In the next 20 years, medical care in Russia will become less available because the state can’t fully Fund health care. The way out can be a copay for medical services by the population. This is stated in the expert feedback on the draft budget forecast of Russia until 2034 at the Higher school of Economics (HSE), sent to the Ministry of Finance of the Russian Federation and published on the HSE website.

The cause of the deterioration of medical care experts “towers” consider the demographic situation. By 2034, the working-age population of Russia decreased by 4.4 million people, and the number of pensioners in need of medical assistance, will grow by five million. If the health will not find additional sources of funding, medical services will become less available.

The reduction in the availability of medical care, according to the authors of the opinion, “manifest not so much in the revision of the list of services, how much to increase time, size of legal and informal payments and in reducing the uptake of them low-income populations.”

“We must persist in the search for reserves of state funding for the industry. However, we must recognize that these reserves are not limitless, which is why it is necessary to discuss the options of co-financing of medical services by the population”, – stated in the opinion.

Another solution can be found by using the remote examination and treatment

Director of the Scientific research financial Institute (nifi) Vladimir Nazarov in comments RBC was named the co-financing of medical care inevitable process that is already running. In his opinion, the introduction of such forms of payment at the official level could have a positive impact on improving the efficiency of resource use in health care.

Today the population uses the primitive model of co-financing: is the payment of medical services that the state for any reason cannot guarantee. According to the Fri, the population pays about 40% of the total medical care. Sofinansirovanie in the direction of dentistry.

Another form of co-financing, which is not used yet in Russia, but can be used – a small fixed fee for any medical care. In that case, all medical services should be set pobremente rates, for example, 100 rubles per appointment at the clinic, says Nazarov.

The most advanced type of co-financing – a combination of compulsory health insurance (CHI) and voluntary health insurance (VHI): the state guarantees on OMS service with defined parameters. If the patient wants to improve these parameters, then the difference covered by his secondary insurance.

Director of the Institute of health Economics HSE Larisa Popovich believes that the analysis was not sufficiently taken into account the development of modern technologies, telemedicine (remote assessment and treatment) that can reduce the resource requirements on health care. “Scanners, mobile health, drones that can deliver medical supplies and evacuate citizens, telemedicine – all this will significantly reduce spending on the industry and will help to avoid attracting the public to pay for medical care”, – the expert believes.

The President of the League of defenders of patients Alexander Saversky is also noted that modern technologies allow to save budgets, and the forced payments of the population for medical services calls a violation of constitutional rights. Free assistance to all citizens guaranteed by the Constitution.

In the study of the Financial University under the government of the Russian Federation, commissioned by the social block of the Cabinet, saidthat for five years significantly the share of Russian adults who attend paid clinics and hospitals rose from 34% to 40%. Other studies show that almost half of Russians does not believe national health care is free.

In addition to raising the retirement age, the HSE recommended to get rid of the early retirement

With the aging of the population lies another budget problem – the challenges to the pension system. HSE experts believe that the government will not be able to avoid raising the retirement age for men and women. They also agreed that alignment of the regulatory retirement age for men and women, and recommended that “to reduce liabilities on early retirement”.

“Today, despite the difference in five years in the legal retirement age for men and women, on average women retire at the age of 53, and men at age 54. According to our calculations a reasonable reform of early retirement may liberate in the year to 0.1% of GDP”, – stated in the opinion.

The theme of raising the retirement age is discussed for a long time, last time it was raised in November in the presentation of the head of the Pension Fund of Russia Anton Drozdov, however, the Department declaredthat such a matter is not being examined and orders from the leaders sotsbloka to raise the retirement age in 2019, the FIU had received. Before raising the retirement age to balance within the pension system between the payers of contributions to the pension Fund and the recipients of payments – commented the Minister of economic development Alexei Ulyukayev before the arrest and resignation.

Now Russian men retire at 60, women at 55. To raise the retirement age to 65 years for both men and women in increments of 6-12 months in the beginning of the year suggested the Ministry of Finance, the issue was mentioned by the chair of the Center for strategic research, former Finance Minister Alexei Kudrin.

However, according to the Vice Prime Minister Olga Golodets, who oversees social bloc of the government, and Prime Minister Dmitry Medvedev, the Cabinet of Ministers on that matter.

The HSE has predicted a departure from the free medicine and recommended that the state “co-funded by the population” 30.11.2016

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