Obligatory medical insurance in Russia: the participants' perspective.
The Russian Federation adopted a nation-wide system of obligatory medical insurance in 1993 in an effort to earmark a targeted source of funding for health care and to reverse a steep decline in health outcomes. The author conducted a survey in 1995-1996 of managers of two of the new institutional participants in Russia's health insurance scheme: Territorial Health Insurance Funds and private medical insurance companies. The survey results reveal deep dissatisfaction with the level of financing provided by the new system; continuing confusion and substantial regional variation in the implementation of the insurance legislation; fierce bureaucratic and institutional infighting between the major players, stemming primarily from controversy over delineation of responsibilities and ongoing battles for control over resources; promising hints of competition and other market-based incentives emerging from the current chaos; and broad agreement that further structural reform must accompany increased infusions of resources in order for significant systemic improvements to be realized.
Twigg
J L
JL
Department of Political Science and Public Administration, Virginia Commonwealth University, Richmond 23284-2028, USA. jtwigg@vcu.edu
D018166:Health Care Reform; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D007373:Interinstitutional Relations; D011787:Quality of Health Care; D012426:Russia; D011795:Surveys and Questionnaires; D013660:Taxes; D019472:Universal Health Insurance / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*