Health Special

Er… What happens when I get ill?

Well what does happen when you fall sick? In this country, it all depends on whether or not you have medical insurance, or, if you break a leg today and don’t have insurance, how much money you can lay your hands on.

If you go for the insurance path, there are many alternatives. As a kind of left-over from the Soviet Union, every Russian citizen has compulsory medical insurance. People using this insurance are treated in a network of polyclinics and state hospitals throughout Russia. The policies are easily obtained from local polyclinics, and foreigners who live here permanently can go to their local polyclinic and get such a policy. To prove you live here permanently, you need to have been living here for a year or two (it varies according to the polyclinic), and prove you are registered here, which means you do have to register your visa when you arrive. It helps also to have a permanent address with documents. If you have a residence permit “Vid na Zhitelstvo” you can get this document straight away. The local polyclinics will give you basic medical care. You may have to wait in a queue for treatment which may not be easy if you aren’t used to that, and stress levels go up considerably when there are children around. The ward in the hospital where you get put may be dirty, the food likened to that in a prison, cockroaches on the floor, but the doctors— great. Sometimes there is nothing particularly wrong with the nearest clinic, it’s just too far away, and nobody speaks your language. Whatever the reason, many foreigners want something better, and it doesn’t have to cost the earth, as you can see by reading this article and some of the short articles in this PASSPORT health special over the next few pages.

Dr Poletaeva, Deputy Head of the Reso Garantiya Clinic

Call centre at the Reso Garantiya Medical headquarters

For better conditions, you have to take out a so-called “voluntary health insurance” with an insurance company, which uses one or several of the new private clinics working in Moscow, St. Petersburg and some larger cities. Anybody can buy these policies, whether you are here for one week or ten years, with or without a residence permit. This kind of insurance is bought for a year at a time and there are two basic types: corporate, for a legal entity for over ten people, and private. There are, according to Dr Poletaeva, the deputy head of medical services at Reso Garantiya three main levels of service. The first is a little better than what the state offers, the third level is the European Medical Centre (EMC) the American Medical Centre (AMC) and SOS. Price for home visits, ambulance and hospitalisations when needed at the second level are about 1200 Euros per year for the and 4000 Euros for the third level. English-speaking staff are available in clinics on the second level, but not everybody speaks foreign languages as in clinics of the third level. As Dr Poletaeva commented: “Mostly, we take the opinion that if somebody is sent to work in a country like Russia, they should be able to speak the language that is spoken here.”

When assessing the cost of each individual policy, there are many factors involved, too many to list in detail here here, but basically, on each level, different services are available. For example you may only want a policy that covers home visits, or may want hospitalisation cover as well, and so on. “It’s like Lego, you can build your own policy,” Dr Poletaeva said. In general, according to Russian law, all insurance packages have to cover serious, pain-causing illnesses, not necessarily preventative medicine, such as a complete check-up, which can be bought separately. Here the maths can be interesting. A complete check up in place like EMC can set you back 200,000 roubles as a pay-as-you-go patient. You can have the same done in a level two clinic for an additional yearly policy which costs 6000 roubles. The insurance company will be interested in your past medical history unless you are a member of a corporate package.

In general, health insurance policies on sale here are a bit wider than the usual international medical insurance you get back home which basically cover only emergency situations. The cost goes up once you are over 60, for obvious reasons.

There are only a few insurance companies offering insurance packages for foreigners here on an individual basis. Reso Garantiya (www.reso.ru) is a large insurance company which runs a series of clinics at the second level throughout Moscow. Then there are some foreign companies which are offering special policies for foreigners here, such as in2matrix (www.in2matrix.com) which is working with the British Business Club and presenting its services to other business clubs as well. They are offering programmes here in Moscow for the third level of service for about $4000 per person for its “world-wide coverage minus USA programme.” EMC and AMC for example also offer health-care programmes of their own, but these are generally higher than going through an insurance company.

No clinics offer a complete range of medical services. Even the top clinics do not cover tertiary care (specialist cancer care, neurosurgery, etc.) and they will probably send you to a Russian hospital with which they work closely, where you will get treatment under supervision of the clinic. The hospital concerned must have a licence allowing them to work in this way, and usually hospitals, according to Dr Poletaeva, are interested in more patients, thus keeping costs reasonable as compared to high costs and few patients. This is good for everyone, the hospitals because they are guaranteed a high number of people passing through their wards, and also the clinics because if patients have to pay huge premiums for really expensive treatment, the cost of insurance policies will go up, and thus there will be fewer clients.

Facilities at a Reso Garantiya Clinic

Facilities at a Reso Garantiya Clinic

No insurance policies cover things like valves which are needed in a heart operation for example. These you have to buy yourselves. Most medicines for most operations are included in the price but things like artificial limbs are hardware you have to buy yourself. Free body equipment is available in Russian hospitals, but there is usually a wait involved, and you will get the cheapest (usually Chinese) option, which probably will not be the best available and may go wrong quickly. So the real cost of getting fixed up in Russia isn’t just the price of the insurance policy, it is also the cost of those parts of the treatment that the insurance policy doesn’t cover. One also has to remember that as the law only states that health-care providers have to provide treatment for serious illnesses and real physical pain, physical therapy and post-operation treatment is not included.

The alternative for some is not to get involved in the Russian health-care system at all. You can buy, or your company can buy an evacuation policy such as that offered by SOS International, although they are also using, when suitable, local services in the form of joint ventures with top, third-level providers. You have to look at the fine print and ask questions when you talk to insurance people. What is available here in Russia is actually better and more varied than a lot of people realise. We have come a long way over the past twenty years. You can get treatment faster and pay more than for comparable health-care from Britain’s NHS for example, but certainly for a lot less money than comparable services in the USA for the majority of patients and illnesses. There is more paranoia and misunderstanding surrounding health in Russia than irresolvable problems.

You need to decide what kind of service you need. Phone around the clinics, look at the insurance companies’ sites, talk to people, ask questions and sign up!