dgisocioЦифровая социология/Digital SociologyDigital Sociology2658-347X2713-1653Государственный университет управления10.26425/2658-347X-2025-8-4-38-53dgisocio-416Research ArticleЦИФРОВАЯ СОЦИОЛОГИЯ: НАПРАВЛЕНИЯ ИССЛЕДОВАНИЙDIGITAL SOCIOLOGY: RESEARCH AREASДоступность медицинского обслуживания и фарм-препаратов в Российской Федерации: роль социально-экономических факторов и цифровых инновационных решенийAccess to healthcare in Russia: the role of socioeconomic factors and digital technologieshttps://orcid.org/0009-0006-8457-5195ЧижовД. А.ChizhovD. A.

Чижов Дмитрий Анатольевич - Аспирант

г. Москва

Dmitry A. Chizhov - Postgraduate Student

Moscow

carina-7@mail.ruhttps://orcid.org/0009-0001-8938-720XЧеркасовД. И.CherkasovD. I.

Черкасов Дмитрий Игоревич - Аспирант

г. Москва

Dmitry A. Chizhov - Postgraduate Student

Moscow

t.i.d.13.08.2000@gmail.comГосударственный университет управленияРоссияState University of ManagementRussian FederationРоссийский экономический университет им. Г.В. ПлехановаРоссияPlekhanov Russian University of EconomicsRussian Federation202505032026843853Copyright © Чижов Д.А., Черкасов Д.И., 20262026Чижов Д.А., Черкасов Д.И.Chizhov D.A., Cherkasov D.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://digitalsociology.guu.ru/jour/article/view/416

Проведен анализ структурных детерминант доступности медицинской помощи в Российской Федерации. Исследование фокусируется на взаимовлиянии социально-экономических факторов (социальной стратификации, территориального неравенства), экономических механизмов (государственного финансирования, коммерциализации) и цифровизации на формирование дуалистической модели здравоохранения. Эмпирическую базу исследования составили данные 20 полуструктурированных глубинных интервью с руководителями российских компаний-производителей фармацевтических препаратов и ведущими специалистами в сфере здравоохранения. Результаты исследования выявляют устойчивость ключевых системных вызовов: региональную асимметрию в обеспеченности ресурсами, дефицит кадров и растущую нагрузку на систему обязательного медицинского страхования. Анализ дискурса экспертов демонстрирует его амбивалентный характер: при декларируемой поддержке политики импортозамещения и экономического суверенитета респонденты акцентируют проблему технологического разрыва и институциональные барьеры. Аргументирован тезис о необходимости смены парадигмы с экстенсивной «борьбы с болезнями» на проактивное «управление здоровьем» с интеграцией регулярного мониторинга общественных аттитюдов в процесс формирования государственной политики. Эффективность импортозамещения ставится в зависимость не только от объемов финансирования, уровня технологий и цифровизации, но и от трансформации символического капитала отечественной медицинской продукции в глазах профессионального сообщества и населения.

The analysis of the structural determinants of medical care availability in Russia has been carried out. The research focuses on the mutual impact of socio-economic factors (social stratification and territorial inequality), economic mechanisms (government financing and commercialization), and digitalization on forming a dualistic healthcare model. The empirical basis of the study has been made up of data from 20 semi-structured in-depth interviews with the heads of Russian pharmaceutical companies and leading healthcare professionals. The study results have revealed the persistence of key systemic challenges: regional asymmetry in the resources provision, staff shortages, and the growing burden on the compulsory health insurance system. The analysis of the experts’ discourse demonstrates its ambivalent nature: with the declared support for the policy of import substitution and economic sovereignty, respondents emphasize the issue of the technological gap and institutional barriers. The thesis has been argued on the need for a paradigm shift from extensive “disease control” to proactive “health management” with the integration of regular monitoring of public attitudes into the process of public policy formation. The effectiveness of import substitution depends not only on the amount of financing, the level of technology, and digitalization, but also on transformation of the symbolic capital of domestic medical products in the eyes of the professional community and the population.

