Universal Health Coverage in Russia : Extending Coverage for the Poor in the Post-Soviet Era
Over the past two decades Russia experienced a significant increase in state-financed entitlements for health care through the Program of State Guarantees for Medical Care (PSG). The PSG, which is underpinned by the Constitution was an important el...
| Main Authors: | , , , |
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| Format: | Working Paper |
| Language: | English |
| Published: |
World Bank, Washington, DC
2018
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/785671528870478212/Universal-health-coverage-in-Russia-extending-coverage-for-the-poor-in-the-Post-Soviet-Era http://hdl.handle.net/10986/30026 |
| Summary: | Over the past two decades Russia
experienced a significant increase in state-financed
entitlements for health care through the Program of State
Guarantees for Medical Care (PSG). The PSG, which is
underpinned by the Constitution was an important element of
the social contract implemented by the State on the back of
rapid economic growth during the 2000s. The PSG is a
universal program with uniform benefits paid for through a
single national pool. The PSG was accompanied by significant
supply side investments to develop a multi-level service
delivery system, substantially increase tertiary care
provision, strengthen the diagnostic capacity of medical
facilities and reduce geographic variations in funding and
services. This case study examines what the increase in
state financed entitlements for health meant for coverage of
the poor in Russia, using the health sector in Russia in the
early 1990s as the starting point. The economic and
political transformations of the early 1990s resulted in a
significant deterioration in health outcomes and financial
protection. Although health outcomes have improved, they
continue to lag behind that of comparator countries. Large
PSG related investments and reforms during the 2000s
supported the achievement of health gains and moderated the
reversal of trends during the fiscal crisis. Fiscal
redistribution has been used to increase resource allocation
to less well-off areas. Increased public spending on
hospital care helped improve access to inpatient care for
the poor, particularly the elderly. Increased investment in
diagnostic equipment at outpatient care facilities is
associated with increased access to tests and services,
albeit only in major cities. A push to reallocate spending
towards primary care increased access to both physicians and
services in rural areas. Limited PSG coverage for outpatient
drug purchases means that OOP drug payments remain one of
the biggest threats to financial risk protection. To
further deepen and expand coverage for the poor, there is a
critical need to narrow the divergence between PSG’s de jure
and actual coverage. In principle, the PSG provides a
uniform benefits package that all Russians are entitled to
under the Constitution. In practice, underfunding and a lack
of clarity over the benefits package lead to implicit health
care rationing through inadequate access to good quality
health care services and affordable drugs and supplies.
Additional fiscal space for health is needed and health
policy must make more effective use of available resources.
Expanding coverage for outpatient drugs and strengthening
primary care are immediate priorities. |
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