Creating health care consumers: The negotiation of un/official payments, power and trust in Russian maternity care
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Creating health care consumers: The negotiation of un/ official payments, power and trust in Russian maternity care Anna Temkina1 · Michele Rivkin‑Fish2
© Springer Nature Limited 2019
Abstract Over the last three decades, the Soviet model of universal, free health care has shifted to a mix of public, private, and semi-private services influenced by neoliberal ideology. These changes have been particularly palpable in the emergence of new consumer relationships between health care users and providers. Examining St. Petersburg childbirth services from the early 1990s to the present, this paper examines the gradual development of consumer subjectivities and their impacts on authority, trust, and domination in Russian health care relations. We trace three processes: (1) women’s emerging uses of monetary payments for care in both unofficial transactions (“in the doctor’s pocket”) and through official channels (“at the cashier”), as symbolic expressions of new consumerist subjectivities; (2) hospitals’ transformation of unofficial, personalized health care relations into officially paid consumer relations; and (3) the partial transformation of providers’ power, authority, and domination through consumer relationships with patients. We argue that Russian childbirth services illuminate the ways consumer relations address particular problems of Soviet health care while remaining a severely limited means of empowerment for patients and providers. Keywords Consumerism · Russia · Maternity care · Doctor–patient relations · Unofficial relations · Trust
* Michele Rivkin‑Fish [email protected] Anna Temkina [email protected] 1
Department of Political Science and Sociology, European University at St. Petersburg, 6 Gagarinskaya, St. Petersburg, Russia 191187
2
Department of Anthropology, University of North Carolina at Chapel Hill, 301 Alumni Building, CB #3115, Chapel Hill, NC 27599, USA
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A. Temkina, M. Rivkin‑Fish
Introduction: Tamara’s birth experiences and changes in Russia’s maternity care As a 43-year-old mother interviewed in November, 2015, Tamara’s[i] (a pseudonym) three birth experiences illustrate the dramatic changes in health care this paper examines. Her first child was born in 1998, in a “Soviet type” maternity hospital, which she described as “torture” [muchenie]. Several women shared a delivery room and postpartum ward, which had neither a toilet nor shower. Tamara had no choice about her providers, whom she described as rude and frequently neglecting the women’s needs. Although Tamara’s care was free of charge, she gave the labor and delivery doctor a bottle of wine to express her gratitude for having a healthy child. When preparing to give birth ten years later in 2008, Tamara drew on her personal networks to find a doctor with whom she could establish an unofficial agreement to personally care for her during and after delivery, a newly created relation known as a “personal doctor.” For this arrangement, she agreed to pay 12,000 rubles (around $400) to the doctor under-the-table. Tama
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