History of health economics. The influence of a market economy on healthcare The mechanism of market relations in healthcare

Macro means big. Macroeconomics deals with large-scale properties and institutions that characterize the system as a whole. People become an economic system only when they enter into exchange relationships with each other.

In doing so, they create a whole that is greater than the sum of its parts, establish a government to determine the rules by which trade will operate, and create a special vehicle, money, for carrying out trade. In macroeconomics, it is customary to evaluate gross domestic product (GDP) as an indicator of economic activity on a national scale, its increase (growth) or contraction (decline), and the dynamics of the processes through which these changes occur (investment, trade, unemployment, bankruptcy). Rather than examining the income of an individual or firm, macroeconomics examines the growth and distribution of income as a whole. Macroeconomics seeks to determine the number of rich and poor people, whether the same people belong to the same socioeconomic groups over time, and whether the difference between them is growing or shrinking as a measure of economic inequality.

Macroeconomic (systemic) processes

Dynamics

Distribution

Macroeconomic (systemic) institutions

Government

Health care macroeconomics examines the interrelationship of large-scale system indicators concerning (a) spending, employment, and other factors affecting health care as part of the economy and (b) biological indicators of the health of the population as a whole and their relationship to economic changes. Thus, it should study how growth in gross domestic product affects the number and income of doctors, as well as the health (life expectancy, morbidity) of the population and, accordingly, how increasing life expectancy affects treatment costs (medical care) and GDP growth .

Characteristics of the health care system

Institutions in the healthcare system

Medical professions

Hospitals and medical organizations

Financial structure (insurance and compensation)

More on topic 13.1 What is healthcare macroeconomics?:

Contemporary voices in psychology What is the development of perception - an innate or socially conditioned process?

Lecture topic No. 1. Health economics as a science

and subject of teaching.
Questions:

introduction to economic theory;
economic foundations of health care;
reasons for distinguishing health economics as an independent science;
the place of health economics in the structure of modern economic sciences;
subject and tasks of health economics;
methods used in health economics;
the role and place of healthcare in the country's economy;
economic problems of health care development.

Introduction to Economics

The term “economics” itself is translated from Greek literally as the art of housekeeping.

The subject of economic science covers commodity-money, market relations that take place between producers, sellers of goods or services and their buyers. These relations also include property relations associated with the formation and transformation of property, the transfer of property from one owner to another. The most important objects of study of economic science are labor, labor relations, forms of remuneration, and the efficiency of labor activity.

Economic science is designed to provide answers to questions of interest to society: “What to produce?”, “How to produce?”, “How to use the produced product?”, “How to achieve a balance between production and consumption?”

Thus, the economy can realize itself only in a system of relationships between people. These can be either industrial relations or relationships of an interpersonal or family nature. Interpersonal relationships involve solving economic problems such as work or employment issues. Understanding these problems will make it possible to solve family economic problems, namely: warmth and comfort in the home, fashionable and modern clothing, providing the family with high-quality and nutritious food. But we are more interested in industrial relations between people.

Relations of production- these are objective relations, independent of the will and consciousness of people, regarding the production of material goods, their distribution, exchange and consumption.

The diverse activities of people in the production, distribution, exchange and consumption of various goods form what is called the “economy” or “economic system”.

Industrial relations at the level of society are relations in a broad sense, in other words, they are social economic relations. In this regard, one of the definitions of economics can be given.

Economy is a social science that helps solve economic, social and political problems facing society and people in particular.

All these provisions and definitions from basic economic theory, with some amendments and clarifications, can be applied to health care economics.

Economics of Health Care

Healthcare economics studies and develops new forms and methods of healthcare management, which allows for the most efficient use of material, human, financial and other resources in the industry, which is why economic knowledge is so necessary for managers of healthcare organizations.

Knowledge of economic laws is also extremely important in the work of practicing doctors, since in market conditions doctors, in fact, are sellers of medical services, choosing rational schemes for examining and treating patients.

Practitioner must understand issues of financing public, insurance and private medicine. A doctor must be able to calculate the cost of medical services, make an estimate of the institution’s income and expenses (regardless of the form of ownership) and be able to manage his profits. He must know and adhere to the quality standards of medical care, be able to assess the economic efficiency of his activities, as well as the forms of remuneration of medical workers used in various countries, their advantages and disadvantages.

It has now become obvious that every doctor must consider his work not only from a professional, but also from an economic point of view. However, this position was unacceptable for a long time. It was believed that problems of protecting public health were the object of study only by the biomedical and social sciences. However, over time, interest in issues of protecting and promoting the health of citizens increased, which neither medical nor social sciences could solve in isolation. It has become recognized that health is not only a social category, but also an economic one, despite the fact that, according to its primary nature, it does not belong to commodity-money categories and does not represent a product sold and purchased on the market. Health, accordingly, does not have a market price, although it has the highest value for society and the individual. At the same time, it is necessary to spend material and other resources to maintain, strengthen, and restore health. Health, therefore, has value, which allows us to consider it indirectly as an economic category.

Therefore, when they say that health is expensive, they again mean the costly side, i.e. large expenses associated with maintaining and restoring lost health. Health Communication with the economy and social side of people’s lives is also manifested in the fact that the level of health as a medical, demographic and social category represents an important component of the socio-economic concept of “standard of living of the population.” The state of people's health depends significantly on how people live, what goods they consume, and what their standard of living is. At the same time, people’s lifestyle and quality of life also reflect their health status – the better the health, the higher the quality of life, and vice versa.

We also cannot agree with the fact that healthcare is traditionally classified as a non-productive sector, as a sector of non-material services. Medicine combines commodity-material and spiritual-informational activities. In this sense healthcare can be called the “branch of preservation and production of health”, giving this concept a broad meaning, and consider it as preserving and strengthening people’s health through the use of a large set of medical, general health, epidemiological methods and means.

Taking into account Having said this, problems naturally arise such as:

valuation of health as the most important component of national wealth and a factor in the economic growth of the state;
the price of an individual medical service and the cost of types of medical care in general;
assessment of the resource potential of healthcare and the search for new sources of its formation;
the effectiveness of the functioning of the healthcare industry and the development of economic relations in the conditions of transition to a market.

Even this very short list of economic health problems confirms that not a single established science is able to study them in full. What is needed is the “docking” of a variety of areas of knowledge and the creation on their basis of what is essentially a new scientific discipline—health economics. This science is designed to study the economic problems of health care in close connection with medical, biological and social aspects.

The development of the healthcare economy should be carried out, first of all, in the direction of improving the planning and financing of the industry and ensuring multi-channel financing. This is especially relevant given the fact that currently money for healthcare comes from various sources: budgets of all levels, compulsory and voluntary health insurance, funds from charitable organizations and sponsors, personal funds of citizens, income from business and other activities of healthcare organizations not prohibited by law .

1.3. Reasons for distinguishing health economics

into an independent science
There is an opinion that health economics has begun to attract the attention of researchers only in recent years. At the same time, certain issues of health care economics sound new, despite the fact that they have been discussed before. Let's look at history to understand how true this is.

The first attempts to study the economic damage from morbidity include studies by V.V. Favre (1903), who determined the costs of treating patients with malaria and the economic damage from loss of working time due to illness.

In 1911, Russian medical scientists made an attempt to determine the economic damage from excessive morbidity and mortality based on an analysis of the monetary costs of treatment, lost wages of workers, as well as labor losses associated with mortality in working age.

After 1917, with the formation of the People's Commissariat for Health, much attention was paid to saving money in Russia. Explaining the policy of austerity in healthcare, the first People's Commissar of Healthcare N.A. Semashko pointed out: “If we can and should cut (save) expenses in every possible way in economic activities, in the administrative apparatus, then we must be extremely careful about expenses for a sick person, since improper savings can most sensitively affect the interests of the patient and even disrupt the matter of improving the health of the population. Such an austerity regime will only be to the detriment of the patient and must be vigorously protested against.”

As an independent science, healthcare economics was formed in the second half of the 20th century, and due attention to this discipline began to be paid only in the 90s of the last century, in connection with the transition to the principles of a market economy.

The emergence of health economics as an independent scientific field is due not only to the need to increase the effectiveness of measures to preserve people’s health, but also to the involvement of increasingly numerous resources for the normal functioning of the industry.

Among the main The reasons for separating health economics into an independent science are the following:

Firstly, it was in the 20th century that healthcare emerged as the largest sector of the country’s economy. It has become one of the resource-intensive industries that accumulates a large amount of material, labor, financial, information and other resources. In this regard, naturally, the problem of rational planning and effective use of these resources has arisen;
secondly, with the development of modern medical science and technology, the volume of medical services offered and, accordingly, the demand for them has increased, so there is a need to regulate supply and demand in healthcare in a market economy;
thirdly, it was in the 20th century that the role and place of healthcare in the social production system changed. The integration of healthcare with other sectors is expanding, which has a positive effect on the efficiency of the healthcare system itself;
fourthly, healthcare, shaping public health and influencing the potential of the workforce, has become increasingly involved in reproduction processes. It was in the 20th century that healthcare began to be considered as a promising sector for investment of private or public capital in programs related to improving the health of the population, which is economically profitable and brings real income to society;
fifthly, the transition from a planned to a market economy, the formation of market relations in healthcare led to the operation of such general economic laws in the healthcare system as the law of supply and demand, the law of increasing marginal costs, etc.

