This paper investigates the patterns of Russia’s out-of-pocket household expenditure on health care using the household and individual data of Rounds 5 to 9 of the Russia Longitudinal Monitoring Survey covering the period of 1994-2000. Over this period, total household monthly expenditure on health care had grown slowly in real terms by about onethird On average, households were spending about three percent of their income on prescribed drugs and medical services in 1994-1998. In 2000, this percentage suddenly grew to twelve percent due mainly to a drop in the average reported monthly household real income. Most of the household money spent on medical services went to the public medical care system for services that were supposed to be provided for free. The burden of out-ofpocket expenditure was income-regressive. While the households from the top income quintile were spending about two times more in absolute terms than the households from the bottom income quintile, in relative terms, they were spending about ten times less share of their income than the bottom quintile households. Our results, in general, comply with findings of other research that were based on surveys of treatment facilities, and other household data. We conclude that the level of out-of pocket expenditures is substantial and growing, and that the development of a shadow market for publicly provided medical services worsens the population differentiation with respect to the ability to receive high-quality health services.