Transcript The problematic development of private health insurance in

Society, Culture and Politics of Eastern Europe
Conference, 12 and 13 December 2008
The problematic development of
private health insurance in Russia
Benoit Mathivet – CEELBAS SSEES/UCL
A snapshot of the current healthcare
situation in Russia.
• Russians are ill.
• Life expectancy at birth slightly over 60 years in 2006 for
men, 73 for women.
• Public funding for healthcare is low.
• Public spending on health as share of GDP: 3.2% of
GDP in 2005 (WHO-HFA)
• Russians massively pay for healthcare.
• Russian citizens contribute to nearly 40% of total health
spending according to official data.
• This is mainly out-of-pocket, often informal.
• Coverage by voluntary health insurance (VHI) is growing.
The recent development of VHI
Evolutions of sums reimbursed by voluntary health insurance companies, (1000 Rubbles).
2000
2005
2006
Russian Federation
6927511
35287478
39752093
City of Moscow
4510897
25560636
29028919
Source: Healthcare in Russia 2007 – Statistical Agency of the Russian Federation.
between 2005 and 2006.
13.5% growth in Moscow City.
10.2% growth in other Russian Territories.
A very localised development,
mainly in Moscow and large cities.
Sums reimbursed by voluntary health insurance companies in 2006 (1000 Rubbles).
10723174
City of Moscow
All other territories
29028919
Source: Healthcare in Russia 2007 – Statistical Agency of the
Russian Federation.
Aims of the study
• Explain how VHI was integrated in the
Mandatory Health Insurance (MHI) reform of
the early 1990s.
• Analyse how it developed (in parallel or as a
result of MHI failure).
• Provide a clear picture of the current state of
development of VHI in Russia and assess
potential threats for the Russian Healthcare
system as a whole.
The MHI system launched in 1991-1993.
The failure of the MHI system
• Lack of resources due to low level of payroll
contributions: at best, a quarter of total public
resources for healthcare.
• Insurance companies did not compete with
each other and did not improve quality and
cost-efficiency of care.
• The formerly « closed » system remained
developed and accessible for a fee.
The present picture.
A case study: the company Sovita
• Wages the MHI coverage of 5.5 million citizens in 12
different territories, including 800000 citizens in
Moscow.
• Proposes VHI with a wide coverage including GP
visits, emergency care, hospital treatment.
• Options are available for child and mother care.
• Premiums vary with the « prestige » of the
contracting healthcare institution.
• Premiums decline when bought in numbers, hence
targeting corporations providing benefit packages to
their employees.
A potential threat for the development
of the Russian healthcare system.
• Increased inequality of access to healthcare.
• Concentration of ressources in the « closed »
healthcare system.
• Surprisingly: lack of guaranties for VHI
patients.
• A dangerous option for future healthcare
reforms.