Medical personnel 2018], 31 July 2019, url, p. 42
485
Author interpretation based on the resources discussed.
486
Tchokhonelidze, I, and Zemchenkov, E., Current status, challenges, and the role of ISN in advancement ofnephrology in the Newly Independent States and Russia region, 26 February 2019, url, p. 50
487
Milchakov, K.S. et al., Renal replacement therapy in the Russian Federation: a 20-year follow-up, 6 August 2020,
url, p. 2
488
Zakharova, E., History, Current Advances, Problems and Pitfalls of Nephrology in Russia, 31 August 2018, url,
p. 244; Bikbov, M.M. et al., Chronic kidney disease in Russia: the Ural eye and medical study, 25 May 2020, url, p. 6;
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Bikbov, M.M. et al., Chronic kidney disease in Russia: the Ural eye and medical
study, 25 May 2020, url, p. 6
489
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
490
Milchakov, M. et al., Renal replacement therapy in the Russian Federation: a 20-year follow-up, 6 August 2020,
url, p. 2
491
Tchokhonelidze, I. and Zemchenkov, E., Current status, challenges, and the role of ISN in advancement ofnephrology in the Newly Independent States and Russia region, 26 February 2019, url, p. 50
492
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
484

177

EUROPEAN UNION AGENCY FOR ASYLUM

9.4.

Insurance and national programmes

Healthcare for nephrology is theoretically covered by the OMS public health insurance. 493
RRT is financed by territorial OMS funds under a dedicated budget line for eligible patients,
which stretches to include the majority of Russian citizens and legal residents. 494 Kidneytransplants are supported by the existence of a deceased donor register 495 and are possible
through the hi-tech care scheme. Yet, the public health system only funds HD in inpatient
centres rather than at patients’ homes and national healthcare regulations finance only thisform of dialysis. The vast majority of patients receive HD and PD at the relevant treatment
centres, which are either located at hospitals or form dedicated HD centres. 496 Yet, out-ofpocket payments are still common for some treatments and some are only covered by private
health insurance. 497 The OMS covers medication in inpatient settings, such as public
hospitals, but not medicines prescribed in outpatient settings. There is no universal
medication coverage per se, but certain categories of patients are entitled to subsidised or
reduced prices, and some are also entitled to free medications. 498
492F

493F

494F

495F

496F

497F

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the conditions that entitle patients to receive free or discounted
medications from the state.
Insufficient funding remains a serious problem today. 499 People on low incomes are forced torely on the public healthcare system out of lack of choice. 500
498F

499F

Patients with private healthcare insurance, including VMI, can opt to receive treatment atprivate healthcare facilities. Stateless people are obliged to pay for private healthcare as they
are not covered by the OMS policy. However, chronic illnesses, including chronic
nephrological conditions, are often considered as pre-existent conditions and are not covered
under many VMI policies. 501 Table 46 shows the nephrology services that are covered by
OMS and private medical insurance, including VMI.
500F

Tchokhonelidze, I. and Zemchenkov, E., Current status, challenges, and the role of ISN in advancement ofnephrology in the Newly Independent States and Russia region, 26 February 2019, url, p. 50
494
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
495
Tchokhonelidze, I. and Zemchenkov, E., Current status, challenges, and the role of ISN in advancement ofnephrology in the Newly Independent States and Russia region, 26 February 2019, url, p. 50
496
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
497
Tchokhonelidze, I. and Zemchenkov, E., Current status, challenges, and the role of ISN in advancement ofnephrology in the Newly Independent States and Russia region, 26 February 2019, url, p. 50
498
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
499
Baranov et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
500
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
501
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
493

178

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme
Mandatory
public healthinsurance
(OMS)

Focus

Requirements

Russiancitizens andpermanent
residents,
includingreturning
Russianmigrants andmigrants fromex-Soviet
countries.

1. Public/Federal

Migrants fromex-Soviet
countries canobtain an OMS
policy throughtheir employers
if the employer
agrees.

2. Employers financeOMS throughcontributions, 2-3 % ofsalary goes into social
tax, a percentage of
which is paid into anational Russian
healthcare fund. Once
paid, the employee has
the right to free medicalcare from public
Russian healthcare
clinics.

Scope ofcoverage

Nephrology services
coveredCovershealthcare
benefits for all
people eligible
for OMS

Services included:• Kidney failure(KF): accessibilityof kidney
replacement
therapy forpatients with KF• Dependence onHD• Kidney transplant• Little use of
peritoneal
dialysis (PD)• Medications ininpatient settings,
such as public
hospitals
Services excluded:• PD – notexcluded intheory but widely
not covered inpractice• Home HD• Medications in
outpatientsettings

For theregisteredindividual andsometimes theirfamilies

Information not
publicly available

3. People who cannot
work and do notcontribute to OMI (e.g.
unemployed,
pensioners, children,
sick people) can still
access free basic
healthcare. 502
50 1FGovernment
healthinsurance
programmes
for employeesof specialist
agencies, e.g.,
law
enforcement

Employees of
selected
government
agencies andcompanies

Private sector
healthinsurance,
including VMI

502

For theregisteredindividual
and/or theirfamily (if an
employerpurchases VMI
for anemployee, it

Expatica, Healthcare in Russia: the Russian healthcare system explained, n.d., url

179

Coverage of services
depending on thehospital or medical
facility that the
specific insurance
policy covers. An
example list is:
Diagnosis:• Ultrasound exam
• CT scan• MRI scan

EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

Nephrology services
coveredusually only
covers that
individual andnot their family)

Treatment:
Renal
replacement
therapies like:• Continuous
ambulatory
peritoneal
dialysis (CAPD)• Automatedperitoneal
dialysis (APD)• Dialysis in acentre• Homehaemodialysis• Kidneytransplantation(one needs adonor)• Conservative
treatment (painand condition
management) 503
502F

Table 46: Public and private healthcare insurance nephrology coverage in Russia 504
503F

9.5.

Cost of treatment

Nephrology healthcare is provided free of charge under the OMS to all eligible patients in
Russia. Treatment prices are 30 %-50 % higher in the private sector. Costs are also higher in
wealthier regions than poorer ones. These statements are based on treatment prices inpublic facilities for non-eligible patients. Public facilities must adhere to official publishedprices (‘tariffs’) determined by the regional OMS funds in settlements with the Territorial Fundof Obligatory Medical Insurance (TFOMS, ТФОМС in Russian), and other public facilities.
When public healthcare facilities provide services to patients who are not eligible to receive
OMS coverage, prices are regulated by the private healthcare market, as are treatment prices
ordinarily at private sector healthcare facilities. 505 Table 48 shows the cost of all relevant
treatments for nephrological conditions.
504F

Health Tourism, Treatment of Cystic Diseases of the Kidney in Moscow, url, accessed 17 September 2021;
Fresenius Medical Care, Products, therapies and services for healthcare professionals, n.d., url; Diaverum,
Treatment, n.d., url
504
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
505
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
503

180

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

9.5.1.

Methodology of data collection on treatment prices

The price of treatments, diagnostics and equipment were collected using an initial internet
search for their availability and costs in Moscow. The websites used are shown in Table 47.
Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)https://www.krasotaimedicina Aggregator of prices and availability of the medical services (surgery,.ru/
diagnostics, etc.) in Moscow from a lot of private clinics
https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/
https://market.yandex.ru/

Cost of equipment: overview and access to offers from many online
and offline shops (medical equipment, orthopaedic supplies,
rehabilitation devices, etc.)

Table 47: Websites consulted for treatment prices

The most common prices were compared, and the median price agreed and included inTable 48.
Treatment Price RUB

Reimbursement/
specialprogramme/free/comments

PublicOutpatient

PublicInpatient

PrivateOutpatient

PrivateInpatient

Consultation by
an internist

FOC

FOC

1 732

1 732

Price in Moscow

Consultation by
a nephrologist

FOC

FOC

2 771

2 771

Price in Moscow

Specialist

181

EUROPEAN UNION AGENCY FOR ASYLUM

Publictreatment
price

Privatetreatment
price RUB

Reimbursement/special
programme/free/comments

Acid-base balance in blood andurine; e.g. serum and urine pH,
electrolyte levels

FOC

1 992

Price in Moscow

Bacterial cultures

FOC

1 039

Price in Moscow

Electrolytes; potassium, sodium,
calcium and magnesium

FOC

4 330

Price in Moscow

PTH, calcium, phosphate

FOC

1 212

Price in Moscow

Renal/kidney function (creatinine,urea, proteinuria, sodium, potassium
levels)

FOC

1 472

Price in Moscow

FOC

2 165

Price in Moscow

Hospital admission in nephrology
department (daily rates) *

FOC

5 196

Price in Moscow

Chronic haemodialysis (3/week);
cost of one session

FOC

32 908

Price in Moscow**

Acute hemodialysis (cost of one
session)FOC

31 869Price in Moscow**

FOC

1 195 068

Price in Moscow**

Laboratory tests

Medical diagnostic procedures

diagnostic imaging by means ofultrasound (of the kidney)

Treatment

Transplantation of kidney including
pre- and after care (costs of182

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Publictreatment
price

Privatetreatment
price RUB

Reimbursement/special
programme/free/comments

Subdivide price per living
donor/diseased donor

FOC

883 311

Price in Moscow**

Surgical placement of an arterial
shunt for haemodialysis

FOC

19 918

Price in Moscow**transplantation and costs of
pre/after care session/consultation)

Notes
FOC:

Free of charge to eligible patients.

* Daily rate includes bed and food only, everything else is extra (laboratory and imaging tests,
physician consultations, medications and procedures)** Queues and quotations foreseen in public sector
Table 48: Cost of treatments for nephrological conditions in the public and private health systems in Russia

9.6.

Cost of medication

Medicines for nephrological conditions are accessible across the whole of the RussianFederation in theory, but in practice access is better in urban and particularly metropolitan
regions. Low-income regions have relatively poorer access to medicines, especially imported
and expensive ones. Pharmacies, particularly inter-hospital pharmacies, stockpile medicines
to mitigate specific shortages. 506
505F

The major nephrology medicines are registered in Russia and only registered drugs can belegally produced or imported into the country. Those which are not controlled or restricted
may be brought into Russia for personal use. 507 Many nephrology medicines are included on
506F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
507
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
506

183

EUROPEAN UNION AGENCY FOR ASYLUM

the national Vital and Essential Drugs List (VEDL). 508 Prices for medications on this List are
regulated and strictly controlled by the state and cannot exceed the formal prices. 509
507F

508F

The drugs registration process is expensive and cumbersome and it may limit availability ofnewer medications developed in other countries. In recent years, considerable efforts havebeen made by the state to encourage medications production in Russia and limit dependency
on imports. 510 Table 50 shows the cost of all relevant drug treatments for nephrologicalconditions.
509F

9.6.1.

Methodology of data collection on drug prices

The prices of drugs for nephrological conditions were collected using an initial internet search
for their availability and costs in Moscow. The website used for the initial search are shown in
Table 49.
Name and url of website

Subject matter for prices

https://aptekamos.ru/ 511

Aggregator of prices and availability of the medications in

510F

Moscow pharmacies
https://www.eapteka.ru/

Big online pharmacy with option of ordering medications thatare rarehttps://apteka.ru/

Big online pharmacy with option of ordering medications thatare rarehttps://grls.rosminzdrav.ru/grls.aspx State Register of Medicines
Table 49: Websites consulted for drug prices

The most common prices were compared, and the median price agreed and included inTable 50. Each medication was checked on the VEDL. 512 If medication was not found under ageneric name from the internet search, it was checked against the State Register ofMedicines. If it was registered, a further internet search was performed using its brand name.
511F

Russia, Administration of the Russian President, Федеральный закон от 12.04.2010 г. № 61-ФЗ Об обращении
лекарственных средств. [Federal Law No. 61-FZ of 12 April 2010 ‘On the Circulation of Medicines’], url
509
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
510
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons511
Note from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
512
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url
508

184

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric Name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

Hematopoietic growth factor; for anaemia due to renal problems

Darbepoetinalpha

30 mcg,
0.3 mlInjections

1

3 118

Pharmacy

Includedin VEDL

Epoetin alpha2 000 IU

Injections

10

4 330

Pharmacy

Includedin VEDL

Epoetin beta

2 000 IU

Injections

10

7 274

Pharmacy

Includedin VEDL

Aranesp®

Phosphate binders

Calcium
acetate +magnesium
carbonate

Osvaren®

435 mg+ 235 mg

Tablets

180

3 464

Pharmacy

N/A

Lanthanum
carbonate

Forsenol®

500 mgTablets

45

not
found

Hospital

N/A

779

Pharmacy,
foodsupplements shop

N/A

Calciumcarbonate

Sevelamer

1 kg

800 mgPowderTablets

Vitamins

185

1

180

5 975

Pharmacy

Includedin VEDLEUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

DosageForm

Number ofunits
in thecontainer

Alfacalcidol

0.25 mcg

Capsule60563

Pharmacy

Includedin VEDL

Colecalciferol;chole-calciferol

15 000
IU/ml,
10 ml

Drops

1

173

Pharmacy

Includedin VEDL

40 mg/ml,
200 mlInjections

28

1 905

Pharmacy

Includedin VEDL

50 mg/ml,
10 ml

Injections

1

4 763

Pharmacy

Includedin VEDL

30 mg

Tablets90

390

Pharmacy

Dietary
supplement

80 mg

Tablets30

390

Pharmacy

N/A

400 mgTablets30

87

Pharmacy

Generic Name

Brand
name

Medication to treat metabolic acidosis

Sodiumbicarbonate (=sodiumhydrogencarbonate)

General anaemia

Ferric carboxymaltose(intravenousiron)

Ferinject®

Ferrousfumarate

Ferroussulphate

Tardiferon®

Pain medication

Ibuprofen

186

Includedin
VEDL inRUSSIAN FEDERATION – MEDCOI COUNTRY REPORTGeneric Name

Brand
name

DosageForm

Number ofunits
in thecontainer

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free
many
forms

Morphine

10, 30, 60,
100 mgInjections,capsule,tablets

20

N/A

Specialised
pharmacies bygovernmentally
paid
receipts
only

Naproxen

275 mgTablets20

398

Pharmacy

N/A

Paracetamol

500 mgTablets20

43

Pharmacy

Includedin VEDL

Tramadol

50 mg

Capsule20

87

Pharmacy

Includedin VEDL

Diclofenac

100 mgTablets,
gel

20

69

Pharmacy

Includedin VEDL

Metamizole

500 mgTablets

20

69

Pharmacy

N/A

Azathioprine

50 mg

Tablets50

390

Pharmacy

Includedin VEDL

Ciclosporin

50 mg

Capsule50

2 252

Pharmacy

Includedin VEDL

Includedin VEDL

Immunosuppressants187

EUROPEAN UNION AGENCY FOR ASYLUM

Price
per
box
RUB

Place
(pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

DosageForm

Number ofunits
in thecontainer

Cyclophosphamide

50 mg

Tablets50

866

Pharmacy

Includedin VEDL

Methotrexate

2.5 mgTablets50

303

Pharmacy

Includedin VEDL

Methylprednisolone

4 mg

Tablets30

346

Pharmacy

Includedin VEDL

Mycophenolate mofetil

250 mgCapsule

100

2 685

Pharmacy

Includedin VEDL

Tacrolimus

1 mg

Capsule50

3 118

Pharmacy

Includedin VEDL

200 mgTablets60

520

Pharmacy

Includedin VEDL

Generic Name

Hydroxychloroquine

Brand
name

Plaquenyl®

Table 50: Cost of drugs for nephrological conditions in the public and private health systems in Russia

NGOs

9.7.

There is no evidence of international non-governmental organisations (INGOs) orinternational organisations operating programmes to provide healthcare to nephrology
patients. 513 Some domestic Russian NGOs and non-commercial organisations (NCOs) provide
assistance to nephrology patients, in particular to children or people with disabilities (see thechapter Patients with disabilities). 514 However, they rarely help with the costs of and access to
512F

513F

Author interpretation based on her experience of the research process.
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
513

514

188

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

medications as most are only available on prescription and their circulation is strictly
controlled by state institutions. 515
514F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
515

189

EUROPEAN UNION AGENCY FOR ASYLUM

10. Pulmonology
10.1. General information
Pulmonology concerns the epidemiology, mechanisms, prevention and diagnosis of diseases
involving the respiratory tract. 516 In the context of this report, pulmonology refers totuberculosis (TB), asthma and chronic obstructive pulmonary disease (COPD).
515F

10.1.1.

Epidemiological context

Rosstat report that, in 2018, there were 52 833 000 cases of disease of the respiratoryorgans. 54 273 000 cases were reported in 2019. In 2018, per 1 000 population, there were369.8 cases of disease of the respiratory organs and in 2019, there were 356.2 cases per
1 000 population. 517 There is no consistent data on disease prevalence or incidence that is
disaggregated by age, gender or region. 518
516F

517F

These figures are comprised of aggregated data for the following diseases defined by the
MoH: Respiratory diseases: Pneumonia; Allergic rhinitis (hay fever); Acute laryngitis andtracheitis; Chronic diseases of the tonsils and adenoids, peritonsillar abscess; Chronic andunspecified bronchitis, emphysema; Acute obstructive laryngitis [croup] and epiglottitis;
Asthma, status asthmaticus; Interstitial, purulent pulmonary diseases, other diseases of thepleura; and Other chronic obstructive pulmonary disease. 519
518F

There is statistical evidence of a drop in rates of TB. Several studies have estimated rates. 520
519F

In terms of patient deaths, TB is often comorbid with HIV in infected patients. 521 The numberof terminal TB/HIV coinfection cases, however, decreased between 2010 and 2019. 522 In 2017
annual TB mortality rate of 6.5 deaths per 100 000 population appeared to be lower than theminimum rate of 7.4 deaths per 100 000 population documented in 1989. 523
520F

521F

522F

WHO reported that trachea, bronchus and lung cancers combined were the third leading
cause of death in Russia, with an estimated death rate of 37.3 deaths per 100 000 population
and were responsible for an estimated 949.2 DALYs in 2019. COPD also ranked highly as

Healthline, What does a pulmonologist do?, n.d., url
Rosstat, Население. Здравоохранение. Заболеваемость. Заболеваемость населения по основным классам
болезней [Population. Healthcare. Morbidity. Morbidity by major classes of diseases], 30 November 2021, url
518
Contact 2, Research Assistant, email, July-September 2021. The person wishes to remain anonymous for security
reasons
519
Contact 2, Research Assistant, email, July-September 2021. The person wishes to remain anonymous for security
reasons
520
Author interpretation based on the sources discussed in the paragraph.
521
Nechaeva, O.B., Эпидемическая ситуация по туберкулезу в России [Tuberculosis epidemic situation in Russia],
2018, url, pp. 15-16
522
Nechaeva, O.B., Состояние и перспективы противотуберкулезной службы России в период COVID-19 [Thestate and prospects of TB control service in Russia during the COVID-19 pandemic], 2020, url, p. 7
523
Nechaeva, O.B., Эпидемическая ситуация по туберкулезу в России [Tuberculosis epidemic situation in Russia],
2018, url, pp. 15-16
516
517

190

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Russia’s eighth leading cause of death, with an estimated 25.1 deaths per 100 000 population
and a rate of 614 DALYS per 100 000 population. Asthma caused fewer deaths, with only 1.2
cases per population in 2019 and 120 DALYs lost. 524
523F

Regional variations in the distribution of chronic respiratory diseases (CRDs) are exemplifiedin statistics published by the Federal State Statistics Service and cited in a 2017 study of CRDs
in the North of Russia. This study indicated that in this northern region – a territory consistingof 70 % of the country’s landmass with 17.8 % of Russia’s total population – experienced aburden of CRDs twice the average of the rest of the country. This was owing to a greaternumber of risk factors, such as industrial air pollution, occupational hazards and smoking. 525
524F

10.1.2.

