Обеспечение доступности здравоохранения в России: инструменты государственной политики

Abstract

Ensuring the accessibility of healthcare system is formulated as one of the most important tasks of the state policy of Russia in the field of protecting the health of citizens and thus improving human potential. In this article, issues related to theoretical and practical aspects of access to medical care are considered from the point of view of public policy instruments that can be used to improve it. The analysis of methodological approaches to understanding and defining accessibility as a goal of public policy has been carried out. Discussion on the role of public policy instruments is focused on two aspects, namely standardization and health care financing covering both general issues and problems of Russian practice. The analysis of standardization in health care makes it possible to single out different types of standards, namely clinical, managerial-organizational, and behavioral. The article shows both the positive aspects of standardization in ensuring the availability of medical care as well as problems that arise when standards are used in healthcare. An important instrument of state policy that affects the access to medical care is the amount and direction of funding. The paper highlights the growth of personal “out of pocket” expenses of citizens as an important factor limiting accessibility, which in turn makes it important to increase public health financing, primarily as a share of GDP, and to improve the efficiency of using public funds allocated for health care. It is concluded that in order to increase the accessibility of healthcare for citizens in Russia, it is necessary to develop the system of standards, based on strengthening the behavioral component, as well as to ensure a high level of polling resources in healthcare first of all via increase in the amount of public funding.