Integrated Health Care Payment Methods: Typology, Evidence And Pre-Conditions Of Implementation
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.
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.
Many countries have recently started the search for new payments methods with the specific objective to encourage the integration in service delivery. This paper suggests their typology. A brief overview of these methods in the USA and Europe, including Russia, indicates that there is still no strong evidence of their effects on integration and other dimensions of service delivery performance. It is argued that relative to other integrated methods global payment is the most promising method, since it provides incentives for comprehensive organizational changes. But this method is hard to implement – mostly due to a high probability of excessive financial risks placed on providers in integrated networks. The activities to mitigate these risks are discussed based on the approaches used in the Alternative Quality Contract in Massachusetts and fundholding scheme in Russia. The major pre-conditions for global payment implementation are specified: involvement of hospitals in global payment schemes, shared savings arrangements, special set of activities to mitigate financial risks, performance transparency system. It is also argued that there is a dilemma of strong economic incentives with serious implementation problems and lower economic incentives with less substantial implementation problems.
The article is devoted to the study of the authoritarianism prevalent in the mass consciousness of Russians. The article describes a new approach to the consideration of the authoritarian syndrome as the effects of the cultural trauma as a result of political and socio-cultural transformation of society. The article shows the dynamics of the symptoms of the authoritarianism, which appear in the mass consciousness of Russians from 1993 to 2011. This paper proposes a package of measures aimed at reducing the level of the authoritarianism in Russian society.
This work looks at a model of spatial election competition with two candidates who can spend effort in order to increase their popularity through advertisement. It is shown that under certain condition the political programs of the candidates will be different. The work derives the comparative statics of equilibrium policy platform and campaign spending with respect the distribution of voter policy preferences and the proportionality of the electoral system. In particular, it is whown that the equilibrium does not exist if the policy preferences are distributed over too narrow an interval.
The article examines "regulatory requirements" as a subject of state control over business in Russia. The author deliberately does not use the term "the rule of law". The article states that a set of requirements for business is wider than the legislative regulation.
First, the article analyzes the regulatory nature of the requirements, especially in the technical field. The requirements are considered in relation to the rule of law. The article explores approaches to the definition of regulatory requirements in Russian legal science. The author analyzes legislation definitions for a set of requirements for business. The author concludes that regulatory requirements are not always identical to the rule of law. Regulatory requirements are a set of obligatory requirements for entrepreneurs’ economic activity. Validation failure leads to negative consequences.
Second, the article analyzes the problems of the regulatory requirements in practice. Lack of information about the requirements, their irrelevance and inconsistency are problems of the regulatory requirements in Russia.
Many requirements regulating economic activity are not compatible with the current development level of science and technology. The problems are analyzed on the basis of the Russian judicial practice and annual monitoring reports by Higher School of Economics.
Finally, the author provides an approach to the possible solution of the regulatory requirements’ problem. The author proposes to create a nationwide Internet portal about regulatory requirements. The portal should contain full information about all regulatory requirements. The author recommends extending moratorium on the use of the requirements adopted by the bodies and organizations of the former USSR government.