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Governance in gridlock in the Russian health system; the case of Sverdlovsk oblast


  • Sheaff, Rod


Epidemiological, demographic and environmental crises, transition to a new political regime and exceptionally severe economic crises were powerful stimuli to health sector reform in Russia. The Russian Federation responded by introducing medical insurance whilst decentralising public administration. Yet despite intense contextual pressures to do so and a new policy climate, Russian hospitals found it difficult to reprofile services and reallocate their resources. A case study analysing governance structures in Sverdlovsk oblast reveals that medical insurance created incentives to reduce costs by reducing bed-days, but if hospitals did so they would lose money under the formulae through which decentralised local government still allocated around three-quarters of hospital income. If instead hospitals tried to increase budgetary income by increasing numbers of bed-days, the insurance system would penalise them. This specific form of policy mess can be called 'governance in gridlock'. The juxtaposition of two overlapping but incompatible sets of governance structures practically immobilised official hospital management systems. It is as one-sided to blame residues of the Soviet system for this gridlock as it is to blame the medical insurance system. Gridlock resulted from the interaction of the two, a problem to which all health system reform is potentially vulnerable.

Suggested Citation

  • Sheaff, Rod, 2005. "Governance in gridlock in the Russian health system; the case of Sverdlovsk oblast," Social Science & Medicine, Elsevier, vol. 60(10), pages 2359-2369, May.
  • Handle: RePEc:eee:socmed:v:60:y:2005:i:10:p:2359-2369

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    References listed on IDEAS

    1. Liu, Yuanli & Rao, Keqin & Fei, John, 1998. "Economic transition and health transition: comparing China and Russia," Health Policy, Elsevier, vol. 44(2), pages 103-122, May.
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    3. Curtis, Sarah & Petukhova, Natasha & Taket, Ann, 1995. "Health care reforms in Russia: The example of St Petersburg," Social Science & Medicine, Elsevier, vol. 40(6), pages 755-765, March.
    4. Sheiman, Igor, 1994. "Forming the system of health insurance in the Russian Federation," Social Science & Medicine, Elsevier, vol. 39(10), pages 1425-1432, November.
    5. Sheiman, Igor, 1991. "Health care reform in the Russian Federation," Health Policy, Elsevier, vol. 19(1), pages 45-54, September.
    6. Cornia, Giovanni Andrea & Paniccia, Renato (ed.), 2000. "The Mortality Crisis in Transitional Economies," OUP Catalogue, Oxford University Press, number 9780198297413.
    7. Pauly, Mark V & Redisch, Michael, 1973. "The Not-For-Profit Hospital as a Physicians' Cooperative," American Economic Review, American Economic Association, vol. 63(1), pages 87-99, March.
    8. McKeehan, I. V., 2000. "A multilevel city health profile of Moscow," Social Science & Medicine, Elsevier, vol. 51(9), pages 1295-1312, November.
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    Cited by:

    1. Gordeev, Vladimir S. & Pavlova, Milena & Groot, Wim, 2011. "Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector," Health Policy, Elsevier, vol. 102(2), pages 270-277.


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