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Directions  and mechanisms of developing integrated, transparent and efficient health system

Priority areas of development: state and public administration
2015
The project has been carried out as part of the HSE Program of Fundamental Studies.

Goal of research: identification of the conditions for effective introduction the new institutions of health care delivery, health care financing, and health workers remuneration. 

The study includes two components:

  1. The comparative analysis of institutional factors in the development of health care in the post-socialist countries
  2. Analysis of the impact of changes in remuneration of medical workers on their working motivation

Methodology:

The following research methods are used in the first component of the studyt: a review of literature on health care reform in post-socialist countries; international comparisons; institutional analysis of changes in the organization and financing of health care; statistical analysis of indicators of health system reform and performance indicators.

To second component of the study the methods of kross-table analysis, variance analysis, factor analysis, cluster analysis.

Empirical base of research:

Seven countries have been chosen as the objects for the first component of the study: Belarus, Estonia Hungary, Kazakhstan, Latvia, Poland, Ukraine. The sources of the data was the WHO and OECD database, the national health policy acts and health care regulations, research publications in these countries and international journals and reviews.

The empirical base for the second component encompasses five surveys of health care workers carried out in the 2007-2014.

Results of research:

The c similarity of the health system that existed in the countries of Central and Eastern Europe and the CIS led to the similarity declared in the 90s directions necessary changes in the organization of health care delivery and financing: promotion of healthy lifestyles and the development of disease prevention, improve the efficiency of primary health care on the basis of the transition to general practitioner model, hospital sector restructuring, the introduction of compulsory health insurance system, the formation of economic motivation of medical organizations and their employees to improve the quality of care, and others.

This similarity contrasts with the characteristics of correspondence of real policy to declared reform goals. The most consistent were the health care reforms in Estonia. The high degree of compliance with the declared objectives of the reforms and their implementation is provided in Poland. In Hungary, Kazakhstan and Latvia the implementation of a large part of the declared components of reforms proved to be unstable and contradictory. In Belarus, the consistency of declarations and implemented reforms was higher, but the range of goals of modernization of the health system was much narrower. In Ukraine, the reforms were carried out only in pilot regions in the 2010-2014., and they  included a limited list of tasks that are solved. The main factor in determining the path of reform is the degree of political consensus in the understanding of the need for change, their content, the possible costs and the desired results.

An analysis of the impact of changes in wages of medical workers on their labor motivation revealed the most important motives for work, and clusters of doctors differed by these motives. There is significant increase in 2014 the willingness of health workers to have higher share of the base salary in their total remuneration. It is shown that the influence of attestation of health workers to changes in their working motivation is limited.

Level of implementation,  recommendations on implementation or outcomes of the implementation of the results

The results of the study can be used in the development of concepts, strategies, programs of health care development as well as activities to improve its effectiveness, including strengthening of motivation of health workers.

Publications:


Шишкин С. В., Сажина С. В., Селезнева Е. В. Изменения в деятельности страховых медицинских организаций в новой системе ОМС // Обязательное медицинское страхование в Российской Федерации. 2015. № 5. С. 32-37.
Кочкина Н. Н., Красильникова М. Д., Шишкин С. В. Доступность и качество медицинской помощи в оценках населения / Высшая школа экономики. Серия WP8 "Государственное и муниципальное управление". 2015.
Sheiman I. Payment Methods for Integration: Typology, Evidence and Pre-conditions of Implementation // Journal of Pharmaceutical Care & Health Systems. 2016. P. 1-10. doi
Шишкин С. В., Бондаренко Н. В., Красильникова М. Д. Практики оплаты медицинской помощи // Вестник общественного мнения. Данные. Анализ. Дискуссии. 2015. № 1(119). С. 61-80.
Vlassov V., Lindenbraten A. Best practices and research priorities in health systems strengthening - Eastern Europe and Central Asia P. 46-49.
Шишкин С. В. Анализ состояния и направлений улучшения здоровья населения в контексте устойчивого развития // В кн.: Доклад о человеческом развитии в российской Федерации за 2015 год. Человеческое развитие в условиях спада экономики / Науч. ред.: Л. М. Григорьев, С. Н. Бобылев. М. : Аналитический центр при Правительстве Российской Федерации, 2015. Гл. 10. С. 209-222.
Шишкин С. В., Аполихин О. И., Сажина С. В., Шадеркин И. А., Золотухин О. В., Просянников М. Ю. Повышение эффективности специализированной медицинской помощи: опыт структурных преобразований // Вопросы государственного и муниципального управления. 2015. № 2. С. 79-99.
Шишкин С. В., Шейман И. М., Сажина С. В., Боярский С. Г., Абдин А. А. Российское здравоохранение в новых экономических условиях: вызовы и перспективы // В кн.: Российское здравоохранение в новых экономических условиях: вызовы и перспективы. Доклад НИУ ВШЭ по проблемам развития системы здравоохранения / Рук.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2016. С. 1-84.