Social inequality and strategies for getting medical care in post-Soviet Russia

This article examines the relationship between social status and medical help-seeking strategies in St. Petersburg, Russia. Analysis of in-depth interviews with a cross-section of the population revealed that access to and use of medical care varied greatly across the urban social structure. Those in the highest social strata used their knowledge and connections to gain access to the best care. Their social position and understanding of the system also privileged them in interactions with physicians, enabling them to take greater advantage of „free? services. Even with similar levels of material well-being, people with less education received poorer health care. Lacking confidence in their ability to assess quality and reluctant to consider options outside the impoverished, inefficient state medical system, they bore the brunt of its inadequacies. This reinforced a long-standing, culturally based predisposition to delay treatment until health problems had become more difficult and costly to manage