Current problems of the program on state guarantees to deliver free medical care to the citizens

Abstract

Aim. The study aimed to provide the specialists with information on the dynamics of regulations of the program on state guarantees to deliver free medical care to the citizens and to facilitate managerial decision-making in increasing health care efficiency. Information sources. Data from the Federal State Statistics Service of the Russian Federation, data on medical care regulatory requirements contained in the State Guarantee Programs approved by relevant resolutions of the Government of the Russian Federation, expert assessments, and international databases were used in this study. Results. The study showed that the cost of providing different types of medical care according to the state guarantees of free medical care to the citizens in 2019 increased insignificantly in comparison with the previous year. At the same time, the amount of financial support for the free provision of types of medical care at the expense of public funding sources was 1.98 trillion rubles in 2019. In contrast, the planned consolidated healthcare budget should be no less than 3.12 trillion rubles in 2019. Therefore, despite the widespread opinion about the scarcity of the program, the calculations indicate that there is no funding shortage for the program at the macro level, including the basic program of compulsory health insurance (CHI). The materials presented in the article indicate the need for changes in the system, character, and methods of public administration and authority activities in the field of healthcare. The program on state guarantees to deliver free medical care to the citizens in the current form disorients the population and medical workers and causes a negative assessment of the quality and effectiveness of healthcare management. The authors argue that it is necessary to cultivate such an approach to the organization of medical care, in which the main object is the patient. Meanwhile, the purpose of the activity and the main economic criterion is the adoption or approval of changes by the patient considering his/her health as a direct result of the medical care received. This approach implies the fullest enjoyment of human rights concerning health, clinical and economic feasibility, and the safety of diagnostic and treatment processes. Conclusions. The absence of scarcity in the funding of the program in Russia is combined with private health expenditure of comparable volume with public spending as well as with the aggravation of health care quality problems.