From variability to uniformity: standardizing tariff agreements as a tool for improving the efficiency of the compulsory health insurance system
https://doi.org/10.17749/2070-4909/farmakoekonomika.2025.336
Abstract
Background. At present, the compulsory health insurance (CHI) system in the Russian Federation is lacking a standardized format for tariff agreements. This leads to significant variability in the structure of documents and, consequently, to errors, low transparency of tariff policy, and financial control difficulties.
Objective: To develop a unified form of tariff agreement in the Russian CHI system.
Material and methods. The research methodology was based on an integrated analysis of the regulatory framework and regional tariff agreements, followed by testing of the developed form in pilot Russian regions.
Results. A unified form of tariff agreement has been developed. This standardized form minimizes the administrative burden on participants in the CHI system, ensures transparency in tariff formation, enables comparative analysis of regional indicators, and optimizes the process of document approval by the Federal CHI Fund.
Conclusion. The introduction of the standardized form for tariff agreements and the digitization of their processing will significantly improve the efficiency of tariff policy management in the CHI system of Russia.
About the Authors
D. V. Fedyaev
Financial Research Institute ; Center for Healthcare Quality Assessment and Control ; Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Denis V. Fedyaev
WoS ResearcherID: W-3848-2019. Scopus Author ID: 57206481925
3/2 Nastasyinskiy Passage, Moscow 127006
6/20 bldg 2 Pokrovsky Blvd, Moscow 109028
2 bldg 1 Barrikadnaya Str., Moscow 123995
O. A. Volkova
Center for Healthcare Quality Assessment and Control
Russian Federation
Russian Federation
Oxana A. Volkova, PhD
Scopus Author ID: 57391349700
6/20 bldg 2 Pokrovsky Blvd, Moscow 109028
S. А. Kovaleva
Financial Research Institute ; Center for Healthcare Quality Assessment and Control
Russian Federation
Russian Federation
Svetlana А. Kovaleva
3/2 Nastasyinskiy Passage, Moscow 127006
6/20 bldg 2 Pokrovsky Blvd, Moscow 109028
E. S. Samsonova
Financial Research Institute ; Center for Healthcare Quality Assessment and Control
Russian Federation
Russian Federation
Elena S. Samsonova
WoS ResearcherID: X-3920-2019
3/2 Nastasyinskiy Passage, Moscow 127006
6/20 bldg 2 Pokrovsky Blvd, Moscow 109028
V. V. Omelyanovskiy
Center for Healthcare Quality Assessment and Control ; Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Vitaly V. Omelyanovskiy, Dr. Sci. Med., Prof.
WoS ResearcherID: P-6911-2018. Scopus Author ID: 6507287753
6/20 bldg 2 Pokrovsky Blvd, Moscow 109028
2 bldg 1 Barrikadnaya Str., Moscow 123995
References
1. Fedyaev D.V., Nikitin F.S., Artamonova T.N., et al. Analysis of tariff agreements of the constituent entities of the Russian Federation: form and completeness of data presentation. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2023; 16 (3): 363–74 (in Russ.). https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.203.
2. Shishkin S.V., Ponkratova O.F. Territorial disparity between tariffs for inpatient care in the Compulsory Health Insurance. Public Administration Issues. 2021; 1: 75–99 (in Russ.).
3. Smirnova E.V. The role of changes in the tariff agreement in the field of Compulsory Health Insurance for assessing the effectiveness of medical organizations. City Healthcare. 2022; 3 (2): 42–8 (in Russ.). https://doi.org/10.47619/2713-2617.zm.2022.v.3i2;42-48.
What is already known about thе subject?
► The tariff agreement (TA) serves as the main regulatory document governing the order of funding of medical services in a specific constituent entity of the Russian Federation. It establishes mechanisms for medical care coverage, tariffs, measures of financial responsibility for failure to fulfill obligations to provide such care within the territorial compulsory health insurance (CHI) program, as well as the scope of services and levels of their financial support
► Despite the requirements established by the Russian Ministry of Healthcare for the structure and content of TA, their form, presentation format, and level of detail are not regulated
► A comparative analysis of TAs in 2022 revealed significant variations in their structure and level of detail, which complicates the analysis of information, reduces the transparency of regional tariff policy in the CHI system, and makes it difficult to assess the effectiveness of budget spending in healthcare
What are the new findings?
► A unified table format was created for regional TA, which will enable standardization of documentation, reduce the number of errors when filling out and checking forms, eliminate ambiguity in the interpretation of provisions, and significantly facilitate automated data processing
How might it impact the clinical practice in the foreseeable future?
► The use of standardized table formats plays a key role in ensuring data comparability between regions, implementing digital transformation, and organizing operational analytical monitoring. This approach is consistent with the current trends in healthcare system modernization and requirements for improving industry management efficiency
► The introduction of unified digital formats for TA creates a fundamentally new methodological basis for managing the Russian healthcare system, enabling an integrated effect. This includes complete transparency in pricing policy, operational monitoring of TA implementation, and automated control of the volume and quality of medical care in accordance with established standards
Review
For citations:
Fedyaev D.V., Volkova O.A., Kovaleva S.А., Samsonova E.S., Omelyanovskiy V.V. From variability to uniformity: standardizing tariff agreements as a tool for improving the efficiency of the compulsory health insurance system. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2025;18(4):513-520. (In Russ.) https://doi.org/10.17749/2070-4909/farmakoekonomika.2025.336
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