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Regular version of the site
Of all publications in the section: 4
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Article
Sheiman I., Shevski V. Health Policy. 2014. Vol. 115. No. 2-3. P. 128-137.

Fragmentation in organization and discontinuities in the provision of medical care are problems in all health systems. A major challenge is to strengthen integration in order to enhance efficiciency and health outcomes. This artickle assesses issues related to fragmentation and integration in concptual terms and argues that key attributes of integration are teamwork, coordination and continuity of care. It then presents a summary of service integration problems in Russia and the results of a large survey of physicians concerning the attributes of integration. It is argued that characteristics of the national service delivery model don't ensure integration. Teh Senashko model is not an equivalent to the integrated model. Big organizational forms of service provision, like polyclinics and integrated hospitals-polyclinics don't have higher scores of integration indicators than smaller ones. Proposals to improve integration in Russia are presented with the focus on the regular evaluation of integration/fragmentation, regulation of integration activities, enhancing the role of PHC providers, economic incentives. 

Added: Mar 9, 2015
Article
Sheiman I., Shevski V. Health Policy. 2014. No. 1. P. 1-10.

Fragmentation in organization and discontinuities in the provision of medical care are prob-lems in all health systems, whether it is the mixed public-private one in the USA, nationalhealth services in the UK, or insurance based one in Western Europe and Russia. In all ofthese countries a major challenge is to strengthen integration in order to enhance efficiencyand health outcomes. This article assesses issues related to fragmentation and integrationin conceptual terms and argues that key attributes of integration are teamwork, coordi-nation and continuity of care. It then presents a summary of service integration problemsin Russia and the results of a large survey of physicians concerning the attributes of inte-gration. It is argued that characteristics of the national service delivery model don’t ensureintegration. The Semashko model is not an equivalent to the integrated model. Big orga-nizational forms of service provision, like polyclinics and integrated hospital-polyclinics,don’t have higher scores of integration indicators than smaller ones. Proposals to improveintegration in Russia are presented with the focus on the regular evaluation of integration/fragmentation, regulation of integration activities, enhancing the role of PHC providers,economic incentives.

Added: Jan 28, 2014
Article
Christopher J. Gerry, Kaneva M., Liudmila Zasimova. Health Policy. 2017. Vol. 121. No. 11. P. 1177-1185.

With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a recent Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia’s voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing.

Added: Nov 2, 2017
Article
Shishkin S., Kuhlmann E., Richardson E. et al. Health Policy. 2019. P. 1-9.

This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessmentframework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning. 

Added: Jun 20, 2019