The evaluation of the balance of standard rates within the program on state guarantees to deliver free medical care to the citizens of the Russian Federation

Aim. The evaluation of absolute and relative difference in the growth of standard rates and financing of medical help based on the calculation for Program on State Guarantees to Deliver Free Medical Care to the Citizens of the Russian Federation (PSG) by the parameters approved by the Decree of the Government for 2019 and 2020.

Materials and methods. The evaluation was performed by the methods of mathematic modeling. Mathematic modeling of the calculation of the volumes of medical help (MH) and financial costs in the subjects of the RF was based on the Decrees of the Government for 2019 and 2020 and the method of calculation of the standard rates specified in the Letter on the economic grounds for territorial PSG. Modeling for each region was used to compare the absolute and relative difference in the growth of standard rates for the obtained values in the absolute and relative expression of the calculated planned parameters of PSG for 2019 and 2020 according to the described method in terms of types, conditions, and profiles of medical help.

Results. It was revealed that the existing standard rates for financial costs did not provide a uniform growth of costs by all the conditions and types of MH. The growth of financing by types and conditions varied from 1.43 to 9.59% of the 2019 baseline in the RF. Certain “specialized” (profile) standard rates within the conditions of MH showed a significant growth at a slower growth of financing of the rest of MH types (3.86% for all-day inpatient service and -0.6% (decrease in financing) for day-time inpatient service). The calculation of the model for the subjects of the RF showed even greater fluctuations: from –0.11% to –3.03% for day-time inpatient service and from 1.35% to 7.27% for all-day inpatients service.

Conclusion. Despite the annual growth of the financing of PSG, redistribution of the budget within the conditions of medical service provision is uneven. This situation provides background for the improvement of the mechanisms of planning of MH within PSG using obligatory modeling and balanced standard rates for the subjects of the RF.

1. Federal Law of November 21, 2011 N 323-FZ (as amended on December 27, 2018) "On the basics of public health protection in the Russian Federation" (as amended and supplemented, entered into force on January 31, 2019) (in Russ).

2. Decree of the Government of the Russian Federation of December 7, 2019 N 1610 "On the Program of State Guarantees of Free Provision of Medical Care to Citizens for 2020 and for the Planning Period of 2021 and 2022" (in Russ).

3. Letter of the Ministry of Health of Russia dated December 24, 2019 No. 11-7 / I / 2-12330 "On the direction of clarifications on the formation and economic justification of territorial programs of state guarantees for free provision of medical care to citizens for 2020" (in Russ).

4. Federal Law of 02.12.2019 N 382-FZ "On the budget of the Federal Mandatory Health Insurance Fund for 2020 and for the planning period of 2021 and 2022" (in Russ).

5. Federal Law of 28.11.2018 N 433-FZ "On the budget of the Federal Mandatory Health Insurance Fund for 2019 and for the planning period of 2020 and 2021" (in Russ).

6. Decree of the Government of the Russian Federation of 10.12.2018 N 1506 "On the Program of State Guarantees of Free Provision of Medical Care to Citizens for 2019 and for the Planning Period of 2020 and 2021" (in Russ).

7. Letter of the Ministry of Health of Russia dated December 21, 2018 No. 11-7 / 10 / 1-511 "On the formation and economic justification of the territorial program of state guarantees of free provision of medical care to citizens for 2019 and for the planning period of 2020 and 2021" (in Russ).