Attitudes to reform: Could a cooperative health insurance scheme work in Russia?
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.
KeywordsCooperative health insurance Willingness to pay Risk aversion Solidarity Cognitive bias Russia Health reform
JEL ClassificationI13 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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