Medical care: state 'free of charge' or social solidarity?

• Nataliya A. Kravchenko
• Andrey V. Ragozin

Abstract

The share of personal medical expenses of the Russian population is growing and in 2016 amounted to 40.5% of current health care expenses. This is significantly higher than in developed countries, where the share of personal expenses of citizens is on average 10-20%. The reason for the inflated share of personal expenditures of the population is the deficit of the state guarantee program, which promises Russian citizens almost all types of medical services for free, having a deliberately insufficient budget of 3.5% of GDP. Meanwhile, the experience of developed countries shows that even the limited (with exceptions, deductibles and limits) availability of modern aid requires spending at least 7-9% of GDP annually. As a result, the lack of funding forces to impose paid services on the population, reducing the territorial, organizational and financial availability of free assistance guaranteed by the state. The authors see the lack of the principle of social solidarity as the root cause of the deficit. The population does not participate in the financing of public assistance, health resources are disintegrated into many independent channels and there is no equality of medical guarantees, the availability, quality and volume of which depends on the place of residence, social status, place of work and position of a particular Russian. On the contrary, the economic efficiency of health systems in developed countries is the result of social solidarity in the financing of public health care. First, it involves the entire society - the state, employers and the population that pays targeted social or medical income tax or participates in the payment of social insurance contributions. Secondly, health resources are consolidated within a single channel - social insurance or in the budget of a single state payer. Third, all citizens are guaranteed the same amount of medical services, the availability of which throughout the country is a key criterion for the effectiveness of the health system.

Keywords:financing of medical care, share of personal payments ("out-of-pocket"), social solidarity, single-channel, equality of rights to medical care

References

1. World bank // worldbank.org: official site 2020. URL: https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=RU-US-EU&name_desc=true (date of access February 15, 2020)

2. World health organisation // who.int: offi cial site 2020. URL: http://apps.who.int/gho/data/view.main.GSWCAH41v. (date of access February 10, 2020)

3. World bank // worldbank.org: official site 2020. URL: https://data.worldbank.org/indicator/SH.XPD.GHED.GD.ZS. (date of access March 10, 2020)

4. World health organisation // who.int: official site 2020, URL: http://apps.who.int/gho/data/node.main.GHEDCHEpcUSSHA2011?lang=en. (date of access March 10, 2020)

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