Justification of the unacceptability of medical savings accounts system introduction in the healthcare financing system in Russia
On November 23, 2022, the project on amendments to the Federal Law «On Compulsory Medical Insurance in the Russian Federation» using individual medical savings accounts (IMNS) was discussed in the State Duma of the Russian Federation on the platform of “The Fair Russia” party. This project was prepared by specialists of the Finance Department of the Bauman Moscow State Technical University. The research team of the Higher School of Healthcare Management under the leadership of Dr. G.E. Ulumbekova analyzed this project and an explanatory note to it. The article presents the results of this analysis, including a description of the essence of the bill, explanations about the incorrect assumptions of the authors, data on international experience and proposals for urgent measures in the healthcare of the Russian Federation, including in terms of the volume and model of financing. The main conclusion of the Higher School of Healthcare Management specialists is that the IMNS model cannot be implemented in the Russian Federation, since it will lead to a decrease in the availability of government financed healthcare, especially for people with low income (in the Russian Federation, almost half of the population has incomes of up to 27 thousand rubles in months) and people with chronic diseases, as well as to managerial chaos and collapse of whole healthcare system. As a result, this will cause an increase in mortality and an increase in social tension in the country.
A systematic analysis of the lessons of the introduction of the IMNS system in the world, which was limited by the number of countries and the proportion of the population in them (Singapore ~3 mln people, China – a pilot project, South Africa ~9 mln people, USA ~8 mln people), showed that the IMNS model is acceptable only for countries with a high proportion of the young population with high incomes at the same time. This system is ineffective for countries with a high proportion of chronically ill and low-income citizens, such as the Russian Federation. That is why the IMNS experience has not been widespread in the world: China and South Africa have switched from experiments with them to a unified system of compulsory health insurance, and Singapore additionally has several solidarity funds to pay for healthcare care for citizens. As a rule, the lobbyist and beneficiary of the IMNS system is the banking sector, which receives additional working capital to its accounts.
Keywords:individual medical saving accounts; affordability of government financed medical services; solidarity of healthcare financing; value of government healthcare financing; mortality
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Ulumbekova G.E., Khudova I.Yu. Justification of the unacceptability of medical savings accounts system introduction in the healthcare financing system in Russia. ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2022; 8 (4): 4–12. DOI: https://doi.org/10.33029/2411-8621-2022-8-4-4-12 (in Russian)
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