Финансовая устойчивость систем обязательного медицинского страхования: вызовы и ответная реакция

Профилактическая медицина. 2023. Т. 26. № 3. С. 14–22.

Potapchik E.

In the context of the constant growth of costs for the services provided under compulsory health insurance (CHI) programs, on the one hand, and the cyclical nature of economic crises that adversely affect the revenue base of CHI systems, on the other hand, the issue of financial sustainability is becoming increasingly relevant. Many countries, faced with the problem of insufficient contributions for insurance programs, are looking for innovative methods of financing CHI systems. Objective. To analyze and systematize the methods used in foreign countries to maintain the financial sustainability of CHI systems. Material and methods. The search for publications and regulatory acts was conducted in the Embase and MEDLINE databases, on the websites of international organizations, and the websites of individual countries’ health ministries. The search strategy included a combination of the terms “free text” and “heading medical subject” related to the financial sustainability of CHI systems. The applied methods of maintaining the financial sustainability of CHI systems were systematized in the context of the main types of sources. Results and discussion. In recent years, the use of CHI worldwide has been growing. In most countries with CHI systems, budget transfers are also used as a source of funding, reflecting contributions from government budgets for specified purposes. The share of budget transfers in the total revenue of CHI systems varies significantly by country, which is due to the purpose of transfers.

In response to current challenges, the role of budget transfers is increasing. Budget transfers act as a mitigating buffer when income-based contributions are reduced in times of economic crisis. The practice of introducing new sources of financing for compulsory health insurance systems is expanding. Conclusions. The combination of the growing demand for health care services with the limited resources available to cover it poses a serious threat to the financial sustainability of compulsory health insurance systems and the universal health coverage achieved. It encourages searching for and using new funding sources for the compulsory health insurance system. In the vast majority of developed countries, the role of budget transfers to the compulsory health insurance system is growing.

Keywords: обязательное медицинское страхование, financial sustainability, compulsory health insurance, финансовая устойчивость

Publication based on the results of: The impact of the healthcare system on the economy of the Russian Federation (2022)