The countries of the former Soviet Union (FSU) over the last 20 years have
experienced an impressive transformation. Fundamental change has occurred
in almost all aspects of political, economic and social spheres. The market
economy and new freedoms have generally positively impacted citizens’
lives but access and financial protection within the national health systems
as well as health status of the population more generally have not kept pace
and are still considerably worse than in other countries of similar economic
performance. Health and social protection systems were slow to adapt to
the rapid epidemiological and demographic change, characterized by a
preponderance of noncommunicable diseases, health issues linked to lifestyle
choices and challenges related to an ageing population. At the same time, as
in most countries of the former Soviet Union, once the economy opened and
information started to flow more freely, consumer expectations started to rise
across the board. In the health sector, this resulted in high growth rates of
private health expenditure, mostly related to high-end tertiary care services,
branded pharmaceuticals and the use of expensive medical technology – often
with a limited evidence base. Those who could not afford high formal and
informal out-of-pocket (OOP) expenditure were increasingly at risk to either
forego or postpone necessary medical interventions. When confronted with a
catastrophic health event, the middle classes and the poor often experienced the
impoverishing effects of a health system lacking social solidarity, such as proper
mechanisms of risk pooling and strong regulation as part of functioning health
insurance mechanisms.