In order to regulate “shuttle;” business and exert a real control over it, the RF government adopted resolution No. 1322 on December 23, 1993 “On the procedure of transportation across the customs border of the Russian Federation by private individuals of goods, which are not intended for production or commercial activity”. The new rule made equal from the point of view of payments ordinary and “shuttle” import. Private individuals could now bring in duty-free goods to the amount of USD 2000. For goods exceeding this quota there was introduced a single rate - 60% of the customs cost.
By the RF Government resolution No. 553 of 03.06.95 the single rate of customs payments was reduced two-fold – up to 30%, however, in order to control under declaration of dutiable value for a number of goods, specific duties (in ecu a piece or kilogram) were introduced. These are clothes and shoes, audio- and video equipment, TV-sets, video games and cartridges for them, toys, leather and fur dress.
In order to restore the budgetary losses caused by cancellation of export duties in 1996, the conditions of transportation to the territory of Russia of goods by private individuals from abroad again tightened. By Resolution of the RF Government No. 808 of July 18, 1996 “On the procedure of transportation across the customs border of the Russian Federation by private individuals of goods which are not intended for production or commercial activity” the rates of duty-free transportation of goods to the territory of Russia by private individuals had been reduced from USD 2000 to USD 1000, on condition that the total weight of goods does not exceed 50 kg. Any commodity items that cost less than USD 10 thousand (weighing no more than 200 kg) were imposed by customs duties by single rate in the amount of 30% of the customs cost, but no less than 4 ecu per 1 kg.
Since January 1, 2004, the Provision came into force on application of single duty rates and taxes with regard to goods brought across the border of the Russian Federation by private individuals for their personal use, approved by the RF Government Resolution No. 718 of 29.11.03. Under the Provision private individuals could bring in goods, without paying customs duties (excluding transport means), which total value does not exceed Rb 65 thousand and which total weight does not exceed kg.
The new wording of the Provision reconsidered the rates of duty-free transportation of luggage by private individuals. From now on, one can bring in goods, without paying customs duties, which total weight does not exceed 35 kg. Also, the frequency of crossing the border of Russia has changed. If before now one could bring in duty-free goods as frequent as once a week, now one can do this only once a month. But nothing has changed with the cost parameters of the imported goods. As before, one can bring in goods without paying taxes and customs duties (excluding transport means), which total cost does not exceed Rb 65 thousand.
The purpose of changes – to create competitive conditions equal for all the participants of foreign economic activity. The existing procedure of goods importation by private individuals made possible for commercial structures to bring in goods without paying customs duties, through the use of “shuttle” businessmen they employed for this purpose. As a consequence, the federal budget could not receive considerable sums of money both from customs and domestic taxation.
Besides, Russia is deeply involved in the process of joining the World Trade Organization, but neither WTO nor the norms of international trade contain the rules of “shuttle” business. In addition, the emerging domestic producers are not satisfied with the goods brought in duty-free to our country via “shuttle” business operations. As luxury goods brought in to Russia are not imposed by excises and the value-added tax, persons with high level of incomes exempted taxation. At last, “shuttle” business – is rather criminogenic. Such goods do not go through needed certification for safety and quality, often infringing goods are brought in to the country. As a result, overstocking of the domestic market takes place with imports of low quality.
Considering the aforementioned, the Ministry of Economic Development and Trade of Russia (MERT) offers to reduce the standard factory values of duty-free importation of consumer goods by private individuals from Rb 65 to 15 thousand since January 1, 2007. MERT had already prepared respective amendments to the Customes Code, now they are being agreed at interdepartmental meeting. The criteria must be clearly stipulated in the bill, under which the customs officers will be able to determine if consumer goods are brought in for sale or for personal use, so that this sanction does not concern people who buy things abroad for themselves, and not for sale.
N.Volovik Priority National Project in the Sphere of Healthcare: Goals and Risks The priority national project in the sphere of healthcare embodies the strategy “money without reforms”. However, the allocation of money resources to individual “problematic zones” without institutional changes is associated with the risk of not to receive the expected noticeable improvements in availability and quality of medical aid for population.
Since September of last year the main efforts of the Government in the sphere of healthcare were concentrated on the preparation and start of implementation of the priority national project. By the way, its name has changed several times in the course of work. First it was “Health”, then “Modern Healthcare”, and at last, since 2006 they began to use in the official documents the word-combination “Priority National Project in the Sphere of Healthcare”. The debates that were held in October in the presidium of the State Council of the Russian Federation about raising the availability and quality of medical aid did not cause any real steps in future on adoption of new laws and the start of reforming the healthcare. It’s true, starting from December the possibility was discussed in the Administration of the RF President of adding the national projects with experiments in pilot regions aimed at advancement of complex reforms in healthcare, education, housing services and the social sphere of villages.
However, up to the end of February no decisions had been taken. It’s clear that the socio-cultural industries that fell into such institutional traps and unwillingness of the power elite to take actions, connected even with small socio-political risk, leave the only possibility of slight softening problems in these spheres: selective financing of individual directions of activity. The strategy “money without reforms” has been embodied in the national priority projects.