Доступность медицинского обслуживания в Россиисоциальное неравенствотерриториальная дискриминацияимпортозамещение в медицинефармакологический суверенитетэкономический патриотизмдоступность лекарственных средствAccessibility of healthcare in Russiasocial inequalityterritorial discriminationimport substitution in medicinepharmacological sovereigntyeconomic patriotismaccessibility of medicinesReferencesВолгина Н.А. «Звеньевая» реструктуризация глобальных фармацевтических цепочек под влиянием пандемии COVID-19. Вестник МГИМО Университета. 2022;1(15):126–142. https://doi.org/10.24833/2071-8160-2022-1-82-126-142Binagwaho A., Mathewos K., Davis S. Time for the ethical management of COVID-19 vaccines. The Lancet Global Health. 2021;8(9):e1169-e1171. https://doi.org/10.1016/S2214-109X(21)00180-7Галицкая В.А., Мещерякова Н.Н. «Цифровые парадоксы» в системе здравоохранения. Вопросы государственного и муниципального управления. 2022;4:176–196. https://doi.org/10.17323/1999-5431-2022-0-4-176-196Chaudhuri S. Can foreign firms promote local production of pharmaceuticals in Africa? In: Making Medicines in Africa: The Political Economy of Industrializing for Local Health. 2026. Pp. 103–121. https://doi.org/10.1007/978-1-137-54647-0_7Губина М.А. Импортозамещение и/или экспортная ориентация: опыт фармацевтической промышленности Индии. Вестник Санкт-Петербургского университета. Экономика. 2019;2(35):197–222. https://doi.org/10.21638/spbu05.2019.202Cherian J., Rahi M., Singh S., Reddy S., Gupta Y. et al. India’s road to independence in manufacturing active pharmaceutical ingredients: Focus on essential medicines. Economies. 2021;2(9):71. https://doi.org/10.3390/economies9020071Гусев А.Б., Ширяев А.А. Болевые точки стратегического развития России. Journal of Economic Regulation. 2021;3(12):6–25. https://doi.org/10.17835/2078-5429.2021.12.3.006-025Civaner M. Sale strategies of pharmaceutical companies in a “pharmerging” country: The problems will not improve if the gaps remain. Health Policy. 2012;3(106):225–232. https://doi.org/10.1016/j.healthpol.2012.05.006Доржиева В.В. Стратегия новой индустриализации фармацевтической промышленности: национальные приоритеты и новые вызовы. Научные труды Вольного экономического общества России. 2023;2(240):198–215.Cowart T., Rashi T., Bock G. Should pharma companies waive their COVID-19 vaccine patents? A legal and ethical appraisal. Laws. 2023;3(12):47. https://doi.org/10.3390/laws12030047Золотов А.А., Паникарова С.В. Кадровый дефицит в региональном здравоохранении: мифы, причины, решения. Профессиональное образование и рынок труда. 2025;1:75–94. https://doi.org/10.52944/PORT.2025.60.1.005Dneprovskaya I., Arakelova I., Legenkova N., Danilenko E., Tikhonova A. The prospects for the development of the domestic pharmaceutical industry in the context of import substitution. In: Anticrisis Approach to the Provision of the Environmental Sustainability of Economy. 2023. Pp. 43–51. https://doi.org/10.1007/978-981-99-2198-0_5Иванова Н.И., Мамедьяров З.А. Специфика развития российской фармацевтической отрасли. Журнал Новой экономической ассоциации. 2022;1(53):248–255. https://doi.org/10.31737/2221-2264-2022-53-1-15Dorzhieva V.V. Strategy of the new industrialization of the pharmaceutical industry: national priorities and new challenges. Scientific works of the Free Economic Society of Russia. 2023;2(240):198–215. (In Russian).Мамедьяров З.А. Тенденции и перспективы российской фармацевтической отрасли и применимость мирового опыта. МИР. 2017;4(8):772– 780. https://doi.org/10.18184/2079-4665.2017.8.4.772-780Dosi G., Marengo L., Staccioli J., Virgillito M. Big pharma and monopoly capitalism: a long-term view. Structural Change and Economic Dynamics. 2023;65:15–35. https://doi.org/10.1016/j.strueco.2023.01.004Мамедьяров З.А. Развитие науки и технологий: посткризисные оценки. Мировая экономика и международные отношения. 2022;5(66):14–22. https://doi.org/10.20542/0131-2227-2022-66-5-14-22Gajbhiye D., Choudhry S., Goel S. Changing Dynamics of Indian Pharmaceutical Sector: Opportunities and Challenges. Journal of Development Economics and Finance. 2022;1(3):77–98. https://doi.org/10.46791/jdef.2022.v03i01.04Налимов П.А., Руденко Д.Ю. Мировой фармацевтический рынок: полярность глобального здоровья. ЭКО. 2015;3(489):116–128.Galitskaya V.A., Meshcheryakova N.N. “Digital paradoxes” in the healthcare system. Issues of state and municipal management. 2022;4:176–196. (In Russian). https://doi.org/10.17323/1999-5431-2022-0-4-176-196Пылаева И.