London School of Hygiene and Tropical Medicine, UK.
Health Policy Plan. 2011 Nov;26(6):453-63. doi: 10.1093/heapol/czq082. Epub 2011 Jan 2.
BACKGROUND Many Russians experienced difficulty in accessing prescription medication during the widespread health service disruption and rapid socio-economic transition of the 1990s. This paper examines trends and determinants of access in Russia during this period. METHODS Data were from nine rounds (1994-2004) of the Russia Longitudinal Monitoring Survey, a 38-centre household panel survey. Trends were measured in failing to access prescribed medication for the following reasons: unobtainable from a pharmacy, unable to afford and 'other' reasons. Determinants of unaffordability were studied in 1994, 1998 and 2004, using cross-sectional, age-adjusted logistic regression, with further multivariate analyses of unaffordability and failure to access for 'other' reasons in 2004. RESULTS After 1994, reporting of unavailability in pharmacies fell sharply from 25% to 4%. Meanwhile, unaffordability increased to 20% in 1998 but declined to 9% by 2004. In 1994, significant determinants of unaffordability were unemployment and lacking health care insurance in men. By 2004, determinants included low income and material goods in both sexes; rented accommodation and low education in men; and chronic disease and disability-related retirement in women. Not obtaining medicines for 'other' reasons was more likely amongst frequent male drinkers, and low educated or cohabiting women. Regional and gender differences were widest in 1998, coinciding with the Russian financial crisis. CONCLUSIONS Rapid improvements in drug availability in the late 1990s in Russia are a probable consequence of a more liberalized pharmaceutical sector and an improved pharmacy network, whilst later improvements in affordability may relate to expanded health care insurance coverage and economic recovery after the 1998 crash. A significant minority still finds prescription costs problematic, notably poorer and sick individuals, with inequalities apparently widening. Non-monetary determinants of affordability indicate its partly subjective nature, however. Ongoing research into access is needed, due to recent national changes in prescription drug subsidies, and into doctor- and patient-related influences on access and prescribing for individual conditions.
在 20 世纪 90 年代广泛的医疗服务中断和快速的社会经济转型期间，许多俄罗斯人在获取处方药方面遇到了困难。本文研究了在此期间俄罗斯获取药物的趋势和决定因素。
数据来自俄罗斯纵向监测调查的九个轮次（1994-2004 年），这是一个 38 个中心的家庭小组调查。通过未能获得以下原因的处方药物来衡量趋势：从药房无法获得、无法负担和“其他”原因。在 1994 年、1998 年和 2004 年研究了不可负担性的决定因素，使用横截面、年龄调整的逻辑回归，2004 年进一步对不可负担性和“其他”原因的无法获得进行多元分析。
1994 年以后，报告药房无法供应的比例从 25%急剧下降到 4%。与此同时，不可负担性在 1998 年增加到 20%，但到 2004 年下降到 9%。1994 年，不可负担性的显著决定因素是男性的失业和缺乏医疗保险。到 2004 年，决定因素包括男女双方的低收入和物质商品；男性的租房和低教育水平；以及女性的慢性疾病和与残疾相关的退休。出于“其他”原因而未获得药物的可能性在男性中频繁饮酒者以及低学历或同居的女性中更高。1998 年区域和性别差异最大，恰逢俄罗斯金融危机。
1990 年代后期俄罗斯药品供应的快速改善可能是制药部门更加自由化和药房网络改善的结果，而后来可负担性的提高可能与医疗保险覆盖面扩大和 1998 年崩溃后的经济复苏有关。少数人仍然认为处方费用是个问题，尤其是较贫穷和患病的人，不平等现象显然在扩大。可负担性的非货币决定因素表明其具有一定的主观性，然而。由于最近国家对处方药补贴的变化，以及对获取和针对个别情况开具处方的医生和患者相关影响的研究，因此需要对获取药物进行持续研究。
