2008年-世界发展银行全球_Public_Spending_in_Russia_for_Health_Care___Issues_and_Options_33页_746kb

Summary of Public Spending in Russia for Health Care: Issues and Options

Core Content

This report provides an analysis of public spending on health care in the Russian Federation, focusing on efficiency, distributional impact, and future considerations for increasing health spending. It highlights the challenges in translating economic growth into improved health outcomes and the need for policy, structural, and institutional reforms.

Main Causes of Poor Health Outcomes

• Non-Communicable Diseases (NCDs): These are the primary cause of premature death and ill health in Russia, including cardiovascular diseases, cancer, and diabetes.
• External Causes: Injuries from traffic accidents, industrial, and domestic incidents are a major contributor to mortality and disability, especially among younger adults.
• Health Disparities: There are significant differences in health outcomes between men and women, and within regions, with women generally living longer than men and people in wealthier regions outliving those in poorer ones.

Health Expenditure Trends

• Low Spending Levels: Russia spends only 5.3% of GDP on health, significantly below high-income countries and the EU-15.
• Historical Context: Public health spending declined by one-third in the 1990s due to the closure of many health facilities and services.
• Recent Growth: In 2006, public health spending increased slightly above pre-transition levels, driven by the National Priority Health Program.
• Future Outlook: With rising incomes, an aging population, and a growing middle class, demand for health services is expected to increase, leading to higher health spending as a percentage of GDP in the medium to long term.

Efficiency of Health Spending

• Comparative Analysis: Russia's health outcomes are comparable to countries that spend 30–40% less on health, indicating significant inefficiency.
• Private vs. Public Spending: Private spending accounts for a large share of health expenditure in Russia, reflecting high out-of-pocket payments and limited outpatient drug benefits.
• Regional Efficiency: There is a wide variation in health care efficiency across regions, with some regions performing up to 100% better than others.

Distributional Impact

• Regional Disparities: Health spending varies significantly by region, with some regions spending as low as 2% of GRP and others up to 15%.
• Income Distribution: There is a strong correlation between income levels and access to health care. Lower-income groups are more likely to face financial barriers to medical services.
• Health Outcomes by Region: Life expectancy and health status are strongly influenced by regional spending, with disparities in both access and outcomes.

Factors Influencing Future Health Spending

• Demographic Shifts: A shrinking working-age population and an aging society will increase pressure on health systems.
• Economic Growth: As the economy grows, there is a potential for increased health spending, but this requires reforms to improve efficiency and effectiveness.
• Sustainable Funding: The report discusses the need to identify new sources of funding and to allocate resources more effectively to meet rising health demands.

Policy and Reform Considerations

• Reform Possibility: Health system reform is considered possible in Russia but requires addressing systemic inefficiencies and improving the quality of care.
• Key Areas for Action: The report outlines several areas for reform, including improving efficiency, reducing disparities, and enhancing the quality of health services.
• Importance of Data: The lack of comprehensive data on health outcomes and outputs limits the ability to fully assess efficiency and distributional impacts, highlighting the need for better data collection and analysis.

Conclusion

The report underscores the critical need for increased and more efficient public spending on health care in Russia to improve health outcomes and reduce regional and income-based disparities. It emphasizes the importance of policy and institutional reforms to align health spending with economic and social development goals.