С., Подшивалова М.В., Подшивалов Д.В. Влияние пандемии COVID-19 на устойчивое развитие фармацевтических компаний России. Вопросы экономики. 2022;10:86–112. https://doi.org/10.32609/0042-8736-2022-10-86-112Gonzalez Pena, O., Lopez Zavala M., Cabral Ruelas H. Pharmaceuticals market, consumption trends and disease incidence are not driving the pharmaceutical research on water and wastewater. International Journal of Environmental Research and Public Health. 2021;5(18):2532. https://doi.org/10.3390/ijerph18052532Устюжанина Е.В., Дементьев В.Е., Евсюков С.Г. Проблемы распределения власти и экономической ренты в сетях создания стоимости. Экономика и математические методы. 2020;1(56):5–17. https://doi.org/10.31857/S042473880008468-3Gubina M.A. Import substitution and/or export orientation: the experience of the pharmaceutical industry in India. Bulletin of St. Petersburg University. Economy. 2019;2(35):197–222. (In Russian). https://doi.org/10.21638/spbu05.2019.202Binagwaho A., Mathewos K., Davis S. Time for the ethical management of COVID-19 vaccines. The Lancet Global Health. 2021;8(9):e1169-e1171. https://doi.org/10.1016/S2214-109X(21)00180-7Gusev A.B., Shiryaev A.A. Pain points of Russia’s strategic development. Journal of Economic Regulation. 2021;3(12):6–25. (In Russian). https://doi.org/10.17835/2078-5429.2021.12.3.006-025Chaudhuri S. Can foreign firms promote local production of pharmaceuticals in Africa? In: Making Medicines in Africa: The Political Economy of Industrializing for Local Health. 2026. Pp. 103–121. https://doi.org/10.1007/978-1-137-54647-0_7Horner R. Global value chains, import orientation, and the state: South Africa’s pharmaceutical industry. Journal of International Business Policy. 2021;5. https://doi.org/10.1057/s42214-021-00103-yCherian J., Rahi M., Singh S., Reddy S., Gupta Y. et al. India’s road to independence in manufacturing active pharmaceutical ingredients: Focus on essential medicines. Economies. 2021;2(9):71. https://doi.org/10.3390/economies9020071Ivanova N.I., Mamedyarov Z.A. Specifics of the development of the Russian pharmaceutical industry. Journal of the New Economic Association. 2022;1(53):248–255. (In Russian). https://doi.org/10.31737/2221-2264-2022-53-1-15Civaner M. Sale strategies of pharmaceutical companies in a “pharmerging” country: The problems will not improve if the gaps remain. Health Policy. 2012;3(106):225–232. https://doi.org/10.1016/j.healthpol.2012.05.006Klarin A., Ray P. Political connections and strategic choices of emerging market firms: Case study of Russia’s pharmaceutical industry. International Journal of Emerging Markets. 2019;3(14):410–435. https://doi.org/10.1108/IJOEM-05-2016-0138Cowart T., Rashi T., Bock G. Should pharma companies waive their COVID-19 vaccine patents? A legal and ethical appraisal. Laws. 2023;3(12):47. https://doi.org/10.3390/laws12030047Kumar P., Tripathy S., Dureja H. Pharma emerging market’s scaning by look and feel of its opportunities and challenges. Applied Clinical Research, Clinical Trials and Regulatory Affairs. 2015;2(3):115–122. https://doi.org/10.2174/2213476X03666151125220257Dneprovskaya I., Arakelova I., Legenkova N., Danilenko E., Tikhonova A. The prospects for the development of the domestic pharmaceutical industry in the context of import substitution. In: Anticrisis Approach to the Provision of the Environmental Sustainability of Economy. 2023. Pp. 43–51. https://doi.org/10.1007/978-981-99-2198-0_5Mamedyarov Z.A. Trends and prospects of the Russian pharmaceutical industry and the applicability of world experience. MIR. 2017;4(8):772–780. (In Russian). https://doi.org/10.18184/2079-4665.2017.8.4.772-780Dosi G., Marengo L., Staccioli J., Virgillito M. Big pharma and monopoly capitalism: a long-term view. Structural Change and Economic Dynamics. 2023;65:15–35. https://doi.org/10.1016/j.strueco.2023.01.004Mamedyarov Z.A. Development of science and technology: post-crisis assessments. World economy and international relations. 2022;5(66):14–22. (In Russian). https://doi.org/10.20542/0131-2227-2022-66-5-14-22Gajbhiye D., Choudhry S., Goel S. Changing Dynamics of Indian Pharmaceutical Sector: Opportunities and Challenges. Journal of Development Economics and Finance. 