National programmes and policies on healthcare forpulmonological conditions

A programme for TB incidence reduction in 2018 to 2027 is in place, with a goal of halving TB
incidence in 10 years and with specific goals for each region of Russia and plans to increase
the level of formal organisation to detect TB. A healthcare programme to treat TB in HIVinfected patients was also purported to take place. 526 The Russian government recognised in
its Healthcare Development Strategy for the period up to 2025 a need to improve the qualityof doctors’ training for TB care. 527
525F

526F

Table 51 lists some leading pulmonology treatment centres in Russia from both the public andprivate healthcare sectors. These were identified through a search of their websites.

10.1.3.

Key facilities for the treatment of pulmonological conditions

State or city

Facility nameFacility type
PublicSpecialisms

Private1

Moscow

European
Medical Centre

X

2

St Petersburg

EuroMed Clinic

X

Received an award for best
multidisciplinary health centre 2021 (aWHO, Global Health Observatory, Deaths, DALY, and population in Russian Federation for both sexes aged allages, n.d., url
525
Gambaryan, M.H. et al., Chronic Respiratory Diseases in the Regions of Northern Russia: Epidemiological
Distinctions in the Results of a National Population Study, 26 July 2017, url, pp. 1-12
526
Nechaeva, O.B., Эпидемическая ситуация по туберкулезу в России [Tuberculosis epidemic situation in Russia],
2018, url, p. 16
527
Russia, Administration of the Russian President, Указ Президента Российской Федерации №254 от
06.06.2019 «О стратегии развития здравоохранения в Российской Федерации на период до 2025 года»[Decree of the President of the Russian Federation No. 254 of 6 June 2019 ‘On the Strategy for Development of
Healthcare in the Russian Federation until 2025’], 6 June 2019, url
524

191

EUROPEAN UNION AGENCY FOR ASYLUM

private healthcare award, global healthand pharma)
3

Near Moscow

Krasnaya Pakhra
sanatorium

X

Specialist spa for respiratory diseases

4

Kislovodsk

Elorma Clinic

X

Nervous system specialist, specialist
spa

5Samaraprovince

LesnoyeSanatorium,
Tolyatti

X

Focuses on TB, open to patients from all
regions

6

Arkhangelsk

Arkhangelsk
Regional Antituberculosis
DispensaryX

Has both inpatient and outpatient
departments and can provide
treatment for all cases of TB, including
multidrug-resistant TB (MDR-TB) andextensively drug-resistant
TB (XDR-TB) cases

Table 51: Pulmonology treatment centres in Russia from the public and private healthcare sectors

10.2. Access to treatment
10.2.1.

Structure and organisation of the system for pulmonary
healthcare in Russia(a) Public healthcare system

In Russia, patients with suspected pulmonary diseases are treated in the primary healthcare
sector in the first instance and referred to secondary hospital care if needed. Patients are
initially seen by a district internist or GP. GPs usually perform routine diagnostic tests, such as
a complete blood count, chest radiograph, spirometry or basic metabolic profile, etc. If adiagnosis is still unclear and further consultations and/or tests are required, the patient isreferred to a specialist pulmonologist in the same polyclinic or consultative polyclinic. Many
pulmonologists work in outpatient settings as consultants rather than in ICUs, unlike
physicians in other countries. Patients requiring hospitalisation are admitted to either aninternal medicine or pulmonology department at a city or a regional hospital. The latter
department only exists in large regional or city hospitals. Therefore, patients in close
proximity to these facilities, and in high-income areas which tend to have better medical
facilities, have sufficient access healthcare for pulmonological conditions. 528
527F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
528

192

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTPatients with acute or severe respiratory failure are treated at ICU departments. Patients withpulmonary TB (PTB) are treated at specialised facilities called anti-TB dispensaries, whichhave outpatient and inpatient departments, as well as sanatoriums for recovering patients. 529
528F

As of 2014, all patients with smear positive tests were admitted to the dispensary for inpatient
treatment and smear-negative patients were seen in the outpatient department. All patientswith TB and deaths from TB in the region were registered. Each patient who received adiagnosis had to complete a questionnaire to chart sociodemographic characteristics,
medical symptoms and any delay. WHO’s strategy for TB control – directly observed
treatment, short-course (DOTS, also referred to as TB-DOTS) – was active in 2014, as was the
MDR TB management programme, a drug management strategy, and ongoing screening
according to the WHO diagnostic definition. 530
529F(b) Private healthcare system
Healthcare and treatments in relation to certain pulmonological conditions are also available
in the private healthcare sector. 531 As of 2014, no private healthcare providers treated TB. 532
Two examples of private treatment centres offering outpatient clinic and inpatient hospital
services are:
530F

•

531F

JSC “Medicine” in Moscow, which offers prevention, diagnostics and treatment ofdiseases of the respiratory system, such as bronchitis, asthma, obstructive pulmonary
disease and multiple bronchiectasis, pneumonia, allergic alveolitis and fevers of unclear
genesis, as well as tests and diagnostic measures including X-ray, ultrasonicinvestigation and bronchoscopy puncture; 533 and532F•

the Pirogov National Medical and Surgical Centre in Moscow, which treats acute andchronic bronchitis, chronic cough and shortness of breath of various aetiologies, chronic
obstructive pulmonary disease; bronchial asthma, pneumonia and interstitial lungdiseases. 534
533F

10.2.2. Limitations to patient access to healthcare for pulmonologicalconditions in Russia
Access to pulmonology specialists, thoracic surgeons and treatment centres can be limited inrural and scarcely populated remote areas and can prove difficult to access. Most patients inthese areas are referred to nearby towns, cities or regional capitals to be reviewed by aContact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
530
Kuznetsov, V.N. et al., A comparison between passive and active case finding in TB control in the Arkhangelsk
region, 14 February 2014, url, p. 2
531
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
532
Kuznetsov, V.N. et al., A comparison between passive and active case finding in TB control in the Arkhangelsk
region, 14 February 2014, url, p. 2533
JSC “Medicine” Clinic of Academician Roytberg, Pulmonology, 2022, url
534Национальный медико-хирургический центр имени Н.И. Пирогова [Pirogov National Medical and SurgicalCentre], Consultative and Diagnostic Department, 2022, url
529

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EUROPEAN UNION AGENCY FOR ASYLUM

pulmonologist or thoracic surgeon. Travel costs are borne by the patient, which could beprohibitive and impact their access to healthcare. Low-income patients are reliant on publichealthcare, and in poorer areas, experience a lower standard of healthcare. 535
534F

10.2.3. Resources(a) Facilities
The leading national centre for pulmonology is the Department of Pulmonology and theClinic of Pulmonology and Respiratory Medicine, at the I.M. Sechenov First Moscow State
Medical University which claims to be the top medical university in Russia. 536 The staff fromthis department work jointly at the pulmonary, consultative and diagnostic departments andthe Department of Functional Diagnostics of the University Clinical Hospital № 4. 537
535F

536F

(b) Staff
There are no available statistics enumerating on the availability of pulmonologists
throughout Russia’s different regions. 538 There were 732 thoracic surgeons in Russia in 2018,or an estimated rate of 0.05 thoracic surgeons per 10 000 population. However, in someregions - Nenetzkiy Autonomous District, Jewish Autonomous Region, Chukotskiy
Autonomous District, Altai, Tyva and Khakasiay Republics and others - there were no thoracic
surgeons available. Phthisiologist, or phthisiatrist (“фтизиатр” in Russian) is a medical
speciality in Russia. These physicians diagnose and treat patients with TB in both in- andoutpatient settings. There were 7 015 phthisiologists in Russia in 2018, or an estimated rate of
0.48 phthisiologists per 10 000 population. Of these specialists, 3 158 were district outpatientphthisiologists, for an estimated rate of 0.22 phthisiologists per 10 000 population. These
specialists were rather evenly distributed among regions, with a few regions - Kurgan,
Arkhangelsk, Ul'yanovsk and Tula regions - having significantly fewer specialists. 539
537F

538F

10.3. Insurance and national programmes
Like healthcare for the population at large, pulmonology healthcare coverage is provided
under the state-funded health insurance system, the OMS. Healthcare is provided to Russian
citizens, permanent legal residents or long-term visa holders and/or legally employed people
who hold an OMS policy and have a registered address in Russia. Returning Russian migrants

Kuznetsov, V. N. et al., A comparison between passive and active case finding in TB control in the Arkhangelsk
region, 14 February 2014, url, p. 2; Contact 1, Medical Doctor and local consultant, email, July-September 2021. The
person wishes to remain anonymous for security reasons
536
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Author interpretation based on experience of the research process.
537
FMSMU, Department of Pulmonology, n.d., url
538
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Author interpretation based on experience of the research process.
539
Russia, MoH, 14_Ресурсы и деятельность медицинских организаций здравоохранения, [14_Resources andactivity of medical healthcare organisations], 2018, url, p. 126
535

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

and foreign migrants to Russia are covered by OMS once they are registered as legal
residents. Urgent care is universally provided for free. 540
539F

The OMS covers pulmonology treatment of all eligible patients, including invasive procedures
and surgeries. OMS coverage includes medication in inpatient settings, such as public
hospitals, but not medicines prescribed in outpatient settings. There is no universal
medication coverage per se, but certain categories of patients are entitled to subsidised or
reduced prices if in receipt of a valid prescription, and some are also entitled to free
medications. 541 Insufficient funding remained a problem as recently as 2017: government
spending on health remained below the 6 % minimum recommended by WHO and wasapproximately 4 % of GDP. 542
540F

541F

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the conditions that entitle patients to receive free or discounted
medications from the state.

10.3.1.

Private healthcare insurance

Different forms of private medical insurance, including VMI, enable patients to receive
pulmonology healthcare at private facilities. People on low incomes rely on the publichealthcare system for pulmonology healthcare. 543
542F

Table 52 shows the pulmonology healthcare services that are covered by OMS and private
medical insurance, including VMI.
Programme

Focus

Mandatory
public healthinsurance(OMS)

Russiancitizens andpermanent
residents,
includingreturning
Russianmigrants.

Requirements

1. Public/Federal
2. Employers
finance OMS
through
contributions,
2 % to 3 % ofsalary goes intosocial tax, apercentage of
Migrants fromwhich is paid intoa national
ex-Soviet
Russiancountries canhealthcare fund.
obtain anOnce paid, theOMS policy
employee has

Scope ofcoverage

Pulmonology services
coveredCovershealthcare
benefits for all
people eligible
for OMS

Services included:•
Inpatient medications
during hospital stays•
Invasive procedures andsurgeries•
Medicines for asthma
patients•
Services excluded•
Outpatient medications

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons541
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons542
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
543
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
540

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EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Government
healthinsurance
programmes
for
employees of
specialist
agencies, e.g.
law
enforcement

Focus

Requirements

Scope ofcoveragethrough theiremployers if
the employer
agrees.

the right to free
medical carefrom public
Russianhealthcare
clinics.
3. People who
cannot work anddo not contributeto OMI (e.g.
unemployed,
pensioners,
children, sickpeople) can still
access free basic
healthcare.

Pulmonology services
coveredFor theInformation not publicly
registeredavailable
individual andsometimes theirfamilies

Employees of
selected
government
agencies andcompanies

Private sector
healthinsurance,
includingvoluntary
medicalinsurance(VMI)

For theregisteredindividual
and/or theirfamily (if an
employerpurchases VMI
for anemployee, it
usually only
covers that
individual andnot their family)

Available services
depending on the hospitalor medical facility that theinsurance covers. An
example list is:•
Bronchoscopy•
Drainage of the pleuralcavity•Mediastinotomy•
Pleuroscopy (also called
thoracoscopy)•
Tracheostomy•
Tracheotomy

Table 52: Public and private healthcare insurance coverage in Russia 544
543F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
544

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

10.3.2. International donor programmes
The search conducted for this MedCOI report found no evidence of pulmonology healthcare
being provided by international donor programmes or foundations. However, the charitablefoundation TAC Fund supports people with TB as well as cancer and HIV/AIDS. 545
544F

10.4. Cost of treatment
10.4.1.

Overview

Pulmonology healthcare is provided free of charge under the OMS to all eligible patients in
Russia. Treatment prices are 30 % to 50 % higher in the private sector than the public healthsystem. Costs are also higher in wealthier regions than poorer ones. Public facilities must
adhere to official published prices while prices in private facilities are regulated by the private
healthcare market. 546
545F

Table 54 shows the cost of all relevant treatments for pulmonological conditions.

10.4.2. Methodology of data collection on treatment prices
The prices of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. Websites used are shown in Table 53.
Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)https://www.krasotaimedicina Aggregator of prices and availability of the medical services (surgery,.ru/
diagnostics, etc.) in Moscow from a lot of private clinics
https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/ТАК надо! Благотворительный фонд поддержки людей, больных раком, ВИЧ, СПИДом, туберкулезом
[TAKE it! Charitable Foundation for Support of People with Cancer, HIV, AIDS, Tuberculosis], What we do, n.d., url
546
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
545

197

EUROPEAN UNION AGENCY FOR ASYLUMName and url of website

Subject matter for prices

https://market.yandex.ru/

Cost of equipment: overview and access to offers from many online
and offline shops (including medical equipment, orthopaedic supplies,
rehabilitation devices, etc.)

Table 53: Websites consulted for treatment prices

The most common prices were compared, and the median price agreed and included inTable 54.
Treatment Price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Consultation by apulmonologist

FOC

FOC

2 511

2 511

Prices in Moscow

Consultation by ageneral practitioner

FOC

FOC

4 763

4 763

Prices in Moscow

Specialist

Treatment Price RUB

PublicPrivateDrug resistance test for tuberculosis (drugs)

FOC-

Sputum smear microscopy (tuberculosis)

FOC

779

Diagnostic research: PCR for M.Tuberculosis

FOC

1 732

Laboratory tests

Diagnostic investigation

198

Reimbursement/
specialprogramme/
free/ comments

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Treatment Price RUB

PublicPrivateReimbursement/
specialprogramme/
free/ comments

Diagnostic research, in the form of lung function
tests (i.e., spirometry)

FOC

1 732

Price in Moscow

Bronchoscopy

FOC

10 652

Price in Moscow

Diagnostic research: measuring arterial blood
gas; arterial pH, pCO2, “base excess", arterial
oxygen saturation

FOC

1 039

Price in Moscow

Diagnostic research: measuring of blood oxygen
level (e.g. pulse oximetry)

FOC

520

Price in Moscow

Breathing machines (ventilator, etc.)

