Paper/Speech Details of Conference Program for the 25th NISPAcee Annual Conference Program Overview V. Public Finance and Management Author(s) Tatiana Chubarova Lomonosov Moscow State University Moscow Russian Federation Grigorieva Natalia, Title How Effective is Public Finance? A Case of Out of Pocket Payments in Russian Health Care. File Paper files are available only for conference participants, please login first. Presenter Tatiana Chubarova Abstract Problems of effectiveness of public finance is on the agenda in many countries raising the issues of whether enough public money is allocated to reach the goals set by public policy. Health care is a good case as limits of public funds that can be mobilized and allocated to health care in modern capitalist society give rise to the problem of how to find resources to cover raising health care needs of populations and how to use the available funds more effectively. The trend that nowadays manifests in Russia is decrease in state appropriations and, accordingly, increased private spending. The share of private finance in total health expenditures is significant while OOP constitute the major share of private health expenditures. The paper analyses the existing public-private mix in health finance in Russia, first of all introduction of fee for services in state health services. The aim of the paper is to discuss the ideological and economic aspects of a situation when state health services receive a right to charge fee for medical treatment and how it might affect amount and structure of public finance. In course of transition the role of the state in society as well as in health care has changed with the emergence of strong individual ideology that led to decreasing role of government in health care in the post-Soviet Russia. One can even speak about “individual”, rather than just private health care financing. This is likely to led to negative results making it difficult for certain population groups to access health services. Thus, effective use of public funds is high on health agenda in Russia. However, the programme-based measures aimed at solving particular problems in health systems and based either on epidemiological or resource approach, does not seems to contribute much to overall health system performance (lacking systematic vision and proper sequencing, creating gaps). Lack of public resources allocated to health care is likely not only to impede assess to health care by a large population segments but to change relevant policies. The role of private finance seemed to be institutionalized, even more, it is not just supported by existing delivery structures but such structures are likely to develop based on the notion of “individual health finance”. An important consequence is that virtually no redistribution happens in health financing that undermines the basis of social solidarity, when rich pays for the poor and healthy pay for those who are ill. Government seems to be ready to shift responsibilities for health care to people as a way to solve problem of health financing. In such a situation building health systems on “basic packages” opens a possibility for the state to easily change the composition of such a package to increase individual finance. It is argued here that if Russian government is not prepared to expand its health responsibilities, other collective forms of prepayment need to be developed if universal health coverage is to be a reality in Russia. This provides a new role for governments to control not only public but also private health expenditures as well as in the course of public sector reforms.