2022;1(3):77–98. https://doi.org/10.46791/jdef.2022.v03i01.04Nalimov P.A., Rudenko D.Y. The global pharmaceutical market: the polarity of global health. ECO. 2015;3(489):116–128. (In Russian).Gonzalez Pena, O., Lopez Zavala M., Cabral Ruelas H. Pharmaceuticals market, consumption trends and disease incidence are not driving the pharmaceutical research on water and wastewater. International Journal of Environmental Research and Public Health. 2021;5(18):2532. https://doi.org/10.3390/ijerph18052532Nezhnikova E., Maksimchuk M. Pharmaceutical industry in Russia: Problems and prospects of development. RUDN Journal of Economics. 2019;1(27):102–112. https://doi.org/10.22363/2313-2329-2019-27-1-102-112Horner R. Global value chains, import orientation, and the state: South Africa’s pharmaceutical industry. Journal of International Business Policy. 2021;5. https://doi.org/10.1057/s42214-021-00103-yOkereke M., Essar M. Time to boost COVID-19 vaccine manufacturing: The need for intellectual property waiver by big pharma. Ethics, Medicine, and Public Health. 2021;19:100710. https://doi.org/10.1016/j.jemep.2021.100710Klarin A., Ray P. Political connections and strategic choices of emerging market firms: Case study of Russia’s pharmaceutical industry. International Journal of Emerging Markets. 2019;3(14):410–435. https://doi.org/10.1108/IJOEM-05-2016-0138Pourraz J. Making medicines in post-colonial Ghana: State policies, technology transfer and pharmaceuticals market. Social Science & Medicine. 2022;311:115360. https://doi.org/10.1016/j.socscimed.2022.115360Kumar P., Tripathy S., Dureja H. Pharma emerging market’s scaning by look and feel of its opportunities and challenges. Applied Clinical Research, Clinical Trials and Regulatory Affairs. 2015;2(3):115–122. https://doi.org/10.2174/2213476X03666151125220257Pylaeva I.S., Podshivalova M.V., Podshivalov D.V. The impact of the COVID-19 pandemic on the sustainable development of Russian pharmaceutical companies. Economic issues. 2022;10:86–112. (In Russian). https://doi.org/10.32609/0042-8736-2022-10-86-112Nezhnikova E., Maksimchuk M. Pharmaceutical industry in Russia: Problems and prospects of development. RUDN Journal of Economics. 2019;1(27):102–112. https://doi.org/10.22363/2313-2329-2019-27-1-102-112Tannoury M., Attieh Z. The influence of emerging markets on the pharmaceutical industry. Current Therapeutic Research. 2017;86:19–22. https://doi.org/10.1016/j.curtheres.2017.04.005Okereke M., Essar M. Time to boost COVID-19 vaccine manufacturing: The need for intellectual property waiver by big pharma. Ethics, Medicine, and Public Health. 2021;19:100710. https://doi.org/10.1016/j.jemep.2021.100710Ustyuzhanina E.V., Dementyev V.E., Evsyukov S.G. Problems of distribution of power and economic rent in value creation networks. Economics and mathematical methods. 2020;1(56):5–17. (In Russian). https://doi.org/10.31857/S042473880008468-3Pourraz J. Making medicines in post-colonial Ghana: State policies, technology transfer and pharmaceuticals market. Social Science & Medicine. 2022;311:115360. https://doi.org/10.1016/j.socscimed.2022.115360Van Dijk J.A.G.M. The evolution of the digital divide: The digital divide turns to inequality of skills and usage. In: Bus J., Crompton M., Hildebrandt M., Metakides G. (eds.) Digital enlightenment yearbook. Amsterdam: IOS Press; 2012. Pp. 57–75.Tannoury M., Attieh Z. The influence of emerging markets on the pharmaceutical industry. Current Therapeutic Research. 2017;86:19–22. https://doi.org/10.1016/j.curtheres.2017.04.005Volgina N. Business models of big pharma in Russia: A pharmaceutical value chain perspective. RUDN Journal of Economics. 2022;1(30):57–69. https://doi.org/10.22363/2313-2329-2022-30-1-57-6Van Dijk J.A.G.M. The evolution of the digital divide: The digital divide turns to inequality of skills and usage. In: Bus J., Crompton M., Hildebrandt M., Metakides G. (eds.) Digital enlightenment yearbook. Amsterdam: IOS Press; 2012. Pp. 57–75.Volgina N.A. “Link” restructuring of global pharmaceutical chains under the influence of the COVID-19 pandemic. Bulletin of MGIMO University. 2022;1(15):126–142. (In Russian). https://doi.org/10.24833/2071-8160-2022-1-82-126-142Volgina N. Business models of big pharma in Russia: A pharmaceutical value chain perspective. RUDN Journal of Economics. 2022;1(30):57–69. https://doi.org/10.22363/2313-2329-2022-30-1-57-6Zolotov A.A., Panikarova S.V. Personnel shortage in regional healthcare: myths, causes, solutions. Vocational education and the labor market. 2025;1:75–94. (In Russian). https://doi.org/10.52944/PORT.2025.60.1.005

The authors declare that there are no conflicts of interest present.