Effectiveness of Reforming the Budget Network in the Health Sector in the 2010s

Over the last decade, the health care system in Russia has carried out significant reforms: changes in the budget network regulation, the introduction of financing standards, the May Decree No. 597 implementation regarding specific categories medical organizations employees’ salaries, the transition to single-channel financing. At the same time, the results are ambiguous: against the background of noticeable optimization achievements, while maintaining the indicators of surgery operations performed, and patients served, there was an increase in the overall mortality rate in the country. This study aims to evaluate the effect of health care reforms in the 2010s. The data envelopment analyses (DEA) used to estimate the government regional health sector efficiency to reveal the most and the least efficient regions. Then the factors with the most significant impact on the resulting performance indicator are identified. Among such factors, the organizational and legal structure of the region budget network and the transition to single-channel financing dummy variable are analysed. The results show that the transformation of institutions into autonomous ones according to the Federal law 83-FZ did not have a positive impact on the efficiency of the regional health care system. At the same time, the transition to single-channel funding has had some positive effects, which, however, has not been sustainable over time, and therefore more research is needed after the later periods’ data accumulation. Although the changes had some impact on the performance of the budget network institutions, they did not solve the fundamental problems of the health system, such as chronic underfunding and regional differentiation.

healthcare, efficiency estimation, DEA, data envelopment analyses, reforms, budget network

1. Shishkin S.T., Sheiman I.M., Potapchik E.G., Ponkratova O.F. Analysis of the state of insurance medicine in Russia and prospects for its development. Moscow: Higher School of Economics; 2019. (In Russ.).

2. Charnes A., Cooper W., Rhodes E. Measuring the efficiency of decision-making units. European Journal of Operational Research. 1978;2(6):429–444.

3. Lampe H., Hilgers D. Trajectories of efficiency measurement: A bibliometric analysis of DEA and SFA. European journal of operational research. 2015;240(1):1–21.

4. Emrouznejad A., Yang G. A survey and analysis of the first 40 years of scholarly literature in DEA: 1978–2016. Socio-Economic Planning Sciences. 2018;(61):4–8.

5. Charnes A., Cooper W.W., Rhodes E. Measuring the efficiency of decision-making units. European Journal of Operational Research. 1978;2(6):429–444.

6. Tone K. A slacks-based measure of efficiency in data envelopment analysis. European Journal of Operational Research. 2001;130(3):498–509.

7. Cantor V.J.M., Poh L. Integrated analysis of healthcare efficiency: a systematic review. Journal of medical systems. 2018;42(1):8(1–23).

8. Pelone F., Kringos D. S., Romaniello A., Archibugi M., Salsiri C., Ricciardi W. Primary care efficiency measurement using data envelopment analysis: a systematic review. Journal of medical systems. 2015;39(1),156(1–14).

9. Büchner V.A., Hinz V., Schreyögg J. Health systems: changes in hospital efficiency and profitability. Health care management science. 2016;19(2):130–143.

10. Anthun K.S., Kittelsen S.A.C., Magnussen J. Productivity growth, case mix and optimal size of hospitals. A 16-year study of the Norwegian hospital sector. Health policy. 2017;121(4):418–425.

11. Tiemann O., Schreyögg J. Changes in hospital efficiency after privatization. Health care management science. 2012;15(4):310–326.

12. Banker R.D. Maximum Likelihood, Consistency and Data Envelopment Analysis: A Statistical Foundation. Management Science. 1993;39(10):1265–1273.

13. Banker R.D., Natarajan R. Evaluating contextual variables affecting productivity using data envelopment analysis. Operations research. 2008;56(1):48–58.

14. Avksentyev N.A., Baidin V.M., Zarubina O.A., Sisigina N.N., Kulkova S.A. Evaluating the effectiveness of regional health care expenditures in Russia. Pharmacoeconomics. Modern pharmacoeconomics and pharmacoepidemiology. 2015;8(4):10–20. (In Russ.).