Financing of the Program of state guarantees of free medical care: how to solve the deficit problem?

Abstract

Introduction. The critical problem of Russian health care is the deficit of funding for the program of state-guaranteed medical care for citizens of Russia. Purpose of the study. To search for solutions to the problem of financing the deficit of the program of state guarantees of free medical care in the Russian Federation. Material and methods. Retrospective data analysis was carried out to analyse the reasons for the deficit in the financing of the program of state guarantees of free medical care and search for solutions in the experience of other countries. Results. The analysis showed that the reasons for the deficit of the program of state guarantees of free medical care are the shortcomings of the mandatory health insurance (MHI) income system: linking contributions for the working population to the wages fund; the vagueness of the definition of the non-working population and the payment of contributions for its MHI by the constituent entities of the Russian Federation; non-participation of the solvent population in the co-financing of medical care; deficit of economic integration between the payment of MHI treatment and the health care system; the absence of formalized mechanisms for reimbursing the expenses of the MHI system by the federal budget to pay for aid in catastrophic situations. Discussion. The authors see the solution to the problem of the deficit of the program of state guarantees of free medical care in the modernization of the MHI income system: replacement of the MHI contributions paid by employers with an additional “medical” part of the value-added tax; replacement of the MHI contributions paid by the constituent entities of the Russian Federation for the non-working population with a targeted “medical” tax on retail sales; creation of a system of additional income based on the principle “the guilty person pays for causing harm to health”; recognition of the cost of medical care to the population in catastrophic situations as an unconditional obligation of the federal budget. Conclusion. a systemic solution to the problem of the financing deficit of the program of state guarantees of free medical care for the citizens of Russia seems to be the modernization of the MHI income system.