Health Insurance in Russia: Public vs. Private

Published on October 3, 2025 and written by Cyril Jarnias

In the vast landscape of health insurance in Russia, a captivating duel unfolds between public and private coverage, each bringing its own set of promises and challenges. At the heart of this system, the Russian Federation offers a state-funded public health model, aiming to guarantee access to essential care for all citizens. However, with an infrastructure sometimes challenged by growing demand, many Russians turn to private insurance to fill the gaps, hoping for faster access to higher quality and more personalized medical treatments. This article explores the key differences between these two systems, their impact on the Russian population, and the underlying reasons that drive some to invest in private health options.

Comparison of Healthcare Coverage Systems in Russia

Healthcare Coverage System in Russia: Public vs. Private Comparison

Aspect	Public System	Private System
Organization	Centralized management by the state via the Social Insurance Fund; access to public facilities for all registered residents	Primarily urban, organized around private clinics and hospitals, either independent or networked
Funding	Mandatory social contributions deducted from salaries (flat rate of 30% up to the cap, 15.1% beyond)	Direct payment by the user, optional private insurance, or employer coverage
Coverage	Primary, preventive, common emergency, and public specialized care; limited coverage (excludes rehabilitation, dental care, prosthetics, non-essential medications)	Access to a wide range: specialists, hospitalization, dental care, vision, medications; modern equipment and personalized services
Accessibility	Universal for residents; free at point of use but often overcrowded and under-equipped, especially outside major cities	Reserved for affluent individuals, expatriates, executives; availability mainly in urban areas; high cost

Types of Services and Costs

• Public System:
  • Free consultations and hospitalizations in public facilities.
  • Medications and specialized care often at the patient’s expense.
  • Limited services outside major cities.
• Private System:
  • Quick consultations, access to specialists without delay.
  • High fees, payment per service or via private insurance.
  • Premium services: private rooms, choice of practitioner, foreign languages.

Effectiveness and Challenges Comparison

Criterion	Public System	Private System
Quality of Care	Variable; often outdated equipment, staff shortages, lower quality outside major cities	High; modern equipment, qualified staff, personalized services
Wait Times	Long, especially for specialists and exams	Short, quick and flexible appointments
Satisfaction	Average to low, especially in rural areas	High, but limited to a minority

Socio-Economic Impact

• Public System:
  • Guarantees access to basic care for the entire population.
  • Limits access inequalities to some extent but remains dependent on public funding levels.
  • Significant burden on the state budget and businesses via social contributions.
• Private System:
  • Exacerbates inequalities: only the wealthiest benefit from quick and superior quality access.
  • Attracts qualified healthcare professionals, worsening public sector shortages.
  • Contributes to a “two-tier healthcare system” and urban/rural segmentation.

Concrete Examples of Public/Private Choices

• Preference for Public:
  • A Russian citizen with limited resources, living in a rural area, will use the public system for basic consultations and emergencies.
  • For preventive care or chronic diseases requiring regular follow-up, public remains the default solution.
• Preference for Private:
  • An executive or expatriate in Moscow needing specialized intervention or quick hospitalization will opt for private to benefit from high-quality service without waiting.
  • For dental care or treatments not covered by the public system, turning to private is almost systematic.

Summary of Main Advantages and Disadvantages

System	Advantages	Disadvantages
Public	Free, universal, guaranteed basic access	Limitations, underfunding, wait times
Private	Quality, speed, comfort, extended services	High cost, limited accessibility, inequalities

Advantages and Disadvantages of Public Insurance in Russia

Healthcare coverage provided by the government:

• Mandatory medical insurance mainly covers:
  • Primary healthcare
  • Preventive care
  • Common emergencies
  • Certain specialized care in the public sector
• Benefits accessible to citizens:
  • Treatment of infectious diseases
  • Coverage for everyday accidents
  • Coverage for serious illnesses (tuberculosis, cancer, AIDS, neurological diseases)
  • Free care for retirees, students, disabled persons (via state funding)
• Non-covered benefits:
  • Rehabilitation
  • Dental care
  • Prosthetics
  • Non-essential medications

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Limitations and Disadvantages of the Public System:

• Choice of Healthcare Providers:
  • Limited to accredited public facilities
  • Little flexibility in choosing a doctor or hospital
  • Difficult access to specialists or modern infrastructure outside major cities
• Wait Times for Treatments:
  • Sometimes long delays for specialized consultations or certain treatments
  • Priority given to the most urgent cases
  • Reduced wait times in the private sector
• Quality of Care:
  • Suffers from chronic staff shortages and lack of modern equipment
  • Variable public investments depending on the region
  • Uneven quality, better in major cities

