Russian Federation

The Federal Ministry of Health is responsible for health policy and system governance, as well as the regulation of health care providers and the definition of the universal health benefit package. Regional health authorities are responsible for the provision of most medical services, including primary care. District and regional hospitals provide secondary care, and most tertiary care is provided by federal hospitals. Primary care plays a gatekeeping role and is largely provided by multispecialty polyclinics staffed by district physicians and specialists. Since 2019, the focus of reforms in the Russian Federation has been on improving access to and quality of primary care, particularly in rural areas.

The Russian Federation has universal health coverage, with all citizens entitled to free care in state and municipal medical facilities or services contracted from private providers through social health insurance, which is funded by a mix of general taxation and employer contributions. In practice, however, the quality and availability of services vary widely from region to region.

There are two medical benefit packages: the basic universal package is set at the federal level, and the territorial package is set at the regional level. The basic package ensures coverage of a defined list of services that is universal throughout the country, while the territorial package can be expanded to include additional services that reflect the needs of the population in the territory, capacity and infrastructure, and are available based on residency status. Most primary and secondary services are covered, with exceptions for some diagnostic tests and services accessed without a referral. Patients pay for prescriptions, with exceptions for some chronically ill patients, the disabled and military veterans, and territorial packages can extend pharmaceutical coverage to other populations.