Проблемы перехода на подушевой принцип оплаты первичной медико-санитарной помощи

Вопросы государственного и муниципального управления. 2016. № 4. С. 143–164.

Sheiman I.

The paper addresses state policy in the area of primary health care payment methods in the system of mandatory health insurance in Russia. The need for the transition from physicians’ visits reimbursement to capitation payment is substantiated. It is argued that the current payment method hinders disease prevention activities, chronic disease management, integration of service delivery as well as a shift of services from inpatient to outpatient settings. The latest regulatory documents on this subject are critically evaluated with the focus on the attempts to combine the capitation method with the fee-for-service one. Alternative approaches aimed at cost containing and strengthening disease prevention are discussed. Versions of fundholding schemes are suggested as well as the ways to mitigate their excessive financial risks. Various options of the pay-for-performance are seen as the necessary addition to the fundholding scheme. Problems of the capitation rate development under the fundholding are reviewed. It is argued that the budget of a fundholder should include only 163 Sheiman Igor M. Problems of Transition to the Capitation Method of Primary Care Payment a manageable part of the inpatient care cost. The methods of planning primary health care utilization should also change – from the current planning of the number of a physician’s visits to the planning of the size of a catchment area in terms of the number of residents served by primary health care providers. Some recommendations on the algorithm of transition to the capitation payment are made. Keywords: health care; health care payment methods; primary health care; fundholding

Keywords: здравоохранение, фондодержание, способы оплаты медицинской помощи, первичная медико-санитарная помощь

Publication based on the results of: The transformation of the structure of the health workforce and motivation of medical personnel under the influence of economic, technological factors and state human resources policy (2016)