Strengthening competitive forces in Russian mandatory health insurance

The Russian healthcare system has experienced significant reforms since the early 1990s. The traditional Semashko system of the Soviet Union was replaced by a more decentralised and insurance-based system, which in turn was augmented and modified several times with the goal to strengthen competitive forces for better quality of healthcare, to open equal access to quality medical care, in particular. Nevertheless, despite these serious attempts, the actual situation is still far from this goal. A serious lack of financial means, and framework conditions, which are not in favour of strong competitive forces, have to be blamed in the first place. In this context, a rigorous formal analysis is applied to provide insight into the competitive forces in Russian mandatory health insurance. The paper investigates first the current system. Thereafter, a modified system with more possibilities of competition will be proposed. Besides an increase in funding, this modified system requires structural changes in comparison to the current system. The results obtained refer to existence of equilibria and their structural, efficiency and fairness properties, which are of relevance for the further development of the Russian healthcare system.