“Informal Healthcare” in Modern Russia and Its Developmental Factors —Evidence from a Pilot Study

Abstract

Yulia Krasheninnikova – Expert, Laboratory for Local Administration, Higher School of Economics; Associate Professor, Department of Management, Higher School of Economics (HSE Campus in Perm). Address: 20, Myasnitskaya St., Moscow, 101000, Russian Federation. E-mail: decrua@gmail.com

There are various economic agents providing goods and services for health and healing practices in contemporary Russia outside orthodox medicine. The author defines this sphere as «informal healthcare» which is functionally replacing the network of public healthcare organizations and institutions, but lacks inner coherence or a fixed structure. This sphere is wider than what is implied by «alternative medicine». It also includes non- medical social institutions offering services which substitute for traditional appointments with doctors (such as religious organizations, pharmacies, the mass media). In «informal healthcare» different types of products are supplied to consumers: manufactured goods, natural remedies, services, ideas and doctrines, and information and knowledge.
We use three criteria to match empirical references (different phenomena or practices) with the object of study: 1) the emphasis on the therapeutic effect of products and services; 2) the degree of recognition by orthodox medicine; 3) the degree of recognition by the Russian legal framework. Within this framework «informal healthcare» appears as a heterogeneous system, the core of which comprises illegal activities and practices on the border of legal medical or health-provision services. The boundaries between this sphere and public healthcare system are flexible. In particular, they depend on the state of the legal framework and the circumstances surrounding its agents.
The article presents the results of a pilot sociographic study of «informal healthcare» in the Perm region. The data was collected through in-depth interviews and observations in towns and villages of different sizes. The study revealed that «informal healthcare» tends to flourish in bigger towns, rather than small settlements. This is somewhat counter-intuitive, since public health services in urban areas are known to be better than in the countryside. Presumably, one of the key factors stimulating demand for informal healthcare is not the quality of medical services and health facilities, but the presence of a certain number of people with specific systems of beliefs and attitudes towards health. These people are both active consumers and suppliers of goods and services in informal healthcare. An exception are settlements, which have special natural or other resources (healing springs, holy items and places, geographic anomalies) which attract tourists. «Informal healthcare» markets which focus specifically on visitors emerge from these resources, even if these resources have nothing to do with orthodox medicine.