Looking at the Russian health care system: through the eyes of patients with diabetes and their physicians

Aims People with diabetes are well placed to evaluate and to assess the performance of health systems. We take the perspective of people living with diabetes and those caring for them to gain insights into how the contemporary Russian health system works for them. Methods We conducted 15 semi-structured interviews with patients with diabetes and physicians in rural and urban settings, in public and private sectors. Interviewees were identified using snowball sampling. Results Patients worried about high and rising costs of care, while physicians noted concerns about lack of time to treat patients adequately. Although all specifically diabetes-related services are free of charge, patients requiring urgent surgery often face high user fees, either to bypass waiting lists in state facilities or to be treated immediately in a private institution. These ‘hidden’, out-of-pocket payments impact adversely on equity and act as a barrier to timely care. Conclusions Although reform of health services in Russia has led to improvements in quality of care for diabetes, many gaps remain, particularly for management of complications. This paper provides further evidence of how people with diabetes can shed light on the reality, as opposed to the rhetoric of health system reform, especially in middle-income countries.