The program of urgent measures in the healthcare sector of the Russian Federation to overcome the systemic crisis
Introduction. On January 15, 2020, the President of the Russian Federation V.V. Putin addressed the Federal Assembly of the RF with the State of the Nation message. In that message, he set the task to ensure availability of medical care, first of all in the primary link of the health care and to satisfy the demands of the population in the social sphere2.
Aim - based on the analysis of key problems of the health care system, to substantiate a program of urgent measures for the health care system of the Russian Federation for the years 2020-2024.
Materials and methods. The research was based on the principles of analysis of complex multipurpose and multi-tiered systems to which the health care system belongs, as well as taking into account the WHO recommendations, techniques of integrated assessment of the activity of health care systems in various countries (United Kingdom, the Netherlands, USA, France, etc.), scientific works on research into health care systems. In the course of the research, the following methods were used: analysis of literature, strategic analysis, comparative analysis, building dependences of indicators, and the synthesis method.
Results. Today, in the health care of the Russian Federation, a critical situation has shaped, which is characterized by unsatisfactory indicators of public health, low availability of medical care, discontent from both the population and health workers. To stabilize the situation in the industry, it is necessary to eliminate the deficit of health care personnel (through increase in their remuneration), to upgrade their skills and to implement a system for general provision with medicines, that is, to ensure availability of free drugs not only for specific categories of citizens but also for all the citizens to whom the doctor wrote a prescription. To that end, additional state-funded financing in the amount of 710 billion rubles in the prices of 2019 is necessary every year.
2 State of the Nation message by the President of the Russian Federation to the Federal Assembly dated 15.01.2020.
Medical care: state 'free of charge' or social solidarity?
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.
Evaluation of demographic and socio-economic indices of the Republic of Bashkortostan during 2012 to 2018
Experience of developed countries in the sphere of antialcoholic politics
This paper presents an estimation of demographic indices, public health indicators of the Republic of Bashkortostan and the factors determining them. The estimation was performed in dynamics from 2012 to 2018 and in comparison versus the Russian Federation and the Volga Federal district on average, including that versus each of 14 entities being members of the district. Based on the findings, conclusions and recommendations for the Republic of Bashkortostan in the sphere of public health and healthcare have been produced.
Experience of developed countries in the sphere of antialcoholic politics
The paper presents an estimation of the alcohol consumption dynamics in the Russian Federation and analyzes the matters of its influence upon the mortality ratio in the group of employable population. Issues of consumption of strong alcoholic drinks per each subject of the RF have been studied, with a comparative analysis of situation in the subjects of the RF situated in the polar and transpolar zones, with the arctic territories of the world countries performed.
The World Health Organization (WHO) recommendations on the antialcoholic policies and an example omnibus programme of a municipal level with the logical model prepared by ©Graduate School of Healthcare Organization and Management (VSHOUZ) are represented.
An analysis of scientific research into the efficiency of measures aimed at the reduction of alcohol consumption in the USA and Canada for the period of 2018-2019 was carried out. The data has been structured by the following subsections: general principles of the antialcoholic policies; restrictive measures; measures aimed at prevention of pregnancy complications related to excessive consumption of alcohol; consumption of alcohol in specific states.
Projected costs of single-payer healthcare financing in the United States: а systematic review of economic analyses
Background. The United States is the only high-income nation without universal, government-funded or - mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach.
Methods and findings. We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, Lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis.
Conclusions. In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available.
Why was this study done?
■ As the US healthcare debate continues, there is growing interest in "singlepayer" also known as "Medicare for All." Single-payer uses a simplified public funding approach to provide everyone with high-quality health insurance.
■ Public support for provision of universal health coverage through a plan like Medicare for All is as high as 70%, but falls when costs are emphasized.
■ Economic models help assess the financial viability of single-payer. Yet, models vary widely in their assumptions and methods, and can be hard to compare.
What did the researchers do and find?
■ We found and compared cost analyses of 22 single-payer plans for the US or individual states.
■ 19 (86%) of the analyses estimated that health expenditures would fall in the first year, and all suggested the potential for long-term cost savings.
■ The largest savings were predicted to come from simplified billing and lower drug costs.
■ Studies funded by organizations across the political spectrum estimated savings for single-payer.
What do these findings mean?
■ There is near-consensus in these analyses that single-payer would reduce health expenditures while providing high-quality insurance to all US residents.
■ To achieve net savings, single-payer plans rely on simplified billing and negotiated drug price reductions, as well as global budgets to control spending growth over time. ■ Replacing private insurers with a public system is expected to achieve lower net healthcare costs.
Funding. CC, JR, IO and KB each received a student summer research grant of $750 each from Physicians for a National Health Program (http://pnhp.org/about/) to support this study. No other support. The funders had no role in the study design, data collection, analysis, decision to publish or manuscript preparation.
Competing interests. CC is an executive board member of Students for a National Health Program (SNaHP). SNaHP had no role in study design, data collection, analysis, decision to publish or manuscript preparation.
Author contributions. Conceptualization - Ponce N., Rodriguez M., Bertozzi S., Kahn J.G. Data curation - Cai C., Runte J., Ostrer I., Berry К. Formal analysis - Cai C., Runte J., Ostrer I., Berry К., White J.S., Kahn J.G. Writing, original draft - Cai C., Jackson Runte, Ostrer I., Kacey Berry. Writing, review & editing - Ponce N., Rodriguez M., Bertozzi S., White J.S., Kahn J.G.
The role of the state in the development of innovative drugs
The article is devoted to the analysis of macro indicators of the pharmaceutical industry and government policy aimed at stimulating the development and introduction of new drugs (medicinal products) in Russia, USA, EU (UK), South Korea and China. The objectives and certain measures in this direction are described, namely: increase of state investments and private funds for investments in research and development (R&D) and support of new drugs production, their stimulation of registration and marketing, support when entering the markets, marketing development, training of qualified personnel for the pharmaceutical industry. It has been shown that state programs to support the innovative development of the pharmaceutical industry are being actively implemented not only in the countries that traditionally lead in this area (USA and EU), but also in South Korea and China. Based on the analysis of these programs, it is recommended for the Russian Federation: to increase state funding for R&D by minimum 8 times, to expand the market for medications by increasing the volume of state purchases of medications, as well as to develop an intergovernmental management system.