Healthcare in Russia

by Stan Jacox

A couple people on that thread were interested in medical care conditions here (Stan lives in Russia) so I wanted to relate my story that may resonate with them.

I am not sure if this is relevant for the other thread members but here it is.

Regarding health care….As non-citizens you would need insurance or just pay out of pocket. There is no waiting for appointments and there are many intermediate facilities called Polyclinics where most services that are needed for anything except acute care or operations, or hospitalization. That really cuts down on the cost of providing routine care, everything in one building including lab tests.

Cost of services for non-residents is considered expensive by Russians who always assumed it should be free. But to foreigners, the usual response is “Is this ALL?”

Here is a long story of one of the very few times I have ever been to a doctor:

Good example. I kept up my health insurance in the US even after I moved here (to Russia), foolish move, but the $824 a month I figured was worth the cost in case a major illness or accident occured, because, as everyone in the US says. “we have the best health care in the world”.

I was paying 12 years and never used it once. When my right hip gradually deteriorated I finally went to the doctor (in the US) for his 5 minute allotted time per patient, after waiting 2 weeks for the appointment. My hip was getting so bad it prevented most activities, gradually increasing in pain for 3 years before I did anything about it. The view of the doctor was that a hip replacement was the only solution. The insurance was notified and a clerk there denied it saying the problem might have started 12 years 1 month ago, before I had that policy. The doctor protested saying I would have been in a wheel chair 9 years ago if that was the case but the claims clerk had the power to deny any claim. I checked with the local hospital the doctor has privileges in and they said it would cost $90,000 plus $30,000 for physical therapy and expect to be out of action for 3-6 months and pain medication for about $10,000. Swell, I said to myself.

I flew back to Russia and asked all my medical related friends (mostly young nurses and doctors I met out socializing in dance clubs) and all but one recommended the same name for an orthopedist. I tracked him down to one of the clinics he made rounds to and called. The receptionist said the doctor was not there normally, only when a patient was closer to that clinic, one specializing in foreigners. She said she would relay my message of wanting an appointment.

I was sitting in a small outdoor cafe during the call. 10 minutes later a man called and asked one question before even introducing himself. “Are you in pain…if so, I can come to you?” I said I was but was used to it so no need for him to come to me. I briefly described the problem and then asked for a normal appointment. He replied he was very busy but could set up an appointment. He started mumbling to himself as if reading days from his calendar. It was the first of the month so he was saying…”5,6, humm, no, 7″ And I interrupted and said the 7th would be great. He asked “why wait that long?” I did not realize he was suggesting 7 like 7pm that evening. I met him at that clinic, a very modern place, more expensive because foreigners were used to paying a lot, but still much cheaper than an apointment in the US. He thought I would feel more comfortable in a place that was western standard. I had been to neighborhood polyclinics taking ill friends (yes, they still do house calls, saying that it is safer to treat at home than infecting a whole bus or clinic).

I met him at 1 minute after 7, and he apologized for keeping me waiting…1 minute! He asked hundreds of questions, about all my life style, diet, love life, history, family, and conducted the most thorough examination and explanation ever….3 hours. At the end he drew detailed drawings of what he suspected was wrong but said if I wanted a second opinion he recommended a color MRI, but warned that it was not needed, and was very expensive. I was curious about cost and he said $100. I told him I would like it simply because I never saw one before and this one was a new high tech version. It was located in the Military Medical Academy, the most prestigious medical academy in the region. But to go there I could not walk in, I had to go by ambulance which was another $25. It was well worth it. I was rather apprehensive about an operation because I was on a ‘knee and hip patient and doctor forum’ called BoneSmart and the horror stories everyone had about how much paid, they were in for months, and how they needed assistance in doing everything for a while, so recommended I hire a nurse for a couple months. But when seeing the color images, and comparing to the detailed drawings he made, they were identical, with the size and angle of the bone spurs that were well developed and source of additional pain besides the cartilage being completely gone.

Anyway, I preferred going to a full hospital for the operation, that I put off for months, instead of the western clinic. He thought I would be afraid of seeing a national health care hospital. I had already been there, and since I was actually paying money for operation and hospital stay, I reserved a 10 day stay in their VIP section (meaning money was to exchange hands)

I checked in the day before and was met by an attractive mid 30s blonde doctor who said she was responsible for my general health so wanted to do some tests. She did and the results came back a bit low on iron in the blood so said they would address that with diet. My room was one of 10 on the floor, all single bed rooms. The room consisted of the room, with an old style articulating hospital bed, a guest area…living room with sofa bed for guests to spend the night if desired, a kitchen with plasma TV, microwave, refrigerator etc, and a 400 sq meter bathroom/sauna with a walk-in shower big enough for a party, plus a sauna and a whirlpool bath, and dressing area.

