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Monitoring of economic developments in health care system

Priority areas of development: state and public administration
Department: Laboratory of Economic Problems in Health Care
The project has been carried out as part of the HSE Program of Fundamental Studies.

Object of research: Urban and rural population of the country.

Goal of research: to monitor on the systematic basis economic developments in Russian health care system. In 2013, the monitoring study focused on identifying the size of the population expenditure for different types of medical services, causes and conditions of payment.

Empirical base of research:

• RLMS-HSE, 21 round data for 2012;

• population survey on the practices of payment for medical care, commissioned by the HSE and implemented by the Levada Center in May and June 2013 with the sample of 4027 respondents, representing the adult urban and rural population (16 years and older). The target sample of those who paid for care in the previous three months was 1103 respondents.

Results of Research:

According to the RLMS data, the incidence of patient payment when applying for ambulatory care increased in the period from 1994 to 2012. The proportion of patients paid for inpatient care, grew up in the 90s, but declining over the past ten years, mainly due to the decrease in the share of those who are forced to buy medicines for the treatment in the hospital. Payments for consultations of physicians and for diagnostic services are increasingly made officially (through cash register of medical facilities). Conversely, the share of patients paying for inpatient care officially in the total number of those who paid for this kind of care has stabilized in the last decade. In 2012, as in the mid -2000s, about 66% of patients who paid for inpatient care made this informally (via cash register).

According to the population survey in 2013, the proportion of those patients who paid for medical care in the last three months prior to the survey was 44 % in cases of receiving outpatient care, 69 % - dental, and 7 % - ambulance. Cases of inpatient care payment were reported by 32 % of respondents hospitalized during the last year.

23 % of patients from those who paid for outpatient care in public facilities did so informally. Under-the-table payments exist also in private clinics, and 7 % of patients paid informally here. 60% of patients who paid in hospitals did so informally.

Informal payment is rarely used as addition of formal payment: most of patients who paid for care have done this or only through cash register or only via cash register. A small proportion of respondents indicated that they used both forms of payment.

The most cases of paid medical care were provided in public facilities. The only exception - dental care, which is provided mainly by private clinics for a charge.

Analysis of the extent of formal and informal cash flows that arise in the provision of outpatient services, shows that four-fifths of these payments are legal, and are paid trough cash register of medical facilities. More than half (52%) of official payments for outpatient care is formed by provision of paid diagnostic procedures.

The share of official payments in the total volume of cash payments for inpatient care is 60%. Among the latter 37% are payments for treatment as a whole, about 24% - for medicines and medical supplies, and 26% - for operations. The payment for operations is the leading component (39 % of the total volume) of informal payment in hospitals.

Linear regression analysis showed that among the respondents who applied for outpatient care, the average frequency of payments is higher if: the respondent has a high level of income, has a chronic illness, lives in Moscow or St. Petersburg.

The average amount of household expenditure on health care is about three hundred rubles in a month, i.e. 2 % of the average family budget. But these small average figures mask very large contingent of the population for which such payments are a heavy burden on family budgets. On average, about 5 % of the population spends on health care for more than 10 % of family budgets, and almost a half percent - more than 30%.

Approximately two-thirds of respondents report their willingness to pay for health care services under certain conditions, and only a third (32%) are not willing to pay under any circumstances.

The data show that the practice of out-of-pocket payment for medical care is in the process of dynamic development, requires monitoring and balanced state, socially and geographically differentiated policies of ensuring access to health care and regulating paid medical services provision.

Level of implementation, recommendations on implementation or outcomes of the implementation of Results:

The results of the study can be used to specify the priorities of the state policy to guarantee free medical care and developments forms of public participation in health care payment.

Field of application:

Health care finance system.


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