The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia

Author:

Shishkin Sergey,Sheiman Igor

Abstract

Most post-Soviet countries have introduced mandatory health insurance (MHI) systems which completely or partially replaced national health systems known as budgetary models. In Russia, an attempt was made to introduce a competitive MHI model with multiple health insurers. The current MHI system has, however, acquired an increasing number of features inherent in the previous budgetary model. This study analyzes the institutional characteristics and the outcomes of a new mixed model. A combination of two analytical approaches is used as follows: (1) considering three functions of the financing system (revenue collection, pooling funds, and purchasing healthcare) and (2) exploring three types of the model regulation (state, societal, and market). We analyze the types of regulation that are used to implement each of the three financial functions. The model has contributed to more sustainable health funding, its geographical equalization, and service delivery restructuring, while the implementation of its purchasing function has many unsolved problems. We highlight the dilemma of the further development of the model by (a) continuing to replace the remaining market and societal regulatory mechanisms with state regulations or (b) developing market mechanisms and thereby strengthening the impact of health insurers on the health system performance. Lessons for countries considering the transformation of their budgetary health finance model to the MHI model are presented.

Publisher

Frontiers Media SA

Subject

Public Health, Environmental and Occupational Health

Reference27 articles.

1. Descriptive framework for country-level analysis of health care financing arrangements;Kutzin;Health Policy.,2001

2. Understanding the legacy: health financing systems in the USSR Eastern Europe prior to transition in implementing health financing reforms: lessons from countries in transition;Davis;Copenhagen: World Health Organization on behalf of the European Observatory on Health Systems and Policies,2010

3. Forming the system of health insurance in the Russian Federation;Sheiman;Soc Sci Med.,1994

4. Preconditions for efficiency and affordability in competitive health markets: are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland?;Van de Ven;Health Policy.,2013

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