Research On The Financial Guarantee Mechanism Of Basic Medical And Health Care In Russia:Based On The Perspective Of Universal Health Coverage

Promoting and protecting health is indispensable for the sustainable development of economy and society,and it is also the human well-being that countries all over the world have been striving for.Although there are many differences in the reform of medical security system in different countries,there is a common trend: the medical security system should gradually develop towards universal health coverage,and the government should play an active and effective role in the financing of medical security.According to the elaboration of universal health coverage in the 2010 World Health Report "Financing of Health System: The Way to Achieve Universal Coverage",universal health coverage mainly covers three contents:how many people are covered? How many services are covered? How much is covered?Whether for a country or the whole world,the two key factors to achieve universal health coverage are the economic accessibility of key health services and the degree of economic risk protection for people who use health services,that is,the raising of public health funds.Countries with different income levels will have different health financial security mechanisms,which will not only affect the fairness and accessibility of their medical and health services,but also have an important impact on a country's health output,human capital status,economic development and social stability.In recent years,Chinese governments at all levels have paid more and more attention to universal health coverage,and adopted a series of measures to effectively improve the fairness of basic medical and health services.However,compared with the rapidly growing GDP,the development of public health services in China lags behind obviously,and many problems remain outstanding.It is a long way to go to improve the fairness,accessibility and convenience of basic medical and health services.In fact,from the basic national conditions,as a developing country still in transition,China has many similarities with Russia in terms of socio-economic development background,transition time and initial conditions,and medical security model selection.However,with the different choices of economic reform paths between the two countries,the reform in the field of medical and health services is also different: China gradually promotes the reform by piloting first and then expanding,while Russia adopts radical reform of "small steps and fast running",especially Putin's ",On October 8,2013,the Russian Minister of Health reiterated in public that Russian citizens will always enjoy free medical services in the Russian Federation,and the number of free medical services will continue to increase every year.This means that Russian citizens will enjoy the same treatment in free medical care,and no one will be turned away from hospitals because of poverty.Although many scholars have doubts about Russia's "free medical care",on the whole,after more than 20 years of reform and development,the average life expectancy of Russia has increased from 63.8 years in the early 1990 s to 73.6 years in 2019,an increase of9.8 years.;The mortality rate decreased from 15.1‰ in 2006 to 12.5‰ in 2019,a decrease of17.3%;Russia's population has also increased significantly,from 143.23 million in 2006 to146.79 million in 2019,an increase of 3.56 million,an increase of nearly 2.5%...In front of these data,we must admit that Russia's financial investment in the field of medical and health services has achieved good results,making the medical services enjoyed by its citizens improve rapidly.Its medical reform process and basic medical and health financial guarantee mechanism are worthy of study,consideration and reference.On the basis of theoretical analysis,this paper combs the development history,organization and management,financing sources and main reform measures of the financial security mechanism of basic medical and health care in Russia.Under the measurement index framework of universal health coverage,this paper constructs a set of index system to evaluate the fairness and effectiveness of medical and health expenditure,and comprehensively analyzes the fairness,efficiency and benefit of basic medical and health expenditure in Russia by empirical analysis methods such as Lorentz curve,Gini coefficient,theil index method,data envelopment analysis(DEA)and econometric regression model.At the same time,combined with the development plan,relevant policies and reform measures of basic medical and health care promulgated by Russia in recent years,this paper discusses the problems existing in the financial security system of basic medical and health care in Russia and its reform and development direction;Finally,on the basis of a deep analysis of the similarities and differences between China's basic medical and health financial security mechanism and Russia's,this paper puts forward some policy suggestions to improve the reform of China's related fields by drawing lessons from the reform of Russia's basic medical and health financial security mechanism.Through the above research,this paper draws the following conclusions:1.Russia's financial security reform of basic medical care in recent 30 years is worthy of recognition.As a country with insufficient fiscal revenue,Russia has been promoting economic development while taking universal health coverage as the ultimate goal of health development,adhering to the concept of universal health coverage of "free medical care",and strengthening the top-level system design in the medical and health field by standardizing the legal system and adhering to the government's leadership;Expand funding sources,increase medical investment,and improve the sustainability of free medical policy;Many reform measures,such as introducing competition mechanism,improving hardware and software facilities,and improving the supply capacity of medical and health services,have ensured that people enjoy basic medical and health services free of charge.After nearly 30 years' reform of medical and health financial security mechanism and continuous financial input,the basic medical security system framework covering the whole people in Russia has taken initial shape,the