Health Care in Moscow Part 1

healthcareHealth is a very touchy thing. Most expats have pretty strong feelings about the Russian Health Service. In the first of a series of articles about health care available in Moscow, Moscow expat Life looks at what is available free or comparatively cheaply from the Russian Health Service. Following articles will look at semi-private and private options.

Officially, when it comes to life-threatening situations, Moscow has absolutely free medical assistance. You don’t need to show your medical insurance policy if your guts are hanging out after a car accident. Emergency medical care is provided to all foreign nationals in case of  life-threatening conditions that require immediate medical treatment. No foreigner I know of has ever been refused access to care in an emergency. The question is, what kind of care?

This question is fairly academic in 90% of real emergencies, as there may not be time to summon an ambulance from your private health care provider, and traffic jams may make it impossible for them to reach you anyway. Private health care providers may rely on Russian emergency services to deliver their patients to them. If you have private medical insurance, it is a good idea to keep an updated insurance document with you at all times.

Having been put into an ambulance, you will then be taken to a local Russian state-run hospital, unless your insurance states you to be taken elsewhere, where you will be given first aid and emergency surgery when necessary. After that, The Russian health care system does not have to provide any further treatment to people without a ‘Compulsory Medical Insurance’ which virtually all Russians have.

Without such a policy, the foreign national will not be offered free treatment for a hip operation, for example, unless he is danger of dying. With a policy, he can get surgery for free, but only if he waits anything from a few weeks to a few months, as resources in the Russian Health Service are limited as they are in most countries’ national health services. There is usually some paper work involved but all of these issues do not present insurmountable problems if you speak the language or know somebody who does. If you are very busy and earn enough to take out private insurance, the Russian Health Service may not be for you. If you want to jump the queue and do not have the time to wait your turn for surgery, then you will need to pay a certain amount of money to the private sector within most hospitals, something which is now done quite legally, as most hospitals have commercial departments. In this case, you can get reasonably good treatment at a very reasonable charge. There are as many different stories about Russian doctors as there are patients, but most of the people I have spoken to who have paid for treatment within the Russian health service were satisfied. You don’t actually have to be a ‘Compulsory Medical Policy’ holder to access these services.

health-in-moscow3Emergency treatment aside, ‘Compulsory Medical Policy’, holders are able to get free consultations in the nearest polyclinic to where he or she lives. So if your ear is blocked up, you have an ingrowing toe nail or you think you have cancer, you can get to see a specialist and undergo all necessary scans, tests for free.

Clearly, you will have to be prepared to wait in line for to see a specialist. Whilst there may be only a few days wait to get to see a doctor to clean your ears out, it may take a week or two to get treatment for an ingrowing toenail. This is something that the local polyclinic will be able to handle, and at this level, in terms of quality of treatment, there probably won’t be a vast difference between the treatment provided by the Russian Health Service and that provided by the private sector, apart from the fact the polyclinic’s facilities may not be as clean as that of a private hospital, and the attitude is different. When I, for example, had to have one my big toenails removed, I was given a lecture about why I look after my feet so badly in the first place. I wasn’t expecting his little telling off, but it was actually very useful. The equipment at many state clinics and polyclinics is now vastly improved in comparison to the situation 10 years ago, however it may take you a couple of weeks to get all the necessary scans done before any surgery can take place, if you have cancer for example.

Getting a ‘Compulsory Medical Insurance’ is easy if you have a residence permit вид на жительство or a temporary residence permit, even a long-term visa. Further details can be found on the site: http://www.mgfoms.ru  which is a Russian language site. You have to scroll down to the bottom of the page and click on: Реестр пунктов выдачи полисов.

health-in-moscow2So what do those foreigners who have used the Russian health care system think of it?

Aik Gobbling is from London. In Moscow he has been teaching English for 5 years. Aik speaks Russian quite well. He is almost a Russian as he calls himself.

“Right now in case of health problems I go to the public hospital mostly. All I needed was a policy which I was given for free because I have a permanent visa. In you go to a pubic hospital, you should be prepared to wait for a doctor for a long time. You may be told something like: ‘the doctor is sick’.

“If you are healthy and need to make just a check up, if you don’t want to spend money, go to the public hospital. But it is going to be hard in case you don’t speak Russian language. I can say 90% of doctors have poor English. Sometimes they try to understand you. But this is not everywhere. For instance, two weeks ago I went to the public hospital to have a check up because I was too weak to work. The women at reception asked me: ‘If you don’t speak Russian then why are you here?!’ I didn’t want to reply her, for me it was painful.

“Before I got my permanent visa I went to the American Medical Center and it is quite OK. The quality of treatment in a public hospital and in a private one is the same but the attitude is different. You buy your own medicines in both types of clinic. But in the private clinics and hospitals there it is much more of a personal touch. They ask you more questions and basically look after you better.

“If we talk about urgent treatment, the Russian system works well. If you need surgery or you had an accident or you are in a serious condition you are taken into a hospital. They will treat you well. I think in that way they are very good because it is not the weekly check up, it is something like life threatening. Even in case you don’t have the documents they won’t tell you to go away.

