Attitudes to reform: Could a cooperative health insurance scheme work in Russia?

  • Maria KanevaEmail author
  • Christopher J. Gerry
  • Nikolay Avxentiev
  • Valerii Baidin
Research article


As for all health systems, in Russia, the demand for medical care is greater than its health system is able to guarantee the supply of. In this context, removing services from the state guaranteed package is an option that is receiving serious consideration. In this paper, we examine the attitudes of the Russian population to such a reform. Exploiting a widely-used methodology, we explore the population’s willingness to pay for cooperative health insurance. Distinguishing between socioeconomic and demographic factors, health-related indicators and risk aversion we find, consistent with other literature, positive income and risk aversion effects. We interpret the former as evidence that the Russian population is not opposed to the idea of progressive redistribution, to pool the costs of health-related risks; and the latter as evidence that risk-averse individuals demand more insurance coverage. In exploring these results further, we show that cognitive bias is important: overestimating the benefits leads to the purchase of additional insurance, while underestimating lowers demand for insurance. Our overall conclusion is that the introduction of a supplementary cooperative health insurance scheme in Russia could increase the accessibility of healthcare, lower the tendency for informal payments, incentivize the personal maintenance of good health and create a new source of funding for public healthcare.


Cooperative health insurance Willingness to pay Risk aversion Solidarity Cognitive bias Russia Health reform 

JEL Classification

I13 D81 



We are grateful to participants in RANEPA seminars for helpful comments on this paper.


Russian Presidential Academy of National Economy and Public Administration, Moscow (RANEPA). We are grateful also to the UCL School of Slavonic and East European Studies (UCL SSEES) for financing the data collection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.International Laboratory for Healthcare Economics and Its ReformsGaidar Institute for Economic PolicyMoscowRussia
  2. 2.Institute of Economics and Industrial EngineeringSiberian Branch of the Russian Academy of SciencesNovosibirskRussia
  3. 3.Oxford School of Global and Area Studies (OSGA)University of OxfordOxfordUK
  4. 4.Institute for Social Analysis and Forecasting of The Russian Presidential Academy of National Economy and Public Administration (ISAF RANEPA)MoscowRussia
  5. 5.Center for Perspective Financial Planning, Macroeconomic Analysis and Financial StatisticsFinancial Research Institute of Ministry of FinanceMoscowRussia
  6. 6.Center for Fiscal PolicyFinancial Research Institute of Ministry of FinanceMoscowRussia

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