As the Russian economy struggles to lift itself out of its oily quagmire – the rouble hit a record low of 85 to the dollar this week – private healthcare keeps plugging away. Alarming figures are never far from the press: Medsi profits fell almost 5 times year-on-year and the country’s biggest imaging provider will see them cut to a third. In 2008/09, a third of private clinics went under, but we don’t think things are so bad this time around.

For sure, anyone with dollar-denominated debt probably feels like they’ve been visited by Bulgakov’s Professor Woland, and greenfield expansion is a long-forgotten dream or an expensive hangover from the naïveties of yesteryear. Then you have falling real incomes and crashing consumer expenditure. The PHI market is also teetering on the edge of a cliff, with employers cutting staff entitlements this year. MHI is not much better – many of the regions are in dire straits and they have to cut healthcare expenditure by the back door. And you can forget about foreign capital – FDI inflows are likely to become outflows sooner rather than later.

But dig a little deeper. To begin with, Russians, for so long some of the world’s premiere medical tourists, are now staying at home. Foreign travel has fallen by 30%, according to The Economist. That bodes well for domestic operators. Then you have an increasingly private friendly state. At the level of the regions, things are muddy, and we hear that most local bureaucracies are as impenetrable and self-serving as ever, but new laws that incentivise PPPs and are opening up the social care sector have already been passed. Budget cuts to state healthcare are mostly fuelling the grey sector, but could spill into the private, particularly outpatient.

OK, so the crisis is a severe test that many are unlikely to pass. But the end-result will be a healthier, more consolidated market with a better appreciation of quality. There is still only one JCI accredited hospital in the country! And domestic investors are already lining up to replace the foreign. Where better to put those spare roubles in a crisis than healthcare? If you want to learn more, take a look at this month’s feature.