Eight years ago, in that moment, a woman lay in a bed at the Luga maternity hospital by the quiet fields. A distant voice echoed a memory: a line about the city of Luga in the St. Petersburg region. That day marked a turning point. She arrived in the middle of pregnancy with severe pain. The attending physician explained plainly that a complete placenta previa required urgent action elsewhere. In Luga, saving both mother and baby would be unlikely; in St. Petersburg, there would be a real chance to act quickly if bleeding began.
Her husband rushed to pick her up, and they headed straight for St. Petersburg. They had a residence permit and a home there. In the ward, a local woman with a permit waited alongside them. The husband hoped for a quota to reach the perinatal center. Meanwhile, the baby in her womb did not survive the ordeal. The child did not make it, while the mother endured the loss and the long waiting process that followed.
Over the years, the memory faded into the background until a new challenge surfaced, driven by a bureaucratic force many locals call Propiska. After years living outside the city, the decision to leave the city clinic behind and attach to a nearer Novgorod clinic felt practical. The change required replacing the St. Petersburg policy with a local policy, and the prospect was daunting.
In Russia, the power of this registration system remains strong, though it has softened with the general improvement in living standards. Registration still often dictates access to high‑tech care, timely checkups, and accurate diagnoses. Many residents still gravitate toward Moscow or St. Petersburg for the most advanced care.
Even for those who live in Moscow, obtaining access to a well-equipped polyclinic can hinge on a district doctor’s approval. If a family stays in Petrovka, there is a better chance to connect with a local clinic. In contrast, renting a room in a new apartment block in a city edge can make it harder to secure local doctor approval due to crowded waiting rooms and the need to manage new patient intake.
Should a patient carry a complex health issue to a local clinic in the capital, securing a quota for services at a cardio center, oncology center, or hematology hospital typically requires navigating TFOMS guidelines and often traveling back to the patient’s homeland for certain procedures. The result is a frustrating loop of referrals and waiting periods, especially for those far from their registered residence.
On a practical level, the system creates a harsh reality: a Moscow resident with a serious illness can sometimes access care more swiftly than a provincial neighbor who must travel long distances. For someone from a rural area, getting a primary history and starting treatment often means waiting for each stage of approval, from district hospitals to regional centers and eventually to a metropolitan clinic.
The old days are remembered when patients faced extortion or unethical conduct from some physicians. A memory from 1997, when a mother was urged to pay for an operation, is recalled as a stark lesson. That moment highlighted the flaws in the system and underscored the role of journalism in exposing wrongdoing. The experience, though painful, helped shape a career focused on medicine and public policy.
Today, the landscape has changed in many ways, and rapid access to specialist clinics remains inconsistent when quotas and provincial lines come into play. People still frequently relocate to larger cities for work or housing, while maintaining ties to their home region through registration. This creates a tension between the desire to stay local and the need for timely, specialized care.
Life now balances on a different axis. Rural residents often travel to Moscow or St. Petersburg for urgent care when needed, while many metropolitan transplants settle in smaller cities with the intent to stay. The internet has shifted consumption patterns and access to information, yet medical access, especially for serious conditions, still depends on registration and quotas.
The absence of large, centralized medical facilities in every region remains a reality. Even in places praised for their health systems, gaps appear in urgent care, specialized procedures, and recurring tests. The path to wellness can require private clinics or traveling to megacities, and even then, the process of retesting and revalidation persists within the boundaries of registration.
Even when a local attempt is made to obtain a clear diagnosis, long waits and the need to secure quotas can delay treatment. The farther someone lives from their registered residence, the longer the journey to care tends to be. Moscow and St. Petersburg still act as magnets for those seeking faster treatment, while regional centers work under strained conditions that complicate timely access to specialized care.
A pattern emerges: there are many diseases and injuries where carrying a capital registration provides an advantage in treatment. For instance, a resident from a province who needs retinal surgery may face longer waits for a quota, while a capital resident receives priority. The ability to travel, to arrange urgent care by air, and to access immediate treatment in a capital hospital makes the difference between survival and prolonged hardship for some families.
Thus, the reality remains: living in the capital can influence the odds of timely care. A possible plan for families is to secure local coverage for everyday health needs while keeping the option to return to the primary city for urgent or complex treatment. Waiting for quotas, a common refrain, can determine outcomes in emergencies.
There is a vast geographic dimension to this discussion. Some regions lack neurosurgery, certain specialists, or rapid access to imaging. In emergencies, those in big cities often fare better, while those in distant villages face longer transfers and more significant delays.
The quotas system and the distribution of expensive resources continue to shape choices about where to seek care. When an urgent placenta complication occurs near a perinatal center, the outcome is often favorable due to immediate access. In more remote villages, the path to life-saving care can be uncertain and slow, with families sometimes arranging chartered ambulances to reach the capital hospitals where quicker action is possible.
There are also broader implications. For some conditions, such as retinal detachment, capital residents receive clearer, faster treatment, while provincial residents depend on a series of bureaucratic steps and waiting periods. This dynamic reinforces the value many place on capital residency for health outcomes, even as some relocate to smaller towns for daily life. It is possible to obtain local coverage for routine needs, but serious health events may still require a return to the registered place for timely care.
Ultimately, the current system invites a reassessment of how medical quotas are allocated and how access to essential services can be more equitably distributed. The aim would be to ensure that the right to life and quality of care is not entirely contingent on where a person is registered. While personal perspectives may differ, the overarching concern remains clear: improving access to timely, high-quality medical care for all residents, regardless of their residence status.
The writer’s perspective reflects a personal stance and does not represent any editorial position others may hold.