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. Last Updated: 07/27/2016

Medical Care Access A Question of Cash

Nina Dyomina cut a lonely figure in the courtyard of Russia's pre-eminent cardiac-surgery-research institute.

"Money, money for everything," she said softly, dabbing at her tears with a soiled handkerchief. "The only word you hear is 'money.'"

Not far away, in a hospital ward, lay her husband, Viktor Dyomin, 58, a school administrator from a remote village in the Tambov region, 437 kilometers south of Moscow. Dyomin, diagnosed with heart trouble, and his wife had made a long journey to reach the Bakoulev Cardiovascular Surgery Institute here, where they hoped he could get a heart bypass operation.

But they ran out of money -- and out of luck -- in the new Russia. Although the heart operation theoretically was free, Dyomina, a peasant woman, said she did not have enough money for medicine and post-operative care. The formula was simple: No money, no surgery.

Their predicament is hardly unusual. The kind of heart surgery that President Boris Yeltsin is planning to undergo would be extraordinarily difficult for him to receive if he were a poor pensioner.

Medical care, like just about everything else here, is available for those who can pay huge sums for it. But those who cannot -- especially pensioners -- discover the path to an operation is strewed with obstacles.

What has happened to surgery in Russia reflects a larger change in society. In the great leap to free-market economics, sophisticated medical care is available first to those with money.

Russia performs only a fraction of the number of heart operations done in the United States. Several thousand bypass operations are done in Russia each year, most of them in Moscow. "But the demand for such operations is much higher," said Yevgeny Kurgin, chairman of Rosno, Russia's largest health insurer.

It can take years of pleading with authorities to get on a waiting list for a sophisticated operation. "Whether you will be alive after this, I don't know," said Kurgin. He added that an average 65-year-old man in Yeltsin's condition "has practically no chances" for such surgery if he does not pay for it.

Private medical-insurance firms have taken root, offering better-quality clinics and care, largely because the state system is decrepit. But the cost of a private insurance policy, starting at $100 a year per person and rising as high as several thousand dollars, is out of reach for many Russians.

The Dyomins' journey to Moscow offers a glimpse of how average Russians try to cope. They live in a village, Stepanovka, in the "black earth" agricultural region of southern Russia. When Viktor Dyomin first fell ill, the issue of money arose immediately.

"You know, medicines are very expensive," Dyomina recalled. "I bought medicines and brought them to the hospital or just paid for the medicines that they provided in the hospital. I was told a hundred times, 'Bring your own medicines to the hospital.'"

Her husband was later moved to a regional hospital in the town of Tambov. "And again we had to pay through the nose," she said. "We had to pay more than a million rubles," (about $200). But he failed to recover, and they turned to the regional health administration. They were given paperwork referring them to a hospital in Moscow.

"They said that everything would be free of charge," she recalled. Dyomin came to Moscow with $200 in his pocket, but when he got to the hospital, he was told he would need $500 for tests.

"He said he had no money," she recalled. "And they said 'You will just have to come back another time when you have the money.'"

They began borrowing money from relatives. They got together almost $1,000 and paid the $500 for the tests. "After that, they told us it was enough, but that after the operation we'll need all kinds of medicines and we need more money for that. But we have run out of money. The other day, Viktor said maybe we should give this whole idea up.

"What can we do?" she asked. "If we're poor, it means we die."