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

Priority areas of development: state and public administration
2013
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: health economics.

Goal of research – analysis of key factors of enhancing health system efficiency 

Empirical base of Research:

  • international database of labor resources
  • statistical forms of the Rosstat and the Minzdrav of Russia
  • results of in-depth interviews with representatives of medical community on the role of this community in encouraging professional upgrading of medical personnel 
  • data of RLMS

Results of Research

Component 1 Directions and mechanisms of labor development in the context of health sector modernization»

Structural changes of labor in the Russian Federation health sector are much less substantial than in Western countries. The strategy of extensive development of health labor still dominates. There are many structural disproportions  - between various types of care, specialties, physicians and nurses.    

The analysis of international practice of health labor planning indicates that this planning should not be limited to the assessment of volumes of care and required labor resources, as it is done in Russia. It is necessary to take into account technological and organizational shifts that lead to the change in the structure and content of labor.

 The estimated need for physicians can be decreased by 9,5% as the result of contradicting trends – making district physicians’ patient enrollment lower, a shift from district physician to general practitioner model and decrease in the average length of stay in hospitals.    

The rates of optimal ratios between various professional groups of providers are developed.

The activities for improving additional professional education are suggested. It is argued that the current regulation does create obstacles to these activities.

Component 2 «Developing forms of patients involvement in health care funding»

The analysis of the international experience indicates that fixed co-payment for medical services is the most solidarity-based  form of out-of-pocket payment. It is recommended to start this scheme with the adoption of copayment for the services of private providers reimbursed from the source of mandatory health insurance.

Guidelines for the evaluation of copayments impact on utilization of care, additional revenue of public health system and private expenditures are developed. Also, guidelines for the evaluation of the burden of private expenditures in household budgets are developed.

The empirical estimates oppose the point that copayments, if adopted, will  decrease utilization of care. However, they suggest that copayments will lead to the increase in private expenditure and higher burden of private health expenditures in household budgets.

New guidelines can be used for developing health expenditure prognosis with the range of assumptions regarding options of various patients groups involvement in copayment, as well as various options of medical care coverage.

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

Research outcomes of the first component can be used for the specification of health labor development strategy as well as for substantiating the need for physicians and optimum ratios between various groups of medical personnel.

Research outcomes of the  second component can be used for the prognosis of the impact of copayment introduction.

Field of application:

Health labor planning. Modernization of health finance system.

Publications:


Шишкин С. В., Засимова Л. С. Введение // В кн.: Внедрение новых технологий в медицинских организациях: зарубежный опыт и российская практика / Отв. ред.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2013. Гл. 01. С. 11-15.
Shishkin S. Russia’s health care system: difficult path of reform, in: The Oxford Handbook of the Russian Economy / Ed. by S. Weber, M. V. Alexeev. Oxford : Oxford University Press, 2013. Ch. 31. P. 748-774.
Zasimova L. S., Shishkin S. Adopting new medical technologies in Russian public hospitals: what causes inefficiency? / NRU Higher School of Economics. Series PA "Public Administration". 2013. No. WP BRP 07/PA/2013.
Шишкин С. В., Селезнева Е. В., Потапчик Е. Г., Карчевская С. А., Кравчук С. Г. Методы оплаты медицинской помощи в системе ОМС в оценках страховых медицинских организаций // Обязательное медицинское страхование в Российской Федерации. 2013. № 5. С. 26-29.
Акиндинова Н. В., Кузьминов Я. И., Использовались материалы следующих авторов: Гурвич Е.Т., Андрущак Г. В., Шишкин С. В., Малева Т. М., Блинкин М. Я. «Бюджетный маневр» (предложения по реструктуризации расходной части бюджета) // В кн.: Стратегия-2020: Новая модель роста — новая социальная политика. Итоговый доклад о результатах экспертной работы по актуальным проблемам социально-экономической стратегии России на период до 2020 года / Науч. ред.: В. А. Мау, Я. И. Кузьминов. Кн. 2. М. : Дело, 2013. Гл. 26. С. 385-406.
Шишкин С. В., Засимова Л. С. Заключение // В кн.: Внедрение новых технологий в медицинских организациях: зарубежный опыт и российская практика / Отв. ред.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2013. С. 233-241.
Шишкин С. В., Кадыров Ф. Н. Практика принятия решений региональными органами управления здравоохранением о внедрении новых технологий // В кн.: Внедрение новых технологий в медицинских организациях: зарубежный опыт и российская практика / Отв. ред.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2013. Гл. 3.3. С. 117-130.
Sheiman I., Shevski V. Health care integration in the Russian federation: conceptual framework, evaluation, and new instruments / NRU Higher School of Economics. Series PA "Public Administration". 2013. No. WP BRP 10/PA/2013.
Шишкин С. В., Кадыров Ф. Н., Засимова Л. С. Направления и механизмы повышения эффективности внедрения новых технологий в российских медицинских учреждениях // В кн.: Внедрение новых технологий в медицинских организациях: зарубежный опыт и российская практика / Отв. ред.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2013. Гл. 4. С. 218-241.
Шишкин С. В., Засимова Л. С. Внедрение новых медицинских технологий как предмет государственного регулирования // В кн.: Внедрение новых технологий в медицинских организациях: зарубежный опыт и российская практика / Отв. ред.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2013. Гл. 3.1. С. 106-109.
Шишкин С. В., Засимова Л. С. Внедрение новых медицинских технологий в государственных и муниципальных медицинских учреждениях // В кн.: Внедрение новых технологий в медицинских организациях: зарубежный опыт и российская практика / Отв. ред.: С. В. Шишкин. М. : Издательский дом НИУ ВШЭ, 2013. Гл. 3.4. С. 131-179.