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Access to health care among the elderly in Russia


Armstrong, Tracy Lynn (1998). Access to health care among the elderly in Russia. Master's thesis / Doctoral dissertation.


This dissertation is a case study of the functioning of the medical health care system in Russia, during a transitional period. It explores the determinants of access to medical insurance and utilization of health care services. This research initiative is divided into two parts. The first part consist of four chapters which provide extensive background on: (a) the demographic profile of the aging population; (b) changes in the Russian health care system from the Zemstvo health system (in 1864) to the present Mandatory Health Insurance Fund (MHIF); and (c) the theoretical justification for this study. The second part consists of three chapters of results examine the appropriateness of the Andersen's behavior model approach to understanding access to health. This research project uses Round VI (collected in 1995) of the Russian Longitudinal Monitoring Survey (RLMS), which is a national sample. As expected, the overall results show that having medical insurance enhances individuals' probability of being seen by a medical institution or personnel. Moreover, the study suggests that individuals with the greatest need for health care services actually have access to medical facilities. However, after examining gender and age interactions, findings indicate that women and older people (55 year old and older) have greater access to medical insurance but surprisingly it does not translate into a high probability of health care usage. The opposite pattern occurs with males and younger people (25-54 years of age) as they have less access to medical insurance but are significantly more likely to utilize health services. Furthermore, among those who have medical insurance, having health insurance has a greater benefit for younger people than older people. Finally, there are no significant differences by gender among those who have health insurance. Despite the fact that most of the hypotheses are not supported, one important finding is that women and older people are not worse off than was earlier thought. Furthermore, as discussed in the conclusion on the sociological importance of this dissertation, further steps are taken to minimize the quality of data concerns.

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Armstrong, Tracy Lynn