All of the above predetermined the formation of a new scientific discipline - “health economics” - and necessitated the training of specialists in this field.

1.4. The place of health economics in the structure of modern economic sciences
Currently There are four main areas in the structure of economic knowledge:

1. – economics (economic theory) as a basic, fundamental scientific discipline;

2. – sectoral economic sciences, the tasks of which include the study of the characteristics of economic processes in a certain industry (this also includes healthcare economics);

3. – applied economic sciences: accounting, finance and credit, management, marketing;

4. – special economic sciences, developing at the intersection of economics and other humanities and natural sciences: economic geography, economic history, economic statistics, business law, etc.
Health Economics is a branch of economic science that studies the effect of objective economic laws, as well as various conditions and factors influencing the level of satisfaction of the population’s needs for maintaining and promoting health.
Naturally, health economics is developing in close connection with other related economic sciences. Health economics borrows terminology and basic economic laws from economic theory.
1.5. Subject and tasks of health economics
In healthcare, as in any other field of knowledge, professional and economic aspects of activity can be distinguished. The professional aspect is the purely medical side of the activity. Economic – involves the study of economic processes in medical activities.

Indeed, no type of professional activity can be carried out in isolation from economic activity. The success of preventive, therapeutic and diagnostic activities, as well as the solution to many problems that currently exist in this industry, depend on solving the economic problems of healthcare.

Consequently, healthcare economics can be defined as a complex of economic knowledge about the forms, methods, and results of economic activities in the field of protecting public health.
The subject of economics healthcare are economic relations that arise and develop between people in the process of providing medical services. Relationships between people in professional activities can be divided into two groups: organizational-economic and socio-economic.
The nature of organizational and economic relations is determined by the technology of the preventive, treatment and diagnostic process itself and reflects the common features inherent in all types of medical institutions (hospitals, clinics, diagnostic centers, etc.). An example of organizational and economic relations is the system of financing medical institutions, which includes the methodology of budget formation, cost accounting, remuneration, pricing, etc.

Analysis of socio-economic relations makes it possible to identify specific, special features of the economic activities of healthcare organizations that operate in different conditions and in different organizational and legal forms (state, municipal, private, etc.). For example, the size and procedure for calculating wages differ significantly in these institutions with the same volume and quality of medical services provided.

Economic relations can be considered at four levels:

metaeconomic;
macroeconomic;
mediumeconomic;
microeconomic.

Metaeconomic(world-class. At this level, interethnic economic relations of healthcare systems of different countries are formed with their integration into the world economy. The coordinator of these processes is the World Health Organization.
The following tasks are solved here:

development, economic justification and financing of targeted programs for the prevention and control of major infectious and non-infectious diseases;
coordination and integration in the development of modern medical technologies, production of medicines and medical equipment;
financing of biomedical research and training of specialists.

Macroeconomic(federal) level is the interaction of the healthcare system with other sectors of the national economy. At this level, relationships develop within the national economy, primarily in those sectors that are directly related to healthcare.
The following main tasks are implemented here:

determination of the share of government spending on health care (percentage of GNP);
development and economic justification of federal target programs in the field of public health;
development of mechanisms to ensure a balance between the volume of state guarantees in providing the population with free medical care and the financial capabilities of the state;
development and implementation of a system of strategic planning and financing of health care;
development and implementation of healthcare investment policy;
development of a legislative framework to create a competitive environment in the medical services market;
development and economic justification of a program of state guarantees for the provision of free medical care to citizens of the Russian Federation.

Mediumeconomic(regional) level – these are economic relations within the health care system itself.
At this level, the following tasks are developed and solved:

determining the share of healthcare costs in the consolidated budget of a constituent entity of the Russian Federation;
development and economic justification of territorial programs of state guarantees for the provision of free medical care to citizens of the Russian Federation;
economic justification for the need of the population of a constituent entity of the Russian Federation for various types of medical care and prospects for the development of a network of healthcare organizations, taking into account demographic characteristics, structure and morbidity level of the population;
formation of a per capita standard for financing the healthcare system of a constituent entity of the Russian Federation;
improving financing mechanisms for individual organizations and the health care system itself at the regional level;
control over compliance with the norms and rules of budget and tax legislation;
analysis of the cost-effectiveness of using health care resources;
creation of monitoring of financial and economic activities of the healthcare system.

Microeconomic(institutional) level covers the activities of each individual treatment and prevention institution and its structural divisions.
At this level the following tasks are implemented:

analysis of the cost-effectiveness of resource use in a separate healthcare organization;
maintaining accounting, tax and statistical records;
implementation of a system of municipal, state orders and contracts for the provision of free medical care to the population;
attracting additional (non-budgetary) funds to finance healthcare organizations;
formation of the budget of healthcare organizations.

In fact, the tasks of these four levels are closely interrelated and, as a rule, are solved in a comprehensive manner.
1.6. Methods used in health economics
Methodological The basis of health care economics is a fundamental economic theory on the basis of which the actions of economic laws and the development of economic relations in health care are studied at various stages of the evolution of society.
In health economics The following methods are widely used: mathematical and statistical, analysis and synthesis, balance sheet, forecasting, economic and mathematical modeling, economic experiment, etc.
Mathematical and statistical methods help to reveal the quantitative relationship between phenomena.
Analysis and synthesis. In the process of analysis, the phenomenon under study is divided into its component parts. Synthesis involves the integration of the obtained data in order to identify the most significant patterns. For example, when conducting an experiment to introduce new forms and methods of management in different regions of Russia, a lot of experience was accumulated, which required in-depth analysis and assessment. At the next stage, it was necessary to use the synthesis method in order to highlight positive and negative results common to all regions and to outline further ways to improve the organization and economics of healthcare management.
The balance sheet method is a set of methods of economic calculations. It is used to establish a strictly defined quantitative relationship between any components of the process (for example, the relationship between supply and demand for medical services, for different types of medicines and medical equipment, financial resources, between the revenue and expenditure parts of the budget, etc.). The scheme of economic balances is built on the principle of equality of quantities: resources and possibilities for their use, taking into account the creation of reserves. The latter is very important, since without the presence of reserves in conditions of an acute shortage of resources, one or another functional link of the healthcare system may fail, which is fraught with serious medical and social consequences.
Economic and mathematical modeling is the reproduction of economic objects and processes in small, experimental forms. In economics, mathematical modeling is more often used by describing economic processes with mathematical dependencies. A model of an economic object, as a rule, is supported by real statistical data, which allows one to make forecasts and carry out objective assessments. This method is especially important given the introduction of new economic relations in healthcare, subject to the laws of a market economy.
Forecasting is a scientific prediction of the most likely changes in the state of the healthcare industry: the need for medical services, the production capacity of the medical industry, directions of technical progress, etc.

At the same time, the construction of probable forecasts for the development of the industry should correspond with forecasts of changes in the health status of the population.

Economic experiment. One of the currently widespread methods is economic experiments. They are reasonable and necessary. The search for certain methods of increasing the efficiency of the health care system using the example of several regions or individual medical institutions is of great practical importance. The experimental method allows us to find and test new financing schemes, forms of remuneration for medical workers, pricing mechanisms, and new forms of providing preventive, therapeutic, diagnostic and rehabilitation care to the population.

1.7. The role and place of healthcare in the country's economy
As mentioned above, there is a close relationship between the level of population health and the state of the state’s economy, which is studied, in particular, by health care economics.

The relationship between healthcare and the economy of the entire country’s economy must be considered in two main aspects:

The first is the impact of health and healthcare on the level of well-being of the population and economic development.

The second is the impact of economic development of society on people's health and healthcare.

Thus, we can give another definition of health care economics - this is a branch economic science that studies the economic laws of interaction between health care and the economy of the entire country, as well as the formation, distribution and use of material, labor, financial, information and other resources in health care in order to preserve and strengthen the health of the population .
The work of healthcare workers does not create direct material values, however, the impact of healthcare on the development of the country's economy occurs due to an increase in labor productivity by reducing morbidity, mortality (primarily in working age), temporary and permanent disability, and improving health in general. On the other hand, the well-being of society affects people's health.
Welfare – This is a measure of people’s provision of vital goods and means of subsistence. UN experts believe that the level of well-being of a society can be assessed using the human development index, which includes:

per capita income;
average life expectancy;
infant mortality;
literacy level of the population.

Thus, the richer the state, the more funds it can allocate for health protection, labor protection, improvement of the environmental situation and living conditions, which will undoubtedly lead to a healthier population, an increase in the period of active labor activity of people, an increase in labor productivity and, in general, , to the steady growth of the country's national income.

