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

Abstract

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.

Appendices

Appendix 1: Original coding of and responses to Q5a

Card shown	Amount, RUR	% of respondents who chose this card	Number of respondents who chose this card
1	500	17.68	58
2	1000	27.74	91
3	1700	7.93	27
4	2500	13.11	43
5	3500	6.40	21
6	4500	6.10	20
7	5500	6.10	20
8	7000	3.05	10
9	9000	0.30	1
10	Over 9000	3.96	13
99	Cannot answer	7.62	25

Appendix 2: Distribution of answers to the lottery question (q8), N = 1602

How much would you be willing to pay for the lottery ticket? (Rubles)	Frequency	Percentage	Cumulative percentage
Cannot answer	222	13.86	13.86
I would not participate in the lottery	895	55.87	69.73
10	20	1.25	70.97
15	1	0.06	71.04
20	17	1.06	72.10
25	1	0.06	72.16
30	22	1.37	73.53
35	1	0.06	73.60
40	3	0.19	73.78
50	74	4.62	78.40
60	1	0.06	78.46
70	2	0.12	78.59
80	1	0.06	78.65
99	1	0.06	78.71
100	143	8.93	87.64
150	16	1.00	88.64
200	45	2.81	91.45
250	8	0.50	91.95
300	22	1.37	93.32
500	42	2.62	95.94
700	1	0.06	96.00
1000	41	2.56	98.56
2000	8	0.50	99.06
3000	10	0.62	99.69
5000	5	0.31	100.00
Total	1602	100

Appendix 3: Distribution of Arrow–Pratt measure, A–P, for the sample N = 299

A–P	Frequency	Percentage	Cumulative percentage
− 0.0000471	1	0.38	0.38
0	7	2.68	3.07
0.0000244	5	1.92	4.98
0.0000471	17	6.51	11.49
0.0000573	17	6.51	18.01
0.0000612	6	2.30	20.31
0.0000621	2	0.77	21.07
0.0000630	14	5.36	26.44
0.0000640	3	1.15	27.59
0.0000649	40	15.33	42.91
0.0000654	1	0.38	43.30
0.0000656	1	0.38	43.68
0.0000658	16	6.13	49.81
0.0000660	1	0.38	50.19
0.0000661	4	1.53	51.72
0.0000663	3	1.15	52.87
0.0000664	1	0.38	53.26
0.0000665	2	0.77	54.02
0.0000667	120	45.98	100.0
Total observations	261a	100

1. ^aDoes not equal to 299 due to missing values

Appendix 4: Summary statistics for socioeconomic and health-related factors, N = 299

Variable	Definition	Mean	SD	Min	Max
Gender	0 = Females 1 = Males	0.485	0.501	0	1
Age	Age of respondent	42.043	14.999	18	88
Age squared	Squared age of respondent	1991.876	1386.492	324	7744
Good self-assessed health	1 = respondent states that he/she is in good health 0 = otherwise	0.421	0.495	0	1
Chronic illness	1 = respondent has one or more chronic illnesses 0 = respondent does not have any chronic illnesses	0.321	0.468	0	1
Work	1 = respondent has a job 0 = otherwise	0.719	0.450	0	1
Student	1 = respondent attends university 0 = otherwise	0.030	0.171	0	1
Pensioner	1 = respondent is retired 0 = otherwise	0.164	0.371	0	1
Unemployed (reference)	1 = respondent is unemployed 0 = otherwise	0.087	0.282	0	1
Married	1 = respondent is married 0 = otherwise	0.689	0.464	0	1
Divorced	1 = respondent is divorced 0 = otherwise	0.114	0.318	0	1
Single	1 = respondent is single 0 = otherwise	0.134	0.341	0	1
Widower (reference)	1 = respondent is a widow(er) 0 = otherwise	0.064	0.244	0	1
Capital	1 = respondent lives in a capital of a region 0 = otherwise	0.197	0.399	0	1
Town	1 = respondent lives in a town with population of more than 100,000 0 = otherwise	0.164	0.371	0	1
Small town	1 = respondent lives in a town with population of less than 100,000 0 = otherwise	0.331	0.471	0	1
Village	1 = respondent lives in a village 0 = otherwise	0.207	0.406	0	1
Moscow (reference)	1 = respondent lives in Moscow or Saint Petersburg 0 = otherwise	0.100	0.301	0	1
Primary education (reference)	1 = respondent attained primary education 0 = otherwise	0.080	0.272	0	1
Secondary education	1 = respondent attained secondary education 0 = otherwise	0.599	0.491	0	1
Higher education	1 = respondent attained higher education 0 = otherwise	0.321	0.468	0	1
Income category 1 (reference)	1 = we hardly live, we have no money for food 0 = otherwise	0.010	0.100	0	1
Income category 2	1 = we have enough money for food but not for clothes 0 = otherwise	0.064	0.244	0	1
Income category 3	1 = we have enough money to buy food and clothes but not durable goods (like TV and refrigerator) 0 = otherwise	0.605	0.490	0	1
Income category 4	1 = we can buy durable goods (like TV and refrigerator) but we cannot afford a car 0 = otherwise	0.261	0.440	0	1
Income category 5	1 = we can buy a car but there are still things we can’t afford 0 = otherwise	0.060	0.238	0	1