Baltic Rim Economies - Baltic Port List

Expert article 889 Baltic Rim Economies, 21.12.2011 Quarterly Review 5�2011
Modernization of public health care system in Russia
By Sergey Shishkin
Russia significantly lags behind industrialized countries by key
health indicators. Although over the past several years mortality
rate has notably dropped from 16.1 deaths per 1,000 population in
2005 to 14.2 deaths per 1,000 population in 2010, this level is still
very high compared to European countries (9.6 in EU, 2009).
Probability of dying aged 15-60 years is almost twice as high in
Russia as Europe’s median: 269 deaths vs 146 deaths per 1,000
population (2009). Morbidity rate in the country keeps growing.
Funding of health care in Russia is several times lower, while
the rights of citizens to health care are comparable to those
enjoyed by people in the industrialized countries. The overall
health care expenditure as a share of GDP is almost 1.7 times
lower than in the EU countries (5.2% vs 9% in 2008), while
government health care spending as a share of GDP is twice as
low (3.4% vs 6.9%). In absolute terms the Russian state spends
3.9 times less on health care needs of one person than the EU
median ($ 567 US vs $ 2,203 US by purchasing power parity,
2008).
The importance of health problems and the need to modernize
the health system to assure social and economic progress of the
country have been clearly realized by the Russian government. In
recent years the government has indeed done quite a lot to
improve the health care system. Health care has become a priority
in budget policy. Public funding of health care increased in 2010 in
1.4 times in real terms in comparison with 2005.
The decline of mortality since 2006 may be partly at¬tributed to
large-scale health programs undertaken by the government such
as the Priority National Project "Health" started in 2006 and the
Program of supplementary free drugs supply for selected
categories of population, including the disabled and veterans
initiated in 2005, as well as rising public funding of health care.
The funding of the Project “Health” has added another 10
percent to public health funds. The Project includes investments in
primary and tertiary care, increase of primary care workers’ salary,
vaccination, subprograms for cardio-vascular and oncology
diseases, urgent care for victims of car accidents, etc. The
implementation of the Project has provided for substantial
upgrading of medical equipment in local clinics, and has increased
the amount of free tertiary care services, regular medical screening
services, disease prevention services, etc.
The new stages of reform began in 2010 with the adoption of
the new law on compulsory health insurance. The main change in
its design is centralization of funds and administration. That was
inspired by the willingness to ensure sustainability of CHI funds
collection and equity in its distribution among regions.
Government increased payroll tax for health insurance from
3.1% to 5.1% in 2011. This surplus of funds has been used for
financing two years programs of health care modernization
elaborated in each Russian region.
The law on the foundation of health protection of citizens in the
Russian Federation was adopted last November. This law
envisages centralization of health care administration in the
subjects of the Russian Federation: a regional authority and
regional compulsory health insurance fund concentrate
administrative and financial resources for all regional health care
system. Municipalities have yet very low responsibility for health
development. This reform will facilitate modernization of medical
facilities network in the regions. However it creates risks of
disengagement of municipalities from any health policy.
Both new laws have created some preconditions for
development competition among insurers and among health care
providers. The citizens have got the right of free selection of health
insurance company and outpatient clinic for primary care. They will
have also the opportunity to choose physician and facility for
specialized outpatient and inpatient care from the set of providers
that should be proposed for patient by physician who makes the
referral for medical services that he isn’t able to provide
themselves.
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However, despite obvious positive dynamic in health care system
modernization current measures are not enough to resolve its long
standing problems.
The continuum of health care is still heavily dominated by
curative services provided by health care institutions. At the same
time, attention given to measures designed to promote healthy life
style, sports and wellness, healthier environment is not adequate
to the role such measures can play in reducing morbidity and
mortality compared to health care per se.
The urgent problems are inadequate and sharply differentiated
actual accessibility to quality health care, inadequate protection of
patients’ rights, risks of unaffordable out-of-pocket payments
forced on patients for treatment, which is formally free of charge
(29% of patients have to pay out-of-pocket to get needed medical
services, and 56% of hospitalized patients do this under-the-table).
Existing health financing mechanisms provide insufficiently
strong incentives for health care providers and insurance
companies to make them truly motivated and committed to
sustaining the health of the citizens.
Health care continues to be characterized by deep structural
disproportions. In particular, inpatient care institutions are strained
due to excessive workload, while outpatient services remain
underdeveloped. The efforts of different physicians and health care
providers that work with a patient are not sufficiently coordinated.
It is noteworthy that approximately half of the Russian
population (53%) believes that health care as the branch of
economy is in poor condition.
There is a need to shift the focus of public policy towards
restructuring health care system. Better health outcomes for the
populationwill be achieved through establishing an integrated,
transparent and effective health care system. This is a system that
provides for intersectoral approach to health care, coordination of
activities among organizations that deliver different types of care,
involvement of patients as active partners of health care providers
in prevention, diagnostics and treatment of illnesses. This is a
system that provides for implementation of clear and feasible
guarantees of free health services, ensuring legal, clear and fair
conditions for receiving health services for a fee. This is a system
in which all stakeholders are motivated to achieve maximum social
and health outcomes per the unit of cost.
Modernization of the Russian health care system requires an
increase of public funding by 1% of the GDP to 2020 as a
minimum, and by 3% of the GDP as a desirable maximum.
However, the crucial factor for the success of modernization of the
health care system is not mere money but persistency of the
government in the implementation of rational system of health care
financing and delivery.
Sergey Shishkin
Dr. Sc., Professor
The National Research University
Higher School of Economics
Moscow
Russia
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