Health Care Reform in the Former Soviet Union: Beyond the Transition

Dina Balabanova, Bayard Roberts, Erica Richardson, Christian Haerpfer, Martin McKee

Research output: Contribution to journalArticlepeer-review

101 Citations (Scopus)


Objective. To assess accessibility and affordability of health care in eight countries of the former Soviet Union.

Data Sources/Study Setting. Primary data collection conducted in 2010 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia, and Ukraine.

Study Design. Cross-sectional household survey using multistage stratified random sampling.

Data Collection/Extraction Methods. Data were collected using standardized questionnaires with subjects aged 18+ on demographic, socioeconomic, and health care access characteristics. Descriptive and multivariate regression analyses were used.

Principal Findings. Almost half of respondents who had a health problem in the previous month which they viewed as needing care had not sought care. Respondents significantly less likely to seek care included those living in Armenia, Georgia, or Ukraine, in rural areas, aged 35-49, with a poor household economic situation, and high alcohol consumption. Cost was most often cited as the reason for not seeking health care. Most respondents who did obtain care made out-of-pocket payments, with median amounts varying from $13 in Belarus to $100 in Azerbaijan.

Conclusions. Access to health care and within-country inequalities appear to have improved over the past decade. However, considerable problems remain, including out-of-pocket payments and unaffordability despite efforts to improve financial protection.

Original languageEnglish
Pages (from-to)840-864
Number of pages25
JournalHealth Services Research
Issue number2
Early online date23 Sept 2011
Publication statusPublished - Apr 2012

Bibliographical note

Joint Acknowledgement/Disclosure Statement: The HITT Project was funded by the European Union's 7th Framework Program, project HEALTH-F2-2009-223344. The European Commission cannot accept any responsibility for any information provided or views expressed.We are grateful to all members of the Health in Times of Transition Project (HITT) study teams who participated in the coordination and organization of data collection for this working paper. We are also grateful to the anonymous referees for their helpful suggestions.


  • Armenia
  • Azerbaijan
  • Cross-Sectional Studies
  • Delivery of Health Care
  • Georgia (Republic)
  • Health Care Costs
  • Health Care Reform
  • Health Care Surveys
  • Health Services Accessibility
  • Humans
  • Kazakhstan
  • Moldova
  • Patient Acceptance of Health Care
  • Questionnaires
  • Republic of Belarus
  • Russia
  • Ukraine


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