I could literally write a book about all I learned and experienced this last week.  I am going to have to break this report up into multiple posts or this one would make War and Peace look like light bathroom reading.

First, a little context:  the Russian middle class has grown from about a million people in 1999 to over 30 million people today and heading up like a rocket.  This has led to significant growth in the healthcare, real estate, retail and media industries as well as the financial markets around them.  Healthcare accounts for around 4% of GDP in Russia, as compared to 18% in the US, but the two countries have a similar rate of growth in healthcare costs at around 10% per year.  Information technology, similarly, accounts for 1% of Russian GDP and about 4% of US GDP.  I was reading a newspaper in Moscow Sunday morning which said that the fastest growing IT segments in Russia are cloud, big data, mobile and security systems.  It could have been a page out of TechCrunch.

On the healthcare front the differences are profound but there are also some very interesting similarities.  The Russian healthcare system is essentially a single payer government sponsored system.  While there are private physicians and a nascent and growing private employer insurance market, the vast majority people receive care through the state plan and state-owned hospitals and clinics.  Doctors are not revered the way they generally are in the US and make an average of $500 per month salary.  That is not a typo.  The average US physician salary is closer to $150,000.  Fewer than 3% of Russian doctors speak English and this means they are typically never exposed to the latest medical research because it is typically published in English and there is little to no translation to Russian.

Even though all Russians are technically entitled to free healthcare from the central system, upwards of 60% of all healthcare costs are paid directly by consumers themselves.  This is because it is often essential to pay the state-paid doctors and hospitals an under-the-table payment to actually get seen and also because many things aren’t covered by the system, like pharmaceuticals. Most prescribed drugs bought at a pharmacy are patient-paid, including the items we all know to be very expensive.  When patients need a blood test they go to a lab to get one with no doctor’s orders.  Traffic is so bad in Moscow, where a large portion of the population resides, that it can take literally hours to drive to a nearby doctor visit.  God help you if you need to be transported by ambulance.  Many of the most advanced treatments our US system pays for are just not paid for in the Russian system at all, even when needed.  The use of imaging modalities and next generation surgical devices, for example, is vastly different.  There is no real concept of “personalization” in medicine yet, by which I mean modifying coverage and interventions to address individual sub-populations.  Health plans are focused more around professions and there isn’t yet a willingness to engage in widespread disease management-style programs that are customized to small sub-groups, as we have more and more of in the US.