FOC

597 534

Price inMoscow**

Medical devices pulmonology: nebuliser

FOC

4 417

Price in Moscow

Spacer (with mask) for inhaler with asthma
medication

FOC

1 992

Price inMoscow**

Medical devices pulmonology: oxygen therapy
with device and nasal catheter

FOC

779 / 1 hour

Price inMoscow**

Medical devices pulmonology

Medical devices pulmonology: oxygen therapy
with O2 pressure tank

FOC

1 472 / session

FOC

5 196

Price inMoscow**

Treatment

Hospital admission in pulmonology department(daily rates)*

199

Prices in
Moscow

EUROPEAN UNION AGENCY FOR ASYLUM

Treatment Price RUB

PublicPrivateReimbursement/
specialprogramme/
free/ comments

Notes
FOC

Free of charge to eligible patients* Daily rate includes bed and food only, everything else is an extra (laboratory and imaging tests,
physician consultations, medications and procedures)** Queues and quotations foreseen in public sector
Table 54: Cost of treatments for pulmonological conditions in the public and private health systems in Russia

10.5. Cost of medication
10.5.1.

Overview

Medicines for pulmonological conditions are accessible across Russia in theory, but access ismuch better in urban and particularly metropolitan regions. 547 Pharmacies, particularly interhospital pharmacies, stockpile medicines to mitigate specific shortages. The major medicines
for pulmonological diseases are registered in Russia and only registered drugs can be legally
produced or imported into the country. Many are included on the national VEDL. 548 Prices for
medications on this list are regulated and strictly controlled by the state, and those prescribedin public facilities must adhere to prices, i.e. tariffs determined by regional OMS funds.
546F

547F

The registration process is expensive and cumbersome and it may limit the availability of newer
medications developed in other countries. In recent years, considerable efforts have been
made by the state to encourage medications production in Russia and limit dependency on
imports. 549
548F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
548
Russia, Government of Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 260-261
549
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
547

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

10.5.2. Methodology of data collection on drug prices
The prices of drugs for pulmonological conditions were collected using an initial Internet
search for their availability and costs in Moscow. The websites used for the initial search are
shown in Table 56.
Name and url of website

Subject matter for prices
Aggregator of prices and availability of the medications in

https://aptekamos.ru/ 550

Moscow pharmacies

549F

https://www.eapteka.ru/

Big online pharmacy with option of ordering medications that arerare

https://apteka.ru/

Big online pharmacy with option of ordering medications that are
rare
State Register of Medicines

https://grls.rosminzdrav.ru/grls.aspx
Table 55: Websites consulted for drug prices

The most common prices were compared, and the median price agreed and included inTable 57. Each medication was checked on the VEDL and if not found under a generic namefrom the Internet search, it was checked against the State Register of Medicines. 551 If it was
registered, a further Internet search was performed using its brand name.
550F

Generic name

Brand
name

DosageNumber ofunits
in thecontainer

Form

Price
per box
RUB

Place(Pharmacy,
hospital)

Reimbursement/
specialprogramme/
freeFirst line TB medicines

Note from the drafter: The link is functional in Russia, but the site blocks enquiries from non-Russian IP addresses
Russia, Government of Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 12 October 2019, url, pp. 260-261
550
551

201

EUROPEAN UNION AGENCY FOR ASYLUM

DosageForm

Number ofunits
in thecontainer

Combination of
isoniazid+rifampicin+ethambutol+pyrazina-mide(e.g. withbrand name
Forecox®)

75 mg,
400 mg,
150 mg,
275 mgTablets

100

3 897

Pharmacy

Includedin VEDL

Ethambutol

400 mgTablets

100

8 920

Pharmacy

Includedin VEDL

Isoniazid

10 %,
5 ml

Injections

1052

Pharmacy

Includedin VEDL

Pyrazinamide

500 mgTablets

100

3 464

Pharmacy

Includedin VEDL

Rifampicin

150 mgInjections

10

433

Pharmacy

Includedin VEDL

Generic name

Brand
name

Price
per box
RUB

Place(Pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

Second/third line TB medicines (e.g. with MDR and XDR TB and/or HIV+TB)

Amikacin

Bedaquiline

Linezolid

Sirturo®

250
mg/ml,
2 ml

Injections

10

606

Pharmacy

Includedin VEDL

100 mgTablets

188

21 130

Pharmacy

Includedin VEDL

600 mgTablets

10

10 912

Pharmacy

Includedin VEDL202

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

DosageForm

Number ofunits
in thecontainer

Moxifloxacin(hydrochloride)

400 mgTablets

5606

Pharmacy

Includedin VEDL

Rifabutin

150 mgCapsule30

3 291

Pharmacy

Includedin VEDLTerizidone

300 mgCapsule100

26 846

Pharmacy

Includedin VEDL

Generic name

Brand
name

Price
per box
RUB

Place(Pharmacy,
hospital)

Reimbursement/
specialprogramme/
freeCombined anti-asthmatics

Aclidinium +formoterol

Duaklir
Genuair

340 mcg+ 11,8mcg/
dose

powder

1

2 771

Pharmacy

N/A

Beclometasone +formoterol(combination)

Foster

100 mcg+ 6 mcg/
dose

inhaler

120

2 252

Pharmacy

Includedin VED

Indacaterol +glycopyr-rolate(combination)

UltibroBreezhaler

50 mcg +110 mcg

capsule30

2 944

Pharmacy

Includedin VEDL

0,25 mg+ 0,5
mg/ml,
20 ml

solutionforinhalations

1

303

Pharmacy

Includedin VEDL

Ipratropium +fenoterol(combination)

203

EUROPEAN UNION AGENCY FOR ASYLUMGeneric name

Brand
name

DosageNumber ofunits
in thecontainer

Form

Price
per box
RUB

Place(Pharmacy,
hospital)

Reimbursement/
specialprogramme/free

Not in
VEDL asseparate
medication

Salbutamol +ipratropium

Ipramol
Sterineb

0,2 mg +1 mg/ml
2,5 mlInhalations

60

9 872

Pharmacy registered
but not on
sale

Salmeterol +fluticasone(propionate)

Seretide

12 mcg/
125 mcg/
dose

aerosol

120

1 472

Pharmacy

Includedin VEDL

Tiotropium +olodaterol

SpioltoRespimat

2,5 mcg +2,5 mcg/dose, 4ml

solution

1

2 858

Pharmacy

Includedin VEDL

Vilanterol +fluticasone
furoate(combination)

RelvarEllipta

22 mcg +92 mcg/dose

powder30

1 819

Pharmacy

Includedin VEDL

12 mcgcapsuleforinhalation

60

779

Pharmacy

Includedin VEDL

150 mgInjecttions

1

21 390

Pharmacy

Includedin VEDL

Montelukast
sodium10 mg

tablets28

1 645

Pharmacy

N/A

Salbutamol

100 mcg/
dose

inhaler200

173

Pharmacy

Includedin VEDL

Separate anti-asthmatics

Formoterol

Omalizumab

Xolair204

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

DosageForm

Number ofunits
in thecontainer

25 mcg +50 mcg/dose

inhaler120

433

Pharmacy

Includedin VEDL

200 mgtablets50

216

Pharmacy

N/A

Beclometasone

50 mcg/
dose

spray

200

173

Pharmacy

Includedin VEDL

Budesonide

0,5 mg

Suspension

20

1 299

Pharmacy

Includedin VEDL

Generic name

Brand
name

Salmeterol +fluticasone

Theophylline

Theophylline,
TeotardPrice
per box
RUB

Place(Pharmacy,
hospital)

Reimbursement/
specialprogramme/
freeInhalation corticosteroids

Fluticasone

Flixotide

125 mcg/
dose

inhaler60

1 126

Pharmacy

Not in
VEDL asseparate
medication

322 mcg/
dose

powder60

1 472

Pharmacy

N/A

50 mcg/dose

capsuleforinhalation

30

1 819

Pharmacy

Includedin VEDL

Parasympatholytics

Aclidinium
bromideBeatrisDzhenueir

Glycopyrronium
bromideSibri
Breathhaler

205

EUROPEAN UNION AGENCY FOR ASYLUMGeneric name

Brand
name

DosageForm

Number ofunits
in thecontainerPrice
per box
RUB

Place(Pharmacy,
hospital)

Reimbursement/
specialprogramme/
free

Ipratropium

Atrovent

20 mcg/dose

inhaler200390

Pharmacy

Includedin VEDL

Ipratropium +fenoterol(combination)

Bifradual;
Inspirax

0,25 mg+ 0,5
mg/ml,
20 ml

Inhalations

1

346

Pharmacy

Includedin VEDL

Tiotropium

Spiriva

2,5 mcg/
dose,
4 ml

solution

1

2 165

Pharmacy

Includedin VEDL

Table 56: Cost of drugs for pulmonological conditions in the public and private health systems in Russia

10.6. NGOs
There are international and domestic non-government organisations active in the field of TB
prevention. 552 It was reported by international NGO (INGO) the Red Cross in 2016, that its
Russian branch ran an information campaign since 2015 to distribute health educationmaterials about TB prevention at a detention centre for undocumented migrants in
Moscow. 553
551F

552F

Some domestic Russian NGOs and NCOs provide assistance to pulmonary disease patients,
especially children and people with disabilities. Their help rarely includes medications as
most are only available on prescription, and the circulation of medication is strictly regulated
and controlled by the state. 554
553F

Author interpretation based on experience of the research process.
Anca, A., Red Cross raises TB awareness among women held in Russia, IFRC, 24 March 2016, url, accessed 13
September 2021
554
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Easy Breathing Charity Fund, Implemented projects, n.d., url
552
553

206

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

11. Paediatrics
11.1. General Information
Paediatric medicine encompasses children’s physical, psychosocial, developmental andmental health. It begins periconceptually and stretches through gestation, infancy, childhood,adolescence and young adulthood. 555 In the context of this report, paediatric illnesses refer
to epilepsy, congenital heart diseases, feeding/nutritional problems, asthma, congenital(metabolic) disorders, mental health problems, and development disorders like speech
problems or motor disorders.
554F

11.1.1.

Epidemiological context

According to the Russian Federal State Statistics Service, the estimated annual prevalence of
paediatric illnesses was 45 210 900 cases among children between ages 0 and 14 in 2017. 556
All paediatric cases of illness, including acute respiratory illnesses that some children contract
three to four times per year, are included in these figures. 557 More details can be found in the
publication “Childhood diseases and causes of illness included in paediatric prevalence andincidence statistics, 2017 and 2019”. 558 The Federal State Statistics Service reported that, on
1 January 2021, there were 704 000 children (ages 0-17), registered as disabled. 559
555F

556F

557F

558F

11.1.2.

National programmes and policies

Universal paediatric healthcare is offered under the public health system in Russia and is
free for children aged 0 to 18. Children’s healthcare is enshrined in a set of national
healthcare principles defined by the Federal Law No. 323-FZ ‘On fundamental healthcare
principles in the Russian Federation’ as a priority (Article 7 of the Federal Law). In 2017,

Hardin, A.P. et al., Age limit of pediatrics, September 2017, url, p. 1
Russia, MoH, Статистический сборник 2017 год Заболеваемость детей в возрасте 0-14 лет по основным
классам болезней [Statistical Compendium 2017, Morbidity for children aged 0-14 years by main disease class],
5 July 2018, url; Rosstat, Население. Здравоохранение. Заболеваемость. Заболеваемость населения поосновным классам болезней [Population. Healthcare. Morbidity. Morbidity by major classes of diseases],
30 November 2021, url
557
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
558
Russia, MoH, Статистический сборник 2017 год Заболеваемость детей в возрасте 0-14 лет по основным
классам болезней [Statistical Compendium 2017, Morbidity for children aged 0-14 years by main disease class],
5 July 2018, url; Rosstat, Население. Здравоохранение. Заболеваемость. Заболеваемость населения поосновным классам болезней [Population. Healthcare. Morbidity. Morbidity by major classes of diseases],
30 November 2021, url
559
Rosstat, Население. Положение инвалидов. Уровень Инвалидизации. 1.2. Распределение инвалидов пополу и возрасту [Population. The situation of the disabled. Disability level. 1.2 Distribution of persons with disabilities
by sex and age], 9 April 2021, url
555

556

207

EUROPEAN UNION AGENCY FOR ASYLUM

Russian president Vladimir Putin announced in a Decree of the President of the RussianFederation (No. 240 of 29 May 2017) that 2018-2027 would be a ‘Childhood Decade’. 560
559F

Paediatric healthcare coverage is clearly evolving as new provisions are added. For
example, in January 2021, Putin signed a decree to establish a state fund entitled ‘Circle ofGood’. Its purpose is to help children with severe, life-threatening and chronic diseases,
including rare ones, by allowing the purchase of medications and medical devices notregistered in Russia. If appropriate care is not available in Russia, the fund may also pay forthe treatment abroad. 561 In March 2021, medications for three new orphan diseases wereadded to the fund’s coverage list. 562
560F

561F

11.1.3.

Content and structure of the paediatric healthcare system

The paediatric system is oriented at prevention although this has not always been the case in
the post-Soviet period. Medical writer T. Parfitt wrote in 2005 that the emphasis was ontreatment rather than prevention. 563 Some of its key programmes are as follows:
562F(a) Dedicated government initiatives
These included the ‘National Health Project’ in the early 2000s, which encouraged theimplementation of measures to support maternal and infant care, and previously thepresidential programme, ‘Children of Russia’, which supplied additional funding andmonitoring for important issues in children’s healthcare. 564 Two national projects wererunning during the summer of 2021, entitled ‘Healthcare’ and ‘Demography’. ‘ 565
563F

564F

(b) Health monitoring through paediatric examinations
According to the Russian MoH, the health of up to 90 % of all infants and children ismonitored throughout childhood via a programme of paediatric examinations under the
primary healthcare system. 566 Infants are given preventive examinations up to 26 times per
year in their first year of life by a paediatrician and other medical specialists. Then, children
are assessed annually by a paediatrician until the age of 18. 567 They are also assessed at set
stages in childhood: before entering nursery and primary school, and later at school. Routine
tests (blood, urine, ultrasound and electrocardiogram) are also carried out during childhood. A
565F

566F

Yuryev V.K. et al., Parent appraisal of accessibility and quality of general medical service rendered to children
residing in rural area, Revista Latinoamericana de Hipertensión, 13(6), 2018, url, pp. 592-597
561
Russia, Administration of the Russian President, Указ Президента РФ от 05.01.2021 «О создании Фонда
поддержки детей с тяжелыми жизнеугрожающими и хроническими заболеваниями, включая редкие
(орфанные) заболевания, «Круг добра» [‘On the establishment of a Fund to support children with severe lifethreatening and chronic diseases, including rare (orphan) diseases, "Circle of Good"’], 5 January 2021, url
562
GpX News, The Circle of Good Fund will provide medicines for children with three more orphan diseases,
9 March 2021, url563
Parfitt T., The Health of Russia’s Children, 30 July 2005, url, p. 357
564
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
565
Russia, MoH, Национальные проекты «Здравоохранение» и «Демография» [National projects ‘Healthcare’and ‘Demography’], 11 July 2019, url
566
Baranov, A., et al., The Russian Child Health Care System, 2016, url, p. S150; Contact 1, Medical Doctor and local
consultant, email, July-September 2021. The person wishes to remain anonymous for security reasons
567
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
560

208

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

child undergoes a total of 29 examinations by the age of 18. 568 Russia’s MoH has estimatedthese examinations reach 90 % to 92 % of children in Russia aged 0 to 18 years. 569
567F

568F

(c) Screening
Neonatal screening is offered for the following diseases: phenylketonuria, congenital
hypothyroidism, adrenogenital syndrome, galactosaemia and cystic fibrosis. In their first yearof life, children are offered audiological screening to help diagnose any hearing impairments
so that they can be addressed as early as possible. 570
569F(d) Vaccinations
Vaccines are covered by the paediatric system for children aged 0 to 18 and are funded by
the federal health budget, meaning that they are free. The national programme for
vaccinations is called the National Vaccinations Calendar (Russian: Национальный
календарь профилактических прививок). It was established by the MoH Order No. 125nfrom 21 March 2014, ‘Regarding establishing of the national prophylactic vaccinations
calendar and calendar of prophylactic vaccinations for epidemiological indications’. 571 It isaligned with WHO recommendations with some exceptions: rotavirus and papillomavirus
immunisation, and multicomponent vaccines are not currently covered. Vaccination coveragereaches 95 % to 97 % of children, which is one of the highest inoculation rates in the world,which is owed to the careful monitoring of children in local areas. 572
570F

571F

Children aged 0 to 18 are eligible to receive the following vaccinations: hepatitis B,
tuberculosis, whooping cough, diphtheria, tetanus, polio, measles, rubella, mumps, influenza,
Haemophilus influenzae, pneumococcus, parotitis and pertussis, and their revaccinations. 573
572F(e) Vulnerable and mistreated children
A key priority of the paediatric healthcare system is supporting vulnerable and mistreatedchildren through services provided at paediatric polyclinics. Children’s mental health isprioritised with early detection of psychosocial risk factors. 574 Medical and social assistance isprovided for children and their families who are experiencing difficult situations. 575 Assistanceis for instance provided in case of as parental divorce, single-parent families, so-called
573F

574F

Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S152
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
570
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 775
571
Russia, MoH, Приказ Минздрава России от 21.03.2014 № 125н "Об утверждении национального календаря
профилактических прививок и календаря профилактических прививок по эпидемическим показаниям"[Order of the Ministry of Health of Russia No. 125n of 21 March 2014 ‘On approval of the national calendar of
preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications’], 19January 2016, url
572
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
573
Baranov, A. et al. The Russian Child Health Care System, 2016, url, p. S151; Russia, MoH, Национальный
календарь профилактических прививок [National calendar of prophylactic vaccinations], n.d., url
574
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
575
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S152
568

569

209

EUROPEAN UNION AGENCY FOR ASYLUM

dysfunctional families which experience issues with alcohol, drugs, legal issues, etc. 576 Also
those who are considered to be at social risk of developing mental health problems areprovided with assistance. 577
575F

57 6F

11.1.4.

Main paediatric medical facilities

Table 57 shows a sample of paediatric treatment centres in Russia offering secondary andtertiary medical services for child patients from both public and private healthcare sectors.
These were identified through a search of their websites.
Facility TypeState or city

Public12

34Specialisms

Facility
name

Moscow

The RussianChildren’sClinicalHospital

MoscowMorozov
Children’s
Hospital

Moscow

FilatovskayaChildren’s
Hospital

Moscow

Moscow
RegionPaediatric
Psychoneuro-logicalHospital

PrivatePaid
services
available

X

Claimed largest children’s multiprofile hospital complex in Russia;
has Russia’s only paediatrics
kidney transplant unit; modern
diagnostic and therapeutic
equipment; research into thetreatment of complex diseases.
World rank: 250.

Includes Centre for paediatricstroke; well established, among thecity’s largest and has first child’s
cardiology department.

X

X

Mother and Child: chain of
multidisciplinary children’s
hospitals and clinics in Moscow
and 27 cities. World rank 2748.

XPart of Treat-NMD Neuromuscular
network; performs clinical trials,
received EU and other funding.
Includes Centre for Life of Genetic
Medicine.

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
577
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
576

210

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Facility TypeState or city

Public5

6

7

8

Moscow

MoscowSpecialisms

Facility
namePrivateGEMC
Children’s
Hospital

Medsi II

St Petersburg

St
Petersburg
Children’s
City HospitalX

St Petersburg

St Mary
Magdalene
Children’s
City Hospital

X

X

Part of the European Medical
Centre (see below).

X

Multidisciplinary children’s clinic;
part of a nationwide network of
Medsi clinics, i.e. in Volgograd,
Perm, Bryansk, Barnaul, Izhevsk,
Nyagan, Nizhnevartovsk.

Claimed the leading children’s
hospital in St Petersburg. Many
departments and services uniquein North-western Russia; scientificand clinical centres of
St Petersburg medical universities;
hi-tech medical and diagnostic
complex.

High-tech and emergency hospital,
and an organisational andmethodological centre. Coordinate
the paediatric healthcare in the
Republic of Tatarstan.

9

Yekaterinburg

Republican
ChildrenClinicalHospital,X
with paid
services

211

Three polyclinics and a HealthCentre for Children for 1 508 visits
per shift: two of them (No. 1 andNo. 2) function as consultative
polyclinics for children from
Tatarstan. The children's polyclinic"Azino" functions as a polyclinic
serving Kazan’s population of morethan 38 000 children aged 0 to 17.
Plans for a children’s centre ofEUROPEAN UNION AGENCY FOR ASYLUM

Facility TypeState or city

Specialisms

Facility
namePublicPrivateoncology, haematology andsurgery. 578
577F

10

Kazan

Regional
ChildrenClinicalHospital

Multidisciplinary children’s hospitalproviding hi-tech treatment tochildren and post-parturient
women from across the Sverdlovsk
Region, the Urals Federal District
and other parts of Russia.

