G.E. Ulumbekova
Association of Medical Societies for Quality of Medical Care and Medical Education, Moscow

Summary: The article analyzes the U.S. health care system and the reform initiated by the U.S. Government in 2010. It introduces the health indicators of the population, expenditures and sources of financing, the volume of medical care in comparison with the European Union and the Russian Federation, and also gives a general idea of the U.S. health care system. The reasons which led to the necessity to reform the U.S. health care were thoroughly analyzed, and were given the main points of the suggested measures (in terms of health insurance, state regulation and paying for high-quality care and result). The conclusions for Russian health care system were drawn by the example of the U.S. health care reform.

Aim: to analyze the experience of the U.S. health care system (i.e. reform which is being implemented since 2010) in order to determine the possibilities to apply market mechanisms in financing and liberalization of state regulation in Russian health care system.

Methodology: the article represents in-depth analysis of health indicators, expenditures and sources of financing in health care, the volume of medical care in the United States in comparison with the countries of European Union and the Russian Federation, the article also assesses the impact and effectiveness of the U.S. health care. The basic problems of the U.S. health care at the beginning of XXI century are described.

Results and Conclusions: The study confirmed that the U.S. health care system, which is based on voluntary medical insurance of the majority of population and the use of market mechanisms in financing and management of health care, is less effective than in the countries of European Union. It is concluded that the market mechanisms in health funding lead to uncontrolled growth of health care costs, reducing its availability to the general population (16% uninsured) and disintegration of the process of care for patients.

The main recommendation for the Russian healthcare based on the US experience - is to provide long-term policy measures for maintaining and development of the system of financing of program on state guarantees of delivery medical care for the whole population based on solidarity principle.

In the Russian health care it’s necessary to avoid implementation of any marketing mechanisms in healthcare guarantees financing (i.e. replacement of compulsory medical insurance for a certain part of population voluntary one; the competition of private insurance agencies and state control liberalization in providing guarantees and insurance fees). Concerning management in state health care system, introduction of marketing mechanisms (rules) such as patient’s right to choose medical insurance agency, physician and medical organization, and free pricing of medical services should be carried out under the state control.

Keywords. Healthcare reform in the USA; the healthcare financing; compulsory medical insurance; voluntary medical insurance; state regulation in healthcare, marketing mechanisms in healthcare.

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