+7 495 989 9610, 9am6pm (GMT+3), Monday – Friday
ИД «Финансы и кредит»






National Interests: Priorities and Security

An integrated approach to assessing the efficiency of health financing in the Russian regions

Vol. 16, Iss. 12, DECEMBER 2020

Received: 17 September 2020

Received in revised form: 5 October 2020

Accepted: 22 October 2020

Available online: 15 December 2020


JEL Classification: I01, I13, I15, I18

Pages: 2264–2288


Krivenko N.V. Institute of Economics, Ural Branch of Russian Academy of Sciences (IE UB RAS), Yekaterinburg, Russian Federation


Shipitsyna S.E. Perm State National Research University (PSU), Perm, Russian Federation


Subject. The article presents theoretical and historical considerations on the emergence of the contemporary healthcare system in Russia, developments in models and forms of public healthcare protection as public and economic constructs change.
Objectives. The study substantiates versatile methodological approaches to evaluating the efficiency of healthcare finance regionally.
Methods. Based on the integrated method of factor analysis, the methodological approach evaluates some components of efficiency, i.e. available budgetary finance and resources, social and medical efficiency. To evaluate each type of efficiency, we determines socio-economic, medical and demographic indicators split into blocks.
Results. We examined the model of the contemporary one-source finance of the Russian healthcare in regions and provided a detailed account of all cash flows and influx. The article analyzes the existing methodological approaches to evaluating the efficiency of healthcare finance, marks a wide spectrum of relevant issues pointed out by contemporary researchers. The technique was tested with the case of the healthcare systems in the Perm Krai, Sverdlovsk Oblast and Samara Oblast, and the comparative approach to evaluating the regional healthcare and the national indicators. Thus, we found critical points and challenging areas in the healthcare systems of the analyzable regions.
Conclusions and Relevance. The methodological approach to evaluating the efficiency of regional healthcare finance we propose is versatile and applicable to the constituent entities of the Russian Federation.

Keywords: healthcare, budgetary finance, available resource, social efficiency, medical efficiency