X

Includes separate children’s
palliative hospice. Hospital has
accommodation for parents (notfree). Has regional perinatal care
centre.

Free admission via
clinic/paediatrician referral tospecialist in diagnostic centre.
Paid admission directly to thehospital for the following services:

11

Krasnodar

Regional
ChildrenClinicalHospitalX
with paid
services

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

paediatricians
haematologists
endocrinologists
neurologists
cardiologist
rheumatologist
infectious disease specialists
dermato-venerologists
nephrologists
urologists
psychologists
surgeons
orthopaedic surgeonsmaxillofacial surgeonsorthodontists
gastroenterologists
ENT specialist
an audiologist
speech therapists

Realnoe Vremya, ‘It has long been needed’ — Kazan to open children's cancer centre worth 2bn rub in 2 years,
6 December 2019, url
578

212

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Facility TypeState or city

Specialisms

Facility
namePublicPrivate•••allergists
pulmonologists
ophthalmologists

Moscow

Family and
HealthChildren’sCentreX

13

Moscow

MaryinoSouth East
Municipal
District, DMC
Children’s
MedicalCentre“Healthy
Generation”

X

14

Moscow

ON Clinic
Baby

X

MoscowNatural Child
Health andDevelopment
CentreX

16

Moscow

DMC Human
HealthChildren’sCentreX

17

Moscow

Markushka
Children’sClinicX

Multidisciplinary centre

18

MoscowPremier
MedicaX

Specialised centre in paediatric
medicine

12

15

213

EUROPEAN UNION AGENCY FOR ASYLUM

Facility TypeState or city

Public19

MoscowSpecialisms

Facility
namePrivateMoscow
Children'sCenter of
Neurology
andPediatrics

X

Table 57: Examples of paediatric medical and treatment centres in Russia 579
578F

11.2. Access to treatment
11.2.1.

Facilities and organisation(a) Public healthcare system

The key institution for outpatient paediatric care is the local paediatric polyclinic, which isstaffed by district-level paediatricians and nurses. Paediatric polyclinics service specificneighbourhoods so parents of child patients will automatically be registered with one in theirlocal area. Parents can choose a particular paediatrician who will serve as a child’s primary
doctor. 580 The lead figure at paediatric polyclinics is the district paediatrician (DP), theprimary medical focal point for childhood illness. 581
579F

580F

The DP may be one of the following types of paediatric specialist: paediatric neurologist,
otolaryngologist, allergy, specialist or cardiologists, etc. and will be supported by auxiliary
staff, such as speech therapists. In the first instance, the parents of the child patient willcontact the DP by phone for medical advice and may request a home visit accompanied by aground ambulance team (GA team) if a child becomes severely ill. Emergency paediatric care(for poisoning, injuries, etc.) is provided by GA teams who will travel to the child’s location. A
child will remain under care of the DP and a specialist paediatrician if needed. They may be
admitted to hospital when and if necessary to either a general paediatric hospital or a
specialised department of a children’s hospital. 582
581F

The state/public paediatric healthcare system is made up of a network of outpatient andinpatient facilities and rehabilitation centres, some of which are replacing the sanatoriums

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons580
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
581 Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 152
582
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
579

214

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTand ‘health resorts’ of the 1990s. 583 These facilities and centres combine to provide all
essential healthcare services, including prevention, diagnostics, medical, rehabilitative andpalliative treatments, with additional institutions, such as orphanages and palliative
facilities. 584 In the first instance, primary healthcare is offered in outpatient and paediatricpolyclinics.
582F

583F

Child polyclinics deliver essential healthcare services, as shown in Table 58 including
prevention and therapeutic services, such as vaccinations and health monitoring. They arestaffed by the key figure, a DP, paediatric medical specialists, and auxiliary medical staff, andare equipped with diagnostic, therapeutic and rehabilitation equipment for outpatient care,and medical devices. Mental health services for children and teenagers are increasingly
integrated into paediatric polyclinics, which in some regions include a psychiatrist. Mild cases
and minor issues can be addressed in regular polyclinics. 585
584F

Paediatric polyclinic’s departments of psychiatric health and psychosocial care provide
access to psychologists, social workers, and lawyers for children at risk of harm or
psychosocial issues. 586 Serious and severe mental health conditions are treated in outpatient
or inpatient psychiatric institutions. 587 Other institutions that support vulnerable adolescentsare ‘youth-friendly health centres.’ 588
585F

586F

587F

Healthcare services provided by paediatric polyclinics in Russia

Provision of preventive, consultative, diagnostic and medical assistance and care for entrusted
children

Antenatal care provided by the district paediatrician

Primary nursing care for neonates and infants

Hearing screen for neonates and infants who were not examined for hearing impairments at maternity
facilities

Transfer of information about neonates and infants with hearing impairment identified by means ofhearing screen at the centre (office) of hearing rehabilitation, as well as the transferral of children withhearing impairment to the rehabilitation centre for diagnosis

Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 775
585
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons586
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
587
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
588
Baranov, A. et al., The Russian Child Health Care System, 2016, url, pp. S152-S153
583

584

215

EUROPEAN UNION AGENCY FOR ASYLUM

Healthcare services provided by paediatric polyclinics in Russia

Preventative examinations of children, including children at educational institutions

Provision of appropriate nutrition – for children, under 3, as well as children living and studying in
educational institutions

Medical examinations of students at educational institutions before and during the period of practicaltraining (at the organisations), of which all employees are subject to preliminary and periodic
examinations

Observation of children engaged in physical education and sports

Organisation and implementation of immunoprophylaxis (e.g. vaccines) of infectious diseases

Organisation of preventive measures, detection of early and hidden forms of diseases, as well associally significant diseases, including hepatitis B and C, HIV, tuberculosis, identification of risk factors
regarding diseases, disabilities and child mortality

Organisation and implementation of anti-epidemic and preventive measures and events at centres ofinfectious diseases

Transferal of children with medical indications to the appropriate hospital for examination andtreatment

Organisation of diagnostic and therapeutic in-home careOrganisation of appropriate follow-up care for children with chronic illnesses, children with disabilities,
measures to ensure timely recovery thereof

Protection of children’s reproductive health

Implementation of individual rehabilitation programmes for children with disabilities

Implementation of examinations by specialists to determine a temporary disability of parents (or legal
representatives) and working or ill children

216

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Healthcare services provided by paediatric polyclinics in Russia

Provision of medical and social expertise in order to establish a disability by determining a given
medical indication

Implementation of medical, social and psychological assistance to children and families with children

Medical and social support for admissions to educational institutions

Organisation of medical care for children at recreational institutions

Analysis of the basic medical and statistical rates of morbidity, disability and mortality within children
in the appointed area

Sanitary and hygienic education and training of children and their parents (or legal representatives)

Personal, social and health education for children and parents (or legal representatives) for timely
detection and treatment of paediatric diseases and establishment of a healthy lifestyle
Table 58: Healthcare services provided by paediatric polyclinics in Russia 589
588F

In addition to the paediatric polyclinics, 75 % of kindergartens have a medical office usuallystaffed by a nurse, 16 % have agreements with a local feldsher-obstetric units, and 56 % of all
schools also have a medical office staffed by a doctor or nurse. Of all school, 35 % haveagreements with feldsher obstetric units or other medical organisations. 590
589F

Secondary care within the public healthcare system consists of children’s hospitals that childpatients are referred to by their district paediatrician if inpatient treatment is required, andrehabilitation centres. Children’s hospitals subdivide into those associated with different
healthcare needs: infectious children’s hospitals, maternity hospitals, perinatal centres, andmulti-profile children’s hospitals. Treatment for specific medical fields is provided at thepaediatric departments of specialist hospitals, such as psychiatric and narcological hospitals.
Republican and federal specialist centres accept referrals to treat children who become
seriously ill. Paediatric palliative care is offered at home, palliative care practices, in palliative
care units (wards) in paediatric hospitals and at paediatric hospices. 591
590F

Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
Association of Heads of Educational Organizations, Лишь 56 % школ в России имеют медицинские
кабинеты [Only 56 % of schools in Russia have medical offices], Education Managers, 16 October 2019, url
591
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776; Baranov, A. et al., The RussianChild Health Care System, 2016, url, p. S151
589

590

217

EUROPEAN UNION AGENCY FOR ASYLUM

Rehabilitation centres subdivide into daytime rehabilitation centres found in city polyclinics or
may comprise specialist sanatoriums or ‘health resorts.’ They are staffed by paediatricians,
nurses, physiotherapists, specialists, rehabilitation specialists and support staff. Education isprovided for school-aged children. 592 Some provide facilities concentrated on a particulartherapeutic type, for example climatic and thermal. They do not substitute hospitals and do
not provide full-scale inpatient care. Children are referred to these centres for residential
stays when they are chronically ill or recovering from serious diseases, injuries andsurgeries. 593 They typically stay for around two to four weeks and receive medication,
physiotherapy, exercise therapy, massages and so on, with the exception of paediatrics
patients with TB, who stay much longer.
591F

592F

Finally, orphanages, breast milk banks and children’s hospices complete the network of
paediatric institutions. 594
593F

A typical route for a paediatric patient is as follows: Each child in Russia receives a social
security number and OMS policy right after getting a birth certificate. They are fully covered
by OMS for all routine medical care and hi-tech care if needed. All routine care is provided by
a DP, including check-ups, routine labs, vaccinations and mild illnesses. If needed, a child isreferred to a specialist, such as an ENT surgeon, neurologist, ophthalmologist or other type of
specialist. If the child has contracted a serious illness requiring hospital admission, they arereferred to a paediatric hospital and admitted to a general paediatrics or specialised
department. If any of the required care is not locally available, the child is referred to a facility
elsewhere that can provide the necessary care, such as the nearest town or a regional capitalcity. Further still, it could be one of the federal medical centres predominantly located in
Moscow or St Petersburg. 595
594F

11.2.2.

Healthcare resources(a) Paediatric healthcare facilities in the public health system

According to Parfitt, the country had a severe shortage of new equipment in 2005 and staff
were frequently lost to private medical institutions and other professions. In remote areas,
healthcare facilities were finely spread or otherwise out of reach to those who could notafford out-of-pocket payments. 596 More recently, Baranov et al. observed in 2017 that thevolume of children’s wards has decreased but the medical specialisations they cover has
improved. More outpatient, polyclinics and day hospitals have been added, and rehabilitation
centres are being set up all over Russia to cover the services provided by children’ssanatoriums and health resorts. Since the Soviet era, more than 100 new perinatal centres
have been set up and are continuing to be built equipped with neonatal and obstetric
595F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons593
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
594
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
595
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons596
Parfitt, T., The Health of Russia’s Children, 30 July 2005, url, p. 357
592

218

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

technologies, which has reduced the volume of patients with perinatal and obstetricconditions. 597
596F

Russia’s Healthcare Development Strategy until 2025 reports that the building infrastructure
for paediatric care is underdeveloped, with 31.5 % of buildings at regional and republican
children’s hospitals not meeting ‘modern requirements.’ As a consequence, child patients
receive medical care for various illnesses at the sites of healthcare facilities for adults. 598
597F(b) Paediatric healthcare workforce
Across Russia there are 16.31 paediatric medical professionals per 10 000 children population(see Table 59 for types of paediatric specialists per children population). 599
598F

Type of paediatric medical professional

Number per 10 000 of corresponding
population (children), entire RussianFederation

Paediatricians (total)

16.31

District paediatricians

9.20

Paediatric psychiatrists (0 to 14 years)

0.53

District paediatric psychiatrists

0.28

Adolescent psychiatrists (15 to 17 years)

0.28

District adolescent psychiatrists

0.17

Paediatric oncologists

0.11

Paediatric urologists

0.12

Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
Russia, Administration of the Russian President, Указ Президента РФ от 06.06.2019 г. N 254 “О Стратегии
развития здравоохранения в Российской Федерации на период до 2025 года”, [Decree of the President of theRussian Federation No. 254 of 6 June 2019 ‘On the Strategy for the Development of Healthcare in the RussianFederation for the Period until 2025’], 6 June 2019, url
599
Russia, MoH, 14_Ресурсы и деятельность медицинских организаций здравоохранения [14_Resources andactivity of medical healthcare organisations], 31 July 2019, url
597

598

219

EUROPEAN UNION AGENCY FOR ASYLUM

Type of paediatric medical professional

Number per 10 000 of corresponding
population (children), entire RussianFederation

Paediatric surgeons

1.09

Paediatric endocrinologists

0.34

Table 59: Paediatric healthcare workforce in Russia 600
599F(c) Training for paediatricians
Undergraduate teaching for future paediatricians is conducted separately from medicine for
adults. 601 Paediatricians train at the paediatric faculties of universities. Training is also offered
at a limited number of newly constructed, highly specialised stimulating training centres 602
teaching manual skills for doctors, such as procedures, surgeries and manipulations. 603 Twoyears of postgraduate training is required for student doctors to qualify as a generalpaediatrician. 604
600F

601F

602F

603F

(d) Limitations on access to and quality of paediatric healthcare in Russia
Healthcare awareness can be limited by factors of education and culture. Children living inrural and remote, scarcely populated areas often have to travel to access appropriate
healthcare with travel and travel-related expenses not covered by the OMS, although there
may be exceptions for children with disabilities and HIV-infected children. These costs canimpact families on low incomes. Poor regions have fewer resources so therefore the quality of
medical care may be lower. 605 Child patients with disabilities are at a distinct disadvantage
when trying to access healthcare. While all of Russia’s citizens and permanent legal residents
are entitled to free healthcare without exception, there is a stark contrast between access tohealthcare for disabled children living in urban and central regions and rural areas andperipheral regions. 606
604F

605F

According to the Federal State Statistics Service, 55 % of urban and 40 % of rural children
with disabilities are not at all or not fully informed about the free healthcare that they are

Russia, MoH, 14_Ресурсы и деятельность медицинских организаций здравоохранения, [14_Resources andactivity of medical healthcare organisations], 2018, url
601
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
602
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
603
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons604
Baranov, A. et al., The Russian Child Health Care System, 2016, url, p. S151
605
Russia, MoH, Памятка для граждан о гарантиях бесплатного оказания медицинской помощи [Memo for
citizens on the guarantees of free medical care], 28 December 2018, url
606
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
600

220

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

entitled to. 607 It is the view of an anonymous key informant that this can be explained by thefact that people in rural areas having fewer resources are more motivated to use all careavailable free of charge. 608 Paediatric health was not accessible to 30 % of urban and 40 % ofrural cases when needed by children due to a lack of access to specialists or equipment at
the primary healthcare facility. 609 Treatment and medications for some paediatric conditions
have limited access. These are shown in Table 60.
606F

607F

608F

(e) Health policy limitations on access to treatment for paediatric healthconditions
Table 60 shows the specific conditions where patients face restricted access. Sometreatment and medications are covered by the state fund Circle of Good, but as this is only
recently established it is not possible to state how efficient this will be. 610
609F

Name of disease

Limitation on access: treatment and/or
medications

Leukodystrophy

Treatment has limited access

Arteriovenous malformations

As above

Neuronal ceroid lipofuscinosis type 2

Treatment and medications are limited, butaccessible for free via the state fund Circle ofGood 611
610F

Acute myeloid leukaemia

As above

Primary immunodeficiencies D80

As aboveSpinal muscular atrophy G12

As above

Rosstat, Население. Положение инвалидов. Детская инвалидность [Population. The situation of the disabled.
Child disability], 14 April 2020, url
608
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons609
Rosstat, Население. Положение инвалидов. Детская инвалидность [Population. The situation of the disabled.
Child disability], 14 April 2020, url
610
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons611
It is the professional opinion of Contact 1 that there may not be enough specialised staff for diseases with anincidence rate of far less than 1 in 100 000 live births in most countries. Contact 1, Medical Doctor and local
consultant, email, July-September 2021. The person wishes to remain anonymous for security reasons
607

221

EUROPEAN UNION AGENCY FOR ASYLUMName of disease

Limitation on access: treatment and/or
medications

Tuberous sclerosis Q85.1

As above

Duchenne myodystrophy G71.0

As above

Cystic fibrosis (mucoviscidosis) E84

As above

Cryopyrin-associated periodic syndrome (CAPS),
M08.2

As above

Tumour necrosis factor receptor-associated periodic
syndrome (TRAPS), E85.0

As above

Familial Mediterranean fever (FMF), E85.0

As above

Mucopolysaccharidosis IVA, E76.2

As above

Lysosomal acid lipase deficiency, E75.5

As above

Disordersofphosphorus(hypophosphatasia), E83.3

metabolism

As above

Glycogen storage disease type II (Pompe disease)
E74.0

As above

Short bowel syndrome K92.1

As above

Primary myelofibrosis D47.4

Treatment is limited and medications are notincluded in OMS (state insurance
programmes) either federal or regional

Acromegaly and pituitary gigantism E22

As above

Devic’s disease (Neuromyelitis optic) G36.0

As above

Huntington's disease G10

As above

222

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTName of disease

Limitation on access: treatment and/or
medications

Chronic
thromboembolic
hypertension I27.8

pulmonary

As above

Amyotrophic lateral sclerosis G12.2

As above

Autoinflammatory
diseases(hyper-IgD
syndrome/mevalonate kinase deficiency syndrome(HIDS/MKD), D89.0

As above

Acromegaly, E22.0

As above

Lymphangioleiomyomatosis, D48.7

As above

Urea cycle disorders, E72.2

As above

Biotinidase deficiency, E53.8

As above

Rickets-like diseases

As above

Familial hypercholesterolemia (homozygous form)
Е78.0

As above

Still's disease (adult), M06.1

As above

Transthyretin
I43.1*+E85.8

amyloid

cardiomyopathy E85.4+

As above

Transthyretin familial amyloid polyneuropathy E85.1

As above

Chronic thromboembolic pulmonary hypertension,
I27.8

As above

Table 60: Diseases for which treatment or medications are limited through the public healthcare system in
Russia 612
611F

11.2.3.