Criteria	Public Insurance Russia	Private Insurance Russia
Coverage	Basic care, emergencies, serious illnesses	Extended care, hospitalization, specialists
Provider Choice	Limited, little flexibility	Wide choice, access to modern facilities
Wait Times	Often long	Quick service, easy appointments
Quality of Care	Variable, often lower	High level, recent equipment
Cost to Citizen	Included in taxes or contributions	Additional contribution, often high
Accessibility	Universal for residents	Mainly major cities and expatriates

Health Outcomes Comparison:

• Public Insurance Beneficiaries:
  • Lower life expectancy than European average
  • Higher mortality rate for some preventable diseases
  • Difficult access to medical innovation outside major urban centers
• Private Insurance Users:
  • Better overall care
  • Access to recent treatments and prevention
  • Significantly superior health outcomes for populations able to afford private insurance

Economic Aspects:

• Cost to the State:
  • Primarily public funding, via taxes and social contributions
  • Employer contributions: about 3.6% of payroll
  • Growing weight of the private sector in major cities
• Citizen Contributions:
  • Public insurance funded by taxes and social contributions
  • Private insurance: voluntary contributions or employer subscription

Expert and Citizen Perspectives:

Some experts judge that the public system guarantees minimal access to care but remains insufficient to ensure service quality equivalent to European countries.

Many citizens express frustration with wait times and outdated equipment but appreciate free basic care for the most vulnerable.

Others point out that the development of the private sector worsens inequalities in access to quality care, reserving the best treatments for the wealthiest.

Summary of Advantages and Disadvantages

Public Insurance Advantages	Public Insurance Disadvantages
Universal access to basic care	Limited coverage
Emergency coverage	Frequent wait times
Moderate cost for citizens	Variable quality, lack of innovation
Solidarity funding	Restricted provider choice

International Health Insurance Options for Expatriates in Russia

International health insurance companies offering coverage for expatriates in Russia:

• Indigo Expat (WeCare and OnePack)
• APRIL International
• AISAE (International Health and Assistance Association for Expatriates)
• CARPS INTERNATIONAL

Company	Routine Medical Care	Hospitalization	Dental Care	Medical Evacuation
Indigo Expat	✔️	✔️	Optional	Optional
APRIL International	✔️	✔️	Optional	Optional
AISAE	✔️	✔️	Optional	✔️
CARPS INTERNATIONAL	❓*	❓*	❓*	✔️

*CARPS INTERNATIONAL emphasizes repatriation guarantee, but other coverages must be verified according to the contract.

Types of Coverage Offered:

• Routine Medical Care: consultations, medications, tests.
• Hospitalization: coverage of hospital expenses, surgery.
• Dental Care: generally offered as an option or via specific packages.
• Medical Evacuation and Repatriation: essential in international contracts; coverage of transfer costs to a country with better care or to the home country.

Advantages of International Insurance vs. Local Insurance:

List of Advantages:

• Worldwide or multi-country coverage
• Included evacuation/repatriation guarantee
• Access to an international care network
• Multilingual customer service

List of Disadvantages:

• Costs often higher than local Russian insurance
• Some companies exclude Russia since 2022 due to the geopolitical context
• Sometimes complex administrative procedures

Potential Cost Comparison:

Type of Insurance	Average Monthly Price (€)
International Insurance	350 – 600+
Local Private Russian Insurance	70 – 200
Russian Public System (CHI)	Free or low cost

International insurance is significantly more expensive but offers extensive coverage. Local private insurance is less costly but may limit certain services (especially medical evacuation). The Russian public system is low cost but has variable quality depending on the region.

Specifics of the Russian Healthcare System Influencing the Choice of International Insurance:

• Uneven quality between major cities and remote regions
• Limited coverage for foreigners by the public system
• Frequent need for direct payment before reimbursement
• Significant medical inflation in recent years
• Difficulty accessing English-speaking specialists outside Moscow/St. Petersburg

An expatriate will often prefer international insurance to guarantee access to a reliable medical network, benefit from repatriation if necessary, and supplement the insufficient coverage offered locally.

In summary, choosing suitable health insurance will depend on budget, the expected level of medical services, and the potential need for assistance/repatriation. International companies generally offer more coverage than local Russian options.