Russian Patients and Doctors at the Hospital. Between Paternalist Expectations and Discriminatory Practices
A report by Veronica Kostenko at the regular LCSR seminar
On February 27th Veronica Kostenko (LCSR junior research fellow) presented a proposal of a new research project “Russian Patients and Doctors at the Hospital. Between Paternalist Expectations and Discriminatory Practices” at the regular LCSR seminar.
This project is developed by Veronica together with Eduard Ponarin (LCSR Director) and Boris Sokolov (LCSR junior research fellow). The objective formulated by Veronica, Boris and Eduard is to conduct empirical research of attitudes towards welfare system in Russia. They posit that healthcare is a promising field for studying general attitudes towards welfare state. Therefore, they focus on public perception of performance of healthcare system in Russia and population preferences for health care reform.
This project embraces several specific directions; the first one is focused on the analysis of attitudes towards different types of health care systems among patients of Russian hospitals. It might be useful for answering the question whether Russian citizens are ready to pay high taxes in order to improve healthcare system (or support progressive taxation as well), or they want to pay for their medical treatment directly to the doctors. In other words, which healthcare system, statist or capitalist, seems to be more attractive for Russians?
The second direction within the project is the study of discrimination Whether medical staff discriminate against different social and ethnic groups, and, if so, which groups are at greatest risk? Researchers assume that discrimination, if it exists, can affect both patient’s attitude towards healthcare system and (potentially) her/his health outcomes.
The third important direction of the research project is the investigation of the relationships between individual psychological traits, values, socio-economic factors and population attitudes towards redistribution and welfare state, which may contribute to several fields of research in contemporary sociology and social psychology.
The authors suppose to use a factorial survey method and multilevel modelling which allows using quasi-experimental approach and obtaining more precise results in comparison to other sociological surveys. It is worth noting that qualitative methods are prevalent in Russian sociology of medicine today. Application of quantitative methodology may provide deeper knowledge about Russian healthcare system and its perception by population.
The speaker underlined that the most important goal for the project at this stage is to find an acceptable solution for the major methodological problems of the presented design. One of the main issues is sample randomization because age and social status of patients of Russian hospitals are seriously biased, compared to whole population. Furthermore, quality of medical services and consequently subjective evaluation of healthcare system may depend on type of medical insurance that patient has (compulsory insurance, which is obligatory for all Russian citizens, or voluntary insurance, which is usually bought by people with relatively high status and income). In order to decrease the effect of insurance type on attitudes towards the health care system, the sample is divided on two groups which will be studied separately.
Finally, the possibility of social desirability bias should be taken into account. A direct question – whether the patient experienced discrimination in hospital – is obviously unacceptable, because patients are likely to suppose that their answers may affect medical staff attitude towards them. The using of factorial (vignette) design is one of the possible ways of overcoming this problem.
by Olesya Volchenko