medical financing and security level have been continuously improved,and the people's health level has been continuously improved.The reform of medical and health financial security has achieved positive results,which has significantly enhanced people's confidence in the national medical service system.2.The existing financial guarantee mechanism for basic medical care in Russia is still the product of an unfinished reform.From the empirical analysis of the measurement index system of universal health coverage,Russia's basic medical and health expenditure is fair and pays more attention to the inclusive effect of medical and health services,but there is still a certain gap between expenditure efficiency and benefit compared with developed countries,and there are still some obvious problems: for example,the total amount of government health investment is insufficient,and the sustainability of health investment is facing challenges;The structure of government health investment is not reasonable,and the fairness of health service needs to be improved;The efficiency of government health investment is low and the health service capacity needs to be further improved.Therefore,Russia has carried out a series of new medical and health financial security system reforms with improving people's livelihood and comprehensively promoting health coverage for the whole people as the core,for example,introducing national plans and projects,promoting the development of medical and health undertakings,adjusting and perfecting the structure of health expenditure,optimizing the mode of health financial transfer payment,reforming the mode of management of medical and health budget funds,and promoting the efficiency of the use of medical and health funds,so as to further enhance the accessibility,fairness and effectiveness of medical and health services in Russia.3.The experience and lessons of Russian medical and health financial security reform have important practical reference and enlightenment for promoting universal health coverage in China.The experience of health system development in countries all over the world shows that in the process of promoting universal health coverage,every country,regardless of its national economic and social development level,can formulate the vision,strategy and action to achieve universal health coverage according to its own situation.Universal health coverage has nothing to do with the country's financial resources,but with a country's concept of health service for residents and its continuous political and financial support.For China's medical system reform,we can't blindly imitate and copy the medical security model of other countries.Only by choosing a medical security system suitable for our country's politics,economy,society and history and culture,can we consider the financial security mechanism of China's basic health expenditure and its construction from a realistic perspective on the basis of respecting history and national conditions,so as to promote the process of universal health coverage more effectively.By studying the reform of the financial guarantee mechanism of basic medical and health care in Russia,we can see that in the process of promoting universal health coverage,Russia constantly explores according to its national conditions,adheres to the government's responsibility of "supporting the bottom",pays attention to humanistic care,undertakes the necessary transition costs,uses its limited financial resources for universal health coverage,and walks out of a road of free medical care for all.Significant achievements have been made in ensuring the national demand for basic medical services,alleviating the population crisis,and stabilizing social development,among which the experiences and lessons have important reference and enlightenment significance for China,which has a similar transformation experience,a long tradition of collectivism,and emphasizes national capacity and responsibility.On the one hand,in the process of medical reform,we should fully realize the importance of "five key elements" in realizing universal health coverage,that is,insisting on government leading and supporting is the foundation,perfecting the legal system is the foundation,increasing financial input is the key,realizing the integration of medical security system is the core,and strengthening the performance management of health fund budget is the guarantee;On the other hand,we should pay close attention to and guard against some problems in the process of medical and health financial security reform in Russia,learn from them,and handle the "three important relationships",namely,handle the relationship between the central and local governments in basic medical and health financial security,handle the relationship between the government and the market in basic medical and health supply,and handle the relationship between supply and demand in the allocation of medical and health resources.The innovation of this paper lies in:First,This paper focuses on the basic medical and health services and their financial security in Russia,and comprehensively analyzes the course,effects,problems and directions of the reform of the basic medical and health financial security in Russia through the intersection and integration of health,economy,social security and finance.By summarizing the experiences and lessons of Russia,it puts forward relevant suggestions and suggestions,which provide a useful reference for solving similar problems in the process of promoting universal health coverage in China,and makes the paper have certain innovative value in research perspective and research contentSecond,Based on the measurement index framework of universal health coverage,this paper constructs a set of index system to evaluate the fairness and effectiveness of medical and health expenditure,and systematically studies the fairness,efficiency and benefit of Russia's basic medical and health expenditure by Lorenz curve,Gini coefficient,theil index method,data envelopment analysis(DEA)and econometric regression model,so as to objectively evaluate the financial guarantee mechanism of Russia's basic medical and health expenditure,broaden the performance evaluation thinking of medical and health expenditure and make the analysis process of the paper fuller.