To illustrate, I will cite the results of a scientific study conducted to determine the relationship between certain indicators of public health and the well-being of the country. All countries of the world were divided into three groups:

economically highly developed countries;
countries of the former socialist camp;
developing countries.

Two of the population health indicators were taken: average life expectancy and infant mortality (table).

Table. Comparative characteristics of the influence of state welfare on population health indicators

I will give a number of indicators characterizing the standard of living of the Russian population in 2000.

The share of the population with incomes below the subsistence level is 31.8%.

The average amount of the assigned pension (including compensation payments) is 694.2 rubles.

The average salary (all sectors) of the economy is 2,508 rubles.

The average salary of healthcare workers is 1,460 rubles.

The value of gross national product (GNP) per capita in 1998 was $2,300, which placed it 101st among other countries in the world (for comparison: USA - 29,340; Japan - 32,380; Germany - 25,850).

Economic problems of health care development

Among the many problems that have accumulated in healthcare, at the present stage the following main groups can be distinguished: (film):

First group problems associated with finding the optimal balance between paid and free in healthcare. Taking into account the fact that this problem is not only economic, but, above all, political and social in nature, its solution depends on a complex of factors:

the need to comply with constitutional norms to protect the health of citizens;
level of solvency of citizens;
the volume of resources allocated by the state to ensure the normal functioning of the healthcare system and provide the population with guaranteed (free) medical care;
the chosen healthcare model (budgetary, budgetary-insurance, private).

Second group problems are associated with the need to improve the system of payment for medical care, operating in conditions of an acute shortage of financial resources. At the same time, the remuneration system should:

ensure the priority of preventive health care;
contain the currently costly financing mechanism;
focus on the development primarily of primary health care;
ensure processes of restructuring (optimization) of the network of health care institutions (number, profile, capacity) taking into account the real needs of the population for outpatient, polyclinic and inpatient care and the priority of developing hospital-substituting forms of medical care;
ensure minimization of administrative costs of the financier and in the healthcare organizations themselves;
lead to an increase in remuneration for medical workers, taking into account the volume and quality of work performed.

Third group problems are associated with the need to determine the optimal combination of planned and market mechanisms in healthcare. The relevance of this problem is emphasized by the fact that:

In healthcare in Russia today there is no clear legislative and conceptual basis for a reasonable balance between planned and market mechanisms for managing the industry and its financing:
The transition to a budget-insurance model of healthcare reform, on the one hand, created the need to strengthen the role of the state in the system of measures to protect the health of citizens. On the other hand, market economy mechanisms are being formed (the emergence of healthcare organizations with different forms of ownership, elements of market pricing for medical services, the establishment of contractual relationships between business entities, limiting government intervention in the activities of healthcare organizations, etc.).

Fourth group problems are associated with the need to assess the medical, social and economic effectiveness of healthcare. It should be emphasized that these problems in healthcare become particularly complex due to the following circumstances:

the lack of generally accepted criteria for assessing the medical, social and economic effectiveness of healthcare in general and medical and social programs in particular;
the lack of a unified methodological basis for conducting a comparative analysis of the effectiveness of indicators.

Fifth group problems are associated with the need to create financial and economic monitoring in the industry. This is due, first of all, to the need:

creating mechanisms for the “transparent” passage of financial resources in the healthcare system;

Health Economics

Federal Agency for Education

higher professional education

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Test on health economics.

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Health economics is a branch of science that studies the place of health care in the national economy and develops methods for the rational use of resources to ensure the protection of public health.

Economics as a field of scientific knowledge arose in very distant times. The author of the term “economics,” Aristotle, studied economic processes 2300 years before the present day.

only in the second half of the 20th century (50s). This was due to the following circumstances:

economic relations in healthcare, which led to the formation of a separate area of specific economic knowledge - healthcare economics.

Secondly, it was at that time that the problems of medicine and healthcare began to be considered from the point of view of the economic efficiency of the organization and activities of various health services in order to obtain the desired results with the least material, financial, labor and other resources, since healthcare is a resource-intensive sector of the economy.

Thirdly, it was in the middle of the 20th century that the importance of economic problems arising from the reproduction of the labor force and the relationship of healthcare with other sectors of the economy was realized. Consequently, investments in the development of the human factor, in programs related to the protection and promotion of public health, are economically justified and, ultimately, bring “income” to society as a whole.

Currently, serious steps are being taken in the development of healthcare economics as an independent science. This is facilitated by the emergence and development of market relations, processes of commercialization of healthcare, manifested, in particular, in the growth of the volume of paid services to the population. In addition, the health insurance system is being developed. All this causes an actual change in the economic situation of a medical institution, which acquires the features of a “service-producing” enterprise. A change in the status of a medical institution leads to a change in the nature of all economic ties and relationships that are established in the process of practical activities of medical institutions, which are increasingly forced to operate on a commercial basis, taking into account the principles of self-sufficiency.

In addition, a condition and at the same time a consequence of the development of market relations is the emergence of a multi-structure in healthcare, when the functioning of medical institutions with different forms of ownership has become real.

The economic result of the activities of health care facilities as a whole, as well as the level of their material remuneration, depends on the quantity and quality of their work. Health economics is the study of all these processes in modern healthcare.

Before formulating the subject of health economics, it should be noted that when analyzing the economic problems of health care, it is important to consider it, on the one hand, as an area of human activity, and on the other, as a branch of the economy.

In healthcare, as in any other area of human activity, professional and economic aspects can be distinguished. Professional - constitutes the substantive aspect of medical activity. The economic side presupposes the economic forms within which this professional activity is carried out. Indeed, no type of professional activity is carried out in isolation from any specific economic form. These aspects of activity exist in inextricable connection under any conditions, in any society.

The success of the professional activities of medical workers and the solution to many problems that currently exist in this sector of the economy depend on the solution to the economic problems of healthcare.

Health care economics studies the economic forms of medical professional activity, which in modern conditions has significant scientific and practical significance.

The subject of healthcare economics is economic relations that objectively develop and arise between people in the process of providing medical services, i.e. medical professional activity.

These relationships are divided into two large groups. The first group is called organizational and economic relationships. Their character is determined by the technology of the treatment and prophylactic process itself and reflects the common features that the entire set of medical institutions of this type has (all hospitals, all clinics, all diagnostic centers, etc.). An example of organizational and economic relations is the system of financing health care facilities (including the principle of determining tariffs for medical services, the procedure for mutual settlements, etc.).

Another group of relations is called socio-economic relationship. Their analysis makes it possible to identify specific, special features of the economic activities of medical institutions that operate in various conditions (public, private, cooperative, joint-stock, etc.). For example, the size and procedure for calculating wages differ significantly in these institutions with the same amount and quality of medical services provided.

Both of these groups of relations are closely interconnected. Their study allows, for example, to choose the optimal economic and legal model of entrepreneurial activity in healthcare at a certain stage of its development.

Depending on the level at which economic relations are considered within or outside the health care system, they can be divided into macro-, micro- and midi-economic.

At the macroeconomic level, relations develop within the national economy as a whole and, above all, in those industries that are directly related to healthcare, and there are about thirty such industries. Thus, macroeconomics examines the interaction of the healthcare system with the state and society as a whole and with other sectors of the national economy.

The microeconomic level covers the activities of each individual medical and preventive institution, enterprise, its units and structures.

At the midi-economic level, economic relations within the healthcare system are studied as a sector of the economy, consisting of a number of sub-sectors, industries and specializations related to solving one functional problem - protecting and promoting the health of the population.

Goal and objectives of healthcare economics in modern conditions

A). The general goal of economics and the organization of the healthcare system is the study of economic and organizational relations that objectively arise between people in the process of carrying out medical professional activities.

b). The subject of health economics is the development of methods for the rational use of resources to achieve goals in protecting public health.

V). The designated relations are formed in two planes: organizational-economic and socio-economic.

– Organizational and economic relations. Their nature is determined by the technology of the treatment and prophylactic process itself and reflects those common features that are inherent in the entire set of medical institutions of this type (hospitals, clinics, diagnostic centers, etc.).

private, cooperative, joint stock, etc.).

Definition: The object of the study of health care economics is the economic practice of the health care system and medical activities, which is carried out in certain organizational and economic forms. It should be noted that:

A). From economic theory, health economics borrows terminology.

b). Applied economics is used primarily for health economics research at the micro level, while specialty economics is used for research at the macro level.

V). From the humanities, primarily from philosophy, health care economics adopts a certain methodology, ideology, and worldview.

A). Historical reference:

The separation of health care economics into a separate field of scientific knowledge occurred only in the second half of the twentieth century. This happened under the influence of a number of factors. The most important of them are:

The twentieth century is a century of unprecedented growth in the volume and socio-economic importance of the service sector. It was during this period that medicine emerged as a large branch of the national economy. The object of research increases and, as a result, scientific interest in it increases.

Health care simultaneously declares itself as an extremely resource-intensive industry that is capable of using a variety of material, financial, labor and other resources.

