Russian Federation: conflicting health policy logics

Russian health policy terrain is full of contradictions. After the end of the Soviet Union, far-reaching reforms were initiated, but these transformations have been driven by divergent policy logics that have resulted in often incompatible institutional designs. At the core of these conflicting logics in Russia lie uneasy relationships between the state, the market, health care professionals, and patients. The post-Soviet Russian state has continued positioning itself as a guarantor, provider, and controller of health care. But simultaneously, market mechanisms have been rapidly implemented to fill financial and regulatory gaps. In these circumstances, health care professionals are barely involved in policymaking, while patients are referenced as recipients of health care services in policies but excluded from participating in their formulation. In this chapter we delineate major tensions and uncertainties produced by this background and trace how these tensions and uncertainties are dealt with in practice by actors on the ground.