ИСТИНА

Abstract Accessibility is one of the basic principles which ultimately determine structure, aims and objectives, evaluation of outcomes in health system. The citizens' right to health and health care is enshrined in the Constitution of the Russian Federation together with guarantees of their fulfillment - the possibility for citizens to receive decent quality and timely health care. Improving accessibility of health care is one of the mechanisms of smoothing social inequality in Russian society. In turn, population health status is considered as one of the criteria of effectiveness of social and economic policy. However, even if a country sets a political task to ensure universal access, its practical implementation is likely to face serious difficulties. The paper is divided into two parts. The first part discusses theoretical issues as defining access to health care has a number of methodological difficulties, reflected in the works of both researchers and such bodies as WHO. As main indicators of access experts distinguish the share of population covered by health system, the content of health package, the presence of cost-sharing, geographic, organizational barriers and the level of utilization of available services. Access is often defined “negatively” via “absence of barriers” approach – territorial, financial, cultural that weakens the operational use of the concept. The authors put up a problem of developing aggregate indicator (induce) to provide a measure of access at the level of the health system. The second part analyses the actual state of affairs with access to health care in Russia using the data available in two ways – summing up entitlements to health care fixed in legislation and defining barriers to access – financial and delivery. The analysis shows that low public spending together with increase in out of pocket payments as well as restructuring of health delivery network might hamper access for certain population groups. One of the problems might be the so called optimisation of Russian health system that reflects the contradiction between two roles of the state – a guardian of people’s access to health care and a manager whose main task is cost-effective use of limited resources.