Private healthcare system

223

EUROPEAN UNION AGENCY FOR ASYLUM

The private healthcare sector offers a range of paediatric healthcare services, but primarily
outpatient care, such as consultations, including specialist reviews, diagnostic andtherapeutic procedures. Private healthcare clinics are only available in urban areas (areas
with about 100 000 residents) and typically, in big cities (those with a population starting at
500 000 residents). Private paediatric hospitals are rare and only available in large cities,
such as Moscow and St Petersburg. 613
612F

11.3. Insurance and national programmes
Like healthcare for the population at large, paediatric healthcare in Russia, including dental
care, 614 both outpatient and inpatient, is covered by the OMS mandatory public healthinsurance within the public healthcare system. 615 It is funded by the state for Russian citizens,
permanent legal residents or legally employed people. Returning Russian citizens and foreign
migrants to Russia are covered by OMS once they are registered as legal residents. 616
613F

614F

615F

Children aged three years and under (and some other categories of paediatric patients,
including children with disabilities) are entitled to receive free outpatient medications onreceipt of a valid prescription from a local polyclinic or inpatient treatment facility, andmedical devices and special nutrition if it is medically required. 617 Children are also entitled totreatment in a sanatorium. Paediatric medications are included on the federal VEDL. 618
Regional health authorities in each region of Russia draw up their own list and may add drugs
to the federal VEDL but are not allowed to remove any items from it. Regional drugs lists may
616F

617F

Zaitseva S., Нельзя не помочь. Как в России будут лечить орфанные заболевания? [It is impossible not to
help. How will orphan diseases be treated in Russia?], Аргументы и факты [Arguments and facts],
7 December 2020, url; Kaishauri, N., В России это не лечат [This is not treated in Russia], Милосердие.ru,
22 January 2018, url; All-Russian Union of Patients, Опрос: доступность государственных гарантий в сфере
оказания медицинской помощи и лекарственного обеспечения 2019 год [Survey: availability of state
guarantees in the field of medical care and drug provision 2019], 23 December 2019, url; State fund Circle of Good
(Krug Dobra). Перечень тяжелых жизнеугрожающих и хронических заболеваний, в том числе редких
(орфанных) заболеваний [List of severe life-threatening and chronic diseases, including rare (orphan) diseases], 29
July 2021, url; Russia, Government of the Russian Federation, Проект постановления об утверждении Порядка
обеспечения оказания медицинской помощи (при необходимости за пределами Российской Федерации)конкретному ребенку с тяжелым жизнеугрожающим или хроническим заболеванием, в том числе с редким
(орфанным) заболеванием, либо группам таких детей [Project of the decree on the approval of the Procedure for
ensuring the provision of medical care (if necessary outside the Russian Federation) to a specific child with a severe
life-threatening or chronic disease, including a rare (orphan) disease, or to groups of such children], 3 February 2021,
url
613
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
614
Expatica, Healthcare in Russia: the Russian healthcare system explained – Children’s healthcare, 11 June 2021, url
615
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
616
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
617
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
618
Russia, Government of the Russian Federation, Распоряжение от 12 октября 2019 № 2406-р Об утверждении
перечня жизненно необходимых и важнейших лекарственных препаратов для медицинского применения на2020 год [Government Decree No. 2406-p of 12 October 2019 ‘On approval of the list of vital and essential drugs
for medical use for 2020’], 2019, http://static.government.ru/media/files/K1fPEUszF2gmvwTkw74iPOASarj7KggI.pdf,
12 October 2019, url
612

224

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

have featured more medications than on the federal list. Insufficient funding remains aserious problem today: the government health spending is still below 6 %—the WHO
recommended minimum—and are around 4 % gross domestic product. 619 Parents may also
have to pay for services not covered by OMS or costs that are not medically indicated, forexample, additional tests which are not covered by OMS but that parents want done or forphysical therapy such as massages. In hospitals, they may pay for better facilities, such as a
private or semi-private room, or better food. 620 Public healthcare facilities can only charge
drug and treatment prices set and regulated by the government, but patients are sometimes
still charged unofficial ‘gratification’ charges. 621 In 11 % of urban and 8 % of rural cases of
paediatric patients, parents have had to make an unofficial, out-of-pocket payment. 622
618F

619F

620F

621F

Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the conditions that entitle patients to receive free or discounted
medications from the state.

11.3.1.

Private paediatric healthcare

Different forms of private medical insurance, including VMI, are available to those able toafford them. However, stateless people are obliged to pay for private healthcare as they are
not covered by the OMS policy. People on low incomes are forced to rely on the publichealthcare system out of lack of choice. Parents who hold VMI can use the policy to pay for
their child/ren’s tests, consultations and treatments which are covered. If there are items thatare not covered, they must pay before the medical care commences. On the occasions that aclient is well known and established at a particular medical facility, then payments will be
accepted after the medical care is given. 623 Table 60 shows the paediatric services that arecovered by OMS and private medical insurance, including VMI.
622F

Programme

Focus

Requirements

Scope ofcoverage

Paediatric services
coveredMandatory publichealth insurance(OMS)

Russiancitizens andpermanent
residents,
includingreturning

1. Public/Federal

Covershealthcare
benefits for
all people
eligible for
OMS

Services included:

2. Employers financeOMS throughcontributions, 2-3 % ofsalary goes into social
tax, a percentage of•

Universal
paediatrichealthcare forchildren up to 18
years old,
includingBaranov A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
621
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
622
Russia, MoH, Памятка для граждан о гарантиях бесплатного оказания медицинской помощи [Memo for
citizens on the guarantees of free medical care], 28 December 2018, url
623
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
619

620

225

EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Russianmigrants.

which is paid into anational Russian
healthcare fund. Once
paid, the employee has
the right to free medicalcare from public Russian
healthcare clinics.

Migrants fromex-Soviet
countries canobtain an
OMS policy
through theiremployers if
the employer
agrees.

3. People who cannot
work and do notcontribute to OMI (e.g.
unemployed,
pensioners, children,
sick people) can still
access free basic
healthcare. 624

Scope ofcoverage

Paediatric services
covered

•

•

62 3F

monitoring,mentalhealthcare,rehabilitation
and restorative
care, hi-techcare, dental
care, inpatientand outpatient
care.
Medications forchildren under
three years old
and forinpatients stays‘Circle of Good’fund purchases
medications andmedical devices
not registered in
Russia forchildren withsevere, lifethreatening andchronic
diseases,
including orphan
ones. May also
pay for treatment
abroad if
unavailable inRussia. 625
Neonatal
screening forsome diseases
Vaccines
Social services
support
624F

•
•
•

Services Excluded:••

Medications forchildren over 3
years old
Sputnik V
vaccine against
COVID-19 (still

Expatica, Healthcare in Russia: the Russian healthcare system explained, n.d., url
GpX News, The Circle of Good Fund will provide medicines for children with three more orphan diseases,
9 March 2021, url
624

625

226

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Requirements

Scope ofcoverage

Paediatric services
covered•under trial withpaediatricpatients)
High quality
hospital facilities,
such as a private
or semi-privateroom, or better
food. 626
625F

Government
health insurance
programmes for
employees of
specialist
agencies, e.g.
law enforcement

Employees of
selected
government
agencies andcompanies

Private sector
health insurance,
including VMI

For theregisteredindividual
andsometimes
their families

Information not
publicly available

For theregisteredindividual
and/or theirfamily (if an
employerpurchases
VMI for an
employee, it
usually only
covers that
individual
and not theirfamily)Services included:
Mostlyoutpatient
care,
such
as
consultations,
including specialist
reviews, diagnostic
andtherapeutic
procedures.

Table 60: Public and private healthcare insurance coverage in Russia 627
626F

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
627
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
626

227

EUROPEAN UNION AGENCY FOR ASYLUM

11.3.2.

Paediatric programmes funded by international donors

There is evidence of a small amount of international donor activity on paediatric healthcare
and diseases in Russia. 628
627F

11.4. Cost of treatment
Paediatric healthcare is provided free of charge under the OMS to all eligible patients in
Russia. Treatment prices are 30 % to 50 % higher in the private sector. Costs are also higher
in wealthier regions than poorer ones. These statements are based on treatment prices inpublic facilities for non-eligible patients, not so-called tariffs. Public facilities must adhere to
official published prices (tariffs) determined by the regional OMS funds in settlements with the
Territorial Fund of Obligatory Medical Insurance (TFOMS, ТФОМС) and other public
facilities. 629 When public healthcare facilities provide services to patients who are not eligible
to receive OMS coverage, prices are regulated by the private healthcare market, as aretreatment prices ordinarily at private sector healthcare facilities.
628F

11.4.1.

Methodology of data collection on treatment prices

The prices of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. The websites used are shown in Table 61.
The most common prices were compared, and the median price agreed and included inTable 62.

Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)Author interpretation based on experience of the research process; Bill & Melinda Gates Foundation, Annual
Report, 2000, url, p. 32
629
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
628

228

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTName and url of website

Subject matter for prices

https://www.krasotaimedicina.ru/

Aggregator of prices and availability of the medical services(surgery, diagnostics, etc.) in Moscow from a lot of private clinics

https://gemotest.ru
Costs of laboratory tests and some diagnostics
https://www.invitro.ru/

https://market.yandex.ru/

Cost of equipment: overview and access to offers from many
online and offline shops (including medical equipment,
orthopaedic supplies, rehabilitation devices, etc.)

Table 61: Websites consulted for treatment prices

Public outpatient and inpatient treatments with prices are referred to as tariffs, i.e. fixed prices
used by OMS funds for reimbursements to medical facilities and payments between public
medical facilities. 630
629F

Treatment Price RUB

Reimbursement/
specialprogramme/free/comments

PublicOutpatient

PublicInpatient

PublicInpatient

PrivateInpatient

Consultation by apaediatrician

FOC

FOC

1 905

1 905

Prices in Moscow

Consultation bypaediatriccardiologist

FOC

FOC

2 252

2 252

Prices in Moscow

Specialist

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
630

229

EUROPEAN UNION AGENCY FOR ASYLUM

Treatment Price RUB

Reimbursement/
specialprogramme/free/comments

PublicOutpatient

PublicInpatient

PublicInpatient

PrivateInpatient

Consultation bypaediatricneurologist

FOC

FOC

2 165

2 165

Prices in Moscow

Consultation bypaediatric surgeon

FOC

FOC

2 338

2 338

Prices in Moscow

Consultation bypaediatric
psychiatrist

FOC

FOC

4 936

4 936

Prices in Moscow

Consultation bypaediatric physicaltherapist

FOC

FOC

2 165

2 165

Prices in Moscow

Consultation bypaediatricpulmonologist

FOC

FOC

2 858

2 858

Prices in Moscow

Consultation bypaediatrician
specialised inmetabolic diseases

FOC

FOC

3 031

3 031

Prices in Moscow

Consultation by
speech therapist

FOC

FOC

1 992

1 992

Prices in Moscow

PublicPrivate RUB

Reimbursement/special
programme/free/comments

FOC

5 196

Prices in Moscow

Treatment

Hospital stay/admission
fee in paediatrics
department (or230

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

PublicPrivate RUB

Reimbursement/special
programme/free/comments

FOC

3 464/dayPrices in Moscow

FOC

866/400 g ofnutrition powder forkids under 10 years

Prices in Moscow

FOC

866/400 g ofnutrition powder forkids under 10 years

Prices in Moscow

FOC

866 - tube;
3 031- placement of
tube,
9 - 1L of liquid foodPrices in Moscow

Gastroenterologicalcare/treatment: tube
feeding (PEG)

FOC

19 918 – tube; 29 790- placement of tube;
779 - 1 litre of liquid
food

Prices in Moscow

Feeding: tube feeding;dosage machine/pump

FOC

164 538

Prices in Moscow

Feeding: parenteralnutrition infusions: likeglucose % fat emulsion %aminoplasmal %FOC

6 408 for1 400 kkal/1 920 ml combination of
glucose + fat
emulsion +aminoplasmal

Prices in Moscow; includedin VEDL

Feeding; parenteralfeeding by venous
catheter for children;
Broviac

FOC

12 990 - tube; 39 836- placement of tube

Prices in Moscow

subspecialist paediatricdepartment) (daily rates)*

Day care for children withmedical conditions**

Feeding: supplements forchildren for malnutrition

Feeding: nutrition, liquid
food high energy, highprotein, vitamin andmineral rich

Gastroenterologicalcare/treatment: tube
feeding (naso-gastric)

231

EUROPEAN UNION AGENCY FOR ASYLUM

PublicPrivate RUB

Reimbursement/special
programme/free/comments

Medical devices
pulmonology: spacer (withmask) for inhaler withasthma medication

FOC

1 992

Price in Moscow; queues
and quotations foreseen in
public sector

A multidisciplinary
consultation/evaluation bya centre fordevelopmental
disorders***

FOC

6 062

Prices in Moscow

Note
FOC:

Free of charge to eligible patients.

* Daily rate includes bed and food only, everything else is extra (laboratory and imaging tests,
physician consultations, medications and procedures)** A day under kindergarten teacher and nurse supervision, food, nap time, lessons withpsychologist, speech therapist. Purely medical care - extra/or not possible at the day care institution*** Consultation by neuropsychologist + speech therapist + remedial educationalist: 60-minutetreatment, rehabilitation plan
Table 62: Cost of treatments for paediatric conditions in the public and private health systems in Russia

11.5. NGOs
There is evidence of extensive activity by domestic Russian NGOs and charitablefoundations, but little work by international NGOs. 631 Some Russian non-profit funds canstretch to establishing small medical facilities with a limited number of, for example, hospices.
They provide financial, organisational or judicial assistant, and pay for expensive treatment,
medicines, equipment or arranging for patients to receive treatment abroad in cases thatcannot be successfully treated in Russia. It would be rare for them to fund a scaled-up medical
facility due to expensive and heavy regulation. 632
630F

631F

Author interpretation based on her experience of the research process.
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
631

632

232

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTTo access services funded by NGOs, parents or patients contact the NGO, submit required
information and ask for help. 633 NGOs process these requests through their internal
procedures. Instructions on how patients can access their programmes are missing fromwebsites. 634 A non-exhaustive list of NGOs is provided below.
632F

633F

11.5.1.

Domestic NGOs

Russian NGOs with international donor funding or a combination of donor funding andRussian government funding packages have run specific programmes around children andyouth health. 635 For example, NGO, Healthy Russia Foundation, collaborated with the state torun a programme of health awareness workshops for teenagers called ‘Everything That
Concerns You.’ 636 Other Russian NGOs advocating on paediatric illnesses are shown in Table
63.
634F

635F

Name of NGO(Russian/English)

Purpose/diseases addressedYearfoundedExample annual
turnoverПодари жизнь!
[Give a life!]

Oncological, haematological and othersevere illnesses.

2006

RUB 1 billion
738 million in 2019.

Русфонд [RusFund]

Severe illnesses, orphans and disabledchildren.

1996

RUB 1 billion
436 million in 2019Фонд Алёша [FundAlyosha]Helps sick children.

2009

RUB 864 million in2019Фонд WorldVita[WorldVita Fund]

Helps severely ill children with onco-,haematological, cardio- and otherpathologies.

2009

RUB 856 million in2019Children’s Palliative
Care Fund

Education, pain control, open ICU (accessto ICUs in Russia is often restricted), workwith orphanages for sick children, so
called ‘internats’, perinatal palliative
care, respiratory support[«Детский
паллиатив»,благотворительный фонд развития

RUB 34 million in2020 and slightly
over RUB 3 million
in 2021 (to date)Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons634
Author interpretation based on viewing the websites cited.
635
Author interpretation based on viewing the websites cited.
636
Parfitt, Russia’s health promotion efforts bloom, The Lancet, 27 June 2009, url, p. 2186
633

233

EUROPEAN UNION AGENCY FOR ASYLUMName of NGO(Russian/English)

Purpose/diseases addressedпаллиативной
помощи]
Table 63: Examples of domestic Russian NGOs covering paediatric medicine

234

Year
foundedExample annual
turnoverRUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

12. Patients with disabilities
12.1. General information
Disability is any condition of the body or mind that that limits activities for the person with thecondition and how they interact with the world around them. It includes total or partial loss ofthe person’s bodily or mental functions. 637 Disability has three dimensions: Impairment in aperson’s body structure or function, or mental functioning; activity limitation, such as hearing;and participation restrictions in normal daily activities. 638 In the context of this report, disability
refers to patients with such mental and/or physical disabilities (since birth or acquired), andalso highlights physical disabilities like hearing problems and problems with sight.
636F

637F

12.1.1.

Epidemiological context

The Federal State Statistics Services reports that, on 1 January 2021, there were 11 631 000
people of all ages on the Federal Register of Disabled Persons which equated to 79.6 people
per 1 000 population. 639 These statistics are composed of figures enumerating the following
causes of disabilities: tuberculosis; malignant neoplasms; endocrine system diseases, eating
disorders and metabolic disorders; mental and behavioural disorders; diseases of the nervous
system; diseases of the eye and its adnexa; ear and mastoid diseases; diseases of thecirculatory system; respiratory diseases; diseases of the digestive system; diseases of themusculoskeletal system and connective tissue; the consequences of injuries, poisoning andother influences of external causes; the consequences of industrial injuries; and occupational
diseases. 640
638F

639F

The number of people who are registered as disabled in Russia have increased in the recent
decade – from 4.7 million people (3.2 % of the population) in 1993 to 13.2 million people(9.2 %) in 2013. 641 With population ageing and demographic transition underway in Russia, theproportion of people with disabilities may continue to increase in the next 20 years,
particularly among people over 60. 642
640F

641F

Australian Network on Disability, What is a disability, n.d., url; CDC, Disability and Health Overview, n.d., url
CDC, Disability and Health Overview, n.d., url
639
Rosstat, Население. Положение инвалидов. Уровень Инвалидизации. Общая Численность Инвалидов ПоГруппам Инвалидности [Population. The situation of the disabled. Disability level. Total number of persons withdisabilities by disability group (Table 1.1)], 1 September 2021, url
640
Contact 2, Research Assistant, email, July-September 2021. The person wishes to remain anonymous for security
reasons641
UNCRPD (UN Committee on the Rights of Persons with Disabilities), Consideration of reports submitted by States
parties under article 35 of the Convention : Convention on the Rights of Persons with Disabilities : initial reports ofStates parties due in 2014 : Russian Federation, 9 September 2014, url, p. 4642
Vasin, S.A., Prospects of changes in the total size and age composition of adults with disability in Russia,
7 September 2017, url, p. 558
637

638

235

EUROPEAN UNION AGENCY FOR ASYLUM

12.1.2.

National policies and programmes

When Russia became a signatory to the UN Convention on the Rights of Persons with
Disabilities (UNCRPD) in 2008, it ratified Federal Act No. 36-FZ of 3 May 2012, which enteredinto force on 25 October 2012. This ratification has enabled the country to pass new laws onsocial protection, assistive services i.e. guide dogs, and cash transfers for people with visual
impairments.643
The State Accessible Environment Programme is important as it seeks to cover accessibility
for children and adults with disabilities and refine the disability assessment and rehabilitation
sector, among other goals. The programme’s goal is to foster inclusion within legal, economic
and institutional activities within the country to improve the standard of living for people withdisabilities. Mainly, the act works on mainstreaming and improving accessibility in services,
rehabilitation, employment and facilities, among other aspects of life.644

12.1.3.

