Alina M. FILIPPOVACorresponding author, Russian Presidential Academy of National Economy and Public Administration (RANEPA), Moscow, Russian Federation filippova-am@ranepa.ru ORCID id: not available
Subject. A mechanism for investing in the development of healthcare infrastructure. Objectives. Development of a concept for the development of healthcare infrastructure in Russian conditions using public-private partnership (PPP) models, taking into account the specifics of healthcare facilities and regions of various types. Methods. To substantiate differentiated approaches to the development of healthcare infrastructure, a classification of Russian regions has been developed that takes into account the level of development of the PPP institutional environment and the financial capabilities of the regional budget. To develop a model of incentive payments to a private partner for achieving medical targets, medical statistics data and compulsory medical insurance rates were used. Results. For healthcare facilities with high commercial potential (sanatoriums, specialized hospitals, outpatient clinics), there are broader opportunities for the application of concession agreements and PPP agreements. For facilities with increased social significance (hospices, orphanages), the use of PPP models is less appropriate, and budget financing and private donations should act as the main financing mechanisms. Regions with a developed PPP institutional environment are able to implement complex concession and PPP agreements even in conditions of budget deficit, including by attracting borrowed funds from the bond market using the mechanism of special project financing companies. For regions with a low level of PPP development, it is preferable to use simpler tools, initially limited to outsourcing non-medical services. Conclusions. When implementing projects for the creation or reconstruction of healthcare infrastructure facilities, it is proposed to include basic and incentive components in the payment of a public partner to a private one at the operational stage of the project. The basic component ensures the return on investment of the private partner and the coverage of fixed operating costs. The variable incentive component takes into account the achievement of medical and social outcomes and links the income of a private partner with an improvement in the health status of the attached population.
Keywords: healthcare infrastructure, public-private partnership, regional development, payment based on results, compulsory medical insurance
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