Spatial Deformation of the Public Health System Effectiveness

Using official statistics the authors assess the performance of the public health system in the context of federal districts of the Russian Federation. The study shows that despite the highest level of funding among all federal districts, effectiveness of the public health system in the Far Eastern district remains the lowest in the country, both in absolute terms and measured by rates of their changes. Low efficiency rate can be explained when various constraints are taken into account: demographic, socio-economic and spatial. Among the demographic constraints the authors point towards high mortality rate of working-age males in the region that is highest among all districts, especially in preventable diseases. Under the socio-economic limitations the authors understand low affordability of medical services for the population of almost all subjects of FEFD. Spatial constraints include low population, settlements and road network densities due to historical patterns of settlement. The analysis suggests that, firstly, ignoring the restrictions forms a distorted view of the actual situation in this sector; and secondly, the use of a single healthcare model for all regions reduces affordability and spatial accessibility of medical services for the population, prevents achievement of public health targets and efficient use of public funds.