 

“Two years ago, for example I came down with pneumonia. Fortunately for me, my friends called an ambulance and they took me to a hospital. I spent one week there and then I was transferred to a special clinic at Taganskaya. I was treated completely free of charge and I am quite satisfied. In 2009 one of my friends had a cancer. He was here and he needed quick treatment. He is from UK. The ambulance took him to a special cancer center at Kaschirskaya. As my friend had no insurance but was ready to pay, he was admitted to the hospital, before making payment, by the way. My friend had two operations. The first one cost him 200,000 roubles. They gave him a private room, and he didn’t complain about the treatment. Whatever they did to him, it worked. It is saved his life because of immediate medical intervention.

 

Thierry Cellerin

Thierry Cellerin

Thierry Cellerin came to Russia from France about 10 years ago, and has now set up his own business. He treats health issues no less seriously than business affairs and chooses Private Health Care System.

Within the first 3 years French person is here, he can get medical assistance paid for by the French government, but the amount claimable is very small. So as I was stuck to the National French System it cost me 300 euro a year. Three years later I got Russian insurance from my company which included public hospital care only.

I am a healthy man who never had huge things wrong, fortunately. When I needed a doctor for the first time, my director advised me to go to the hospital on Profsouyznaya. He said that it is for free and it is good. If somebody had told me beforehand about the public medical system in Russia I would never have gone there. The service was terrible. The system itself is very strange. You have to queue to go to the doctor, than you have to queue to the place where you should say that you have visited the specialist and give the documents with the medical insurance. Then I said why should I do this and waste 8 hours of my life when I can pay 1000 rubles and get straight ahead? So I bribed people in the line. In general the doctor was not bad and the treatment was ok. I should have come back to get another X-ray, but I never did. I stopped using that insurance.

 

Haidar Abdulla

Haidar Abdulla

Haidar Abdulla is studying engineering. He has been studying at Peoples’ Friendship University of Russia for 6 years. He is one of the few who is completely satisfied with the Russian Medical Care. In comparison with his country Syria, the Russian medical service surprised him a lot – in a positive way.

“I have a one year visa which I have to renew every year. My insurance is voluntary. Usually I go to the Medical Center of my University or Moscow Public polyclinic №25 when I am sick.

“The first thing which pleased me a lot is the annual medical check-up. We don’t have such a system in Syria. At home, people get to see a doctor when their illness has already become serious, whereas an annual examination helps to prevent illness.

“I like the medical treatment and the doctor’s attention to the patients. All the specialists I had are quite friendly. I can say that they never refused to give me a consultation. I am a healthy man and normally need a full check up once a year. I have never been taken to a hospital but I know how the doctors work. Several years ago on Sunday morning I injured my leg. There was nothing serious but I needed help. So despite a day off I found a surgeon who carried out a small operation, everything went really well. Another story I remember concerns my friend. We were playing football when he fell passing the ball. His leg was badly injured. The ambulance came in 5 minutes, and he is fully recovered now.

Evgeny Avetissov, M.D,  EMC Medical Director

Evgeny Avetissov, M.D,
EMC Medical Director

 

Evgeny Avetissov, M.D,
EMC Medical Director

What do you think of the Russian Health Care System?

“I think that the problem is the qualifications of the doctors. What we can see from talking to  patients who have been exposed to the Russian Health Care System is that some very strange systems of treatment are used, very strange use of prescriptions etc. Sometimes their use is not really logical or done according to international guidelines. There is a clear disconnection between the Russian and international medical systems such as in Europe or America and this is a big problem, in my opinion.“

 

Tanguy de Lassagne, General Manager Russia,International SOS

What do you think about the Russian Health Service?

“After a long period of stagnation, considerable amounts of money are now being invested into building hospitals, procurement of brand new equipment, infrastructure and training of medical staff. Yet the Russian system is not what Western expat would be used to. It remains very bureaucratic, patients should wait in queues for some 1 – 2 weeks until for treatment, and there is a lot of paper work to fill in.

“Ambulances are technically inferior to their western counterparts. Once in hospital, wards are often basic 4-6-8 bedded with no nurse call system and obsolete or no oxygen piping. Hygiene standards are infrequently not being adhered to and nosocomial flora not properly monitored.

“There is an ongoing shortage of nurses and doctors in some areas (emergency, ICU). Medical staff is often overloaded and demotivated being remunerated far below levels dictated by basic common sense. The level of care is overall known as badly substandard with inattention, unprofessional behavior, long waits, and inconsistent access to some specialists and in adherence to internationally accepted guidelines. Over-prescription is common.

“It is said that doctors trained and graduated before the end of Soviet era are very good. But English is not spoken by many doctors and nurses – the further from big cities the less the likelihood. I will not talk about mention fake medications – this does not seem to be a problem now.

Thanks to Alexander Khoderevich, the head doctor  of the People’s Freindship University Medical Centre, and of Moscow Polyclinic No. 25 for help in preparation of this article