Intended for healthcare professionals


Russia’s healthcare system: in need of modernisation

BMJ 2009; 338 doi: (Published 25 June 2009) Cite this as: BMJ 2009;338:b2132
  1. Sergey V Shishkin, prorector1,
  2. Vasiliy V Vlassov, professor2
  1. 1State University Higher School of Economics, Pokrovsky Boulevard, 11, Office E302, Moscow 109028, Russia
  2. 2Moscow Medical Academy, Moscow
  1. Correspondence to: S V Shishkin shishkin{at}
  • Accepted 23 March 2009

Russia’s health system is both inefficient and inequitable. Sergey Shishkin and Vasiliy Vlassov describe the challenges it faces and the government’s plans for reform

The transition to a market economy caused enormous shock to the Russian healthcare system.1 Although health services improved during the economic growth in 1999-2007, the system still needs extensive reform. Modernisation of the public healthcare system was one of the highest priorities in the government’s 2008 plan for long term socioeconomic development of the Russian Federation.2 We describe the health reforms implemented in the past few years and the current plans for reform to 2020.

Low life expectancy and huge health problems

The enormous health problems facing Russia have been recognised for several decades. Life expectancy in Russia has been falling since the 1960s, in contrast to the steady rise in western Europe (figure). One statistic that caused widespread concern was the sharp rise in mortality in the late 1980s and early 1990s. While this was interpreted as a consequence of Russian drinking habits it is now understood as a temporary phenomenon related to the political crisis and accompanying disorganisation of social life, life habits, and health care.3 4 Some other problems are long lasting and they are still unclear.

The mortality pattern is unusual as the death rate is high in middle age. Many deaths in this age group are related to trauma, alcohol, and smoking. More than 60% of men in Russia smoke compared with less than 25% in the UK.5 Chronic diseases have all increased over the past 20 years, and the incidence of cardiovascular diseases and cancer has doubled since 1990. Population ageing is creating additional challenges.

Fig 1 Life expectancy at birth in UK, Germany, Ukraine, and Russia (

Russia is also facing developing epidemics of HIV and tuberculosis (fig 2 …

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