The political economy of healthcare system: how to get out of the crisis

• Vladimir V. Grishin
• Andrey V. Ragozin

Abstract

As a result of reforms, Russia received chimerical healthcare financial model: institutional and corporate medicine was borrowed from the Semashko model; government market of commercial services was inherited from the setup time; from the USA experience corporate voluntary medical insurance was taken, which in Russia is backed by national government (business profits tax relief and personal income tax of employees); and the idea of delegating medical health care financing to the subject of the Russian Federation was borrowed from Canada. In the article key reason that led to this are listed, the inevitability of new reforms carrying out is confirmed and mistakes of the old ones are described. Also, the health care systems of USA (funding is disintegrated into many independent channels, there is no social medical insurance), Israel (social insurance) and Canada (the British model is used) were analyzed and compared. In addition, models of social insurance in the world and in Russia are compared. In the article variants for surmounting the crisis are represented, the main of which is to turn the compulsory health insurance system into fully realised social insurance (roadblocks on the way to achieving it are described), based on which the short-term goal is necessity to turn compulsory health insurance into a nationwide financial system of generally accessible medical aid with an annual budget of at least 6% of GDP (gross domestic product), by consolidating all budget and non-budgetary sources in it. Initial steps on the road to achieving the goal and alternatives to the described strategy are also listed.

Keywords:compulsory health insurance, social insurance, political economy of healthcare, reforms, Russia, healthcare financial models

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