So what they said is, there was a relatively straightforward way of accessing the services; general doctor gives you a referral to a specialist, most likely in Moscow, you get treatment/services at their facility. On paper, state run and covered. In practice, getting better care typically meant greasing some palms. Things like paying out of pocket for sheets at the facility, or a little “gift” to the doctor to ensure you get the better meds. Without that there was still care, just the minimum.

Two important caveats/notes: this was their observations as a youth receiving disability services, so it doesn’t speak to long-term programs for adults. This was also in the waning years of the Soviet Union, so their observations don’t speak for the entirety of the USSR, just that period of heavy flux.