The bill, approved by the RF Government, also provides for the following changes in the CMI system:
exclusion of local budgets as sources of financing CMI payments for the non-employed population; making such CMI payments only out of the budgets of the RF subjects;
* preserving insurance medical institutions as the only CMI insurers but complementing it with stricter standards and state control over their activities;
giving insurants the right to chose their insurers;
unification of mechanisms of price formation and payment for medical healthcare within the CMI system.
A significant role in the modernized CMI system is to be played by the RF Pension Fund which shall list all those insured in the CMI system, shall participate in the concluding multilateral agreements process, shall receive and duly check all the respective information necessary to keep personal accounts of those insured.
It is also planned to gradually concentrate in the CMI Federal Fund a greater part of the CMI monies due to proportional changes in the social taxation distributions between the federal and the territorial CMI funds thus making it easier for the Federal Fund to even up financial conditions of CMI system’s practical implementation in different regions of the country.
Unfortunately, fully ignored were the widely discussed proposals to make it possible for those thus insured to voluntarily quit the CMI system should a respective agreement be concluded on voluntary medical insurance with partial use of the CMI premiums as payment of premiums for the said voluntary insurance.
It could be reasonably stated that, on the whole, this bill is offering quite acceptable solutions of the problems peculiar to the existing CMI system. Accordingly, formal adoption of the new law will undoubtedly stipulate transition to the «uniform payer system» for medical services provided to RF citizens at the expense of the state: concentration of the major budget means in the respective CMI funds in the form of premiums for the non-employed population as well as full-tariff-based payments for the services of medical institutions including all kinds of the respective healthcare. These all do stipulate creating the conditions necessary for a better balance of mutual responsibilities in the CMI system framework including also another step towards higher efficiency in the healthcare of the population.
One more step on the way to improving the state control/regulation over functioning of medical-prophylactic institutions was taken this past year. On May 6, 2003, the RF Government passed # 255 Resolution «On Development and Financing Measures as Connected with the State Guarantees in Providing Free Medical Services to Citizens of the Russian Federation Including Control over their Further Practical Implementation». Fully in accordance with this Resolution, the executive power bodies as well as the respective local self-government ones in the healthcare sphere have the right to set up and further detalize work and function tasks for the organizations under them. It is also to be stated that introduction of such work/function tasks does fully correspond to the Civil Code norms which formally regulate relations between organizations and their respective founders. At the same time, however, this Resolution gives the RF subjects’ healthcare executive bodies the right to set up (as approved by the respective local self-government bodies in the field of healthcare servicing) tasks to the municipal healthcare systems including their structural municipal bodies. Yet, correspondence of the said norm to the local self-government legislation still remains somewhat disputable.
The said tasks to the medical institutions include volume indicators of their budget financed activities. In accordance with the set up budget- insurance model of healthcare financing, this, in fact, meant that business planning of virtually all budget-and/or CMI based functioning of medical institutions is to be done by the respective healthcare bodies. The territorial CMI funds shall be made participants of the task-setting commissions to be set up in each respective subject of the Russian Federation. Participation of medical insurance institutions whose main business is to buy medical services from healthcare organizations, in the planning of the respective medical services volumes is nowhere stipulated for at all.
This Resolution opens the way for planning volumes of medical services — not as indicative (framework) planning, although it has been often suggested by a number of experts – but in the framework of the so called «administrative planning». The national, as well as the local healthcare systems do need sufficiently accurate planning of the volumes of the different level medical services provided through the respective budget and/or insurance means. However, such planning is needed rather as indicative, the one targeting buyers of such or other medical services (legitimate healthcare and/or insurance bodies) as well as medical institutions when concluding agreements for concrete volumes of the healthcare services. Regulated should also be the procedures of the respective contractual relationships as to financial risks distribution. Meanwhile the Resolution introduces a system of obligatory tasks for medical institutions not even mentioning the procedure of concluding agreements with any medical institutions. Any somewhat literal application of this Resolution’s norms shall, in fact, turn these agreements into nothing but a mere formality.
