What is paid medical service: a burden or an alternative?

The aim of the article is to analyze a current and as yet unresolved problem of the commercialization of Russian public health service, which is explored by the authors in the light of international experience, views of expert organization (WHO, ILO, World Bank), and the results of sociological surveys of the population of one of typical Russian regions - the Vologda oblast, where the prevalence of paid medical services in comparison with other regions is quite high. The methodological tools of the study combine system analysis of a complex of information sources, as well as a socio-logical survey of the population. The scientific work presents the results of a sociological survey conducted by ISEDT RAS on aspects of commercialization of public health service. The author contributes to the development of the scientific and practical issue by developing, first of all, motives and preferences of citizens when they seek for medical assistance on commercial terms, thusunderlining the novelty of the study. As a result, it was found that the inhabitants of the Vologda oblast evaluated the quality of medical care provided by government health institutions, as a rule, lower than the quality provided by commercial ones. Among the attractive aspects of treatment on a fee-based basis, respondents note the benefits of “service” (lack of queues, the convenience of medical appointment booking, friendly service), as well as principal issues of quality of diagnostic equipment and treatment and the ability to choose a doctor, which indicates the disadvantages of the so-called “pripisnaya” system of making an appointment, established in government health institutions. The obvious disadvantages of “paid” medical care, according to the residents of the Vologda oblast, are high costs of services and the desire of doctors to order unnecessary labs and medical procedures. The authors try to find out the motives of citizens, seeking for paid medical service. Among them there is an urgent need to get medical labs or to undergo medical examinations, as well as a visit to a particular highly qualified doctor (because he does not consult for free or there is no such specialization in a government health institution), therefore, people are forced to seek for a paid medical service. The results of the study can be recommended to the executive authorities, in particular to the health departments/offices, for developing management decisions and measures aimed at stabilizing the situation in the sphere of commercialization of health care, and also for searching for a reasonable proportion between the “public” and “commercial” sectors in the structure of medical care. The results of the article will also be useful in the academic activity within the framework of educational courses of economics of public health service, public health, public sector economics, etc. The prospects of the research are related to the need and urgency of searching for reasonable boundaries of state participation in health care, as well as tools to consolidate efforts of the public and private sectors in the field of public health, in particular, by implementing public and private partnership projects.