{"title":"ALLOCATION OF MEDICAL CARE VOLUMES IN THE SYSTEM OF COMPULSORY HEALTH INSURANCE: REGULATION AND REAL PRACTICE","authors":"I. Stepanov","doi":"10.17323/1999-5431-2023-0-2-74-102","DOIUrl":null,"url":null,"abstract":"The article discusses the regulation and practices of allocating the volumes of medical care in the system of compulsory medical insurance (CHI), as well as their compliance with the concept of strategic purchasing of medical services recommended by the World Health Organization and other public institutions. The results of a survey of territorial CHI funds of Subjects of the Russian Federation (TFOMS) on the practices of allocating the volumes of medical care among medical organizations are presented. It is shown that these practices are dominated by distribution based on historical values. According to the concept of strategic procurement of medical services, regional distribution practices in general do not meet the requirements for efficiency, which involve the performance of medical organizations and other factors of effective healthcare organization. At the same time, the results of cluster analysis indicate the presence of differentiated approaches to the use of distribution criteria at the regional level. Despite the lack of the criteria for active (strategic) allocation in the Rules of CHI, the TFOMS survey indicates that such criteria are used in regional practices. However, their role in comparison with other groups of criteria considered is noticeably lower. At the same time, the cluster analysis confirms the presence of differentiated approaches to the combination of criteria in the regional CHI systems.","PeriodicalId":43338,"journal":{"name":"Voprosy Gosudarstvennogo i Munitsipalnogo Upravleniya-Public Administration Issues","volume":"1 1","pages":""},"PeriodicalIF":0.2000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Voprosy Gosudarstvennogo i Munitsipalnogo Upravleniya-Public Administration Issues","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17323/1999-5431-2023-0-2-74-102","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PUBLIC ADMINISTRATION","Score":null,"Total":0}
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Abstract
The article discusses the regulation and practices of allocating the volumes of medical care in the system of compulsory medical insurance (CHI), as well as their compliance with the concept of strategic purchasing of medical services recommended by the World Health Organization and other public institutions. The results of a survey of territorial CHI funds of Subjects of the Russian Federation (TFOMS) on the practices of allocating the volumes of medical care among medical organizations are presented. It is shown that these practices are dominated by distribution based on historical values. According to the concept of strategic procurement of medical services, regional distribution practices in general do not meet the requirements for efficiency, which involve the performance of medical organizations and other factors of effective healthcare organization. At the same time, the results of cluster analysis indicate the presence of differentiated approaches to the use of distribution criteria at the regional level. Despite the lack of the criteria for active (strategic) allocation in the Rules of CHI, the TFOMS survey indicates that such criteria are used in regional practices. However, their role in comparison with other groups of criteria considered is noticeably lower. At the same time, the cluster analysis confirms the presence of differentiated approaches to the combination of criteria in the regional CHI systems.
期刊介绍：
PUBLIC ADMINISTRATION ISSUES is a scientific peer-reviewed journal published by the National Research University High School of Economics (NRU HSE).The journal is published quarterly in Russian, and contains original articles by Russian and foreign authors. In addition, a special English language issue containing original articles by Russian and foreign authors has been published since 2014. The editorial board consists of leading Russian and foreign scientists in the field of public administration as well as prominent practitioners. The journal is indexed in the international databases: Scopus, RePEc, EBSCOand the Russian Science Citation Index (RSCI) on the platform of Web of Science. In addition, the journal is on the list of key peer-reviewed scientific journals and publications that the Higher Certification (Attestation) Commission in the RF Education Ministry recommends for publishing the main scientific results of theses for PhD and doctoral degrees in Economics, Sociology and Law. The journal focuses on the following subject areas: − Current theories of public administration. − Theoretical fundamentals of economic and social policy − Factors and Assessment of efficiency in public and municipal administration. − Innovations in the system of public and municipal administration. − Planning and forecasting in the system of public and municipal administration. − Staff of the state and municipal service. Management of personnel in public and municipal bodies and in organizations of the public sectors. − Financial, logistical and information resources of the state and municipalities. − Public service. − Functional features of public sector organizations. − Partnership of the state and municipalities with nongovernmental nonprofit organizations. Economic and administrative challenges facing “third sector.” - Development of education programs on public administration.
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