The context of provider payment reforms in the Russian Federation: a challenging arena for managerial development for twenty-first century Russia.
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Capitation Fee↗
Biomedical subjects
I Sheiman
Publications and source records attributed to I Sheiman.
Methods of payment for outpatient care.
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Ambulatory Care↗
Forming the system of health insurance in the Russian Federation.
A radical reform is being prepared in the Russian Federation health care. Its major point is a transition from tax-financed national health system to social health insurance. The paper highlights the issues of forming the system of health insurance. First, the arguments for a transition to a new model of finance are discussed. Secondly, the concept of the new model and its implementation in the context of the regional experiment are addressed. A discussion of current and expected developments focuses on two major issues: monopsony or pluralistic model of third-party purchasing? What is important for forming the market of health care provision? The major argument is that a transition from a highly integrated to a contractual model may start with regional monopsony or some version of it. A pluralistic model of third-party purchasing needs a refined regulation and may not meet health policy objectives. It is also argued that on the first stage of reform implementation forming the market of health care provision is more dependent on its regulation and management than on the market structure of health care purchasing.
Economic Competition↗
Health care reform in the Russian Federation.
This paper discusses the reasons for and the aims of a new model of health care under consideration in the Russian Federation. The concepts on which the reform is based and the mechanisms to transit from the existing centrally planned and financed health services into more decentralized services, funded in a competitive environment from multiple sources including health insurance, are discussed. The related draft legislation is complemented with viewpoints and opinions of the author.
Budgets↗
[Not Available].
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History, Modern 1601-↗
The development of market approaches in Russia.
In the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and management. The underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state-owned medical facilities, make the reform in the Russian health sector more radical. This paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax-financed to the health insurance system, is presented.
Economic Competition↗
New methods of financing and managing health care in the Russian Federation.
Poor outcomes in Russian Federation health care performance have led to greater efforts being devoted to the search for new methods of finance and management. The new financial and managerial scheme was designed to introduce elements of market relations into a highly bureaucratic system. Strengthening the primary care sector and granting providers more economic freedom were intended to increase the quantity and quality of medical care, and make it more accessible to the population. In the late 1980s, economic experiments started in several regions of the country. This paper highlights the new methods of management, payment of providers, and quality assurance that were the focuses of the experiments. The impact of the experiments will be discussed.
Ambulatory Care Facilities↗