The budgetary and Insurance Model of Healthcare Funding in Russia

Abstract

This paper aims to investigate the essence and method of building a financial model of healthcare in Russia. The author applies methods such as analysis and synthesis, statistical data processing, systemic and structural approaches. This article is an analysis of the basics of building a budgetary and insurance model: cost allocation (various types of medical care, individual costs) by funding sources; system of inter-budgetary relations; the structure of expenditures of the budgetary system of the Russian Federation on healthcare in 2019. The study presents the financial model of the compulsory medical insurance (СMI) system and defines the role of insurance and private medical organizations in the CMI system. The mechanism of financing state (public) healthcare institutions is shown. The procedure for financing medical organizations according to the territorial program is considered (as illustrated by the example of the Irkutsk region). The article analyzes the methodology for calculating the cost of the territorial program and identifies the problems associated with it. The author pays special attention to organizations that do not carry out activities in the field of compulsory medical insurance, outlining the specifics of financing and legal regulation, and arguing the reasons for excluding a number of diseases from the compulsory medical insurance program. The paper examines the content of the new law on the CHI reform, which provides for direct financing from the budget of the Federal CHI Fund of federal institutions providing specialized medical care. The author highlights the main problems of the building of the budgetary and insurance healthcare funding model such as congestion, inconsistency, cost intensity. The author concluded that it is necessary to revise the organization of the healthcare system and mechanisms for its financial support. The outstripping growth in healthcare costs, on the one hand, and inadequate funding of medical institutions, on the other, lead to a constant search for a compromise between equity and cost-effectiveness. Based on this, the author substantiated the goals and determined the directions for further research, such as reducing transaction costs, changing the motivation of participants, identifying cost growth factors and the possibility of eliminating them.