Health Care Systems in Transition i Health Care Systems in Transition Written by Ellie Tragakes and Suszy Lessof Edited by Ellie Tragakes Russian Federation 2003 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Government of Greece, the Government of Norway, the Government of Spain, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Russian Federation ii European Observatory on Health Systems and Policies Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration RUSSIAN FEDERATION © European Observatory on Health Systems and Policies, 2003 This document may be freely reviewed or abstracted, but not for commercial purposes. For rights of reproduction, in part or in whole, application should be made to the Secretariat of the European Observatory on Health Systems and Policies, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. The European Observatory on Health Systems and Policies welcomes such applications. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or its participating organizations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this document are those which were obtained at the time the original language edition of the document was prepared. The views expressed in this document are those of the contributors and do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies or its participating organizations. Suggested citation: Tragakes, E. and Lessof, S. In: Tragakes E., ed. Health care systems in transition: Russian Federation. Copenhagen, European Observatory on Health Systems and Policies, 2003: 5(3). European Observatory on Health Systems and Policies: WHO Regional Office for Europe Government of Greece Government of Norway Government of Spain European Investment Bank Open Society Institute World Bank London School of Economics and Political Science London School of Hygiene & Tropical Medicine ISSN 1020-9077 Vol. 5 No. 3 Russian Federation Health Care Systems in Transition iii Contents Foreword............................................................................................. v Acknowledgements .......................................................................... vii Introduction and historical background ......................................... 1 Introductory overview .................................................................... 1 Historical background .................................................................. 20 Organizational structure and management .................................. 27 Organizational structure of the health care system ...................... 27 Planning, regulation and management ......................................... 44 Decentralization of the health care system ......................... 59 Health care financing and expenditure ......................................... 65 Main system of financing and coverage ...................................... 65 Health care benefits and rationing ............................................... 91 Complementary sources of financing .......................................... 97 Health care expenditure ............................................................. 107 Health care delivery system .......................................................... 117 Structure of the Soviet health care system ................................. 118 Primary health care and public health services .......................... 120 Secondary and tertiary care ........................................................ 133 Social care .................................................................................. 143 Human resources and training ................................................... 144 Pharmaceuticals and health care technolopgy assessment......... 149 Financial resource allocation ........................................................ 159 Third-party budget setting and resource allocation ................... 159 Payment of hospitals .................................................................. 162 Payment of physicians ............................................................... 167 Health care reforms ....................................................................... 169 Aims and objectives ................................................................... 169 Content of reforms and legislation ............................................. 170 Reform implementation ............................................................. 190 Conclusions ..................................................................................... 195 References ....................................................................................... 197 Russian Federation iv European Observatory on Health Systems and Policies Russian Federation Health Care Systems in Transition v Foreword he Health Care Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health care system Tand of reform initiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Systems and Policies. HiTs seek to provide relevant comparative information to support policy- makers and analysts in the development of health care systems in Europe. The HiT profiles are building blocks that can be used: • to learn in detail about different approaches to the organization, financing and delivery of health services; • to describe the process, content and implementation of health care reform programmes; • to highlight challenges and areas that require more in-depth analysis; and • to provide a tool for the dissemination of information on health care systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries. The HiT profiles are produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides the detailed guidelines and specific questions, definitions and examples needed to compile a HiT. This guidance is intended to be flexible to allow authors to take account of their national context. Compiling the HiT profiles poses a number of methodological problems. In many countries, there is relatively little information available on the health care system and the impact of reforms. Due to the lack of a uniform data source, Russian Federation vi European Observatory on Health Systems and Policies quantitative data on health services are based on a number of different sources, including the WHO Regional Office for Europe health for all database, Organisation for Economic Cooperation and Development (OECD) Health Data and data from the World Bank. Data collection methods and definitions sometimes vary, but typically are consistent within each separate series. The HiT profiles provide a source of descriptive information on health care systems. They can be used to inform policy-makers about experiences in other countries that may be relevant to their own national situation. They can also be used to inform comparative analysis of health care systems. This series is an ongoing initiative: material is updated at regular intervals. Comments and suggestions for the further development and improvement of the HiT profiles are most welcome and can be sent to [email protected]. HiTs, HiT summaries and a glossary of terms used in the HiTs are available on the Observatory’s website at www.observatory.dk. Russian Federation Health Care Systems in Transition vii Acknowledgements he HiT profile on the Russian Federation was written by Ellie Tragakes (European Observatory on Health Systems and Policies) and Suszy TLessof (European Observatory on Health Systems and Policies) in collaboration with Yuri M. Komarov (Russian Medical Association), Igor M. Sheiman (Zdravconsult Foundation), Sergey V. Shishkin (Independent Institute for Social Policy), Vadim Tsyboulsky (Central Public Health Research Institute) and Elena Varavikova (Central Public Health Research Institute). The assistance of Kirill D. Danishevski (Open Society Institute) is gratefully acknowledged. The HiT was edited by Ellie Tragakes. The research director of this HiT was Josep Figueras. The Observatory gratefully acknowledges Olusoji Adeyi (World Bank), Michael Borowitz (DFID), Olga Kuznetsova (St. Petersburg Medical Academy of Post Graduate Education), Martin McKee (European Observatory on Health Systems and Policies), Nata Menabde (World Health Organization), Klaus Thielmann and Mikko Vienonen (World Health Organization) for reviewing the HiT. In addition, the Observatory would like to thank Mikko Vienonen for facilitating the HiT writing process. The Observatory is grateful to the Ministry of Health of the Russian Federation for its support. The current series of Health Care Systems in Transition