ALLOCATION OF MEDICAL CARE VOLUMES IN THE SYSTEM OF COMPULSORY HEALTH INSURANCE: REGULATION AND REAL PRACTICE

IF 0.2 Q4 PUBLIC ADMINISTRATION

Voprosy Gosudarstvennogo i Munitsipalnogo Upravleniya-Public Administration Issues Pub Date : 2023-01-01 DOI:10.17323/1999-5431-2023-0-2-74-102

I. Stepanov

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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.

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强制医疗保险制度中医疗保健量的分配:规制与实践

本文探讨了强制医疗保险制度下医疗服务总量分配的规定和实践，以及与世界卫生组织等公共机构推荐的医疗服务战略采购理念的契合度。本文介绍了对俄罗斯联邦各主体的领土医疗保健基金(tfm)关于医疗机构之间医疗保健量分配做法的调查结果。研究表明，这些实践以历史价值分配为主导。根据医疗服务战略采购的概念，区域分配的做法普遍不符合效率的要求，这涉及到医疗组织的绩效和有效医疗组织的其他因素。与此同时，聚类分析的结果表明，在区域层面上，使用分布标准的方法存在差异。尽管在CHI规则中缺乏积极(战略)分配的标准，但TFOMS调查表明，这些标准已在区域实践中使用。但是，与所考虑的其他标准组相比，它们的作用明显较低。与此同时，聚类分析证实了区域CHI系统中存在不同的标准组合方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Voprosy Gosudarstvennogo i Munitsipalnogo Upravleniya-Public Administration Issues PUBLIC ADMINISTRATION-

CiteScore

1.10

自引率

33.30%

发文量

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.