In the twentieth century, health care began to be considered as a profitable, economically feasible area of investment.

b). The main feature of the healthcare sector as a branch of the national economy is that it helps to preserve and strengthen the physical and mental health of every person, every business entity, support their activity, and provide medical care. To achieve and maintain positions in the global market, a set of political, economic, legal, social, cultural, scientific, medical, sanitary and hygienic, and anti-epidemic measures have been directed to the healthcare sector.

Economics and health management as a branch of public health and healthcare

– The need for rational planning and effective use of material, labor and financial means of healthcare as a resource-intensive sector of the national economy;

– The role of healthcare in the social production system as a resource-saving industry;

2). The object of study of health care economics is economic relations in the field of health care, namely, relations of production, distribution, exchange and consumption of medical goods and services.

3). Main tasks of health economics:

– Determining the role and place of healthcare in the system of social production;

– Calculations of the volume of economic health care resources and their effective use;

– Study of trends in changes in the structure of healthcare and their connection with social production;

– Calculation and assessment of the economic efficiency of diagnostic, treatment and preventive work of healthcare institutions;

– Assessment of the economic efficiency of new organizational forms of providing medical care to the population (hospital-replaceable technologies, diagnostic centers, etc.);

– Economic justification for new organizational forms of medical activities;

– Development and evaluation of effective forms of remuneration for medical workers;

4). Methods of health economics.

– The statistical method makes it possible to evaluate the quantitative and qualitative relationship between medical, diagnostic and preventive processes.

– The balance method provides an optimal balance between therapeutic, diagnostic and rehabilitation processes.

b). The health care economy is closely linked to the economy of the country as a whole. There is a close relationship between healthcare and all sectors of the national economy. This relationship primarily concerns:

– the impact of the economy of individual industries on the health of the population.

This means that health economics is a branch science that studies the interaction of health care with the national economy, the formation, distribution and use of material, labor and financial resources in health care.

V). Health protection has an impact on the development of the national economy by preserving the health of the population (reducing mortality, especially in working age, child mortality, morbidity and disability, increasing average life expectancy).

5). The most important directions for the development of healthcare economics:

– Determination of types, volumes of medical services and their organizational and legal support;

– Economic assessment of the efficiency of use of health care resources;

– Financial support for the activities of medical institutions with their economic justification;

– Economic assessment of the professional activities of healthcare workers;

– Development and use of economic methods of management, taking into account the characteristics of healthcare;

– Development of a management and marketing system, including development of effective forms of promoting new methods of treatment and prevention.

The impact of the market on changes in economic processes in healthcare

The development of market relations in general could not but affect the development of economic processes in healthcare. There is a commercialization of public health care. Although the state, according to the Constitution, is the guarantor of ensuring the right of citizens to health care, however, in the current conditions of economic instability, the problem of obtaining quality medical care is increasingly becoming a private problem for citizens.

The state not only fails to fully provide the entire healthcare system, but also refuses to fully finance that part of it that continues to be part of the public sector. Hence the inevitable transfer of healthcare to a commercial basis.

One of the manifestations of commercialization is the increasing increase in the volume of paid medical services. Direct payment involves direct payment by patients to the service provider, as is the case in private medicine. In the medical insurance system, payers can be patients, enterprises, and the state.

In the conditions of market relations, there is also a change in the status of a medical institution in the direction of its convergence with the enterprise: the medical institution is subject to the entire set of economic rights, duties and responsibilities previously inherent in the enterprise.

The very economic content of the economic activities of medical institutions in market conditions puts them in the category of independent economic entities specialized in medical services. A consequence of the change in the status of medical institutions is a change in the nature of the economic ties of medical institutions.

Healthcare, as a complex system that includes a number of subsystems, has economic relations that are diverse in content, relative location, and hierarchy. They can be combined into several groups.

First of all, this is a connection along the line: the medical institution - the state. In modern conditions, medical institutions are not always state-owned; the state does not fully finance medical

institutions that remain his property. The medical institution is interested in the state as a taxpayer.

equipment, etc. Currently, medical institutions themselves have to look for partners who will agree to make the necessary supplies at prices acceptable to both parties. A special group of partners consists of financial and credit institutions, as well as educational institutions that train personnel.

Recently, the development of communication along the line: medical institution - consumer of medical services has become of great importance. If previously a patient was considered as a “clinical case,” now he is a potential source of profit for healthcare facilities with all the ensuing possible consequences in the field of patient differentiation. At the same time, the patient thinks not only about his illness but also about the costs of treatment.

Finally, the impact of the market affects the emergence of diverse forms of ownership, and, consequently, types of business in healthcare: from private clinics to joint-stock forms. Many different providers of medical services form a competitive environment, without which the market cannot exist. The result of economic activity in various forms is a change in the economic situation of healthcare workers themselves, in particular their differentiation by length of service, level of income: from the unemployed to the cooperator, shareholder and even the owner of a medical institution using the labor of hired personnel.

The mechanism of market relations in healthcare

What is their economic content?

Demand is the quantity of medical services that patients are willing and able to purchase over a certain period at a certain price. In other words, demand acts as an effective need for medical services. Demand changes under the influence of price. When the price of services decreases, the patient wants to purchase more services - demand increases. The service becomes cheaper relative to other services and purchasing it becomes relatively profitable.

Thus, other things being equal, the demand for services varies inversely with price.

However, other factors also influence demand:

1. Income level of the population (the higher the income, the more opportunities to receive medical services).

“Forcing demand” for medical services on the part of doctors (their diagnoses and recommendations can change demand).

Changes in the “tastes” of patients (the fashion for certain plastic surgeries has increased the demand for this type of medical services).

At each specific stage of development of society, other factors arise that influence demand.

Supply is the quantity of medical services that doctors can provide to the population over a given period of time. Supply, other things being equal, changes in direct proportion to price changes: as prices rise, manufacturers offer patients more services, and more manufacturers agree to provide these services; as prices fall, the number of manufacturers represented in this market decreases accordingly and the number of services provided.

The supply of medical services is also influenced by factors such as:

2. The appearance on the market of new medical services provided by competitors also increases their supply;"

3. Number of medical workers - the more there are, the greater the supply of medical services;

4. Increases in tax rates lead to a decrease in supply, etc.

Price is the monetary expression of the cost of services. It is formed under the influence of supply and demand, i.e. as a result of interaction between the patient and the manufacturer. If the price issue is resolved, then the service can be provided. The basis of this market operation is profit making.

This means that there are many service consumers in the market. At the same time, the consumer has a certain amount of total monetary income intended to pay for the medical services received. Patients wishing to receive medical services offer prices for them that are related to their income. This is the so-called demand price. The demand price is the maximum price at which the patient agrees to receive this service. The market price cannot rise above the demand price, because patients do not have more money to pay for the service.

are still ready to provide this service to patients. The market price should not fall below the supply price, because then business activity will be ineffective. The supply price for medical services must cover the costs of their provision and make a profit. As a result of the intersection of the interests of consumers and producers, a market equilibrium point is formed. The price at this point suits the largest number of producers and consumers of medical services and, therefore, it is called the “equilibrium price.”

A feature of the equilibrium price is its elasticity: if, under the influence of certain factors, there is an increase in demand with a constant supply, or a decrease in supply with a constant demand, then the price will increase; If, with a constant supply, there is a decrease in demand, or an increase in supply, with a constant demand, then the price will decrease. As a result, an optimal production volume is achieved that corresponds to consumption possibilities.

Demands for health services are volatile and variable. Let's assume that demand has increased in the health care market. The market equilibrium point will move. The economic meaning of this movement is expressed in the fact that patients have an increased need for this service, and they are willing to pay more for it. How does the market react to this? The first reaction of the market mechanism is an increase in prices, an increase in the income of those medical institutions that provide services of this type. The second reaction is the desire of entrepreneurs to invest their money in a profitable business, which naturally increases the volume of supply of these services. Competition is intensifying. Only those who can quickly increase the volume of these services while reducing costs and, consequently, prices will succeed. This happens through the development of advanced technologies.

The market situation will change again. Supply is increasingly matching demand. The increased price cannot be maintained for long. It begins to decline towards a new equilibrium point.

In a different sequence, the market cannot respond to an increase in demand, since organizing additional production of medical services takes time, and the financial side of such an increase will be the additional income received as a result of rising prices.

Thus, the market mechanism is characterized by the ability to achieve a flexible, dynamic equilibrium between supply and demand. The market acts as a self-regulating system. At the same time, a participant in market relations (entrepreneur) must constantly monitor the operation of the market mechanism, monitor what the relationship is at each moment between costs, price and profit.

medical personnel, the market for scientific medical developments, the market for medical equipment and technology, the securities market (the last element occurs only in a developed market).

The market in general, including in healthcare, performs a number of essential functions:

1. Informational. Through changing prices, the market provides production participants with objective information about the socially necessary quantity and quality of services and other products supplied to the market.

2. Intermediary. Economically isolated producers must exchange the results of their activities. Without a market, it is not possible to determine the mutual benefit of their activities.

