Spontaneous commercialisation, inequality and the contradictions of compulsory medical insurance in transitional Russia

This paper analyses spontaneous commercialisation phenomena in the public health care system of transitional Russia. The authors relate these phenomena to the government's policy of vague declarations of comprehensive universal coverage unsupported by sound financial commitments. The paper provides an analysis of data from two Russian household surveys that confirms the existence of pronounced inequalities across income groups and geographical units, and connects these inequalities to the patterns of commercialisation of health care. The paper identifies the difficulties faced by more equitable policy initiatives in the context of the distorted incentives structures and vested interests generated by spontaneous commercialisation. Copyright © 2006 John Wiley & Sons, Ltd.