Europe and Central Asia Knowledge Brief

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This is a regular series of notes highlighting recent analyses, good practices, and lessons learned from the development work program of the World Bank’s Europe and Central Asia Region.

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Restructuring Regional Health Systems In Russia

2010-10, Marquez, Patricio V., Lebedeva, Nadezhda

The delivery of health services in Russia is a federal, regional and municipal responsibility. Reform of the regional health systems, which suffer from over-reliance on curative and inpatient care, deteriorating infrastructure and equipment, and poor quality of services, is a major challenge for the country. From 2003-2008, the World Bank helped strengthen the stewardship capacity of Russia's Federal Ministry of Health and Social Development (MOHSD) and restructure health systems in two pilot regions: the Chuvash Republic and Voronezh oblast. In both regions, hospital bed numbers were reduced while simultaneously increasing service delivery capacity at the primary care, specialized ambulatory, and long-term care facility levels through the introduction of new technologies, clinical protocols, and resource allocation mechanisms that link payments to performance.

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Action Needed : Spiraling Drug Prices Empty Russian Pockets

2010-02, Marquez, Patricio, Bonch-Osmolovskiy, Mikhail

In large measure, this is due to the relatively low level of public health spending in the country (about 3.6 percent of gross domestic product (GDP) in 2008) that underlines the significant gap between the constitutional commitment to a range of medical care services and the actual funding to pay for them. While drugs are supposed to be provided to hospital patients free of charge, an estimated 80 percent of inpatients still have to pay part of the costs of their medicines and most outpatients must purchase them from pharmacies. The outpatient drug program under mandatory health insurance covers only around 16 million people (11 percent of the total population in the country), with more than half of them opting to receive cash rather than in-kind benefits under the 2005 'monetization' of prescription drug benefits. Those who continue with the in-kind benefits appear to be the ones greatest in need of drugs. The situation is further aggravated by the country's ineffective enforcement of controls on wholesale and retail mark-ups for medicines. Household expenditure on drugs accounted for about 30 percent of total health expenditure in Russia, as compared to 12 percent in Organization for Economic Co-operation and Development (OECD) countries in 2008.