Patient Mobility, Health Care Quality, Welfare And Regulation
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.
The article distinguishes the reasons for insufficient development of competition in the sphere of medicine; identifies the major types of such competition, and emphasizes that it can increase the quality of medical support for consumers.
This paper justifies unequal health care quality in a model with two regions and patients differentiated by location and quality perception. There are two efficient regimes of health care quality provision. In the presence of high travel and quality provision costs, qualities should be equal. Reducing these costs results in unequal distribution of quality in effective solution. High health care inequality under a centralised solution is better for the majority of the population as well as for both regions, if the costs are sufficiently low. Market equilibrium implements an efficient solution only when there are high travel and quality provision costs.
The paper examines the structure, governance, and balance sheets of state-controlled banks in Russia, which accounted for over 55 percent of the total assets in the country's banking system in early 2012. The author offers a credible estimate of the size of the country's state banking sector by including banks that are indirectly owned by public organizations. Contrary to some predictions based on the theoretical literature on economic transition, he explains the relatively high profitability and efficiency of Russian state-controlled banks by pointing to their competitive position in such functions as acquisition and disposal of assets on behalf of the government. Also suggested in the paper is a different way of looking at market concentration in Russia (by consolidating the market shares of core state-controlled banks), which produces a picture of a more concentrated market than officially reported. Lastly, one of the author's interesting conclusions is that China provides a better benchmark than the formerly centrally planned economies of Central and Eastern Europe by which to assess the viability of state ownership of banks in Russia and to evaluate the country's banking sector.
The paper examines the principles for the supervision of financial conglomerates proposed by BCBS in the consultative document published in December 2011. Moreover, the article proposes a number of suggestions worked out by the authors within the HSE research team.