3. Pricing. Services of the same purpose enter the market, but differ in costs. The market recognizes only those costs that correspond to the conditions for providing the bulk of services of this type, and it is these that the consumer agrees to pay.

4. Regulatory. Through competition, the market regulates the reduction of costs per unit of services provided, improving their quality, and encourages the scientific and technical process.

When talking about the development of market relations in healthcare, one cannot absolutize the significance of this process. Healthcare, as a specific area that touches on vital issues, will obviously not be able to focus entirely on market relations (at least for now). There will remain socially significant types of medical care that should be subsidized by the state - the fight against AIDS, tuberculosis, epidemics, infectious diseases, etc.

In order for the pursuit of profit and profitable types of medical services not to have a detrimental effect on the entire healthcare system, an effective economic mechanism must be developed that combines budget financing, financing from local budgets, the use of insurance premiums and the transfer of certain types of medical care to a paid basis.

The solution to these issues is associated both with a general improvement in the economic situation in the country and with a change in the economic mechanism of healthcare itself.

Socio-economic models of health care

The organization of the health care system in the former Soviet economy is now recognized as one of the most progressive in the world. This was largely achieved through large government expenditures. Over the past three decades, all countries, including Russia, have seen an increase in the cost of medical services. This is due to the introduction of new equipment and medicines, new diagnostic tools, costs for personnel retraining, etc. Under the conditions of economic reform, the existing Russian healthcare system was unable to effectively use the available resources. Currently, problems related to the state of public health in Russia have worsened. Increasing negative phenomena in the very structure of the population, deterioration of medical and demographic indicators, all this increases the population’s need for medical services. In this regard, the problem of developing methodological approaches to the formation of sources of financial support for healthcare based on the analysis of foreign and domestic experience is of particular importance.

An economic model, reflecting economic phenomena, processes and objects, should reveal their main features without going into minor details. This is the same principle of many political movements and social groups.

Each country has historically developed its own way of attracting economic resources to provide medical care. The system of economic, political, moral, ethical and other relations, the peculiarities of national conditions historically developed in a given country, determines the quantity and quality of resources allocated by society, and the effectiveness of their use in the field of healthcare.

The healthcare system is understood as a single whole of its constituent elements in their interrelation and interdependence. It follows that each country has its own, individual healthcare system. A healthcare economic model is a general framework for healthcare that reflects the underlying principles. It should be noted that in reality, certain healthcare models are not implemented in their pure form, since various features of a particular country make their own adjustments. Based on this, the healthcare system should be considered as an implemented model with the presence of a sum of existing features associated with the process of its implementation.

In reality, a variety of characteristics are used as the basis for classification. There is no disagreement only when distinguishing the Bismarckian (insurance) and Beveridge (national) health care systems. On the other hand, these are specific systems that have certain national and historical characteristics, as a result of which they cannot be considered as reference systems. Due to the lack of a unified classification, various authors identify different healthcare models.

Despite all the differences in the healthcare systems of different countries, reflecting their economic models can be divided depending on what role and functions the state performs in these processes. Depending on this feature, countries are identified where the role of the state is very small; and others where this role is very significant.

The use of market-type mechanisms in healthcare is associated with the following problems. On the one hand, healthcare is considered as a public good, when the provision of medical services to each person is of great importance for society as a whole. This position in most European countries has become part of the traditional consensus on the importance of respecting the principle of solidarity and inclusiveness in the design of population financing programs.

On the other hand, market incentives are based on the assumption that every service is a good that is sold on the open market. The idea that market mechanisms always produce better results than government planning can also be attractive to someone who does not consider social consequences. Market mechanisms will inevitably lead to the creation of conditions in which vulnerable groups of the population, especially the poorest, do not have equal access to quality health care, and the individualism generated by the market will lead to the destruction of collective responsibility on which the legitimacy of the welfare state is based.

Based on this, all existing healthcare systems can be reduced to three basic models:

1. State-budgetary, financed primarily (up to 90%) from budget sources (England, Denmark, Ireland, Portugal, Spain, from the 1930s until recently it was characteristic of Russia).

3. Market or private (USA, Israel, South Korea)

State budget model healthcare is characterized by a significant role of the state; financing is carried out primarily from that part of public resources that comes from tax revenues to the state budget. This model is traditionally based on the system of public medical institutions. Within the framework of state medical programs, medical care is provided to all categories of the population (generally accessible). The state itself determines the extent to which medical care is provided to the population. Management and planning of medical care is carried out by central and local executive authorities. The country's population receives medical care free of charge, with the exception of a small set of medical services. In general, this model ensures equality of citizens in receiving medical care. While providing high social guarantees, this model is at the same time characterized by low economic efficiency, irrational use of funds, and the lack of effective incentives for its further development. Until recently, this model was characteristic of Russia, some countries of Eastern Europe, as well as many developing countries. Thus, the government is the main purchaser and provider of health care, ensuring that most of the public's need for health services is met. The market here plays a secondary role, usually controlled by the state.

Social insurance model is also managed by government agencies, but unlike state-budgetary models, they are financed on a tripartite basis: through budgetary allocations, contributions from employers and employees themselves. This model is characterized primarily by the presence of compulsory health insurance (CHI) for the entire or almost entire population of the country. It is also called managed health insurance. At the same time, people with low incomes and socially vulnerable people, as a rule, do not pay insurance premiums. A distinctive feature of the social insurance model is the simultaneous combination of two opposing principles: the principle of “social solidarity”, when the healthy pays for the sick, the young for the older, the rich for the poor, and the principle of “cost sharing”, when medical services are paid for by the population independently, in addition to public funds. The state here plays the role of a guarantor in meeting the socially necessary needs of all or most citizens for medical care, regardless of income level, without violating the market principles of payment for medical services. The role of the paid market for medical services is reduced to meeting the needs of the population beyond the guaranteed level. A multi-channel financing system creates the necessary flexibility and stability of the financial base of social insurance medicine. This model is typical for most economically developed countries; it is most clearly represented by the health care of Germany, France, the Netherlands, Belgium, and Japan. The health care systems of a number of countries, while remaining within the framework of this model, in a number of characteristics are significantly closer to the state budget. Such systems are often classified as a special option called budgetary insurance. These are the health care systems of the Scandinavian countries and, for a number of characteristics, Canada.

Market or private model in its classic form, it is based on private medical practice with payment for medical services at the expense of the patient. This model is characterized by the provision of medical care primarily on a paid basis, at the expense of the consumer of medical services, and the absence of a unified system of state health insurance. The main tool for meeting the needs for medical services is the paid market for medical services. This model is based on the widespread use of market relations - payments at market prices are made by the consumer of the medical service. He himself (based on the doctor’s opinion and personal financial capabilities) determines the amount of medical care consumed. In this situation, everyone pays for themselves. This leads to high economic efficiency of such a model and promotes scientific and technological progress to increase profits in competition. But due to the different financial capabilities of the population, the volumes of medical services received by individual patients also become different. As a result, part of the population is actually deprived of medical care, which leads to negative consequences. People who are more susceptible to illness, those with severe chronic diseases, and people with disabilities find themselves in an economically disadvantaged position. That part of the needs that is not satisfied by the market is taken over by the state through the development and financing of public health care programs. As a result, the scale of the public sector is small. This model is most clearly represented in the USA. This model is commonly referred to as fee-for-service, market-based, American, sometimes private insurance, or primarily private healthcare.

From an economic point of view, there is the following classification of healthcare models. It is characterized as a classification based on property relations and methods of payment for medical care provided.

1. Private healthcare:

With a direct form of payment for medical care (paid by the consumer himself);

With an indirect (insurance) form of payment;

2. Public health:

With a direct form of payment (paid by the state);

In private healthcare it is possible to use public medical institutions when payment for medical care provided by public medical institutions is carried out by the patients themselves . On the other hand, public health does not necessarily have to be based only on the system of public medical institutions; it is possible for the state to enter into agreements with private medical institutions.

A more detailed version of the classification is presented in the work of L. N. Sholpo .

-Universalist model (England, Ireland). A national health system financed in large part by general taxation. Medical care is provided primarily in public health institutions (hospitals) by salaried or contract workers (primary care, dentistry, pharmacists).

In England, the one adopted in 1948 is used. a healthcare model initiated by Lord Beveridge. The essence of this model is that the British healthcare budget is formed mainly from tax revenues. Sources of healthcare financing: 78% state subsidies, 10% contributions from entrepreneurs, 3.8% insurance contributions from citizens, 8.2% direct additional payments from citizens.

The British system of organizing and financing health care is based on the priority of primary health care. The share of general practitioners in health care in England is about 50% of the total number of doctors. This category of doctors provides medical care to almost 90% of patients.

The main advantages of this healthcare organization are:

State regulation of regional health care budgets by redistributing financial resources from regions with a higher standard of living to regions with a lower standard of living;

Relatively low (compared to other economically developed countries) health care costs ensure high indicators of the health status of the population;

financing, healthcare management, which will bring closer the levels of medical care for different social groups and different regions of the country. In the system of government regulation, in addition to traditional measures, new mechanisms have appeared that are market-oriented and based on the use of appropriate incentives. In turn, effective regulation is aimed at monitoring and evaluating the final results.