  1. Poddubnyi M.V., Egorysheva I.V., Sherstneva E.V. et al. Istoriya zdravookhraneniya dorevolyutsionnoi Rossii (konets XVI – nachalo XX v.) [The history of healthcare in pre-revolutionary Russia (late 16th – early 20th century)]. Moscow, GEOTAR-Media Publ., 2014, 248 p.
  2. Dawson W.H. Social Insurance in Germany, 1883–1911: Its History, Operation, Results, and a Comparison with the National Insurance Act, 1911. London, Fisher Unwin, 1912, p. 16.
  3. Kolokolov G.R. [Problems of legal regulation of healthcare and the method of their resolution]. Vestnik Saratovskoi gosudarstvennoi yuridicheskoi akademii = Saratov State Law Academy Bulletin, 2015, no. 5, pp. 184–188. URL: Link (In Russ.)
  4. Aleksandrova O.Yu. [Prospects for the emergence of public healthcare legislation]. Glavvrach = Chief Medical Officer, 2007, no. 3, pp. 11–29. (In Russ.)
  5. Arrow K.J. Neopredelennost' i ekonomika blagosostoyaniya zdravookhraneniya. V kn.: Vekhi ekonomicheskoi mysli. T. 4. Razd. Ekonomika blagosostoyaniya i obshchestvennyi vybor [Uncertainty and the Welfare Economics of Medical Care. In: Russian edition. Milestones of Economic Thought. Volume 4. Economics of Welfare and Public Choice]. Moscow, Ekonomicheskaya shkola Publ., 2004, 568 p.
  6. Bobadilla J.L., Cowley P., Musgrove P. et al. Design, Content and Financing of an Essential National Package of Health Services. Bulletin of the World Health Organization, 1994, vol. 72, iss. 4, pp. 653–662. URL: Link
  7. Asandului L., Roman M., Fatulescu P. The Efficiency of Healthcare Systems in Europe: A Data Envelopment Analysis Approach. Procedia Economics and Finance, 2014, vol. 10, pp. 261–268. URL: Link00301-3
  8. Grigoli F., Kapsoli J. Waste Not, Want Not: The Efficiency of Health Expenditure in Emerging and Developing Economies. IMF Working Paper, 2013, vol. 13/187, 26 p. URL: Link
  9. Medeiros J., Schwierz Ch. Efficiency Estimates of Health Care Systems. European Economy – Economic Papers, 2015, no. 549, 40 p. URL: Link
  10. Roth G.A., Forouzanfar M.H., Moran A.E. et al. Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality. New England Journal of Medicine, 2015, vol. 372, pp. 1333–1341. URL: Link
  11. Sergeeva N.M. [Comparative estimation of expenditure for health in Russia and European Countries]. Azimut nauchnykh issledovanii: ekonomika i upravlenie = ASR: Economics and Governance, 2018, vol. 7, no. 3, pp. 256–259. URL: Link (In Russ.)
  12. Fedotova L.S. [Healthcare as a public benefit and national models of organization of the medical services system]. Vestnik Udmurtskogo universiteta. Seriya Ekonomika i pravo = Bulletin of Udmurt University. Series Economics and Law, 2017, vol. 27, iss. 4, pp. 54–63. (In Russ.)
  13. Banin S.A. [Healthcare in Russia: Financing issues and ways to solve them]. Vestnik Tomskogo gosudarstvennogo universiteta = Bulletin of Tomsk State University, 2012, no. 3, pp. 112–117. URL: Link (In Russ.)
  14. Nazarov V.S., Avksent'ev N.A. [Healthcare in Russia: Problems and perspectives]. Finansovyi zhurnal = Financial Journal, 2017, no. 4, pp. 9–23. URL: Link (In Russ.)
  15. Gorshkova L.V. [Problems of assessing the healthcare costs effectiveness]. Servis v Rossii i za rubezhom = Service in Russia and Abroad, 2017, vol. 11, iss. 6, pp. 137–151. URL: Link (In Russ.)
  16. Grishchenko K.S. [Comparative analysis of factors affecting the efficiency of the health system]. Problemy ekonomiki i menedzhmenta = Problems of Economics and Management, 2013, no. 1, pp. 26–34. URL: Link (In Russ.)
  17. Ovod A.I. [Mortality as a social indicator of effectiveness of investments in health care]. Azimut nauchnykh issledovanii: ekonomika i upravlenie = ASR: Economics and Governance, 2018, vol. 7, no. 3, pp. 217–220. URL: Link (In Russ.)
  18. Bone M. International Efforts to Measure Health Expectancy. Journal of Epidemiology and Community Health, 1992, vol. 46, no. 6, pp. 555–558. URL: Link
  19. Crimmins E., SaitoY., Ingengneri D. Trends in Disability-Free Life Expectancy in the United States, 1970–90. Population and Development, 1997, no. 23, pp. 555–572.
  20. Vlasova O.V. [Assessment of the dependence of budgetary costs on healthcare from the level of economic development in the Central Federal District regions]. Karel'skii nauchnyi zhurnal = Karelian Scientific Journal, 2018, vol. 7, no. 4, pp. 76–78. URL: Link (In Russ.)
  21. Duganov M.D. Otsenka effektivnosti raskhodov na zdravookhranenie na regional'nom i munitsipal'nom urovnyakh [Assessment of the effectiveness of health care expenditures at the regional and municipal levels]. Moscow, Institute of Transitional Economics Publ., 2007, 112 p.
  22. Tatarkin A.I., Timashev S.A., Kozlova O.A., Makarova M.N. [Assessing the impact of factors on the average life expectancy of the population in the municipality (on the example of Yekaterinburg)]. Mezhdunarodnyi zhurnal prikladnykh i fundamental'nykh issledovanii = International Journal of Applied and Basic Research, 2014, no. 9, pp. 128–132. URL: Link (In Russ.)
  23. Yashina N.I., Grishunina I.A., Yashin K.S. [Methods for assessing the effectiveness of budget resource management in healthcare]. Ekonomicheskii analiz: teoriya i praktika = Economic Analysis: Theory and Practice, 2015, vol. 14, iss. 21, pp. 15–24. URL: Link (In Russ.)
  24. Chereshnev V.A., Chichkanov V.P., Kuklin A.A. Ekonomicheskaya bezopasnost' regiona: kombinatorika i balansirovka sostoyanii: monografiya [The region's economic security: The combinatorial analysis and balance of status: a monograph]. Yekaterinburg, IE SB RAS Publ., 2017, 139 p.

View all articles of issue


ISSN 2311-875X (Online)
ISSN 2073-2872 (Print)

Journal current issue

Vol. 17, Iss. 1
January 2021