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Thursday, 24 September 2015

Obukhova O.V.
Federal Research Institute for Health Organization and Informatics, Moscow

Contacts: Obukhova Olga, email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Abstract: Basic element of structural reforms in health care is the first level of care delivery, providing primary health care, including specialized primary care. Care provided on the outpatient basis is aimed at strengthening preventive activities in healthcare and provision of regular clinical examination of population, which is incorporated as one of the priority tasks of the state program of the Russian Federation "Healthcare development."

Need to intensify preventive activities is the main criterion for choosing a method of payment for medical care provided at primary level. This need explains significance of the paper presented.

The purpose of the study: To analyze capacity of the stated by the Program of state guarantees methods of payment for outpatient medical care in the context of implementing objective to intensify prevention activities.

Methods: Analysis of legal documents (both federal and regional level), establishing ways of payment for medical care provided in outpatient settings. As to research methods, the author used analytical, statistical and descriptive ones.

Results: The author studied practice of using various mechanisms of payment for medical care provided on the outpatient basis, in terms of their effect on preventive activities of a medical organization. Currently, only economic incentives can affect improve performance of health specialists. It is proved that in case of poor population coverage with preventive measures the greatest effect can be achieved by implementation of the costly payment method - per unit, per service, per completed case of treatment.

Conclusions: Payment per completed outpatient case can significantly influence success of preventive campaign if the objective is to ensure comprehensive population coverage with such activities, aggravated by insufficient funding of the healthcare system. To control costs associated with this payment method it is possible to limit amount of funding of a medical organization, calculated on the basis of per capita rate and number of the insured catchment area.

Keywords: completed case; prevention; outpatient conditions; methods of payment; obligatory health insurance


  1. Kadyrov F.N., Obukhova O.V. Effektivnye sposoby oplaty meditsinskoy pomoshchi v svete programmy gosudarstvennykh garantiy [Efficient methods to pay for medical care in the light of the program of the state guarantees]. Menedzher zdravookhraneniya 2013; (11): 6-13. (In Russian)
  2. Metodicheskie rekomendatsii po vyboru sposoba i organizatsii oplaty meditsinskoy pomoshchi v sisteme obyazatel'nogo meditsinskogo strakhovaniya grazhdan v Rossiyskoy Federatsii [Methodical recommendations to select the method and organization of payment for medical care in the system of mandatory health insurance for the citizens of the Russian Federation]. Utv. Federal'nym fondom obyazatel'nogo meditsinskogo strakhovaniya 18.10.1993 g. [Online] [cited 2015 Jun 05]. Available from: http://www.lawrussia.ru/texts/legal_689/doc689a747x707.htm (In Russian)
  3. Obukhova O.V. Usloviya vnedreniya podushevogo printsipa finansirovaniya pervichnogo zvena [The condition for implementation of per capita financing of primary care]. GlavVrach 2012; (2): 61-64. (In Russian)
  4. O Programme gosudarstvennykh garantiy besplatnogo okazaniya grazhdanam meditsinskoy pomoshchi na 2015 god i na planovyy period 2016 i 2017 godov [On the Program of the state guarantees for providing free medical care to the citizens for 2015 and planned period of 2016 and 2017]. Postanovlenie Pravitel'stva RF ot 28.11.2014 N 1273. [Online] [cited 2015 Jun 05]. Available from: http://www.rg.ru/2014/12/05/medpomosch-site-dok.html (In Russian)
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