Winners and losers: expansion of insurance coverage in Russia in the 1990s.
OBJECTIVE
This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage.


METHODS
Data from successive waves of the Russian Longitudinal Monitoring Survey (1992-2000) were analyzed.


RESULTS
Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country's citizens were still uninsured by 2000. Coverage initiation rates were greater at first among citizens who were better off, but this gap closed over the study period. Among individuals of working age, coverage rates diminished with age and were lower for the unemployed, for the self-employed, and for those residing outside Moscow or St. Petersburg.


CONCLUSIONS
The growth of insurance coverage in Russia slowed toward the end of the 1990s, and gaps remain. Achievement of universal coverage will require new, targeted policies.
Balabanova
Dina C
DC
Health Systems Development Programme, London School of Hygiene and Tropical Medicine, London, England. dina.balabanova@lshtm.ac.uk
Falkingham
Jane
J
McKee
Martin
M
D000328:Adult; D004651:Employment / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D018854:Managed Competition / Q000331:legislation & jurisprudence; D037141:Mandatory Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D017057:Medically Uninsured / Q000145:classification / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000639:trends; D040841:Resource Allocation; D012426:Russia; D019472:Universal Health Insurance / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*