Efficiency and Effectiveness in Russian Regional Healthcare
What is governmental effectiveness on the regional level? How can the study of regional effectiveness help us understand the performance of the political, social and economic systems of the state as a whole? These questions are very important from both the theoretical and applied perspectives, and the Russian Federation, with its huge and diverse territory, provides extremely rich material to answer them. Serious institutional reforms in the public sector have been implemented in recent years, and the results vary substantially from one region to another. So, in Russia, we can study how general attempts to make government more effective - guided by federal policies - produce particular regional effects, and, conversely, how regions implement federal policy differently. Both views tell us something important about overall governmental quality.
Governmental effectiveness, though in a broad sense one of the oldest issues in political science and philosophy, is currently enjoying a renaissance. The quantity of recent publications and even a special academic structure - The Quality of Government Institute in Sweden – illustrate the current interest. However, researching governmental effectiveness poses serious difficulties, on both the conceptual and instrumental levels. Despite (perhaps even because of) the variety of available theoretical frameworks, the essential core notions of governmental effectiveness and good governance remain murky. Furthermore, scholars disagree about what effectiveness and efficiency mean in a general sense. These issues obviously make it difficult to construct adequate measurement instruments.
The paper seeks to achieve three goals: 1) to review existing approaches and highlight their weak points; 2) to propose a theoretical framework for analyzing governmental effectiveness using appropriate estimation tools; and 3) to present empirical results based on data on public health care from Russia’s regions. Three patterns that ought to correlate - regional efficiency, how reform has been implemented and public opinion – are, instead, inconsistent with each other. Russia’s health-care sector today faces considerable problems with basic, systemic effectiveness.