Sheiman I
Economics of Social Services Division, Institute of World Economy, Russian Academy of Sciences, Moscow.
Soc Sci Med. 1994 Nov;39(10):1425-32. doi: 10.1016/0277-9536(94)90237-2.
A radical reform is being prepared in the Russian Federation health care. Its major point is a transition from tax-financed national health system to social health insurance. The paper highlights the issues of forming the system of health insurance. First, the arguments for a transition to a new model of finance are discussed. Secondly, the concept of the new model and its implementation in the context of the regional experiment are addressed. A discussion of current and expected developments focuses on two major issues: monopsony or pluralistic model of third-party purchasing? What is important for forming the market of health care provision? The major argument is that a transition from a highly integrated to a contractual model may start with regional monopsony or some version of it. A pluralistic model of third-party purchasing needs a refined regulation and may not meet health policy objectives. It is also argued that on the first stage of reform implementation forming the market of health care provision is more dependent on its regulation and management than on the market structure of health care purchasing.
俄罗斯联邦的医疗保健正在筹备一场彻底改革。其重点是从税收资助的国家卫生系统过渡到社会医疗保险。本文着重探讨了医疗保险体系的形成问题。首先，讨论了向新的融资模式转变的论据。其次，阐述了新模式的概念及其在区域试验背景下的实施情况。对当前和预期发展的讨论聚焦于两个主要问题：第三方购买的买方垄断模式还是多元化模式？对于形成医疗服务市场而言什么是重要的？主要论点是，从高度一体化模式向契约模式的转变可以从区域买方垄断或其某种变体开始。第三方购买的多元化模式需要完善的监管，且可能无法实现卫生政策目标。还有观点认为，在改革实施的第一阶段，形成医疗服务市场更多地依赖于其监管和管理，而非医疗保健购买的市场结构。
