BACKGROUND Many Russians experienced difficulty in accessing prescription medication during the widespread health service disruption and rapid socio-economic transition of the 1990s. This paper examines trends and determinants of access in Russia during this period. METHODS Data were from nine rounds (1994-2004) of the Russia Longitudinal Monitoring Survey, a 38-centre household panel survey. Trends were measured in failing to access prescribed medication for the following reasons: unobtainable from a pharmacy, unable to afford and 'other' reasons. Determinants of unaffordability were studied in 1994, 1998 and 2004, using cross-sectional, age-adjusted logistic regression, with further multivariate analyses of unaffordability and failure to access for 'other' reasons in 2004. RESULTS After 1994, reporting of unavailability in pharmacies fell sharply from 25% to 4%. Meanwhile, unaffordability increased to 20% in 1998 but declined to 9% by 2004. In 1994, significant determinants of unaffordability were unemployment and lacking health care insurance in men. By 2004, determinants included low income and material goods in both sexes; rented accommodation and low education in men; and chronic disease and disability-related retirement in women. Not obtaining medicines for 'other' reasons was more likely amongst frequent male drinkers, and low educated or cohabiting women. Regional and gender differences were widest in 1998, coinciding with the Russian financial crisis. CONCLUSIONS Rapid improvements in drug availability in the late 1990s in Russia are a probable consequence of a more liberalized pharmaceutical sector and an improved pharmacy network, whilst later improvements in affordability may relate to expanded health care insurance coverage and economic recovery after the 1998 crash. A significant minority still finds prescription costs problematic, notably poorer and sick individuals, with inequalities apparently widening. Non-monetary determinants of affordability indicate its partly subjective nature, however. Ongoing research into access is needed, due to recent national changes in prescription drug subsidies, and into doctor- and patient-related influences on access and prescribing for individual conditions.
Notes
Cites: Am J Med. 1972 May;52(5):653-635027555
Cites: Int J Health Plann Manage. 2004 Jan-Mar;19(1):43-6115061289
Cites: Am J Public Health. 1996 Mar;86(3):361-78604761
Cites: Ann Epidemiol. 2008 Feb;18(2):92-10017923417
Cites: Diabetes Res Clin Pract. 2008 May;80(2):305-1318221817
Cites: BMC Health Serv Res. 2009;9:6819397799
Cites: Am J Public Health. 1998 May;88(5):755-89585740
Cites: Health Serv Res. 2004 Dec;39(6 Pt 2):1927-5015544638
Cites: BMJ. 2005 Jul 23;331(7510):204-716037457
Cites: Lancet. 2007 May 26;369(9575):1779-8017536237
Cites: Health Policy. 2008 Feb;85(2):242-5117854946
Cites: Health Place. 1999 Sep;5(3):235-4510984578
Cites: Diabet Med. 2001 Jan;18(1):3-911168334
Cites: Am J Public Health. 2003 Dec;93(12):2124-3014652345