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4 . 2022

Integration of military and civilian medicine: a new method of paying for medical care with separate coverage of fixed and variable costs


The special military operation in Ukraine significantly increased the load on the military medical service: the flow of the wounded, the increase in the incidence of military personnel due to adverse field conditions and the mobilization of reservists. The experience of the USSR’s participation in major military conflicts shows that effective medical care in these conditions requires the organizational, financial, and economic integration of the military medical service with civilian health care. An obstacle to such integration in the Russian Federation is the difference in the financing of civilian and military medical organizations. If in the USSR they were financed in the same way by the budget-estimate method, today this approach has been preserved in the financing of medical care for military personnel, and the main channel for financing medical guarantees for the population is compulsory medical insurance. As a solution, the authors propose not to oppose the insurance and budgetary mechanism, but to complement their strengths and level out the shortcomings within the framework of a new method of paying for medical services with a two-part tariff (Two-Part Tariff – TPT), which is common for civil and military medical organizations, when fixed costs are prospectively billed, and variable costs are retrospectively reimbursed by the insurance mechanism by micro-calculating clinically reasonable variable costs actually incurred for each case of care.

Keywords:military medicine; effective medical care; two-part tariff; variable costs; fixed costs

Funding. The article is based on the results of research carried out at the expense of budgetary funds under the state assignment of the Financial University under the Government of the Russian Federation.

Conflict of interest. The author declares no conflict of interest.

For citation: Ragozin A.V. Integration of military and civilian medicine: a new method of paying for medical care with separate coverage of fixed and variable costs. ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2022; 8 (4): 63–72. DOI: (in Russian)


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Guzel E. Ulumbekova
MD, MBA from Harvard University (Boston, USA), Head of the Graduate School of Healthcare Organization and Management (VSHOUZ)
Medicine today

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