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Dynamics of Interterritorial Settlements in Mandatory Health Insurance System: Results of 2021–2022 Reforms

Author

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  • Natalya N. Sisigina

    (Financial Research Institute, Moscow, Russian Federation; Center for Healthcare Quality Assessment and Control, Moscow, Russian Federation)

Abstract

In the second half of 2010s territorial mandatory health insurance (MHI) funds faced the rapid growth of spending on medical care provided outside the insurance territory. In 2021–2022 federal regulators introduced a series of amendments to interregional settlements (IRS) mechanism to prevent shortfall in territorial MHI programs. The study aims to assess the impact of 2021–2022 reforms on financial burden related to IRS. Using data from acts on territorial MHI funds’ budget implementation author evaluates regional expenditures and revenues in 2019–2024. To analyze the causes of the changes in spending territorial MHI funds experts’ publications were taken. The findings show significant reduction in both national and regional financial burden. The total spending on IRS fell from 4,9 to 3,7% of subvention for territorial MHI funds. The number of regions with high levels of financial losses (> 5% of federal subvention) decreased from 15–18 in 2019–2020 to 3–6 territories in 2022–2024. A significant contribution in spending lowering came from the transition to direct financing of federal medical organizations.

Suggested Citation

  • Natalya N. Sisigina, 2026. "Dynamics of Interterritorial Settlements in Mandatory Health Insurance System: Results of 2021–2022 Reforms," Finansovyj žhurnal — Financial Journal, Financial Research Institute, Moscow 125375, Russia, issue 4, pages 100-119, August.
    • Handle: RePEc:fru:finjrn:260406:p:100-119
    DOI: 10.31107/2075-1990-2026-4-100-119
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    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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