The very text of this Resolution is targeted towards restoring the administrative system of managing medical institutions at the regional level as well as at gradual turning of the CMI system into a passive financing source of part of medical institutions’ expenses with regard to the tasks as directed by the respective higher executive bodies. However, such a scheme obviously contradicts the principles and the tasks of developing the healthcare insurance as clearly determined both in the presidential addresses and the respective key-note documents of the Government. So the Resolution under discussion definitely needs either to be fully revoked or at least significantly corrected with regard to task-setting for the medical institutions primarily so as concerns the right of the regional executive bodies to prepare such tasks including, additionally, their respective norms regulating the adopted procedure of combining the framework healthcare services volumes planning with concluding agreements between the medical healthcare services payers and the respective medical institutions.
The year of 2003 witnessed continued experimental testing of the new higher educational establishment admission rules including those with regard to financing of educational establishments. This in the context when problems of reforming the educational system still remained the subject of active public discussion.
Significantly expanded has become the scale of the «Uniform State Examination» experiment (USE), with the number of its RF subjects participants having increased from 5 (five) in the year of 2001 to 47 (forty seven) in the year of 2003 (see Table 46). Accordingly, the quantity of those who successfully passed both the USE entrance and graduation (high school) examinations increased from 30 000 (thirty thousand) in 2001 to almost 700 000 (seven hundred thousand) in 2003 and the number of the general educational establishments where the said USE was to be taken, grew from 2845 (two thousand and forty five) in 2001 to 18130 (eighteen thousand one hundred and thirty) in 2003, while the number of the state higher professional training establishments, including their branches accepting USE entrants, increased from 16 (sixteen) in 2001 to 464 (four hundred and sixty four) in 2003. Much greater has also become the number of the middle level professional training establishments accepting USE entrants: from 79 (seventy nine) in 2001 to 928 (nine hundred and twenty eight) in 2003. Authorization for 20 (twenty) more higher educational establishments and federal bodies was officially done in that same year.
Indicators of the USE Experiment
Number of RF subjects taking part in the USE experiment (units)
Number of students who have passed The USE examination (thous)
Number of the USE exam subjects (units)
Number of universities and/or branches Taking part in the USE experiment (units)
Number of technical schools taking part in the USE experiment (units)
Number of ministries and departments taking part in the USE experiment (units)
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Source: Data of the RF Ministry of Education
In 2002/2003 academic school years, the experiment was closely followed with further development of the respective administrative and material-technical supply normative base:
the respective new normative documents and regulative materials concerning both the contents and procedures for the USE examinations, the RF State Examination and Appeal Commissions have been thoghrally prepared; test and/or measuring materials for 12 (twelve) general education subjects have been developed;
the USE examination technology has been improved;
*further actualization followed with setting up federal and/or regional data bases as to the respective federal level testing the USE results are well on the way;
training of USE specialists (organizers, operators, members of subject commissions, etc) have been completed;
*schemes of the USE experiment, its regional programs, the respective normative, instructive and methodological materials, etc have been prepared in 47 RF subjects;
*defined and implemented have been the schemes for material-technical and financial provision of the RF subject, participants of the experiment, from the funds of the Federal Development of Education Program (FDEP) and the Federal «Development of Unified Educational Informational Environment (2001 – 2005)» Program;
the necessary equipment and communication channels have been supplied to 47 (forty seven) RF subjects;
work have been carried out with 464 higher educational establishments and 928 high schools participating in the experiment (defining the directions and specialities for acceptance according to the USE results, rules of acceptance, procedures of acceptance, the respective federal data bases, etc);
work has been organized for informing the interested educational establishments – participants of the experiment and mass media means on preparation and carrying out of the experiment through the USE informational support portal (www. ege. edu. ru).
Overall USE expenditures from the FDEP funds in 2003 comprised 586, 6 mln roubles; these included payments for preparing the respective examination tests, training of specialists, purchase of the necessary equipment, etc. Average costs per one experimental region in 2003 comprised 12,5 mln roubles (see Table 47).
Expenditures on Conducting the USE
Общие затраты из ФПРО, млн руб.
Затраты в расчете на один экспериментальный регион, млн руб.
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