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Research Programs / Projects

ANALYSIS OF DIFFERENCES IN REGIONAL SYSTEMS OF FINANCING AND MANAGEMENT OF HEALTH CARE IN RUSSIA

Head: Dr.Sc. S. Shishkin

Duration: August 1, 2005 - January 31, 2006

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

Project Participants: G. Besstremyannaya, A. Zaborovskaya

Coordinator: N. Kanatova

Project is conducted in cooperation with WHO/CIDA Program ”Health care policy and stewardship in Russia”.

Statement of the problem

Significant differences exist in the various subjects of the Russian Federation regarding organization of governmental financing and management for the health care system. Previously, the data about such regional differences were very constrained and difficult to access. During the period from October 2004 to June 2005, the Independent Institute for Social Policy has developed the Database on Mechanisms of Health care Financing and Management in Russian Regions. The results are database that includes various characteristics of regional health care financing and management systems, and general analytical report concerning organization of health care financing and management in the regions of the Russian Federation.

The analysis of regional differentiation of health care financing and management models is a continuation of the above-mentioned project.

Project goal and tasks

The main goal of a project was to develop generalized classifications of health care financing and management systems in regions of Russia based upon measurable characteristics of those systems.

To achieve the goal, the following tasks were done:

- various development indicators of financing and health care systems in the regions were found out to be associated;

- correlation among the following variables were analyzed:

• particular indicators of development of regional health care financing and management systems;
• characteristics of regional health care financing and management systems and the following variables:
• particular indicators of development of regional health care financing and management systems;
• level of economical and political development of a region;
• resources of regional health care systems;
• organization of regional health care systems;
• the health status of the population;
• indicators of region’s engagement in pilot projects of health care reform that are supported by international organizations and other donors.

- criteria to obtain generalized classification of regional health care financing and management systems were developed;

- allocation of insurance liabilities among insurers in regional compulsory health insurance (CHI) systems was analyzed; different financing schemes of various insurers were examined;

- in the most innovative subjects of the Russian Federation that conducted corresponding pilot projects (supported by international organizations and other donors), detailed data on innovations in the financing and management mechanisms were collected and analyzed.

Methods of research

To fulfill tasks data on 88 regions of Russia were used. Relationships among variables were analyzed by methods of mathematical statistics. Integral classifications of health care financing and management systems in Russia regions are based on objective characteristics of commonality measured by methods of mathematical statistics.

In 8 pilot regions, experts engaged in innovations in health care financing and management collected and analyzed additional data on these innovations. Every innovation was described by the same scheme using specified criteria.

Project Results

The project results are as following:

• analytical data on factors that influence the development level of regional systems of health care financing and management;
• integral classification of regional systems of health care financing and management;
• analytical description of the most interesting innovations in the organization of health care financing and management in 8 regions of Russia.

The project has provided public authorities with arguable data to decide upon setting different reform policies of health care system differentiated by groups of regions.

Final project summary as well as results of the previous project on the database development is published in the monograph “Health care financing and management systems in the regions of the Russian Federation” / Ed. by S. Shishkin. Authors: G. Besstremyannaya, A. Zaborovskaya, V. Chernets, S. Shishkin. Moscow, 2006.