Example of treatment centres

Table 64 shows a sample of example treatment centres in Russia specialising in healthcare
for patients with eye disabilities from both the public and private healthcare sectors. These
were identified through a search of their websites.
State or city

Facility nameFacility type
PublicSpecialisms

Private1

Moscow‘Scope’ Clinic, Moscow(‘Sfera’)X

Specialist clinic for
ophthalmology, adults
and children

2

Moscow

Ophthalmology Clinic ‘Vision
Restoration Centre,’ Moscow

X

Ophthalmological clinic
where all types ofdiagnostics and treatmentof eye diseases arecarried out using
microsurgical, laser andtherapeutic methods.

UNCRPD (UN Committee on the Rights of Persons with Disabilities), Consideration of reports submitted by States
parties under article 35 of the Convention : Convention on the Rights of Persons with Disabilities : initial reports ofStates parties due in 2014 : Russian Federation, 9 September 2014, url, pp. 4-5
644
Russia, Ministry of Labour and Social Protection of the Russian Federation Российской Федерации, Отчет оходе реализации и об оценке эффективности государственной программы Российской Федерации
«Доступная среда» [Report on the implementation and assessment of the effectiveness of the state programme"Accessible Environment" of the Russian Federation], 28 February 2020, url
643

236

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTState or city3

Moscow

Facility nameFacility type

S.Fyodorov Eye Microsurgery
Federal State Institution

PublicPrivateX

Paidservices
available

Specialisms

Claims to be a leading
provider of healthservices in the RussianFederation and worldclass centre of excellenceof ophthalmic researchand education.

Table 64: Example facilities for the treatment of patients with eye disabilities645

12.2. Access to treatment
12.2.1.

Overview of access to treatment

In 2020, 71.1 % of people with disabilities, aged 15 or over, sought outpatient and polyclinic
care from health care providers.646

12.2.2. Limitations on access to healthcare for people with disabilities
Patients in rural areas are at a distinct disadvantage when it comes to getting a disability or
disabilities diagnosed. Few rural areas have health facilities with sufficient specialist medical
expertise in-house, which makes it more difficult for patients to have access to these criticalservices.647
The geographical distribution of offices of Medical-Social Expertise is based on a populationbased principle of one office per 70 000 to 90 000 people. Moscow has one office per
17 square kilometres while Krasnodar region has one per 1 170 square kilometres and theContact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons646
Rosstat, Население. Положение инвалидов. Медико-социальная экспертиза и социальное обслуживание
инвалидов, Получение амбулаторно-поликлинической помощи: инвалидами в возрасте 15 лет и более в 2018году [Population. The situation of the disabled. Medical and social expertise and social services for the disabled.
Receipt of outpatient care: for persons with disabilities aged 15 and over in 2018], n.d., url; Rosstat, Население.
Положение инвалидов. Медико-социальная экспертиза и социальное обслуживание инвалидов, Получение
амбулаторно-поликлинической помощи: инвалидами в возрасте 15 лет и более в 2020 году [Population. The
situation of the disabled. Medical and social expertise and social services for the disabled. Receipt of outpatientcare: for persons with disabilities aged 15 and over in 2020], n.d., url
647 Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
645

237

EUROPEAN UNION AGENCY FOR ASYLUM

Republic of Tyva has one office per 42 600 square kilometres, demonstrating how physicallyinaccessible these facilities are for people living in remote settlements.648
Technically, referral systems allow patients to be referred out-of-region for specialist
assessment and care and Russia’s OMS, the mandatory health insurance policy within the
public healthcare system will cover the costs. However, budgetary constraints mean that only
some individuals will have their costs covered through a long process, so some patients –particularly those with urgent needs – must pay directly for travel expenses and sometimes
treatment. In 2018, 23 % of people with disabilities who sought outpatient care at health carefacilities did not receive treatment. The reasons for failing to receive treatment are given as
there being no necessary specialist (35.6%); could not make an appointment with a doctor inadvance (20.5%); there was no necessary medicine or equipment (9.1%); long waiting lists forappointments (7.1%); the necessary treatment was offered on a fee-for-service basis (20.3%);
medical care was refused for another reason (7.3%).649 Other barriers in accessing careinclude unfamiliarity or inability to use computers or legal resources. Cultural beliefs also
deter some people from seeking help with disability from science-based medicine.650

12.2.3. Rehabilitation
As of 2015, Russia’s rehabilitation system was managed by the federal, regional andmunicipal governments. The state funds rehabilitation programmes and will supply necessary
technology and assistive devices. The Social Protection for Persons with Disabilities Act,
Art. 10 guaranteed access to community-based rehabilitation, regardless of where a person
lives and created a database of state-funded facilities.651 Rehabilitation included assistive
living for people with intellectual disabilities, as well as institutions for people withpsychosocial and physical disabilities.652 The state-funded rehabilitation system included 85
offices; 72 prosthetic and orthopaedic companies; 1 411 social care facilities; 134 facilities forchildren with disabilities; 600 rehabilitation centres; and 11 residential colleges for people with

Russia, Ministry of Labour and Social Protection, Сборник по трудоустройству инвалидов, сформированныйна основе успешно реализованных региональных практик и мероприятий, в том числе осуществляемых
социально ориентированными некоммерческими организациями, [A compendium on the employment of
persons with disabilities, based on successful regional practices and activities, including those carried out by sociallyoriented non-profit organisations], 2019, url
649
Rosstat, Население. Положение инвалидов. Медико-социальная экспертиза и социальное обслуживание
инвалидов, Получение амбулаторно-поликлинической помощи: инвалидами в возрасте 15 лет и более в 2018году [Population. The situation of the disabled. Medical and social expertise and social services for the disabled.
Receipt of outpatient care: for persons with disabilities aged 15 and over in 2018], n.d., url;
650
Russia, Ministry of Labour and Social Protection, Сборник по трудоустройству инвалидов, сформированныйна основе успешно реализованных региональных практик и мероприятий, в том числе осуществляемых
социально ориентированными некоммерческими организациями, [A compendium on the employment of
persons with disabilities, based on successful regional practices and activities, including those carried out by sociallyoriented non-profit organisations], 2019, url, pp. 4, 5, 41, 65
651
UNCRPD (UN Committee on the Rights of Persons with Disabilities), Consideration of reports submitted by States
parties under article 35 of the Convention : Convention on the Rights of Persons with Disabilities : initial reports ofStates parties due in 2014 : Russian Federation, 9 September 2014, url, pp. 49-50
652
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
648

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

disabilities. 653 Given the stigma and difficulty accessing disability services, many people withdisabilities were institutionalised.654
Numbers of adults in residential social care, 2011-2014
2011

2012

2013

2014

203 027

206 898

207 478

213 455

4 707

4 234

Facilities for adults
Number of people with disabilities in residence(total)Facilities for children (dropped due to placement with families and adoption)
Number of people with disabilities in residence(total)

6 805

4 359

Table 65: Numbers of adults in residential social care in Russia655

12.2.4. Private healthcare sector
Holders of private healthcare insurance, including VMI, can access medical care and disease
management support at private hospitals and clinics, many of which are located in Moscow,
where most of which are limited to wealthier Russians, international assignees and medical
tourists.656 Two examples are JSC “Medicine” (Clinical of Academician Roytberg) in Moscow,which offers a full range of physiotherapy and other services, including polyarthritis in adults,
exercise therapy, rheumatology, outpatient surgery in its ophthalmology centre,
rheoencephalography, ultrasound scanning at home and manual therapy;657 and the National
Pirogov Medical Centre in Moscow, which offers haematopoietic stem cell transplantation thathelps some multiple sclerosis patients with paralysis to regain their movement.658
Some public facilities offer paid services, and their prices are usually lower than at standard
private sector hospitals.659 An example is an ultrasound of the abdomen costing RUB 1 819 in
the paid public sector in Moscow and RUB 3 031 in the private healthcare sector. In Russia’s
regions, the prices of paid services at public healthcare facilities are 1.5 to 2 times lower.
However, there are limitations to accessing consultations, test and diagnostics, such as

UNCRPD (UN Committee on the Rights of Persons with Disabilities), Consideration of reports submitted by States
parties under article 35 of the Convention : Convention on the Rights of Persons with Disabilities : initial reports ofStates parties due in 2014 : Russian Federation, 9 September 2014, url, p. 50
654
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
655
UNCRPD (UN Committee on the Rights of Persons with Disabilities), Consideration of reports submitted by States
parties under article 35 of the Convention : Convention on the Rights of Persons with Disabilities : initial reports ofStates parties due in 2014 : Russian Federation, 9 September 2014, url, p. 50
656
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
657
JSC “Medicine”, Physiotherapy, n.d., url
658
Pirogov Russian National Research Medical University, About the Centre, n.d., url
659
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
653

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EUROPEAN UNION AGENCY FOR ASYLUM

queues, long waiting times for results and little flexibility in different ways of receiving theresults of medical reviews, which may impact people with disabilities.660

12.3. Insurance and national programmes
Like healthcare for the population at large, healthcare for adults and children with disabilities
is provided under the state-funded health insurance system, the OMS.661 Non-urgent care isprovided to Russian citizens, permanent legal residents or long-term visa holders and/or
legally employed people who hold an OMS policy and have a registered address in Russia.
Returning Russian migrants and foreign migrants to Russia are covered by OMS once they are
registered as legal residents. Access to urgent psychiatric care, including hospital admissions,is provided free to all patients in need.662 Insufficient funding remains a problem withgovernment health spending below 6 % – the WHO recommended minimum – and around
4 % of gross domestic product.663
Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 shows patients with certain conditions entitled to receive free
medications from the state.

12.3.1.

Private healthcare insurance

Different forms of private medical insurance, including VMI, are available to those able toafford them, and enable those patients to receive healthcare at private healthcare facilities.
However, stateless people and internally displaced people are obliged to pay for private
healthcare as they are not covered by the OMS policy. People on low incomes are forced torely on the public healthcare system for neurological healthcare out of lack of choice.664
T shows the public and private healthcare coverage for patients with disabilities that arecovered by OMS and private medical insurance, including VMI.
Programme

Focus

Requirements

Scope ofcoverage

Services covered fordisabled patients

Mandatory
public healthinsurance(OMS)

Russiancitizens andpermanent
residents,

1. Public/Federal

Covershealthcare
benefits for all•
Inpatient
medications duringhospital stays

2. Employers financeOMS throughContact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
661
Russia, Ministry of Health, Ресурсы и деятельность медицинских организаций Основные показатели
здравоохранения 2018, Основные показатели здравоохранения 2018 [Resources and activities of medicalorganisations, Key health indicators 2018], 31 July 2019, url
662
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons663
Baranov, A. et al., Paediatrics in Russia: past, present and future, 2017, url, p. 776
664
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
660

240

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Requirements

Scope ofcoverage

Services covered fordisabled patients

includingreturning
Russianmigrants.
Migrants fromex-Soviet
countries canobtain an
OMS policy
through theiremployers if
the employer
agrees.

contributions, 2-3 % ofsalary goes into social
tax, a percentage of
which is paid into anational Russian
healthcare fund. Once
paid, the employee
has the right to free
medical care frompublic Russian
healthcare clinics.

people eligible
for OMS•
Free ordiscounted prescription
medications for outpatientcare, depending on
approval from federal
authorities, anddepending on the
disability type.
•
Assistive
technology•
Consultation by aphysical therapist•
Consultation byan occupational therapist•
Consultation by
an orthopaedic surgeon•
Consultation by apsychiatrist•
Consultation by apsychologist•
Consultation by aneurologist•
Consultation by aneurosurgeon•
Consultation by asocial worker, social
services orientation, basic
legal help, family
consultation•
Consultation by anurse at home•
Consultation by
an ENT specialist•
Consultation by
an audiologist•
Consultation by
an ophthalmologist•
Special schoolingfor children with hearing
impairment; costs for one
year•
Special schoolingfor the mental/intellectual
disability; costs for one
year•
Institutions/school for blind people; costs
for one year

3. People who cannot
work and do notcontribute to OMI (e.g.
unemployed,
pensioners, children,
sick people) can still
access free basic
healthcare.665

665

Expatica, Healthcare in Russia: the Russian healthcare system explained, n.d., url

241EUROPEAN UNION AGENCY FOR ASYLUM

Programme

Focus

Requirements

Scope ofcoverage

Services covered fordisabled patients•(classic)
Wheelchair•
Electric
wheelchair•
Devices for blind
people•Medical devices
orthopaedics•
Care for patientswith combined mental
and physical disabilities:
long-term institutionalround-the-clock care;long-term institutionalround-the-clock care•
Care for patientswith physical disability:
long-term institutionalround-the-clock care; daycare•
ENT: implantation
repair and follow-up of
Cochlear ImplantServices excluded:•
Outpatient
medications (some arefree or subsidised)•Services forineligible patients, suchas stateless people andinternally displaced
peopleGovernment
healthinsurance
programmes
for employeesof specialist
agencies, e.g.
law
enforcement

Employees of
selected
government
agencies andcompanies

Private sector
healthinsurance,
includingvoluntary
medicalinsurance (VMI)242

For theregisteredindividual andsometimes theirfamilies

Information not publicly
available

For theregisteredindividual
and/or theirfamily (if an
employerpurchases VMI
for anemployee, it
usually only
covers that

Coverage of services
depending on the hospitalor medical facility that theinsurance covers. An
example list is:•
Physiotherapy
and other services,
including polyarthritis in
adults, exercise therapy,
rheumatology

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Requirements

Scope ofcoverage

Services covered fordisabled patients

individual andnot their family)•
Outpatient
surgery•
Rheoencephalogr
aphy (a technique ofcontinuous registrationof cerebral blood flow)•
Ultrasoundscanning at home andmanual therapy•
Haematopoietic
stem cell transplantation

Table 66: Public and private healthcare coverage for patients with disabilities in Russia666

12.4. Cost of treatment
Healthcare for patients with disabilities is provided free of charge under the OMS to all
eligible patients in Russia. Treatment prices are 30 % to 50 % higher in the private sector.
Costs are also higher in wealthier regions than in poorer ones. By law, public facilities must
adhere to official published prices while prices in private facilities are regulated by the private
healthcare market.667 Most public providers do uphold the official tariffs, but in some regions,informal gratuity payments are expected by medical personnel, mainly in relation to rare
medical care and equipment. 668 These payments are not included on any invoices, andaffects if the patient will get help and the speed at which they receive that help. This is a formof inequality and amounts to discrimination.669

12.4.1.

Methodology of data collection on treatment prices

The prices of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. Websites used are shown in Table 67.
Name and url of website
https://docdoc.ru/

Subject matter for prices
Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
667
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
668
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Izvestia, 100 тыс. за инвалидность. Генпрокуратура проверит Минтруд нанарушения в работе медико-социальной экспертизы [100 000 for disability. The Prosecutor General's Office will
check the Ministry of Labour for violations in the work of medical and social expertise], 19 April 2016, url
669
Izvestia, 100 тыс. за инвалидность. Генпрокуратура проверит Минтруд на нарушения в работе медикосоциальной экспертизы [100 000 for disability. The Prosecutor General's Office will check the Ministry of Labourfor violations in the work of medical and social expertise], 19 April 2016, url
666

243

EUROPEAN UNION AGENCY FOR ASYLUMName and url of website

Subject matter for prices

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations in
Moscow from a lot of private clinics

https://zoon.ru/

Aggregator of information on prices for various services (including
medical)https://www.krasotaimedicina.r Aggregator of prices and availability of the medical services (surgery,u/diagnostics, etc.) in Moscow from a lot of private clinics
https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/

https://market.yandex.ru/

Cost of equipment: overview and access to offers from many online
and offline shops (including medical equipment, orthopaedic supplies,
rehabilitation devices, etc.)

Table 67: Websites consulted for treatment prices

The most common prices were compared, and the median price agreed and included inTable 68.
Treatment price RUB

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Reimbursement/
specialprogramme/free/comments

Specialist (for physical and intellectual disabilities)

Consultation by aphysical therapist

FOC

FOC

1 645

1 645

Prices in Moscow

Consultation by an
occupational
therapist

FOC

FOC

3 637

3 637

Prices in Moscow

Consultation by anorthopaedic
surgeon

FOC

FOC

2 944

2 944

Prices in Moscow

Consultation by apsychiatrist

FOC

FOC

2 944

2 944

Prices in Moscow

244

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Treatment price RUB

Reimbursement/
specialprogramme/free/comments

Publicoutpatient

Publicinpatient

Privateoutpatient

Privateinpatient

Consultation by apsychologist

FOC

FOC

5 889

5 889

Prices in Moscow

Consultation by aneurologist

FOC

FOC

2 252

2 252

Prices in Moscow

Consultation by aneurosurgeon

FOC

FOC

2 511

2 511

Prices in Moscow

Consultation by asocial worker**

FOC

/

2 511

2 511

Prices in Moscow

Consultation by anurse at home(price of one
consultation or
price per hour andprice of one day ofcontinuous care at
home)

FOC

/

/

3 897

Prices in Moscow

Consultation by an
ENT specialist

FOC

FOC

1 472

1 472

Prices in Moscow

Consultation by anaudiologist

FOC

FOC

2 944

2 944

Prices in Moscow

Consultation by anophthalmologist

FOC

FOC

1 472

1 472

Prices in Moscow

PublicPrivate RUB

Schooling

245

Reimbursement/special
programme/free/comments

EUROPEAN UNION AGENCY FOR ASYLUM

PublicPrivate RUB

Reimbursement/special
programme/free/comments

Special schooling forchildren with hearing
impairment; costs for one
year

FOC

398 356

Prices in Moscow*

Special schooling for themental/intellectual
disability; costs for one
year

FOC

493 615

Prices in Moscow*

FOC

597 534

Prices in Moscow*(classic) Wheelchair

FOC

9 959

Prices in Moscow

Electric wheelchair

FOC

199 178

Prices in Moscow*

FOCa) 59 753 or 398 356;b) 779;c) 953

Prices in Moscow*

Medical devices
orthopaedics: spinal orcorset brace

FOC

3 464

Prices in Moscow*

Medical devices
orthopaedics: lower andupper limb orthoses

FOC

3 984

Prices in Moscow*

Institutions/school forblind people; costs for
one year

Medical devices

Devices for blind people:a) Braille typewriters orcomputers;b) canes;c) ‘talking’ products, e.g.
special clocks and timers,
etc.