-Continental model ¾ of total health care spending.

In Germany, the healthcare budget is formed as follows: 14.2% of financial resources come from government sources, 72.5% are contributions from entrepreneurs, 6.9% from personal resources of citizens, 6.4% are from private insurance.

The almost 1,200 health insurance funds existing in Germany cover 88% of the country's population with their assistance. These funds are mainly financed by employees and employers. However, about 9% of sickness fund members also use private insurance, and 10% of the population is insured only by private organizations.

In Germany, the healthcare budget is formed as follows: 73% of financial resources come from government sources, 11% from personal funds of citizens, 16% from private insurance.

In accordance with the principles of health insurance, laid down during the reign of Chancellor Otto Bismarck, every German citizen has the right to receive health insurance, and the insurance premium cannot be increased due to the patient’s poor health. These legislative acts were based on the principle: health is capital, increasing the efficiency of social labor. Thus, in the Bismarckian model, health plays the same role in relation to labor as capital. Health increases labor efficiency and the value of so-called “human capital”.

etc. The monthly insurance premium is on average 12.8% of the wage fund. This contribution is paid in equal shares by employees and employers. Insurance premiums for pensioners are paid by pension insurance and by the pensioners themselves. Unemployment insurance is provided by the federal employment office.

services are constantly increasing.

The current healthcare model in Germany can only function effectively in a country with a high level of national income.

-Southern model and private medical institutions.

In Spain, until the 90s of the 20th century, the system of financing healthcare from budgetary sources, which was an exorbitant burden for the state, was similar to the Russian one. Among the most pressing problems facing the government are: the unjustified expansion of medical services subject to state funding; trend of increasing government spending on subsidies to the pharmaceutical sector.

However, in 1997 the following changes were made: a reduction in budget expenditures was provided by streamlining medical services; a list of basic services of the national health care system financed by the state was approved. Restrictions were introduced on compensation for the cost of medicines.

Overall, the reforms did not challenge the need to preserve the fundamentals of universal health insurance, which guarantees free medical care. However, many provisions provided for a significant expansion of paid medical services, which meant a departure from the established model of public health financing.

-Scandinavian model The benefits paid directly depend on earnings. Medical services are provided by both public and private treatment and preventive institutions.

Health financing in developed countries :

State subsidies 71%;

Contributions from entrepreneurs 18.4%;

Direct additional payments from citizens 8.6%.

The Swedish healthcare model is recognized as one of the best in the world. It presupposes not only the accessibility and high quality of medical care, but also the creation of equal prerequisites for maintaining health for everyone.

There are 23 regional councils in the country, which are responsible for the access of every resident of the corresponding region to medical care (free or partially paid). These Councils are the owners of clinics and medical centers; they act as employers for most health workers.

from 50 to 100% of expenses.

Sweden moved away from the use of competitive incentives as a driver of health care reform in 1999, and there was renewed interest in community-based planning as well as national regulation, especially of pharmaceutical costs.

-Predominantly private model (USA) - healthcare financing in these countries is carried out from private and, to a much lesser extent, public sources, and the provision of medical care is carried out by private providers of medical services.

In the United States, the total health care budget consists of the following funds:

State Medicaid program – 10%;

Other government programs – 15%;

Private health insurance – 33%;

Funds from other private sources – 4%;

Personal funds of citizens – 21%.

For the period from 1980 to 1992. US health care spending increased from 9% of GNP to 14%.

In 1970 defense spending in the United States amounted to 8.2% of GNP and exceeded health care spending by 0.4% (7.8%). However, in 1990, the American government spent 3% of GNP on defense, 6% on education, and 12% on health care.

74% of workers in the private sector of the economy and 80% of the public sector are covered. The Medicare and Medicaid programs adopted in 1965 are financed from the federal budget, state budgets, and local governments.

The Medicare program provides mandatory insurance for people over 65 years of age in case of hospitalization. The second part of the program involves additional voluntary insurance, under which the state covers 80% of the cost of treatment, and the remaining 20% is paid by the patients themselves.

The Medicaid program provides free medical care to needy families with children, the blind, and the disabled.

The role of the state in the provision of medical care is insignificant, since even under the government programs Medicare and Medicaid, payments go through private insurance organizations to private hospitals and private doctors.

The main advantages of the organizational healthcare system in the United States are:

 highly qualified medical care, which is based on federal quality standards;

 the presence of a coordinated system of scientific and medical research and development in the field of protecting the nation's health.

 high degree of responsibility of the state and business for maintaining the health of the nation as a whole.

 high degree of legal protection for patients.

 distribution of the federal Medicaid health care budget among states in inverse proportion to state per capita income.

 a well-functioning system for training highly qualified medical personnel.

However, the American healthcare system also has a number of significant disadvantages:

 high growth rates of healthcare costs, which often do not correspond to the growth rates and level of quality of medical services. This means that while spending on health care is the highest in the world, the resulting health outcomes of the US population lag behind those of other economically developed countries, which indicates the low efficiency of health care in the United States. In addition, the cost of medical services has a fairly high share of administrative expenses (in some cases up to 20%).

 remuneration of medical workers is carried out on a fee-for-service basis, as a result of which unnecessary medical procedures and medications are prescribed to patients.

 significant variation in the cost of the same medical services in different states, sometimes this cost differs by 10-15 times.

 complex health insurance system.

The listed shortcomings give rise to dissatisfaction among the US population with the national healthcare system and lead to the need for its reorganization. The main directions of healthcare reform planned in the United States are as follows:

 expanding the scope of the Medicaid program.

 introduction of a national insurance system that provides for the financing of health care through tax revenues (currently only certain elements of it are being implemented).

-Model used in countries with economies in transition (Eastern European countries, some CIS countries, including Russia) – financing that combines elements of state and insurance medicine; gradual introduction of the institution of provision of paid medical services.

The history of health insurance in pre-revolutionary Russia dates back to 1861, when the first law was adopted that introduced elements of compulsory health insurance. The law prescribed the creation of partnerships and auxiliary funds at state-owned mining plants to issue temporary disability benefits in the amount of 1/6 to 3/4 of earnings. Auxiliary funds were formed from contributions from workers, amounting to 2-3% of wages, as well as annual additional payments from the employer.

In 1866 A law was passed obliging factory owners to provide workers with medical care and build hospitals at the rate of 1 bed per 100 workers with free treatment.

With the development of railway transport in Russia, a medical care system was created for railway workers and employees. Cash registers were formed from monthly contributions in the amount of 6% of earnings received. From this amount sickness maintenance, pensions or lump-sum benefits for disability and in the event of the death of the breadwinner were paid.

In the second half of the 19th century, a public insurance system for artisans and hired workers began to develop. The main insurance institutions are sickness funds; the first such fund was formed in 1859 in Riga at the P. H. Rosenkrantz."

In 1903 The law “On remuneration of citizens who suffered as a result of an accident, workers and employees, as well as members of their families in enterprises of the factory, mining and mining industries” was adopted. According to the law, the benefit was half the salary and was paid from the day of the accident until the day of restoration of working capacity. This law forced entrepreneurs to unite into insurance partnerships, to which funds were systematically transferred.

Workers' Insurance", "On the Establishment of the Council for Workers' Insurance", "On Provision of Workers in Case of Sickness", "On Insurance of Workers against Accidents". From now on, a social insurance system is being formed in Russia. The health insurance fund, established at each enterprise with at least 200 employees, became the insurance agency. The health insurance funds consisted of contributions from workers and entrepreneurs, and the contributions of workers were 1.5 times higher than the contributions of entrepreneurs. The main function of the health insurance fund was to issue benefits in the event of illness, injury, childbirth, or death.

issued the following decrees: “On the free transfer to health insurance funds of all medical institutions”, “On health insurance”, “On unemployment insurance”. Based on these decrees, full social insurance was introduced in Russia. It was based on the following principles: the extension of insurance to all hired workers, insurance coverage of all types of disability. All medical factories and all their property were transferred to health insurance funds. Workers' contributions were abolished, and entrepreneurs' contributions were increased.

With the adoption of the Decree of 1918 “On the social security of workers,” the process of centralization of insurance medicine intensified, medical insurance itself was replaced by purely social insurance, and then the concept of “insurance” was replaced by the concept of “security.”

After the adoption of the resolution of the Council of People's Commissars in 1919. “On the transfer of the entire medical part of the former sickness funds to the People's Commissariat of Health”, insurance medicine as such was actually abolished. There was an attempt to partially revive it during the NEP period. Resolutions of the Council of People's Commissars in 1921-1923. For employers of various forms of ownership, insurance premiums were determined, through which expenses for temporary incapacity, disability, and unemployment were reimbursed. In 1922 the amount of the insurance premium ranged from 21 to 28.5% of the wage fund. The target contribution for health insurance based on working conditions was in the range of 5.5-7% of the wage fund. For government institutions, the general social contribution was set at 12% of the wage fund, including 3% for health insurance. Of these, 10% of the collected contributions were sent to the People's Commissariat of Health, and 90% to provincial and local health authorities. However, compulsory health insurance served only as a supplement to government funding for health care.

