Управление мотивами в здравоохранении
The paper analyses the dynamics of the incidence of payment for medical services in different social groups, as well as the dynamics of health care expenditure burden on budgets of households with different income levels. Throughout the 2000s, more solvent population is increasingly applying for paid medical services, preferring to pay for the treatment officially. Poor patients and less developed areas residents often resort to the forms of payment associated with a greater risk of catastrophic expenditure: to informal payments, as opposed to the official, to direct payment, as opposed to voluntary health insurance.
We address the external effects on public sector efficiency measures acquired using Data Envelopment Analysis. We use the health care system in Russian regions in 2011 to evaluate modern approaches to accounting for external effects. We propose a promising method of correcting DEA efficiency measures. Despite the multiple advantages DEA offers, the usage of this approach carries with it a number of methodological difficulties. Accounting for multiple factors of efficiency calls for more complex methods, among which the most promising are DMU clustering and calculating local production possibility frontiers. Using regression models for estimate correction requires further study due to possible systematic errors during estimation. A mixture of data correction and DMU clustering together with multi-stage DEA seems most promising at the moment. Analyzing several stages of transforming society’s resources into social welfare will allow for picking out the weak points in a state agency’s work.