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Research Programs / Projects

CREATION OF A DATABASE ON MECHANISMS
OF HEALTHCARE FINANCING AND MANAGEMENT IN RUSSIAN REGIONS

Head: Dr.Sc. S. Shishkin

Duration: October 11, 2004 - March 31, 2005

Support: grant from the Ford Foundation # 1020-1604; World Health Organization

Project Participants: A. Zaborovskaya, V. Chernets, V. Shevski

Coordinator: N. Kanatova

Statement of the problem

Organization of management and state financing of public health in Russia is characterized by a pronounced regional differentiation. It would not be an exaggeration to assert that each subject of the Russian Federation (i.e. each region) has its own peculiar model which combines elements of budget and insurance health financing. However, information about these regional differences is extremely limited, sporadic and far from systematic. Relevant statistical departments collect data only on the amount of health financing from the budget and the amount of mandatory health insurance (MHI) funds in the regions, as well as on the structure of insurers (the number of medical insurance organizations and regional branches of MHI foundations). There is no data that would characterize organization of health financing from regional and local budgets, as well as from MHI funds; kinds of medical and economic standards and financial norms involved; parameters of chargeable medical services and medicines provision, etc. There is but limited information on mechanisms of horizontal and vertical coordination of the activities carried out by the actors of management and financing in the regions.

In the light of the forthcoming law on general principles of local self-governance, draft laws on mandatory health insurance and state guarantees in healthcare which are to be adopted soon, collection and systematization of information on diverse regional models of public healthcare management and financing and their transformation take on a special significance. Such data would contribute to a more grounded implementation of the state policy in the field of healthcare both at the federal and regional levels.

Project goal and tasks

The project is aimed at a monitoring of innovations in the sphere of public healthcare management and financing in the regions of the Russian Federations.

To achieve this goal, the following tasks would be pursued:

• To set up a database of specific combinations of public healthcare financing (from budget and insurance sources) and specific features of public healthcare management in all Russian regions (subjects of the Federation);
• To collect and systemize information on:
  • distribution of power between regional and municipal authorities in the sphere of health care;
  • ways of their activities' coordination;
  • budget and insurance financing of healthcare;
  • medical, economic and financial standards involved;
  • modes of payment for medical services;
  • methods of drug prices regulation;
  • etc.
• To build up a typology of regions based on their specific systems of public healthcare financing and management.

Methods of research

Sources of information: survey among heads of public health bodies of the Russian Federation regions and heads of the MHI Funds (to be carried out in December 2005).

A system of indicators would be worked out to build up a typology of regions by the character of their health care management and financing organization; a questionnaire would be prepared on the basis of this system. The questionnaire would be tested in two pilot regions in European and Asian parts of the Russian Federation. The final version of the questionnaire would be disseminated on behalf of the Ministry of Health and Social Development. A typology of regions and models of public health financing and control would be constructed on the basis of the survey data.

The project would be carried out in cooperation with the WHO Program "Health Care Policy and Stewardship in Russia", Ministry of Health and Social Development of the RF and Central Research Institute of Public Health Management and Computerization which is planning to start a monitoring of the innovations in healthcare.

Expected results

• A verified questionnaire to monitor innovations in the system of public healthcare management and financing in Russian regions.
• Systemized data on the system of public healthcare management and financing in every region of the RF.
• A typology of regions by their models of healthcare management and financing.

The results would be summarized in an analytical report.

Dissemination of the results

The project results would be submitted to the Ministry of Health and Social Development of the RF and to the CMI Federal Fund as well as to the Presidential Executive Office and State Duma of the RF, so that this information could be used for decision-making on reforming the public health system.

The data and typologies would be published at the IISP web-site in partnership with the IISP "Social Atlas of Russian Regions" program.

THE DATABASE ON MECHANISMS OF HEALTHCARE FINANCING AND MANAGEMENT IN RUSSIAN REGIONS