The system of free healthcare financed directly from the budget that existed during the Soviet period was not effective enough.

In Russia, there is a transition from a completely state system of financing healthcare to a budgetary insurance model, in which medical insurance is combined with budgetary and paid healthcare, but the concept of healthcare reform provides for a transition to a purely insurance model with the expansion of voluntary (private) medical insurance. This decision is very controversial, since the private model is the most costly and does not allow for the efficient use of healthcare resources. In the USA, a country with a private healthcare model, due to the presence of a number of shortcomings (see above), as a result of ongoing reforms, the role of the state in financing the industry is being strengthened through the redistribution of tax revenues.

In a fairly short period, a transition has been made from centralized planning and budget financing to planning for health care development at the regional level, from the system of financing specific health care facilities to the principles provided for by the compulsory medical insurance system. The budgetary method of financing that existed in our country was focused on the budget's capabilities, and not on the real costs arising in this area.

Currently, Russia has both a state system and private health insurance. The state pays the costs of medical institutions through intermediaries - insurance companies. In essence, this is a distribution system with elements of insurance. Private health insurance in our country is sold only by insurance companies and in a variety of forms.

Until now, the state healthcare system has been aimed at providing medical services by state (federal and municipal) medical institutions to all categories of Russian citizens - Article 41 of the Russian Constitution. The list of free medical services is limited. Services are financed through compulsory insurance of medical care costs for a narrow list of services. Expenses for compulsory health insurance are included in the total expenses for social security of citizens.

The population can pay for additional medical services on their own, as well as cover expenses through voluntary health insurance policies. Paid services are allowed to be provided by both private and public medical institutions.

Thus, in Russia there are currently 3 financial models of healthcare:

1. Public health care (in the form of formations of federal and regional compulsory health insurance funds).

2. Voluntary health insurance system.

3. Payment by the population for paid medical services.

This reform was carried out due to the impossibility of quality medical care, relying only on allocations from the state budget. The transformation of the healthcare system in the Russian Federation was an expression of the desire to increase funding for public healthcare by expanding the sources of funds and changing the structure of financial flows.

The replacement of socialist ideology with a market one determined the orientation of health care reforms towards borrowing models of health care organization used in countries with developed market economies.

It should be noted that these models were just beginning to be used in countries at a fundamentally different level of economic development and democracy, and were called upon to solve qualitatively different problems in different institutional conditions: in a developed market economy, with established mechanisms of its state regulation and in that state of civil society. a society that is able to effectively protect the interests of the population [Shishkin S.V. Reform of Russian healthcare financing. - M.: Teis, 2000. -S. 42].

Improving the efficiency of healthcare and introducing mechanisms for the rational use of limited financial resources of the industry will be facilitated by:

Development of a plan for the privatization of part of medical institutions;

Formation of a unified payment system for medical services, which will help achieve social goals and increase the efficiency of use of available resources, which ensure the economic viability of medical institutions;

Improving the system of contracts between territorial compulsory health insurance funds and medical insurance organizations, medical insurance organizations and medical institutions;

What is apparently required is a return to a certain centralization of financing of medical institutions. Currently, more than half of the total budget funding comes from local budgets;

Creation of a system for collecting and disseminating information to facilitate patients’ free choice of medical institutions;

Taking measures to create conditions that impede the development of the informal market for medical services.

systems based on Western European and North American models. These countries typically faced a lack of experienced administrative apparatus capable of making these systems function effectively. Moreover, health care systems based on the Bismarck and Beveridge models have proven poorly suited to the flexible, informal labor market that is now widespread.

It should be pointed out that a simplified interpretation of healthcare models based only on their classical description is inadmissible. The problem of classification cannot be considered as a classification according to one single, albeit most important, attribute. Any set is characterized not only by diversity in any characteristic, but also by the diversity of the characteristics themselves. This fully applies to healthcare models.

The variety of possible healthcare models makes the problem of choosing a specific type quite complex.

There is no ideal healthcare model, and in reality it cannot exist. Any healthcare system must be considered in direct connection with the characteristics of the development and functioning of a particular country. The advantages and disadvantages of each specific model are determined by a combination of various factors. Depending on the specific conditions, each of the models has its own advantages over others in certain indicators.

In essence, choosing a healthcare model is not a once-solved problem. In modern healthcare systems around the world, reform processes are constantly underway, consisting of a multivariate combination of the various healthcare models described above.

healthcare should be provided free of charge by the state. A characteristic feature of economic policy in countries with transition economies was the minimization of the role of the state. It is now clear that in the conditions of the transition period, which is protracted and complex in nature, the responsibility of the state should increase rather than decrease. State intervention must be active in those important areas where market forces cannot ensure the efficient allocation of resources or where access to the basic, most important goods and living conditions of people is inequitable.

Thus, the experience of countries with economies in transition demonstrates the importance of maintaining state capacity, which has been weakened during the reform process. In market economies, the state plays a central role in maintaining economic stability, regulating the market, and providing necessary social services.

Used Books

1. Gerasimenko N.I. Health care reform: some results and prospects // Health care economics. -1997. -No. 1. With. 250

4. Rumyantsev Yu. Financing healthcare in developed countries. // Doctor. -1999, No. 1. -WITH. 42.

5. Kuzmenko M. M., Baranov V. In Financial management in healthcare in Russia. -M.:Medicine, 1995, P. 66

6. Malishevsky B. F. Theory and practice of pension funds. S.-P, 1889, vol. 2, ch. IX

Target: The study of macroeconomics and microeconomics in healthcare, their differences.

Macroeconomics is the part of economic theory that studies the economy as a single, integral system. The field of view of macroeconomics includes economic phenomena and processes, patterns that are significant on the scale of the entire economy of the country or even the world economy. Macroeconomics uses economic indicators that characterize the state of the entire economy of a country or the world economy as one large object.

In macroeconomics, economic quantities are used in the form of indicators of the total, total volume of production and consumption, rates of economic growth and decline, general and national average values of income and expenses, wages, labor productivity, prices, and exchange rates.

Macroeconomic processes include processes that manifest themselves in the entire economy of the country, covering it entirely. These are, for example, economic growth and decline, inflation, employment, and unemployment throughout the country. Macroeconomics allows you to see, explore, and predict the economic picture as a whole, since it does not delve into individual details, but strives to identify the most general qualities, properties, and characteristics.

Under microeconomics understand the field of economic science that studies economic processes associated with the state and activities of individual parts of the economy or, as they say, individual subjects of economic activity. For microeconomics, individual sectors of the national economy, enterprises, firms, producers and consumers, households, markets for goods and services are of interest. The main objects that are the focus of microeconomics are enterprises, companies, corporations, firms, i.e. objects producing products, goods, services, as well as markets for the sale of goods, market prices, supply and demand in markets. So microeconomics is, first of all, the economics of organizations, enterprises, entrepreneurial activities, and markets. When we study how many patients are treated in city hospitals, what is the average salary of a nurse in a clinic, how prices for a certain medicine change in pharmacies, we are dealing with microeconomics.

Microeconomics studies the interaction of producers with consumers, mutual settlements, and prices for different types of goods that develop in markets. Methods of developing and making economic decisions in the lower levels of the economy are also the subject of microeconomics. So if the board of a joint stock company determines which part of the profit to invest in the development of production and which to give out to shareholders in the form of dividends, it solves a microeconomic problem.

Most of the questions that practicing economists have to answer relate to the field of microeconomics. But at the state level, when it comes to solving problems of a national economic scale, one cannot do without macroeconomics. It is sometimes difficult to draw a clear line between micro and macro economics. Certain microeconomic problems acquire such significance that they become macroeconomic.

Gross National Product (GNP) And gross domestic product (GDP) reflect the results of activities in two spheres of the national economy: material production and services. Both are defined as the value of the total volume of final production of goods and services in the economy for one year (quarter, month). These indicators are calculated in both current (current) and constant prices (prices of a base year).

Differences between GNP and GDP:

GDP is calculated according to the so-called territorial basis. This is the total cost of production in the sphere of material production and the service sector, regardless of the nationality of enterprises located on the territory of a given country;

GNP is the total value of the total volume of products and services in both spheres of the national economy, regardless of the location of national enterprises (in their own country or abroad).

Gross Domestic Product (GDP) is the value of all goods and services produced within a country during the year. The calculation of GDP does not include the cost of raw materials, fuel, energy, feed, etc., that is, intermediate goods and services.

Budget– this is the amount of income and expenses expressed in monetary form for a certain period of time (year, quarter, month).

The state budget- this is an estimate of state revenues and expenses for a certain period of time, compiled with an indication of the sources of state income and directions, channels for spending money.

