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Beating the System? The Real Differences Between State and Private Clinics are Cosmetic
Russia’s state medical system is a terminally ill patient, and it is ill with a disease similar to leprosy. This patient has long been infected with the virus, but for many years, it did not affect his appearance. That is how medical care was in the Soviet period. From outside, everything looked wonderful: the Soviet Union had the best medical education in the world; therefore it had the best doctors and nurses. It also had free medicine and the best medical equipment.
Probably the most accurate of the Soviet era slogans regarding medical care was the one praising the professionalism of hospital staff, who did, in fact, work miracles. Often foreigners were amazed by the skill of Soviet doctors, who managed to treat patients while using techniques and equipment that were prehistoric.
In fact, medical care in the Soviet Union was not really free. Ostensibly you paid nothing. But you would be informed that imported medicine would more effective in your case, and since there was none in the hospital, you would have to get it yourself. There was a widespread system of bribes to nurses, ward supervisors and doctors. In theory, you could pay nothing for medical treatment, but to do this, you needed nerves of steel, since everyone involved would tell you that everything would work so much better if only you pay ahead. Incidentally, I don’t think this is true: Soviet doctors were not beasts. But who wants to take a chance with their health? It is too much of a responsibility, so everyone paid.
In this sense, absolutely nothing has changed today. Formally, medical care is still free. All Russians can get free insurance from the state that entitles them to analysis, diagnostic tests, free dental care, consultations, hospital treatment and operations. And all of this is completely free.
But no one is happy with this and people with any money at all go to expensive private clinics because state clinics are scary, decrepit, and smelly. Over the years they have become utterly worthless—just as leprosy irreversibly mutilates a sufferer’s appearance over time. Additionally, to receive treatment in any state-run clinic, you are subjected to endless lines. First you must stand in line to make an appointment with the doctor; then you stand in line outside the doctor’s office; and then outside the offices where medical procedures are carried out. Going to the clinic even for the simplest reason can take up to six hours. The worst part of the system, which forces everyone—even people who are not poor—to go to state clinics is that only state clinics can issue sick notes –official documents that allow you to claim a sick day from your employer. In theory, you can buy annual medical insurance in Moscow that includes sick notes, but it is very expensive.
Although I can afford sometimes to pay for private doctors, I am not prepared to empty my wallet on commercial insurance.It would be wrong to speak of competition between state and private medical care. What competition can there be between something free and bad, and something expensive and good? They are entirely different systems. It is not a question of the market, but a question of one’s ability to pay.
Genuine competition can only happen inside one of the two systems—private clinics. And such competition exists, especially in the dental sector. Paradoxically, this is an area of medicine that appeared to suffer in the Soviet Union, but is now flourishing. There are thousands of private dental clinics with excellent equipment and cutting-edge materials. All you have to do is choose.
Many private clinics employ people who simultaneously work at state institutions. There is nothing bad about this either. I have already said that doctors in Russia are well trained, but they are ridiculously underpaid. Only when a doctor works in the evening at a private clinic after completing a day shift at the state one, is he making decent money. And when patients pay to see him in the evening instead of getting to see him for free at a state clinic during the day, they are saving time that could have been lost standing in line. And everyone’s happy!
I once witnessed a monstrous hybrid of private and state medical care. A friend told me that there was a good neurologist working at a local clinic, and that it was possible to jump the line to see him by paying 200 rubles ($8). I went to the clinic, was welcomed warmly in a special room for paying patients, the receptionist took my money, wrote me a receipt, and escorted me into the doctor’s office. And next to the office I saw a massive line of old women. The administrator guaranteed that I could get in without waiting, and I did, but I was subjected to unreal verbal abuse from the women in the line. So of course the level of comfort and the equipment is better in private clinics. But not the doctors—they are the same.