246

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

PublicPrivate RUB

Reimbursement/special
programme/free/comments

FOC

5 975

Prices in Moscow*

Care for patients withcombined mental andphysical disabilities: longterm institutional aroundthe-clock care (costs for
one year)FOC

536 914

Prices in Moscow*

Care formentally/intellectuallydisabled patients: longterm institutional aroundthe-clock care (costs for
one year)FOC

536 914

Prices in Moscow*

Care for mentallydisabled: day careFOC

1 472 a day

Prices in Moscow*

Care for patients withphysical disability: longterm institutional aroundthe-clock care (costs for
one year)

FOC

Care for patients withphysical disability: day
care

FOC

1 472 a day

Prices in Moscow*

ENT: implantation repair
and follow-up of Cochlear
Implant

FOC

84 434 (without
implant)

Prices in Moscow*

Medical devices
orthopaedics:
orthopaedic shoes

Treatment

536 914Note

247

Prices in Moscow*EUROPEAN UNION AGENCY FOR ASYLUM

PublicFOC:

Private RUB

Reimbursement/special
programme/free/comments

Free of charge to eligible patients.

* Queues and quotations foreseen in public sector** Social services orientation, basic legal help, family consultation
Table 68: Cost of treatments for patients with disabilities in the public and private health systems in Russia

12.5. NGOs
There are several of domestic NGOs and/or NCOs working in the field of disability in Russia,
which resemble developed countries’ patterns of service providers and advocacy-focusedorganisations.670 NGOs and NCOs provide assistance to patients with disabilities, particularly
children. In addition, so do public organisation, public movements, associations and unions
and funds.671
Well-known NGOs in Russia include the following:
The Regional Society of Disabled People ‘Perspektiva’ in Moscow is an NGO that fundraises
for inclusive youth sports activities. Founded in 1997 by Denise Roza, it supports physicaleducation teachers in schools, parents of children with and without disabilities, and training
and inclusive sports activities for a number of disabled athletes. In St Petersburg, Perspektiva
supports families and children with severe mental and physical disabilities in order tonormalise their lives.672
Best Buddies Russia, founded in 2009, is part of a global volunteer movement creating
opportunities for one-to-one friendships, integrated employment and leadership development
for people with intellectual development disabilities.673
Hope (Archangelsk) aims to improve the quality of life of people with disabilities locally. Their
activities include rehabilitation through physiotherapy exercises, personal computer training,
cultural events, board games, dance classes, etc.674
Zhuravlik Foundation (Moscow) is an education charity that fundraises, among other things,
to give children with special needs a chance to be supported by tutors, specialists andToepler, S. and Fröhlich, C., Advocacy in authoritarian contexts: the case of disability NGOs in Russia, 2020, url,
pp. 1482-1483
671
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
672
Perspektiva, Russian disability NGO ‘Perspektiva’, n.d., url
673
Best Buddies, Best Buddies Russia, n.d., url
674
Bridges, Hope, n.d., url
670

248

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

paraprofessionals in state school and preschool environments through its ‘Inclusive Capsule’initiative.675
Happy Childhood is a local NGO in Archangelsk that works in the field of preschool
education, psychological consultation and rehabilitation of disabled children. It funds summer
camps with intensive training for children with autism, autism spectrum disorder, Down’s
syndrome and so on.676
Severodvinsk local public organisation of disabled people with hearing loss. This NGO
operates in the field of health, preschool and school education. Its emphasis is on
rehabilitation through sport and training of specialists.677
Kargopol Organisation of the All Russian Society of Disabled People. This branch of the VOI
helps protect the rights and interests of people with disabilities through help with their leisurepursuits and everyday life. Its activities include consultations, seminars, training andconferences.678
Friends House Moscow, a Quaker organisation, has been running initiatives in the RussianFederation. Additional partners included Vera, a club for people with disabilities, theDepartment of Social Protection, Pokrov Social Centre, the Employment Centre andeducational institutions in the city.679
The United Kingdom’s St Gregory’s Foundation operates in Moscow and St Petersburg. It
helps children and teenagers with hearing loss to communicate and connect to the world inorder to promote independence. It also helps families living with impaired hearing toparticipate fully in their communities. It provides security, care and food aid to disadvantaged
children. Working with local authorities and other charities and organisations it provides part
funding for long-term projects, helps partners build their knowledge and deliver high-quality
skills by bringing together specialists, and encourages local fundraising.680
Garage Museum of Contemporary Art, Moscow. In 2015, this institution became the first in
Russia to launch an Inclusive Programmes Department, as well as a training programme forcultural institutions welcoming deaf and hard of hearing, blind, visually impaired and deafblind visitors, who are entitled to free museum admission with a carer. This grew into anannual international conference. Garage has prepared a compilation of materials entitledExperiencing the Museum for people with disabilities.681
Protek charitable foundation is the charitable arm of one of the largest pharmaceuticalgroups in Russia. Its ‘Health for People’ programme provides free drugs and medicinal
products to all 85 regions, assistance to healthcare institutions, social welfare agencies,

Bridges, Zhuravilk Charity Foundation, n.d., url
Bridges, Happy Childhood, n.d., url
677
Bridges, Severodvinsk Local Public Organization of Disabled People with Hearing Loss, n.d., url
678
Bridges, Kargopol Organization of the All-Russian Society of Disabled People, n.d., url
679
Friends House Moscow, Helping disabled young people find work, n.d., url
680
St Gregory’s Foundation, Welcome to St Gregory’s Foundation, n.d., url
681
Garage Museum of Contemporary Art, Diversity and inclusion, 2022, url
675

676

249

EUROPEAN UNION AGENCY FOR ASYLUM

charitable foundations and non-profit organisations, associations of veterans and disabled
people, orphanages, shelters and boarding schools. During the coronavirus pandemic in
April-June 2020, medicines and personal protective equipment worth more thanRUB 20 million were supplied to 150 institutions in 17 regions.682
The All Russian Society of the Deaf. Based in Moscow but with 615 local branches, this is thelargest and oldest public organisation of the hearing impaired in Russia, formed in 1926. It
aims to foster social rehabilitation and integration, focusing on civil rights, availability of
information and services, education, training and employment, as well as medical care, social
and transport infrastructure, and cultural institutions.683
So-edinenie (Connection) is a deaf-blind support foundation formed in 2014. The aim is topromote solutions and practices that will allow deaf-blind people the opportunity to better
integrate into society. The foundation’s programmes include science and education, regional
projects and initiatives, and improved information and communication attracting volunteers.684

Protek Group, Charity, n.d., url
All-Russian Society of the Deaf, About VOG, n.d., url
684
Со-единение [Connection. The Deaf-Blind Support Foundation], Миссия [Mission], n.d., url
682
683

250

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

13. Elderly patients
13.1. General information
Geriatric medicine is the branch of medicine concerned with all aspects of health and illness
in older adults.685 In the context of this report, geriatric conditions refer to any kind of
conditions related to ageing like any form of dementia, hearing problems, mobility problems
and dependency on care.

13.1.1.

Epidemiological context

In 2018, there were approximately 30 million Russians aged 60 years and older, accounting
for one in five or 21.3 % of all Russians.686 Women, aged 55 and older, and men aged 60 andolder are deemed to be over working age. 687 These are also the ages at which people ofrespective genders become regarded as ‘elderly’. The total estimated incidence rate of
diseases commonly affecting older aged people increased between 2000 and 2018 from73 573 new cases per 100 000 to 78 213, with more substantial increases in diabetes (18 %),as well as cancer and cardiovascular disease (25 %). It was estimated in 2018 that there werearound 4 million senior citizens in need of strong, reliable support.688 In 2019, WHO reported
that Alzheimer’s disease and other dementias were the fifth leading cause of death in Russia.

13.1.2.

National policies and programmes

According to the NGO Human Rights Watch in an article outlining a chronic deficit in homebased care services for senior citizens in Russia, the national constitution and federal laws
promise citizens the right to health and social security that guarantees them a dignified life.
The NGO suggested that these obligations include older people with disabilities and theirright to not be institutionalised, but live with support in the wider community. There havebeen numerous laws containing aged-friendly provisions, yet their implementation remains
the key challenge.689
In 2016, the Russian federal government published the “Strategy of Action for Senior Citizens
in the Russian Federation until 2025” which covered health and social care. There is a federal
government project on elderly people and health called “Development and implementation ofUnited Kingdom National Health Service, Geriatric medicine, date, url
Davis, C.M., Priorities, shortages, and rationing in the UK and Russia national health services during 2000–2019:
initial conditions for responses to Covid-19, 11 September 2020, url, p. 991
687
Puzin, S.N. et al., Disability in Elderly People due to Hypertensive Disease in the Russian Federation,
24 September 2018, url, pp. 171–176
688
Davis, C.M., Priorities, shortages, and rationing in the UK and Russia national health services during 2000–2019:
initial conditions for responses to Covid-19, 11 September 2020, url, p. 997
689
Human Rights Watch, Insufficient Homes Services for Older People, 24 August 2021, url
685

686

251

EUROPEAN UNION AGENCY FOR ASYLUM

the programme of systematic support and improvement of the quality of life of senior citizens‘The Older Generation.’”690

13.1.3.

Key facilities for the treatment of geriatric conditions

Table 70 shows a sample of treatment centres in Russia specialising in health conditions
associating with ageing and gerontology from both the public and private healthcare sectors.
State or city

Facility nameFacility type
Public1

Moscow

Moscow State Healthcare
Institution City Clinical
Hospital №1 NI. Pirogov
and Pirogov Russian
National Research Medical
University, Russian Clinicaland Research Center ofGerontology

Private

UMMC-Health

3 Ekaterinburg

City Clinical Hospital No.40

x

Geriatric medicine
The leading scientific andclinical geriatric institution of
the Russian Federation,according to its website.
Clinic includes therapeutic,
cardiological, neurological,
gynaecological, urological,
orthopaedic and surgicalunits. It provides medical care
for all ages but focuses on
elderly patients.

X

2 Ekaterinburg

Specialisms

X

Provides full range of services
for diagnostics, treatment andprevention of disease.
Specialisms include
gynaecology, neurology,
endocrinology,
ophthalmology and others.
Includes psychiatry for theelderly.

Paid
services
available

Free medical care forresidents of the city insured in
the compulsory medical
insurance system (OMS).
Services include diagnostics,
obstetrics and gynaecology,
outpatient polyclinic, surgery,neurosurgery, infectious
diseases.

Russia, Ministry of Health, Федеральный проект «Разработка и реализация программы системной
поддержки и повышения качества жизни граждан старшего поколения «Старшее поколение» [Federal project"Development and implementation of the programme of systematic support and improvement of the quality of lifeof senior citizens "The Older Generation"], 7 October 2019, url
690

252

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORTState or city

4 Yekaterinburg

Facility nameFacility typeSpecialisms

PublicPrivateGeriatric medicine

X

Paidservices
available

One of the biggest hospitals
in the Ural
region. Autonomous state
institution. Provides medicalcare in areas, including
cardiovascular surgery,neurosurgery, abdominal
surgery, gynaecology,
ophthalmology,
otolaryngology, urology,
oncology, haematology,
traumatology and orthopedy,
gastroenterology, neurology,
rheumatology, endocrinology,
viscera and marrowtransplantation. 11 regional
specialised clinics.

Sverdlovsk Regional
Clinical Hospital # 1

Table 70: Example facilities for the treatment of elderly patients

13.2. Access to treatment
13.2.1.

Structure and organisation of healthcare for elderly patients inthe public healthcare system in Russia

Elderly patients, like other categories of patients, are entitled to access free healthcare
treatment within Russia’s public healthcare system, as described in Chapter 3. Elderly
patients with impairments need expert assessment to receive guaranteed social services. It
has been observed locally that most senior patients gain access to healthcare via the local
polyclinics.691
There are some healthcare privileges for people with disabilities who served for the army,
national security agency and others, such as free medications. Non-recipient older people oflimited income must pay for their own medications prescribed in outpatient settings, althoughthose given during hospital stays and in urgent and emergency settings are covered by the
OMS. The high cost of medications is prohibitive for many elderly. Households with resident
older members tend to give out 2.5 times more payments for medications, in comparison withhouseholds accommodating working and middle-aged members only. Sometimes theseseniors have to choose between food and access to treatment.692 In 2020, Selezneva et alContact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
692
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
691

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EUROPEAN UNION AGENCY FOR ASYLUM

reported that older people have lower levels of trust in physicians and medicine and that theytend to neglect their diseases seeking help late.693
Two Russian academics, Golubeva and Khabarova, based at an academic institution and theregional Ministry of Labour and Social Development in the city of Arkhangelsk, stress thatwhile there remains a great need for care services for older adults, the majority are looked
after by relatives.694 Almost one in three Russian families has relatives who require full-timecare and attention from their families.695 In less populated areas, such as small towns, villages
and rural areas, 35 % to 40 % of senior citizens are looked after by their families. Overall, mostpeople in Russia, around 94 %, provide elderly care independently and just 4 % rely on staterun programmes. Just 2 % received care from private visiting nurse services (home nurses).696
There is no financial support available from the federal government to support family carers,
just restricted support in the form of small benefit payments but no carer training and noncash benefits, such as additional annual leave.697

13.2.2. Healthcare for elderly patients in the private healthcare sector
in Russia
Human Rights Watch postulates that there is a rising count of private nursing homes. Someare operating illegally, avoiding state or independent oversight. Russia’s media reports
problems at these institutions, including fires and other unsafe events.698 Human Rights
Watch estimated that the number of available beds in this sector may be up to 30 000.699
Selezneva et al. conducted a social survey to assess elderly people’s satisfaction with healthand social services. They stated that the main barrier for older people attaining healthcare in
the private sector is the high charges for services and the low incomes of many individuals.
Another barrier is the worry that private healthcare providers may be dishonest. Although theprivate sector is reputed to offer better quality services than the public sector, family
members often have more faith in public social protection, preferring to give social workers
direct financial rewards rather than pay commercial firms for care. Public services are
regulated and monitored. Selezneva reports that elderly patients expressed a preference forsocial services from public sector providers: respondents considered it easier to exercise
control over public sector workers and they valued the lower rates of turnover of personnel

Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, p. 24
694
Golubevaa, E.Y. and Khabarova, L.G., Family Care as a Tool for Mitigating the Social Risks of the Elderly People
in Remote Areas, 13 September 2019, url, p. 374
695
Russia, Government of the Russian Federation, Распоряжение Правительства РФ от five февраля 2016 г. N
164-р О Стратегии действий в интересах граждан старшего поколения в РФ до 2025 г [Order of theGovernment of the Russian Federation of 5 February 2016 No. 164-r On the Strategy of Action in the Interests of
Citizens of the Older Generation in the Russian Federation until 2025], 5 February 2016, url
696
Golubeva, E. Yu. and Khabarova, L. G., Family Care as a Tool for Mitigating the Social Risks of the Elderly People
in Remote Areas, 13 September 2019, url, p. 374
697
Selezneva, E. V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, p.55
698
Human Rights Watch, Insufficient Homes Services for Older People, 24 August 2021, url; RIA Novosti,Нелегальный приют. Кто "убивает" стариков в частных домах престарелых [Illegal shelter. Who "kills" old people
in private nursing homes], 18 October 2017, url; Rossiyskaya Gazeta, Как работают нелегальные домапрестарелых [How illegal nursing homes work], 12 May 2020, url
699
Human Rights Watch, Insufficient Homes Services for Older People, 24 August 2021, url
693

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

which mean that the same social worker will give care to any one person for a longer time.
The respondents to Selezneva’s survey also acknowledged that public sector workers wereoverloaded with clients, and poorly remunerated.700

13.2.3. Geriatric programmes funded by international donors
The search conducted for this MedCOI report found no evidence of geriatric programmes
being funded within the international system.

