Paper/Speech Details of Conference Program for the 19th NISPAcee Annual Conference Program Overview Health Care, Health Reforms and Their Implementation Author(s) Tatiana Chubarova Lomonosov Moscow State University Moscow Russian Federation none Title Patterns of health care reforms in economies under transition: A case of Russia File Paper files are available only for conference participants, please login first. Presenter Abstract Health care reforms in Russia have 20 years history but still the situation in Russian health care is often described as a crisis one. There is still no agreement between experts what the Russian health care model should look like with quite opposite opinions expressed in the debates. It should be noted that problems of population health and its protection have a significant social and political importance in the Russian society. The Russian health care crisis has three dimensions, namely: • the poor population health status and the poor state of health care system; • worsening demographic situation and economic consequences of poor health; • social and moral problems that include the equity of health care system on one hand and people’ s feelings and confidence, on the other hand. It is suggested in the paper that one of the reasons of the poor health of the Russian population and poor functioning of the Russian health care is the way the reforms are developed and implemented and also the assumptions on which they are based on. Russian health care reforms seem to become an endless process that never reaches the stated goals. The main characteristics of any health care model largely depend on the role of the state in both financing and providing health care. Today in Russia so called liberal approaches definitely dominate that consider welfare state to be a burden for the economy. As a result the public-private mix changes and health is considered to be primary the responsibility of an individual. This results in the low state health care expenditures, introduction of co payments and expansion of private health services. To understand these developments it is necessary to bear in mind two myths and two paradoxes of Russian health reforms which though are not stated explicitly nevertheless inform health policy decisions. The first myth is that private provision of health care is always better that the state one. The second myth tells that rich people always prefer to pay for health care. But Russian health policy also contains two paradoxes that are not always easy to explain. First, the government insists that there are little state funds that can be allocated for health but it chooses the insurance model that is more expensive that national health service model. Second, the governments definitely tries to save budget money at any cost but it does not seem to care about how much money people will spend out of their pockets for health care and if they can do this at all taking into account a widespread poverty. But the author suggests that inequality is the main threat to health care system that is not properly addressed by the reforms. The scale of inequality in Russian society – the Gini coefficient is 0,43 — is well documented. Recently several studies have appeared that investigated the influence on inequity of health status and access to health care, including gender inequality. There is a real danger that such inequality would ruin the unified system of health care and Russia might end up with two separate sub-systems—one for rich people who can pay and another for poor people for free. The story about Russian health reforms demonstrates that in designing health reforms especially those carried out in times of great changes in society it is necessary to place health into the wider societal context. Besides, the importance of the government sector that itself has a potential to improve its performance should not be underestimated.
