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Decentralization processes in Russian Federation: the case of health care administration

Kharson, Yulia (2011) Decentralization processes in Russian Federation: the case of health care administration.

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Abstract:Interest in decentralization reforms in public sector was quite common for both developed and developing countries in the period after 1990. Russia was one of the countries that decided to decentralize its health care administration, but many authors, describing this particular reform, argue that its implementation was not done in a quality manner and they blame decentralization processes for the problems connected with addressing “collective heath needs”. One of these problems is the issue connected with the inequalities in health care provision between various regions and districts in Russian Federation. This paper, basing on the theoretical assumptions on the influence of socio-economic, political and administrative forces on the process of decentralization reform, aims to find out which of these forces could possibly lead to the creation and reinforcement of the inequalities in health care provision between six Russian regions (Moscow, Ivanovo, Tver’, Leningrad, Samara and Chelyabinsk) between 1995 and 2008, and therefore to identify which factors should the reformers pay attention to in the framework of decentralization (or recentralization) in Russian health care administration. On the basis of the analysis that had been conducted, this paper describes the influence of the changes in Gross Regional Product and the degree of decentralization, which were chosen as independent variables, on the level of equity in six Russian regions and provides with the recommendations concerning the following investigations of the topic. This study shows that that the degree of decentralization connected with such functions of health care administration as financing, provision, regulatory and steering on the regional level did not influence the inequalities in health care provision between six Russian regions. This paper has therefore proved the theoretical assumption on the indivisibility of political and administrative forces in the case of post-Soviet Russia, as the degree of decentralization of each of the variables in the given period was consistent for all the regions, the reform was implemented under the control of central powers (and the above mentioned functions of health care administration were not completely devolved to the regional authorities) , and the changes were introduced simultaneously in all the regions of the country. The correlation between changes in Gross Regional Product and the inequalities in health care provision (defined in the study as the number of doctors per 10000) in six regions is negative – the highest Gross Regional Product corresponds to the least amount of doctors per capita. This study suggests involving more of socio-economic indicators (such as morbidity level and the amounts of salary payouts for the doctors) in the future researches on the topic in order to find the precise explanation for these results. Key words: decentralization in health care administration, Russian Federation, model of public management reform, Gross Regional Product (GRP), degree of decentralization, inequality in health care provision, post-Soviet reform.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:88 social and public administration
Programme:Public Administration MSc (60020)
Link to this item:http://purl.utwente.nl/essays/62777
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