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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,...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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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. |
format | Online Article Text |
id | pubmed-10046304 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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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