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.
Department of Political Science and Public Administration, Virginia Commonwealth University, Richmond 23284-2028, USA. jtwigg@vcu.edu
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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*