State guarantees of free medical care: What has changed in 20 years?

Abstract

Over the past two decades, state guarantees of free medical care remain the most uncertain type of state guarantees, which leads to an increase in public payments for medical services. The authors believe that state guarantees are necessary not by themselves, but for the most complete implementation of human rights to ensure health care and health in real life. The compulsory health insurance system in Russia that primarily imitates insurance resembles a distribution (budget) financing model based on the organized purchase of guaranteed medical care by private entities, which are not subject to political and economic control. Therefore, in Russia, the share of private expenditure on health care in the structure of total expenditure is almost three times higher than that found in economically developed foreign countries that implement the insurance model in health care. The health care system must be equipped with a “medical policy” that has a strategic focus and covers all levels and components of the health care system. Moreover, this policy must create conditions where the circle of strategic decision-makers in health care will be separated from the circle of people who develop and implement tactical tools.