A couple of months ago, I made an acquaintance with a provincial carpenter. This was rather convenient, since I would soon need to furnish my new apartment. I could either get a good quality but MDF-based factory made bed for around $300, or I could pay him $500 and get a very high quality bed (with drawers) made out of solid wood for $500, with a tabletop for my planned electric table thrown in for free. Why not, let’s support the artisanal economy. He said it would be ready within a couple of weeks.
It’s been more than a month now and it’s doubtful that I am ever going to see the furniture I ordered. As it turned out, he had been diagnosed with Stage I lung cancer half a year ago, though he seemed hale enough when I met him (during our one hour meeting, he managed to smoke a couple of cigarettes, which I suppose explains many things in retrospect). But since then, the illness appears to have taken a turn for the worse, transitioning into the metastatic phase. He has been hospitalized for the past week. Lung cancer is one of the worst cancers out there, and survivability at Stave IV is less than 1%. Assuming those diagnoses were accurate, he’ll likely be gone in another few months.
Obviously, I am not going to press him for the furniture, or to return the money, which I have more or less written off at this stage.
However, this episode did provoke me into taking a look at Russian cancer survival statistics (which are a good proxy for healthcare quality).
I have heard a surprisingly frequent amount of praise for the Russian healthcare system from resident expats. It is certainly much cheaper, and there’s less far less hassle with relatively trivial procedures such as treating a broken arm. It’s very cheap and often entirely free.
However, it was always to be expected that performance was much lower on the more complex operations, such as treating cancer, on account of (1) much lower levels of funding than in the developed world – about 10x lower per capita than in the US, and 5x lower than in the UK; (2) low salaries making medical careers unattractive for the best human capital – for instance, the typical Russian anesthesiologist gets 35,000 [$500] rubles per month (70,000 [$1,000] in Moscow), whereas salaries of $10,000+ per month are not uncommon in the US; (3) correspondingly low level of English language knowledge (which is relevant since almost all scientific production of any value has long occurred in English).
In previous years, I hadn’t been able to find anything particularly interesting, since it’s usually the rich/OECD countries that participate in such comparative studies – though in fairness, I didn’t look particularly hard for them. But this time round I was luckier and managed to locate some relevant papers.
* Goss, Paul et al. – 2014 – Challenges to effective cancer control in China, India, and Russia
- 33% cancer mortality in the US – well funded, mostly private medicine.
- 40% cancer mortality in the UK – well funded, mostly socialized medicine.
Note that the NHS, the so-called “best healthcare system in the world”, has some of the worst cancer survival rates in the developed world. So we can view the 30%-40% cancer mortality interval as the global medical technological frontier.
- 60% cancer mortality rate in Russia – poorly funded, mostly socialized medicine.
Furthermore, as the Lancet article points out, there are issues with statistical quality in certain regions, which makes the 60% figure a lower bound. So true cancer mortality would be somewhere in the 60%-70% range.
Or to put it in simple figures: One third of American cancer sufferers die; two thirds of Russian cancer sufferers die.
Same picture according to another study I tracked down.
* Allemani, Claudia et al. – 2015 – Global surveillance of cancer survival 1995–2009 analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)
Figures for Russia pertain to Arkhangelsk oblast only. I assume it will be around average for Russia.
Also worth noting that data for non-developed countries is pretty poor in general, e.g. I also encountered this criticism of the Brazilian data (which shows remarkably good performance for a country with its development level).
Still, it’s pretty clear that Russia is a severe laggard relative to the developed world, coming last out of the surveyed European countries (though almost catching up to Latvia by 2005-2009).
Breaking an arm – probably better to do that in Russia. Getting lung cancer – it had better be in the US.
So one can see how American expats who broke an arms or whatever don’t have to go through the agonizing insurance reimbursement process would prefer Russia. For the really serious diseases, they can go back to the US or pay for elite level service in Moscow (which is also far cheaper than in the US but financially inaccessible for 90% of Russians).
This has nothing to do with the collapse of the Soviet Union. Back then, complex procedures were inaccessible in principle for 98% of the population. The mass healthcare sector was severely underfunded and many “hospitals”, especially in the rural areas, didn’t even have basic amenities such as hot running water. The USSR did boast of having some of the highest numbers of hospital beds per capita. Staying in a hospital for days on the cheap was (is) easy and often actually required, which is the direct opposite of more rational Western practice.
My impression is that the Soviet system basically trundled on largely unchanged after the USSR’s collapse, as in many other spheres of life. All countries ration healthcare one way or another. In the US, things go smoothly, but at the cost of huge insurance premiums; in the UK, there are endless scandals about waiting lines; in Russia, people without the means to get elite private treatment but with Soviet era connections are obsessed with pushing their ailing relatives into the more elite state-run hospitals, which are typically reserved for the military and high officials but treat ordinary civilians “on the side.” In the next few years, this system is going to get pumped with much more money – as military spending is cut, healthcare spending is projected to double in the next 5 years of Putin’s (presumably) last term.
So I assume these numbers are going to improve in the next few years regardless. Though perhaps there would be even more improvements if more of the system was to be privatized (there’s not even any need for a specifically American system; the Germans perhaps do it better, with free competition between providers while subsidizing and regulating insurance plans – though either are far better than the NHS). But that’s a political no go in Russia.