HEALTH POLICY IN RUSSIA

1

• HEALTH POLICY IN RUSSIA
• Part 3.
• Irina Campbell, PhD, MPH
• ivm1_at_columbia.edu
• www.CampbellHealthAssociates.com

2
Before the HIA could be implemented, an insurance
infrastructure had to be developed.
3
On December 25, 1992, a law was proclaimed "On
Insurance contributions to the Fund of Social
Insurance of the Russian Federation, to the State
Employment Fund, and to the compulsory Health
Insurance of citizens for the First Quarter of
1993."
4
On February 24, 1993, this legislation was
followed by
5
The public health care funds of the 1991 HIA were
redefined in 1993 as part of government social
insurance, which provided compulsory health
insurance, financed as a percentage of employee
wages.
6
In removing mandatory insurance from the private
market, the 1993 Health Insurance Act followed
the Canadian model of guaranteeing universal
access through public health insurance.
7
The breakup of the socialist health bureaucracy
was accelerated with the separation of
administrative and financing functions in the
independent, nonprofit structure of CHI funds.
8
Seven interest groups were specified as part of
the administrative boards of the CHI at the local
level consumers, trade unions, medical
professionals, health insurance companies, the
central bank, representatives from federal health
funds, and legislators.
9
The 1993 revisions of the Health Insurance Act
emphasized medical social security in
guaranteeing universal access and a basic
comprehensive benefits package in the compulsory
insurance component, which was equally available
to the employed, unemployed, and indigent through
the CHI.
10
The health funds were designed to function as
fiscal intermediaries between consumers and
providers, encouraging the growth of insurance
companies and the gradual privatization of health
care, thereby differentiating and restricting
government activities.
11
The exact mechanisms of the transition to private
ownership of the health care delivery system were
left ambiguous in the 1993 revision of the Health
Insurance Act.
12
The 1993 Health Insurance Act constructs an array
of incentives for the development of private
ownership of a state-controlled health care
system it also assures that health care is a
human right rather than a function of income and
privilege.
13
There is the danger that mandatory public
insurance will lead to lesser care for the
greater number, whereas voluntary private
insurance will lead to luxury level care for the
smaller elite.
14
Progress has been made by the Russian Federation
in recognizing health as intrinsically valuable,
not just a convenient ideological platform or
instrumental component of government economic
policy.
15
The health market is not a free market in any
nation everywhere it is a mix between the
private and public sectors.
16
The mix between the public and private health
sectors is converging among most industrialized
democracies to include several common elements.
17
The differentiation of management and finance
from the actual provision of health care exists
to some degree in all efficient health systems.
18
The Russian Federation has incorporated several
of these structural elements into the Health
Insurance Act of 1993, trying to balance the
issues of health care quality and equity for the
public with the lack of private ownership of a
self-financing medical industry.
19
The current provisions of the HIA do not address
the issue of private ownership of hospitals,
clinics, and other medical facilities.
20
The health insurance crisis of the 1990s placed
the problem of health reform legislation and
preventive health policy on the agenda for
nations everywhere.
21
The proposed Clinton Health Security Act argued
for the right of each American to have access to
health by eliminating risk-based insurance.
22
There is, however, a noticeable lack of even a
philosophical commitment in the legislation to
emphasize primary care and preventive programs in
either the public or private sector. Setting
national priorities for health promotion and
disease prevention requires attention to the
following
23
Health reform legislation needs to organize a
uniform empirical data collection system to track
the progress towards the preventive goals
outlined above.
24
Planning, enacting, and implementing legislation
are functionally as far apart as changing beliefs
and changing behavior. The enactment of health
reform legislation exemplifies which beliefs
about the health care system need to be modified.
25
The monitoring of health status indicators, as
the gold standard for assessing the quality of
health care outcomes, provides the rationale for
legislative institutionalization of the set of
beliefs underlying health reform.
26
In the late 1990s, the health insurance system
which Russia tried to implement since 1993 has
been largely a failure.
27
The WHO, the European Union and the World Bank
recommended, in 1999, that Russia revert to its
state health service from insurance medicine,
acknowledging that a mistake was made in advising
such a sudden change in the financing and
organization of health care (UNDP, 1999 WHO,
1999).
28
The health insurance funds rely on a 3.6 percent
tax on all payrolls, supplemented by local funds
for those not working. The money is allocated to
insurance companies that contract with local
hospitals and clinics for care.
29
A catch-22 has been created for both patients and
medical facilities under health insurance, staff
salaries, even if token like 20 per month, were
paid with some regularity, although hospital and
polyclinic budgets have decreased by half.
30
It was estimated that 17 of all health care
spending occurred through additional unreimbursed
cash payments.
31
The WHO representative in Moscow, Mikko Vienonen,
agreed in 1999 that WHO and the World Bank health
policy urged upon Russia were erroneous.
32
Russia no longer has universal health care, but
it also lacks a competitive and effective health
insurance system, almost a decade after being
legislated into existence.