IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

Two Models of Primary Health Care Development: Russia vs. Central and Eastern European Countries

Listed author(s):
  • Igor Sheiman


    (National Research University Higher School of Economics)

  • Vladimir Shevski


    (National Research University Higher School of Economics)

Registered author(s):

    The paper explores primary health care models in Russia and in Central and Eastern European (CEE) countries. Starting with the similar model, they have taken totally different ways of primary health care transformation, including the role of general practitioner, multi-specialty polyclinics and private sector. The comparison of this diversity, based on the conceptual framework of Primary Health Care Activity Monitor in Europe, demonstrated that the scores of primary care in Russia are relatively lower, particularly in the dimensions of accessibility, comprehensiveness, continuity and coordination of care. The score of the selected efficiency indicators is also relatively low. The major reasons for this are discussed, including the lack of strategic vision on the role of primary care, an excessive specialization of primary care and the delay with a shift to a general practitioner model. A debatable issue of primary care extended composition (the involvement of a growing number of specialists) is also addressed. The conceptual presumption that an extended composition presents new opportunities for more integrated care and better performance has not been supported by the evidence. Big multi-specialty policlinics in Russia don’t demonstrate advantages over solo and group GP practices that dominate in CEE countries. The potential of polyclinics is not used because of the lack of specific activities for integration. It is argued that new specialists in the practices can strengthen primary care only when they support generalists rather than replace them. The lesson learnt from CEE countries is that substantial changes are needed to overcome the lagging status of primary care in Russia, including overcoming the excessive specialization of primary care, the replacement of district physicians by general practitioners, developing the forms of independent practices operating in parallel with polyclinics and competing with them

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL:
    Download Restriction: no

    Paper provided by National Research University Higher School of Economics in its series HSE Working papers with number WP BRP 06/PSP/2017.

    in new window

    Length: 30 pages
    Date of creation: 2017
    Publication status: Published in WP BRP Series: Public and Social Policy / PSP, March 2017, pages 1-30
    Handle: RePEc:hig:wpaper:06/psp/2017
    Contact details of provider: Postal:
    Myasnitskaya 20, Moscow 101000

    Phone: +7(495)7713232
    Fax: +7(495)6287931
    Web page:

    More information through EDIRC

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    in new window

    1. Groenewegen, Peter & Heinemann, Stephanie & Greß, Stefan & Schäfer, Willemijn, 2015. "Primary care practice composition in 34 countries," Health Policy, Elsevier, vol. 119(12), pages 1576-1583.
    2. Sheiman, Igor & Shevski, Vladimir, 2014. "Evaluation of health care delivery integration: The case of the Russian Federation," Health Policy, Elsevier, vol. 115(2), pages 128-137.
    3. Sheiman, Igor, 1995. "New methods of financing and managing health care in the Russian Federation," Health Policy, Elsevier, vol. 32(1-3), pages 167-180.
    4. Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
    5. Christopher J. Gerry & Igor Sheiman, 2016. "The Health Workforce of the Russian Federation in the Context Of the International Trends," HSE Working papers WP BRP 01/PSP/2016, National Research University Higher School of Economics.
    6. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    7. repec:dau:papers:123456789/12226 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:hig:wpaper:06/psp/2017. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Shamil Abdulaev)

    or (Victoria Elkina)

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.