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Research Programs / Projects

Financial Provision of State Guarantees in Public Medical Care: An Analysis of the Effects of Different Strategies

Head: S. Shishkin, Dr.Sc.

Duration: January – July 2002

Support: Moscow Public Science Foundation grant # 002/4-02 (financed by USAID)

Project participants: T.Bogatova, Cand.Sc. Ye.Potapchik, V.Chernets, Cand.Sc. A. Chirikova, L.Shilova

Objective. The noticeable gap between state guarantees of free medical care and its financial provision has been a major problem for the Russian system of public medical care. The project sought to explore various strategies to resolve this problem, such as: (1) an increase of state funding to the medical (health) system with minor changes in its organization; (2) restructuring the system of medical care; (3) legalization of the system of informal payments made by the population for medical care and related services.

Main results:

Variant estimations of financial provision of the state guarantees' program of public medical care were made for the years 2003-2010.

Estimations of demonstration variants of restructuring municipal health care systems for two pilot regions and an analysis of corresponding changes in the territorial accessibility of medical care and employment of medical staff were made.

Medical staff (171 respondents) in the two pilot regions were interviewed on the extent to which informal payments are spread, what their reasons and forms are, and what their legalization would bring.

Recommendations were made as to how to achieve a balance between the state guarantees of public medical care and their financial provision, and how to minimize the economic and social costs of this process.

Main results of the project are described in the following IISP publications:

• Free Medical Care: Reality and Prospects. WP1/2002/07 (IISP Working Papers Series) / By Bogatova, T., Ye. Potapchik, V. Chernets, A. Chirikova, L. Shilova, and S. Shishkin. Independent Institute for Social Policy. Moscow: Probel-2000, 2002. (In Russian)

• Informal Payments for Medical Care in Russia. Scientific Reports: Independent Economic Analysis Series, No. 142. Moscow: Moscow Public Science Foundation, Independent Institute for Social Policy, 2003. (In Russian)

• Informal Out-of-pocket Payments for Health Care in Russia. Scientific Reports: Independent Economic Analysis Series, No. 142. Moscow: Moscow Public Science Foundation, Independent Institute for Social Policy, 2003. (In English)

Results of the research were reviewed in articles published in the newspapers Vremya MN, Moskovskie Novosti, Meditsinski Vestnik.

The project is further developed within the Analysis of the Interplay of Formal and Informal Rules of the Provision of Social Services to the Population (the case of medical care)» project.

The project results were discussed with experts and representatives of federal and regional executive and legislation authorities at two workshops (July and October 2002). They also were presented at the Moscow Public Science Foundation conference (November 2002) and IISP conference (February 2003).

Research materials were submitted to the Administration of the President of the Russian Federation, Department of Social Development of the Office of the Government of the Russian Federation, Ministry of Public Health of the Russian Federation, Ministry of Finance of the Russian Federation, Ministry of Economic Development and Commerce of the Russian Federation, the State Duma, and the World Health Organization Regional Office for Europe.