Functions of fiscal policy:

a) provision of non-market services (public services: education, health care, defense, etc.);

b) redistribution of income (taxes, transfers, subsidies, loans, etc.);

c) government regulation (antitrust regulation, employment, etc.);

d) implementation of state control (external control, internal control).

The state budget, like other economic categories, is actively used by the state to practically solve long-term and current socio-economic problems. The state, using the budget as an important means of implementing its organizational function, turns it into an effective tool for economic management. The use of the budget as an economic management tool is due to important characteristic features: it has the force of law; it directly reflects programs aimed at developing social production, increasing its efficiency, and meeting the needs of members of society. The budget has enormous mobilizing and organizing significance, which is associated with the legal form of using budgetary relations.

The state budget is prepared by the government and approved by the highest legislative bodies.

The most important parts of the state budget are its revenue and expenditure parts.

· revenue part – shows the sources of budget funds;

· expenditure part – shows for what purposes the funds accumulated by the state are directed.

Sources of income:

· taxes;

· government loans (securities, treasury bills, etc.);

· issue (additional issue) of paper and credit money;

· loans from international organizations.

Structure of the budget expenditures in the Republic of Kazakhstan:

· social needs: healthcare, education, social benefits, subsidies to the budgets of local authorities - 40-50% of all expenses;

· costs for economic needs: investments in infrastructure, subsidies to state enterprises, subsidies to agriculture, costs for the implementation of State programs - 10-12%%;

· expenses on weapons and material support for foreign policy, maintenance of diplomatic, internal service and loans to foreign states - 10-12%;

· administrative and management expenses, maintenance of government bodies, justice and other 5-10%;

· payments on public debt 7-8%.

The structure of the budget expenditures is determined by the relevance of the tasks set and ways of solving them in accordance with the concept of economic policy.

Revenue part:

· taxes 75-85%;

· non-tax revenues (income from state property and trade) – 5-8%;

· contributions to state social insurance funds, pension funds, unemployment insurance - 10-12%.

Macroeconomic stabilization is determined by government activities aimed at ensuring economic growth, full employment and stable price levels.

Equilibrium in the economic system, which is established on the basis of market self-adjustment of the economy, may be accompanied by high levels of unemployment or excessive inflation. Since inflation and unemployment are most painful during periods of economic crises, policies aimed at macroeconomic stabilization can be defined as government activities to smooth out industrial cycles.

In 1997, Kazakhstan adopted long-term Development Strategy “Kazakhstan-2030”. It provides for seven basic priorities that ensure national security, one of them is health, education and well-being of citizens of Kazakhstan.

The implementation of this priority includes the following main directions: preventing diseases and promoting a healthy lifestyle; improvement of nutrition, environmental cleanliness and ecology; development of a system of modern education, training and retraining of personnel. Finished ahead of schedule in 2012.

Against the backdrop of the stabilization of the economic situation in the country, reforms in the field of healthcare, education, as well as pension reform were successfully carried out, and the demographic situation improved. The coverage of the population by the social security system has expanded significantly.

In the future, the task is to ensure Kazakhstan’s national standard of quality of life at the level of advanced countries.

The functions performed by the state include:

v creation and regulation of the legal basis for the functioning of the economy;

v antimonopoly regulation;

v pursuing a policy of macroeconomic stabilization;

v impact on resource allocation;

v activities in the field of income distribution;

v the activities of the state as a subject of property relations.

Development strategy of the Republic of Kazakhstan until 2050.Her main goal- creation of a prosperous society based on a strong state, developed economy and opportunities for universal labor, Kazakhstan’s entry into the top thirty most developed countries in the world. To achieve this goal "Strategy "Kazakhstan-2050" provides for the implementation of seven long-term priorities:

1. New Deal economic policy is a comprehensive economic pragmatism based on the principles of profitability, return on investment and competitiveness.

2. Comprehensive support for entrepreneurship – the leading force of the national economy.

3. New principles of social policy – social guarantees and personal responsibility.

4. Knowledge and professional skills are the key guidelines of the modern system of education, training and retraining of personnel.

5. Further strengthening of statehood and development of Kazakh democracy.

6. Consistent and predictable foreign policy - promoting national interests and strengthening regional and global security.

7. New Kazakhstani patriotism is the basis for the success of our multinational and multi-religious society.

Literature:

1. Health Economics: a textbook, ed. A.V. Reshetnikova - 2nd ed. - M., 2007 - 272.

2. Economic theory: Textbook/Ed. IN AND. Vidyapina, A.I. Dobrynina, G.P. Zhuravleva, L.S. Tarasovich. - S.-P., 2004.

3. Course of economic theory/Under the general editorship. M.N. Chepurin and E.A. Kiseleva - M, 2004.

4. Economic theory in conditions of market transformations: Textbook. Aubakirov Ya.A. - A., 2003.

5. Market economy of Kazakhstan: problems of formation and development. – In two volumes / Ed. M.B. Kenzheguzina. - A., 2001.

6. State regulation of the economy in the conditions of Kazakhstan: theory, experience, problems. Mamyrov N.K., Ikhdanov Zh. - A.: Economics, 1998.

Additional:

2. State program for the development of healthcare of the Republic of Kazakhstan “Densaulyk” for 2016-2019.

3. Development strategy “Kazakhstan-2030”.

4. Economics and healthcare management: textbook. L.Yu.Trushkina, R.A.Tleptserishev, A.G.Trushkin, L.M. Demyanova - Rostov-on-Don: Phoenix, 2003. – 384 p.

5. Social encyclopedia: A.P. Redkaya, G.N. Gorkin, E.D. Katulskaya et al. - M., BRE, 2000. - 438 p.

6. Public health and healthcare: textbook. Yu.P. Lisitsyn, N.V. Polunina – M.: Medicine, 2002. 416 pp.

7. “Senior nurse”, Journal, MCFER - Kazakhstan, Almaty.

8. Magazine “Chief Nurse”, Moscow.

9. Magazine "Nursing". Moscow.

10. Magazine “Nurse”, Moscow.

Control questions:

1. The concept of “Health Macroeconomics”.

2. The concept of “Microeconomics of healthcare”.

3. Gross national product (GNP).

4. Gross domestic product (GDP).

5. The concept of “Budget”.

6. State budget.

7. Functions of fiscal policy.

8. Structure of the budget expenditures.

9. Structure of the budget revenues.

10. Priority of the long-term Development Strategy “Kazakhstan-2050”.

1. The market commercializes healthcare in general.

2. This leads to a rapid increase in paid and semi-paid services (health insurance).

3. Changes the economic status of medical institutions. The healthcare facility becomes a service-producing enterprise.

4. This leads to a change in economic relations (economic agent).

5. Various forms of ownership arise.

6. The economic situation of the health care worker himself is changing.

In the process of Russia's transition to a market economy, a new sectoral health care economy was formed.

Causes emergence of health care economics:

1.increasing demand for medical services;

2. the need for effective use of material, labor, and financial resources

3.increasing the economic importance of the healthcare system in preserving and strengthening the health of the population, which brings a huge economic effect.

Purpose of Health Economics: to achieve maximum effect in providing medical care at given costs.

Tasks:

· determining the role and place of healthcare in the system of social production;

· study of trends in changes in the structure of healthcare.

· calculation of economic resources and their effective use;

· calculation and assessment of the effectiveness of diagnostic, treatment and preventive work of healthcare institutions;

· economic justification for new organizational forms of medical activities;

· development and evaluation of effective forms of remuneration for medical workers;

· calculation of standards for the activities of specialists, as well as the optimal ratio of medical workers (doctor and paramedical worker).

A significant oversupply of doctors is not economical, it is not profitable to have many doctors, it is more profitable to have a doctor with a large number of assistants. The doctor must have a good work organization so that he can devote more time to directly treating patients.

The number of physician assistants will now increase.

In the Saratov region - 1: 2.14; (currently)

Russia - 1: 2.26; Denmark - 1:5.6; USA - 1: 2.8; Norway - 1: 4.3.

Health Economics Methods:

· mathematical-statistical - evaluates the quantitative and qualitative relationship between therapeutic, diagnostic and preventive processes;

· balance method – ensures an optimal balance between treatment, diagnostic and rehabilitation processes;

· experimental method, allowing to develop effective measures to improve the quality of public health.

Health economics conducts economic analysis :

The influence of population health indicators on social production;

The economic effect of eliminating certain diseases;

The cost of treatment and preventive activities;

Cost-effectiveness of preventive measures.

In healthcare, there are 3 types of efficiency - social, medical and economic.

1.Social efficiency – assessment of improvements in public health.

2.Medical effectiveness – the degree of achievement of the set objectives in the field of prevention, diagnosis, treatment and rehabilitation.

3.Economic efficiency - this is the profit that the national economy receives through health-improving activities and is determined by the amount of absolute increase in social income (i.e. money)

When assessing the economic effectiveness of health measures at work, methods of prevention, diagnosis and treatment, the following are calculated:

The number of days (difference before and after the introduction of new methods) saved as a result of preventing diseases, injuries, disability, mortality;