Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia.

Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined and radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered to normalize public health sector finance and operations.

Abstract

This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined.