Problems and Prospects:

RÉSUMÉ .................................................................................................................................. 2 The context of healthcare reform ................................................................................................................ 5 Healthcare reform must be addressed in the larger context of Russia’s health and mortality crisis ....... 5 The Russian healthcare system today is the product of an unfinished reform......................................... 9 The need for healthcare reform ................................................................................................................. 13 The semi-reformed state of the healthcare system aggravates its underlying structural imbalances..... 13 Healthcare providers and insurers face perverse micro-level incentives............................................... 18 The direction of healthcare reform............................................................................................................ 21 The government has recently been stepping up its healthcare reform efforts ....................................... 21 The government has recently confirmed its healthcare reform priorities for the period to 2010 .......... 23 What can be done to balance commitments and resources?.................................................................. 23 How can a restructuring of provision be engineered? ........................................................................... 25 What will it take to complete the transition to competitive insurance-based medicine?....................... 26 Is there scope for regional diversity of approach?................................................................................. 30 How can the problem of micro-level incentives be resolved?............................................................... 31 Conclusion................................................................................................................................................. 32 BIBLIOGRAPHY......................................................................................................................................... 34 ANNEX 5.A1 The Guaranteed Package Programme................................................................................ 37

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