ALLOCATION OF MEDICAL CARE VOLUMES IN THE SYSTEM OF COMPULSORY HEALTH INSURANCE: REGULATION AND REAL PRACTICE

Abstract

The article discusses the regulation and practices of allocating the volumes of medical care in the system of compulsory medical insurance (CHI), as well as their compliance with the concept of strategic purchasing of medical services recommended by the World Health Organization and other public institutions. The results of a survey of territorial CHI funds of Subjects of the Russian Federation (TFOMS) on the practices of allocating the volumes of medical care among medical organizations are presented. It is shown that these practices are dominated by distribution based on historical values. According to the concept of strategic procurement of medical services, regional distribution practices in general do not meet the requirements for efficiency, which involve the performance of medical organizations and other factors of effective healthcare organization. At the same time, the results of cluster analysis indicate the presence of differentiated approaches to the use of distribution criteria at the regional level. Despite the lack of the criteria for active (strategic) allocation in the Rules of CHI, the TFOMS survey indicates that such criteria are used in regional practices. However, their role in comparison with other groups of criteria considered is noticeably lower. At the same time, the cluster analysis confirms the presence of differentiated approaches to the combination of criteria in the regional CHI systems.