Users' perceptions of health care reforms: Quality of care and patient rights in four regions in the Russian Federation

In the early 1990s, the government of the Russian Federation (RF) decided to depart from the centralised and integrated model of health service delivery and financing in favour of mandatory social health insurance (MHI). The rationale for introducing social health insurance in Russia in the early 1990s was primarily to secure a reliable source of funding but also to improve the quality of care and introduce user entitlements known as patient rights. This paper discusses findings of a survey carried out in 1999-2000 to explore users' perceptions of reforms, changes in quality of care and their satisfaction with patient rights in Murmansk, Yaroslavl, Moscow Region and Moscow City, using a structured questionnaire and metric scales. Nearly half of the respondents thought that the quality of services had not changed significantly since the introduction of the MHI, although the majority accepted the necessity for reforms. Many reported having little or no information about health insurance or patient rights. While there were many similarities among the regions studied, a number of considerable differences existed which could be linked to different ways of implementing the insurance scheme and different levels of funding health care.