The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia

Frontiers in Public Health. 2023. Vol. 11. Article 1104209.

Shishkin S., Sheiman I.

Most post-communist countries have introduced mandatory health insurance (MHI), systems which completely or partially replaced national health systems known as budgetary models. In Russia, an attempt was made to introduce a competitive MHI model with multiple health insurers. But the expectations were too high. The current MHI system has acquired an increasing number of features inherent in the previous budgetary model. The objective of the paper is to analyze the institutional characteristics and the outcomes of a new mixed model. A combination of two analytical approaches is used: i) the consideration of three functions of the financing system (revenue collection, pooling funds, purchasing health care), ii) exploring three types of the model regulation  - state, societal, market. We analyze the types of regulation that are used to implement each of three finance functions. The findings are controversial. The model has contributed to a more sustainable health funding and its geographic equalization, as well as to service delivery restructuring, while the implementation of its purchasing function has many unsolved problems. We highlight the dilemma of the further development of the model: a) to develop market mechanisms and thereby strengthen the impact of health insurers on the health system performance; b) to continue replacing the remaining market and societal regulatory mechanisms with the state regulation. The lessons learned for the countries considering the transformation of their budgetary health finance model to the MHI model are presented.

Keywords: обязательное медицинское страхование, финансирование здравоохранения, Russia, health finance, mandatory health insurance, health finance functions, health finance models, collection of funds, pooling funds, purchasing health care, функции финансирования здравоохранения, модели финансирования здравоохранения, формирование средств, аккумулирование средств, покупка медицинской помощи