International Centre for Health Economics, Management and Policy (CHEMP), National Research University Higher School of Economics, St. Petersburg, Russian Federation; Russian Presidential Academy of National Economy and Public Administration (RANEPA), Russian Federation; University of Oxford, School of Interdisciplinary and Area Studies, St. Antony's College, Oxford, United Kingdom.
International Laboratory for Economics of Healthcare and Its Reforms, Gaidar Institute for Economic Policy, Moscow, Russian Federation.
Health Policy. 2017 Nov;121(11):1177-1185. doi: 10.1016/j.healthpol.2017.09.001. Epub 2017 Sep 8.
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 2011 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.
由于私人医疗保险和现有的公共药品报销计划的参与率都很低，据认为，俄罗斯只有不到 5%的人口能够获得免费的门诊药品治疗。对于一个正在努力改革医疗体系、经济增长低迷或为零、社会服务支出大幅减少的国家来说，这是一个重大的政策挑战。在本文中，我们利用 2011 年列瓦达中心调查的数据，考察了俄罗斯民众对一般药品政策以及对拟议的自愿药品保险制度的态度和社会团结。除了是首批在共产主义后背景下探讨这些重要问题的研究之一，我们还对新兴的政策辩论做出了三个重要贡献。首先，我们发现，如果立即引入且没有精心的规划和准备，俄罗斯的自愿药品保险计划可能会因高风险不健康个体过度选择该计划而在财务上崩溃。其次，高收入群体对财富向贫困人口再分配的负面态度可能会进一步阻碍政府引入自愿药品保险的努力。最后，我们认为，俄罗斯目前缺乏实施这种形式的卫生融资所需的广泛和深入的社会团结。
