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The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia

Most post-Soviet countries have introduced mandatory health insurance (MHI) systems which completely or partially replaced national health systems known as budgetary models. In Russia, an attempt was made to introduce a competitive MHI model with multiple health insurers. The current MHI system has,...

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Autores principales: Shishkin, Sergey, Sheiman, Igor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046304/
https://www.ncbi.nlm.nih.gov/pubmed/36998278
http://dx.doi.org/10.3389/fpubh.2023.1104209
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author Shishkin, Sergey
Sheiman, Igor
author_facet Shishkin, Sergey
Sheiman, Igor
author_sort Shishkin, Sergey
collection PubMed
description Most post-Soviet countries have introduced mandatory health insurance (MHI) systems which completely or partially replaced national health systems known as budgetary models. In Russia, an attempt was made to introduce a competitive MHI model with multiple health insurers. The current MHI system has, however, acquired an increasing number of features inherent in the previous budgetary model. This study analyzes the institutional characteristics and the outcomes of a new mixed model. A combination of two analytical approaches is used as follows: (1) considering three functions of the financing system (revenue collection, pooling funds, and purchasing healthcare) and (2) exploring three types of the model regulation (state, societal, and market). We analyze the types of regulation that are used to implement each of the three financial functions. The model has contributed to more sustainable health funding, its geographical equalization, and service delivery restructuring, while the implementation of its purchasing function has many unsolved problems. We highlight the dilemma of the further development of the model by (a) continuing to replace the remaining market and societal regulatory mechanisms with state regulations or (b) developing market mechanisms and thereby strengthening the impact of health insurers on the health system performance. Lessons for countries considering the transformation of their budgetary health finance model to the MHI model are presented.
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spelling pubmed-100463042023-03-29 The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia Shishkin, Sergey Sheiman, Igor Front Public Health Public Health Most post-Soviet countries have introduced mandatory health insurance (MHI) systems which completely or partially replaced national health systems known as budgetary models. In Russia, an attempt was made to introduce a competitive MHI model with multiple health insurers. The current MHI system has, however, acquired an increasing number of features inherent in the previous budgetary model. This study analyzes the institutional characteristics and the outcomes of a new mixed model. A combination of two analytical approaches is used as follows: (1) considering three functions of the financing system (revenue collection, pooling funds, and purchasing healthcare) and (2) exploring three types of the model regulation (state, societal, and market). We analyze the types of regulation that are used to implement each of the three financial functions. The model has contributed to more sustainable health funding, its geographical equalization, and service delivery restructuring, while the implementation of its purchasing function has many unsolved problems. We highlight the dilemma of the further development of the model by (a) continuing to replace the remaining market and societal regulatory mechanisms with state regulations or (b) developing market mechanisms and thereby strengthening the impact of health insurers on the health system performance. Lessons for countries considering the transformation of their budgetary health finance model to the MHI model are presented. Frontiers Media S.A. 2023-03-14 /pmc/articles/PMC10046304/ /pubmed/36998278 http://dx.doi.org/10.3389/fpubh.2023.1104209 Text en Copyright © 2023 Shishkin and Sheiman. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Shishkin, Sergey
Sheiman, Igor
The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia
title The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia
title_full The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia
title_fullStr The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia
title_full_unstemmed The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia
title_short The hard way from the Beveridge to the Bismarck model of health finance: Expectations and reality in Russia
title_sort hard way from the beveridge to the bismarck model of health finance: expectations and reality in russia
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046304/
https://www.ncbi.nlm.nih.gov/pubmed/36998278
http://dx.doi.org/10.3389/fpubh.2023.1104209
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