13.2.4. Geriatric health and social care resources(a) Geriatric facilities
A recent study by Christopher Mark Davis concluded that Russia’s social care network for theelderly and patients with dementia (as defined by the Organisation for Economic Cooperation and Development (OECD)) is underdeveloped. This situation is plausibly linked toattitudes and institutions inherited from Soviet times, where there was a lack of social workers
and poor financing. Davis reported that between the years of 2000 and 2019, carepossibilities got better, including a rise in the number of government-owned care homes for
elderly and disabled patients, from 1 132 in 2000 to 1,307 in 2018. Simultaneously, there wasan increase in beds from 232 000 beds to 263 000 beds. There was an increase in beds inprivate nursing homes from 700 to 40 000. Yet the standard of care is reported to span from
intolerably low to reasonable.701 Despite the increase in the number of facilities, most older
people opt to remain living at home, and acquire help from family and medical personnel fromthe public healthcare system.702(b) National centre on geriatrics
The Pirogov Russian National Research Medical University in Moscow hosts the Russian
Clinical and Research Center of Gerontology. This has a clinic with therapeutic, cardiological,
neurological, gynaecological, urological, orthopaedic and surgical units, and leads thedevelopment of gerontology and geriatrics in Russia. The Centre trains medical doctors fromacross Russia.703(c) Medical staff focused on geriatric medicine and healthcare
Selezneva et al. reviewed government statistics and concluded that there was a severe
shortage of medical specialists in geriatric medicine in 2018, with only 322 geriatricians inthat year, 17.3 % of the total number required to provide sufficient services to cover the olderaged population. According to these data from 2018, a third of Russia’s regions, being 27 out

Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, p. 55
701
Human Rights Watch, Insufficient Homes Services for Older People, 24 August 2021, url
702
Davis, C.M., Priorities, shortages, and rationing in the UK and Russia national health services during 2000–2019:
initial conditions for responses to Covid-19, 11 September 2020, url, pp. 997-998
703
Pirogov Russian National Research Medical University, Russian Clinical and Research Centre of Gerontology,
About Institute, publication date, url
700

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EUROPEAN UNION AGENCY FOR ASYLUM

of 85, did not have a single geriatrician. This deficit precludes the formation of adequate
professional teams at institutions. The drawback of non-clinical staff predominating at older
aged care homes are their inadequate training in assisting elderly patients, for example, in
administering drugs properly to those patients unable to swallow or who have problems with
their mouth cavity, which may mean these staff may not attempt to administer the drugs.704

13.2.5. Limitations on healthcare and social care for elderly patients inthe public healthcare system
The coverage of healthcare institutions and social services is particularly poor in rural andscarcely populated, remote locations across Russia. Yet this is not connected to anindividual’s status, but to their residential location and its poor accessibility. Patients in theseareas must travel to major cities and regional capitals for most forms of specialist medical
treatment. Another specific major barrier to geriatric healthcare is the shortage of geriatric
medical specialists, discussed above, and also of diagnostic equipment.705
In 2017, Selezneva’s team conducted a review assessing the quality of, and access to public
services, including healthcare and social services, which indicated that many older people
with disabilities in Russia were not accessing the care that they required. The study foundthat 2 % of people older than working age received support from social services, and 7.2 % ofthat proportion had the extra challenge of disabilities. 11 % of older-age people without
registered disabilities get care support from social workers and 17.2 % of those withdisabilities.706 There is a lack of awareness of available services compounded by older
people’s computer and legal illiteracy.707 Other factors in low level of access to care include alack of medical supplies and complex bureaucracy barring gaining access to medical andsocial help, and queues to reach free healthcare treatment provided by the state.708
In addition to the deficit in available care services that is described in this report, there areaccounts of the mistreatment of individuals in residential care institutions.709 The Russian
government stated that 278 000 people live in government-managed residential care

Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, pp. 47, 72
705 Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons706
A Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, pp. 55, 56
707
Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, pp. 48, 60
708
Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons; Shishkin S.V. (ed.), Сроки ожидания медицинской помощи: зарубежный опыт ироссийская практика: докл. к XX Апр. междунар. науч. конф. по проблемам развития экономики и общества,Москва, 9–12 апр. 2019 [Waiting times for medical care: foreign experience and Russian practice], 2019, url; Shishkin
S. V. et al., Рейтинг доступности и качества медицинской помощи в субъектах Российской Федерации [Ratingof accessibility and quality of medical care in the constituent entities of the Russian Federation], 2019, url, pp. 23, 30
709
Human Rights Watch, Insufficient Homes Services for Older People, 24 August 2021, url
704

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

institutions for the elderly and people with disabilities.710 Certain antipsychotics may beprescribed to seniors more often due to reimbursement/pricing. Specifically, the proportion ofolder drugs prescribed in Russia is higher than in Western Europe, likely due to the low pricesof older drugs.711
Another challenge for seniors who wish to access healthcare is negative experience of andhence negative attitude towards formal services, given the small size of pensions, high costsof medication and healthcare, and worries about loneliness.712

13.3. Insurance and national programmes
Like healthcare for the population at large, geriatric healthcare coverage is provided understate-funded health insurance system, the OMS. Healthcare is provided to Russian citizens,
permanent legal residents or long-term visa holders and/or legally employed people who
hold an OMS policy and have a registered address in Russia. Returning Russian migrants andforeign migrants to Russia are covered by OMS once they are registered as legal residents.
Urgent care is universally provided for free.713
The OMS covers medication in inpatient settings, such as public hospitals, but not medicinesprescribed in outpatient settings. There is no universal medication coverage per se, but
certain categories of patients are entitled to subsidised or reduced prices if in receipt of avalid prescription, and some are also entitled to free medications. According to 2016 data,
out-of-pocket payments were reported to be higher for elderly patients, 26 % of the cost ofhealthcare for people aged 65 to 74, and slightly less at 25.6 % for those above the age of
75.714
Table 6 in Chapter 3 Economic factors lists privilege holders who receive free or discounted
medications, and Table 7 lists the conditions that entitle patients to receive free or discounted
medications from the state.
Table 69 shows the geriatric healthcare services that are covered by OMS.

Russia, Ministry of Labour, Доклад о результатах комплексного мониторинга социально-экономического
положения пожилых людей в 2019 году [Report on the results of integrated monitoring of the socio-economic
situation of elderly people in 2019], 15 July 2020, url
711
Kosteva, K. and Osinab, G., Treatment Patterns of Patients with All-Cause Dementia in Russia, 3 January 2020, url,
p. 9
712
Selezneva, E.V. et al., Assessing the Needs of the Elderly in Integrated Health and Social Services in the RussianFederation, World Bank, 2020, url, pp. 4, 24-28
713
Russia, Ministry of Health, Статистический сборник 2018 год – 14 Ресурсы и деятельность медицинских
организаций здравоохранения. Медицинские кадры 2018 [14 Resources and activities of health careorganisations. Health workforce 2018], 31 July 2019, url
714
Baird, K., High Out-of-Pocket Medical Spending among the Poor and Elderly in Nine Developed Countries,
January 2016, url, p.1479
710

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EUROPEAN UNION AGENCY FOR ASYLUM

Programme
Mandatory
public healthinsurance (OMS)

Government
health insurance
programmes for
employees of
specialist
agencies, e.g.
law enforcement

Focus

Requirements

1. Public/Federal
2. Employers financeOMS throughcontributions, 2 %to 3 % of salarygoes into social tax,
a percentage of
which is paid into anational Russian
healthcare fund.
Once paid, theemployee has theright to free medicalcare from public
Russian healthcare
Migrants fromclinics.
ex-Soviet
3.
People who cannot
countries canwork and do not
obtain an OMS
contribute to OMI
policy through(e.g. unemployed,
their employers
pensioners,
if the employer
children, sickagrees.
people) can still
access free basic
healthcare.
Russiancitizens andpermanent
residents,
includingreturning
Russianmigrants andmigrants fromex-Soviet
countries.

Scope ofcoverage

Geriatric services
coveredCovershealthcare
benefits for all
people eligible
for OMS

Services Included:•
Inpatient andoutpatient treatment at
polyclinics and some
hospitals•
Inpatient
drugs•
Some social
services provision•
State nursing
home care
Services Excluded:•
Outpatient
drugs except for
holders of federal
privileges•
Transport toregional specialist
medical centres

For theInformation notregisteredpublicly available
individual andsometimes theirfamilies

Employees of
selected
government
agencies andcompanies

Table 69: Public healthcare coverage for elderly patients in Russia

13.3.1.

Private healthcare insurance

Different forms of private medical insurance, including VMI, are available to those able toafford them. However, stateless people and internally displaced people are obliged to pay for
private healthcare as they are not covered by the OMS policy.715
Table 70 shows the geriatric healthcare services that are covered by private medical
insurance.

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
715

258

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Programme

Focus

Requirements

Privatesectorhealthinsurance,
including VMI

Scope ofcoverage
For theregisteredindividual
and/or theirfamily (if an
employerpurchases VMI
for anemployee, it
usually only
covers that
individual andnot their family)

Geriatric services
coveredAvailable
services
depending on the hospitalor medical facility that theinsurance covers. An
example list is:•
All regular paid
medical services forstandard medical
conditions, such as
diagnostics, treatment
and prevention of
disease, including:•Gynaecology•
Neurology•
Endocrinology•
Ophthalmology•
Psychiatry for theelderly

Table 70: Private healthcare coverage for elderly patients in Russia

13.4. Cost of treatment
Treatment prices are 30 % to 50 % higher in the private sector than the public health system.
Costs are also higher in wealthier regions than poorer ones. Public facilities must adhere to
official published prices while prices in private facilities are regulated by the private
healthcare market.716 Table 72 shows the cost of all relevant treatments for conditions
associated with ageing and geriatrics.

13.4.1.

Methodology of data collection on treatment prices

The prices of treatments, diagnostics and equipment were collected using an initial Internet
search for their availability and costs in Moscow. Websites used are shown in Table 71. The
most common prices were compared, and the median price agreed and included in Table 72.
Name and url of website

Subject matter for prices

https://docdoc.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

https://prodoctorov.ru/

Aggregator of prices and availability of the medical consultations
in Moscow from a lot of private clinics

Contact 1, Medical Doctor and local consultant, email, July-September 2021. The person wishes to remain
anonymous for security reasons
716

259

EUROPEAN UNION AGENCY FOR ASYLUMName and url of website

Subject matter for prices

https://zoon.ru/

Aggregator of information on prices for various services(including medical)

https://www.krasotaimedicina.ru/

Aggregator of prices and availability of the medical services(surgery, diagnostics, etc.) in Moscow from a lot of private clinics

https://gemotest.ru

Costs of laboratory tests and some diagnostics

https://www.invitro.ru/
https://market.yandex.ru/

Cost of equipment: overview and access to offers from many
online and offline shops (including medical equipment,
orthopaedic supplies, rehabilitation devices, etc.)

Table 71: Websites consulted for treatment prices

Treatment Price RUB

Reimbursement/
specialprogramme/ free/comments

PublicOutpatient

PublicInpatient

PrivateOutpatient

PrivateInpatient

Consultation by ageriatric specialist

FOC

FOC

3 291

3 291

Prices in Moscow

Consultation by aninternist

FOC

FOC

1 645

1 645

Prices in Moscow

Consultation by apsychiatrist

FOC

FOC

3 984

3 984

Prices in Moscow

Consultation by aneurologist

FOC

FOC

1 472

1 472

Prices in Moscow

Consultation by an
ENT doctor

FOC

FOC

1 992

1 992

Prices in Moscow

Specialist

260

RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Public treatment pricePrivate treatment
price RUB

Reimbursement/
special program/free/ comments

Walking aid such as awalker or a cane

FOC

2 685, 260

Prices in Moscow*

Wheeled walker("rollator")

FOC

12 124

Prices in Moscow*

Medical devices
urology: (adult) diapers

FOC

1 039/30 pieces

Prices in Moscow*

FOC

25 114

Prices in Moscow*

24/7 care in a nursing
home (costs of one
year)

FOC

536 914

Prices in Moscow*

Geriatric care;sheltered housing for
elderly/ Centre for
elderly without 24/7
care but with day careby nurses (costs permonth)

FOC

363 716

Prices in Moscow*

FOC

173/hour; 3 464 /dayPrices in Moscow*

Medical devices

Medical devices

ENT: hearing aid
including repair andreplacement

Treatment

Home assistance /care at home by a261

EUROPEAN UNION AGENCY FOR ASYLUM

Public treatment pricePrivate treatment
price RUB

Reimbursement/
special program/free/ comments

FOC

87/hour; 2 078/day

Prices in Moscow*

nurse (costs of one
session/day)

Home assistance /care at home by a caregiver/social worker(costs of one
session/day)

Note
FOC: Free of charge to eligible patients.
* Queues and quotations foreseen in public sector
Table 72: Cost of treatments for geriatric conditions in the public and private health systems in Russia

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RUSSIAN FEDERATION – MEDCOI COUNTRY REPORT

Annex 1. Bibliography
Oral sources, including anonymous sources
Contact 1, Medical Doctor and local consultant responsible for in-country data collection of thereport, email correspondence, July-September 2021. The person wishes to remain
anonymous for security reasons.
Contact 2, Research Assistant responsible for translation of statistical information into English
for the report, email correspondence, July-September 2021. The person wishes to remain
anonymous for security reasons.

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EUROPEAN UNION AGENCY FOR ASYLUM

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Российской Федерации от 21 января 2019 года № 32 «О внесении изменений в Порядок
организации и осуществления образовательной деятельности по основным
общеобразовательным программам – образовательным программам дошкольного
образования...» [Order of the Ministry of Education and Science of the Russian Federation
No. 32 of 21 January 2019 ‘On Amendments to the Procedure for Organizing and
Implementing Educational Activities in Basic General Education Programmes - Educational
Programmes of Preschool Education’], 21 January 2019, https://minobrra.ru/upload/iblock/95e/Prikaz_32_ot_21.01.2019.pdf, accessed 9 August 2021
Russia, Ministry of Education and Science, Приказ Минобрнауки России от 20 сентября
2013 г. № 1082 «Об утверждении Положения о психолого-медико-педагогической
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комиссии» [Order of the Ministry of Education and Science of Russia No. 1082 of 20
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здравоохранения [14_Resources and activity of medical healthcare organisations],
31 July 2019, https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-iinformatsionnye-materialy/statisticheskiy-sbornik-2018-god, accessed 14 July 2021
Russia, Ministry of Health, National Prophylactic vaccinations calendar [Национальный
календарь профилактических прививок], n.d.,
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Russia, Ministry of Health, Заболеваемость- СОЦИАЛЬНО ЗНАЧИМЫЕ ЗАБОЛЕВАНИЯ
НАСЕЛЕНИЯ РОССИИ В 2017 ГОДУ [Statistics of Prevalence, Socially significant diseases of
the Russian Population in 2017], https://minzdrav.gov.ru/ministry/61/22/stranitsa979/statisticheskie-i-informatsionnye-materialy/statisticheskiy-sbornik-2017-god, accessed
14 July 2021
Russia, Ministry of Health, Министерство Здравоохранения И Социального Развития
Российской Федерации Приказ от 17 мая 2012 г. N 566н. Об утверждении порядка
оказания медицинской помощи при психических расстройствах и расстройствах
поведения [Ministry of Health Order No. 566n of 17 May 2012 ‘On Approval of the Procedureof Medical Care for Mental and Behavioural Disorders’], 17 May 2012,https://psychiatr.ru/download/2732, accessed 16 March 2022
Russia, Ministry of Health, Национальные Проекты «Здравоохранение» и «Демография»[National Projects ‘Healthcare’ and ‘Demography’], 11 July 2019,https://minzdrav.gov.ru/poleznye-resursy/natsproektzdravoohranenie, accessed 20 March
2022
Russia, Ministry of Health, Национальный календарь профилактических прививок
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accessed 17 September 2021
Russia, Ministry of Health, Основные показатели здравоохранения 2018 [Key healthindicators 2018], 2018, https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-iinformatsionnye-materialy/statisticheskiy-sbornik-2018-god, accessed 21 August 2021
Russia, Ministry of Health, Памятка для граждан о гарантиях бесплатного оказания
медицинской помощи [Memo for citizens on the guarantees of free medical care], 28
December 2018, https://minzdrav.gov.ru/news/2018/12/14/10184-minzdrav-rossii-podgotovilpamyatku-dlya-grazhdan-o-garantiyah-besplatnogo-okazaniya-meditsinskoy-pomoschi,
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Russia, Ministry of Health, Постановление от 28 декабря 2020 г. № 2299 О Программе
государственных гарантий бесплатного оказания гражданам медицинской помощи на
2021 год и на плановый период 2022 и 2023 годов, [Decree No. 2299 of 28 December
2020 ‘On the Programme of State Guarantees of Free Provision of Medical Care to Citizens
for 2021 and for the Planning Period of 2022 and 2023’], 28 December 2020,
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Russia, Ministry of Health, Постановление Правительства РФ от 26.12.2017 N 1640 (ред. от
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здравоохранения" [Decree of the Government of the Russian Federation No. 1640 of
26.12.2017 (as amended 24.07.2021) ‘On approval of the state program of the RussianFederation “Health Development’’’], 11 January 2022,
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Russia, Ministry of Health, Приказ Минздрава России от 12 ноября 2012 г. N 899н Порядок
оказания медицинской помощи взрослому населению по профилю ‘эндокринология’[Order No. 899н of 12 November 2012 ‘The procedure for providing medical care to the adult
population in the specialty area of endocrinology’], 17 June 2013,https://minzdrav.gov.ru/documents/5479-prikaz-minzdrava-rossii-ot-12-noyabrya-2012-g-n899n, accessed 11 March 2022
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профилактических прививок по эпидемическим показаниям" [Order of the Ministry of
Health of Russia No. 125n of 21 March 2014 ‘On approval of the national calendar of
preventive vaccinations and the calendar of preventive vaccinations according to epidemic
indications’], 19 January 2016, https://www.rospotrebnadzor.ru/deyatelnost/epidemiologicalsurveillance/?ELEMENT_ID=5575, accessed 20 March 2022
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развития Российской Федерации от 31 января 2012 г. № 69н "Об утверждении Порядка
оказания медицинской помощи взрослым больным при инфекционных заболеваниях”[Order of the Ministry of Health and Social Development of the Russian Federation No. 69n of
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the needs of the population’], 29 March 2017,https://roszdravnadzor.gov.ru/spec/medactivities/health/documents/39309, accessed 20
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Russia, Ministry of Health, Региональные программы модернизации первичного звена
здравоохранения одобрены проектным комитетом нацпроекта «Здравоохранение»[Regional programmes for the modernisation of primary health care are approved by the
project committee of the national project ‘Healthcare’], 10 December 2020,
https://minzdrav.gov.ru/news/2020/12/10/15617-regionalnye-programmy-modernizatsiipervichnogo-zvena-zdravoohraneniya-odobreny-proektnym-komitetom-natsproektazdravoohranenie, accessed 30 July 2021
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Moscow, 2019], 2019, https://org.gnicpm.ru/wpcontent/uploads/2019/01/14_Resursyi_i_deyatelnost_meditsinskih_organizatsiy_zdravoohran
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encountered in using the service ‘Making an appointment with a doctor electronically’?], n.d.,
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for children aged 0-14 years by main disease class], 5 July 2018,https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnyematerialy/statisticheskiy-sbornik-2017-god, accessed 14 July 2021

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and activities of health care organisations. Health workforce 2018], 31 July 2019,https://minzdrav.gov.ru/ministry/61/22/stranitsa-979/statisticheskie-i-informatsionnyematerialy/statisticheskiy-sbornik-2018-god, accessed 16 September 2021
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November 2011 ‘On the framework of health protection of citizens in the Russian Federation’],21 November 2021, https://minzdrav.gov.ru/documents/7025-federalnyy-zakon-323-fz-ot-21noyabrya-2011-g, accessed 17 September 2021
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системной поддержки и повышения качества жизни граждан старшего поколения
«Старшее поколение» [Federal project "Development and implementation of the programmeof systematic support and improvement of the quality of life of senior citizens "The Older
Generation"], 7 October 2019, https://minzdrav.gov.ru/poleznyeresursy/natsproektzdravoohranenie/stranitsa-5729, accessed 16 September 2021
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эффективности государственной программы Российской Федерации «Доступная среда»[Report on the progress of implementation and evaluation of the effectiveness of the state
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некоммерческими организациями [A compendium on the employment of persons withdisabilities, based on successful regional practices and activities, including those carried out
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Russia, The Prosecutor General's Office of the Russian Federation, В Москве за получение
взяток и служебный подлог осуждены бывшие сотрудницы бюро медико-социальной
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2021
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ТАК надо! [TAKE it!] Благотворительный фонд поддержки людей, больных раком, ВИЧ,СПИДом, туберкулезом, Наши программы [Charitable Foundation for Support of People
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