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National Health Services for Expats in Russia

Submitted: December 2013

The right to health is, in theory, guaranteed by Article 41 of the Constitution of the Russian Federation. As a result, Russia’s national health system is designed to ensure everyone has access to healthcare, regardless of their ability to pay.

This right to health is meant to be achieved through a network of public establishments. Needless to say, it therefore makes a huge difference if you live in a large town or in Russia’s remotest place.

Entitlement is based on social citizenship and does not depend on how much you pay into the system. Accordingly, healthcare in Russia is not free unless you are a citizen or you are treated as an insured person for state healthcare purposes.

In practice, you should be issued a health card and get free healthcare services if you have been granted a visa exceeding three months.

Funding

The state healthcare system is funded by general tax revenue and social insurance contributions. All employers and self-employed individuals are required to pay health insurance. Employees need not pay towards social insurance. Non-working individuals, such as retirees, the unemployed or students, are not subject to social insurance contributions either, and their entitlement to healthcare benefits is unaffected.

Generally, the aggregate rate for social insurance is 34%, which includes mandatory health insurance, contributory pensions and family-related benefits. Many foreign nationals may pay a lower rate, as they are excluded from certain other state benefits, such as sick pay or maternity allowance. However, foreign highly skilled migrants are normally subject to the mandatory health insurance part, just like Russian citizens.

Even if you are an insured person, you should still be prepared to contribute towards certain out-of-pocket costs or private health insurance. According to the WHO, the share of out-of-pocket payments has dramatically increased over the past 20 years, as it now stands above 30% of total health expenditures.

These payments include most notably:

  • excluded services, such as dental care, eye care, cosmetic surgery or medicines
  • informal payments

Informal payments

As the private healthcare sector in Russia is still small-sized, the Russians tend to pay under-the-table in order to ensure they get high-quality service. During the Soviet era, you could pay the doctor like you paid a tip to a bartender, i.e. it was commonplace but not mandatory. Nowadays, you are expected to actually pay in advance.

Typically, informal payments are needed to avoid long waiting times and/or to get better attention. However, they tend to be rather common practice in hospital, and particularly for “critical” services, such as surgery or prenatal care.

International agreements

Russia may have entered into a social security agreement with your home country. Some bilateral agreements include medical assistance for temporary visitors. Typically, you can get free medically necessary services on the same basis as Russian citizens, provided the need arises during your stay in Russia.

Russia tends to be reluctant to include such reciprocity clauses in its bilateral agreements, especially when there is no national health service in the other country.

 

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