System
Lecture 9
Tracey Lynn Koehlmoos, PhD, MHA
HSCI 609 Comparative International Health
Systems
Russiafacts
Largest country in the world.
However, most of the land lacks the
proper climate and soil to be used in
agriculture
Capital: Moscow
Government type: Federation
48 oblasts, 21 republics, 9 autonomous
okrugs, 7 krays, 2 federal cities, & 1
autonomous oblast
Burden of Disease
60% of men have hypertension
Leading mortality and morbidity causes:
CVD causes 56% of deaths (2003)
alcohol-related injury and poisoning
Reform feedback
Conflict between GPs and Specialist
physicians (Specialists say GPs should
classify and send them to a specialist)
Concerns from leadership and staff in the
current healthcare system:
How is it possible that a national health care
project is managed not by the health ministry,
but by the presidential administration?
Is it really about quality or is it about cost?
More trouble
Confusion rages: budget and insurance funding
to organizations
General distrust of releasing funds to the
insurers with no control over the quality or
provision of future care
Lack of incentive for insurers to provide care in
sparsely populated regions
1/3 of regions have no insurance companies
General failure to produce market competition
(in larger cities there is division rather than
competition)
Polyclinic
Basic site of health services delivery
Formerly considered successful by the
sheer volume of patients SEEN
Provider attitude: receive and refer!
30% of initial contacts lead to a referral
New system tries to emphasize primary
carewe will have to wait for the results
Provider Payment
Physicians: Private or Public, most are still
salaried employees of a polyclinic or hospital
Hospitals: Retrospective fee-for-service
The Black Market: The healthcare sector
absorbs the largest proportion of bribes in
Russia (about $600 million in 2000)
This is unreported healthcare spending
A long standing tradition, an expectation of care
Higher in rural areas
Compared to US
American v. Russiafundamental differences
US: Private sector provides most healthcare
services with public sector as a safety net for
the poor.
US: Powerful and diverse private insurance
industry.
Opposite trends: Russian government
attempts to offer more autonomy to health care
providers and users; US, autonomy has been
limited by the long term grasp of managed
care.
Compared to US
US health insurance experience can prove
useful to Russian reformers.
US example of excessive consumption and
skyrocketing costs of health care suggests that
controlling utilization and costs is a crucial
prerequisite for a sustainable health insurance
scheme. Failed US efforts to introduce
compulsory health care coverage can also
serve as an important lesson to Russian
politicians who propose obligatory national
health insurance.
More Comparisons to US
Russian healthcare transitional problems
are not unique:
Public health sector reliance in other countries
have led to shortages, misallocation of
resources, declining quality
Resulting in reduced health status of the
population
More Comparisons to US
Russia healthcare reform should look at
local situation and at successful efforts
abroad
Warning signs: ill-designed benefit
package, hasty decentralization, and overreliance on the private sector
(Rozenfeld for RAND)
Source:
http://www.rand.org/pubs/conf_proceedings/CF124/CF12
4.chap5.html#fn0 accessed 12 May 2006
Summary
The Russian Federations healthcare system
has been in a constant state of flux
Russian health status has dramatically declined
Rapid decentralization without legislation and
competition has lead to market failure and poor
health outcomes.
2006 healthcare reformswill they work? When
will we know? Will throwing money at the
problem solve it?