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December 2003, Vol 93, No. 12 | American Journal of Public Health 2124-2130
© 2003 American Public Health Association

RESEARCH AND PRACTICE

Winners and Losers: Expansion of Insurance Coverage in Russia in the 1990s

Dina C. Balabanova, PhD, MSc, Jane Falkingham, MSc, BSc and Martin McKee, MD, FRCP

Dina C. Balabanova and Martin McKee are with the Health Systems Development Programme, London School of Hygiene and Tropical Medicine, London, England. Jane Falkingham is with the Opportunities and Choices Research Programme, University of Southampton, Southampton, England.

Correspondence: Requests for reprints should be sent to Dina C. Balabanova, PhD, MSc, Health Systems Development Programme, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom (e-mail: dina.balabanova{at}lshtm.ac.uk).

Objectives. This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage.

Methods. Data from successive waves of the Russian Longitudinal Monitoring Survey (1992–2000) were analyzed.

Results. Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country’s citizens were still uninsured by 2000. Coverage initiation rates were greater at first among citizens who were better off, but this gap closed over the study period. Among individuals of working age, coverage rates diminished with age and were lower for the unemployed, for the self-employed, and for those residing outside Moscow or St. Petersburg.

Conclusions. The growth of insurance coverage in Russia slowed toward the end of the 1990s, and gaps remain. Achievement of universal coverage will require new, targeted policies.




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