Initially, the expenditures on the project from the federal budget were planned at the rate of Rb 58.bn in 2006 and Rb 87.7 bn in 2007. In the approved variant the expenditures on the project in 2006 are increased one and half times, that is, to Rb 88.4 bn, while in 2007 – to Rb 120.5 bn. It is likely, the implementation of the project in 2006-2007 is to demonstrate to population improvement of the state of affairs in most problematic segments of the healthcare system: primary care and highly-specialized medical aid. But constructing a project according to the scheme of money investment in most problematic zones, without conducting institutional changes, bear the risk of not to receive the expected results.
The project provides for an increase of salaries for primary care physicians (primary care physicians, pediatricians, general practitioners) and (working with them) nurses by Rb 10 000 and Rb 000, respectfully. The first payments for the two months had already been made. It was planned that transition to new forms of payment for physicians and nurses of the primary care was to be realized not simply by increasing their salaries, but through introduction of the incentive scheme that associates the size of payment with the results of their work. But all that turned to be wishful thinking. And indeed, it’s a hard task to solve– to develop (in reality) for a short period of time in the ministry the single doctors encouragement scheme for the whole country with all variety of its working conditions for primary care physicians and the health status of the population according to the results of their work.
As a result, the Government took the following decision: the funds provided for raising the payment for labor of the above categories of medical workers should be sent to regions not in the form of inter budgetary transfers, but subventions from the Federal fund of Compulsory medical insurance (CMI) to territorial funds of CMI, and then be allocated to the healthcare institutions on condition of their conclusion agreements with the territorial fund of CMI on the fulfillment of the government instructions on provision of additional medical aid. The institutions conclude, in turn, respective additional agreements to labor contracts with the therapists, sector doctors, general practitioners and nurses working with them. It is recommended to include in 9such agreements conducting of preventive medical examinations, prescribing of pharmaceuticals and making copies for recipients of benefits, etc, conducting of immunization of the attached population, etc.
Thus, raising of salaries of the workers of primary medical care will be associated with increase of the volumes of work fulfilled by them. In this case the major risk is in that the growth of respective volumes of pay would not match adequate improvement of the quality of work of primary care physicians and the indicators of the health status of population, as well as the efficiency of operation of the healthcare system as a whole (rates of morbidity, hospitalization, ambulance calls, average duration of wait in queue on reception, etc.). Doctors may consider this raising of their pay as if injustice was rectified and they were given their due, but not as a thing that calls them to improve the quality and effectiveness of their work. Formal conclusion of agreements (under the project) for rendering additional medical service and imitation of their accomplishment (misrepresentations) is also possible in this case.
Raising the pay for the workers of primary medical care does not mean the same deed in respect of medical specialists. For many regions, where the doctors’ salaries and level of income of the population is low this creates strong incentives for medical specialists and nurses (working with them) to come to work in the primary care. The first signs appear already that this process is mounting. However, it may give rise to emergence of local structural deficits in provision of specialized outpatient care (lack of medical specialists, growth of queues, increase in the share of patients who are forced to refuse of treatment).
The project provides for training and retraining of roughly 13.8 thousand of doctors, who provide primary care, including 3 thousand of general practitioners. However, it’s not clear as yet if the RF subjects assume concrete obligations on employment of the trained primary care physicians. The major risk is in that such reorganization may not take place in adequate scales, and the trained general practitioners will have to operate as ordinary primary care physicians and pediatricians.
Under the project it is planned to spend Rb 29.7 bn to equip no less than 11 thousand out-patient clinics with diagnostic equipment, that is more than a half of their total number. However, this project does not provide for monitoring and analysis of efficiency of use of the supplied equipment. Control over the employment of equipment is imposed on Roszdravnadzor (The Federal Service for Supervision in the Field of Healthcare and Social Development) and the RF Subjects, but neither methodology nor funds wee provided for to conduct efficient monitoring of use of equipment. So, such a control would rather be formal. Distribution to municipalities such equipment upon their requests may cause the risk of their inefficient use, and expectations that the Federal budget must allocate funds for renovation concerning other types of medical equipment.
Under the project, according to additional programs of preventive medical examination as many as 4 mln persons in 2006 and 8 mln ones in 2007 are to be examined. It’s clear that such mass medical examination will lead to increase of the number of sick and the necessity to increase the volumes of work for medical specialists, the volumes of diagnostic studies of institutional care. But no money are provided for under the project for the above. Together with medical specialists’ incentives to come to the primary care, this may lead to worsening of serviceability of specialized outpatient care on the local level.
The main investment component of the project is construction of 15 centers of high-tech medical service. It is also planned to increase the volume of free medical care to patients in the current federal clinics. But there is a risk that despite an increase of the number of centers and the volumes of medical service, both in old and new centers there may emerge a practice of informal payment for treatment.
Also, the effect of growth of volumes of funded by the state high-tech aid will be “smoothed” by standard practice of informal extra-paying by patients to clinics specialists.
Summing up, one may conclude that the implementation of this project is associated with the two main risks:
First, the project, which selectively invests money in the healthcare system (which for a long time suffered shortage of the government financing) and does not provide for considerable institutional changes in the organization of the healthcare system, will increase the number of problematic zones that require growth of expenditures for softening the old and new collisions. Reducing such a risk will require either further considerable growth of budgetary expenditures on the healthcare, or starting institutional reforms.
Second, the project focuses on strengthening the centralized administrative control over implementation of its measures, but does not suggest for most part of tasks changes in the technology of control.