Then I was introduced to the 4 nurses on the floor who were supervised by the doctor I first met. Each of the nurses spoke multiple foreign languages and 2 were tall slim and very pretty. The other two were stunning, really…I am used to beautiful women in St Petersburg but these two were very striking even by Russia standards. 10 patients, 4 RNs, and 1 MD. Most of the time there were only 4-5 rooms with patients.

The next day I was scheduled for the operation. A couple hours later I woke up (sleep not general) in the recovery room, which was an atrium with plants and trees, on the top floor overlooking a small lake with swans gliding.. The surgeon came to me a soon as he was told I was awake and he wanted my to try to move my leg by resisting his hand on my ankle. It was hard at first but then I remembered how to move my leg….sounds funny but I really did not know how at that moment. I could push his hand away so he was happy and sent me down to my room.

I only felt pain when first trying to stand with the help of two nurses. A sharp pain but it went away as soon as pressure was released. I never felt like I needed pain medication and never asked for it. One the 9th day of being totally pampered with one nurse helping me practice Russian, and another one stealing fruit and snacks not on my prescribed iron rich diet, both the surgeon and ward doctor came in to say I could leave if I wanted, a day early because the progress was so good. I arranged for friends to come pick me up. When the staff found out I was leaving early, they went scurrying around and came back 45 minutes later with all the makings of a party, including more stolen fruit and cake, balloons and cards, and more than a few damp eyes. They had planned a party for my scheduled release date, which I had prepaid, and had to rush around to create one. Overall, it was one of my best experiences here, My new hip healed quickly and I had a birthday party in a dance club on my 3rd day out of the hospital with me dancing with crutches. 27 days later I put the crutches away and never used them again. The party was attended by 2 of the nurses and the MD, plus a bunch of my young friends here.

Great experience, great results, no pain post-op, no physical therapy other than just going about my daily life like grocery shopping on crutches, walking to my office for 1/2 day, cooking, laundry….that was my physical therapy.

Total price, including the same Swiss made joint as the doctor in California recommended. The hospital back home quoted $12,000 for the joint alone. But here, my entire cost for medical care, hospital, joint and medications: $5,700!

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3 Comments Add yours

  1. quantiger says:

    What few Americans understand is that this $90,000 + $30,000 + $10,000 is the sticker price. You can see reality of what insurers pay in Medicare payments for hip arthroplasty. It’s about $1500.

    In general, insurer discounts from the sticker price are on the order of 75% or more. So the maximum that your insurance would pay is $22,500 + $7500 + $2500. Most likely, they would pay less.

    But, most people have a high deductible and pay 20% of the sticker price even with insurance. So, let’s do the math. You, with insurance, would pay:
    $18,000 + $6,000 + $2000
    The insurance company now has a net payment of:
    $4,500 + $1,500 + $500 = $6,500 total.
    Let’s list actual cost to the insurance company for various common deductibles.
    Deductible | Insurer net
    $5,000 | $1,500
    $2,000 | $4,500
    $500 | $6,000

    You paid $824 per month in that fiscal year.
    $824 x 12 months = $9,888

    Worst case, the insurance company makes a net profit for the year of $3,888.

    This is really how it works. But, if you have no insurance, then, guess what? The medical provider will sue you for the sticker price. This is sometimes called a jackpot.

    Hospitals do this for two reasons:
    A. The hospital is, de facto, colluding with the insurers to give people the idea that the insurance company is really helping them.
    B. When someone who is uninsured but has assets enters the system, this allows much more profit to be made by the hospital/clinic, what have you. A major part of what that goes to is medical care for non-paying uninsured that they are mandated to provide, but the Feds don’t pay them for.

    So – now you see why the Republicans hate the ACA and want to kick people off of insurance when they need it. The purpose is to preserve profits for insurance companies, and to ensure profits for the hospitals and clinics that jackpot off of uninsured middle Americans who own their homes and have retirement savings. That’s it. That is the logic for why Republican Congressmen want to kick people off of insurance, and deny coverage for pre-existing conditions. It’s designed to take that money – from you.

    By forcing insurance companies to pay for pre-existing conditions, and not allowing them to kick people off of their insurance, the ACA has cut into the insurance company gravy train. In reality health insurers do nothing for you at all except eat money. As you can see by the above calculations, when this man’s insurance company denied his claim, they would make a significant profit that year anyway. But they are too greedy to allow even that to happen.

    One has to wonder, given the way our national politics work, if the reason that the Democrats are demonizing Russia, and threatening war, is that our medical care system is upset that they aren’t able to jackpot and take all the assets of middle Americans who are learning to go to Russia, China, or elsewhere for care.

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