Territorial Disparity Between Tariffs For Inpatient Care In The Compulsory Health Insurance

The article discusses the differences in the tariffs in the DRG-based hospital payment system, which remain between the subjects of the Russian Federation after the introduction of this system. Since 2018, the public policy has been stepped up to reduce territorial disparity between tariffs. In 2019, the two keys rule was introduced: the Federal Compulsory Medical Insurance Fund received the right to agree on tariffs for paying for medical care, approved in each constituent entity of the Russian Federation. The article analyzes the effectiveness of this policy. The estimates of the variation in the tariffs for inpatient care and in the modifying factors used in their calculation in 2017 and 2019 are presented. The study analyses the tariff agreements on compulsory medical insurance, concluded in the subjects of the Russian Federation. The results of the analysis show that the interregional disparity between these parameters has decreased but remains large. The reasons that cause it are 1) interregional and intraregional differences in the expenditures of medical care providers for the treatment of similar cases, which are not eliminated during the period of the introduction of the DRG-based hospital payment system; and 2) the need to ensure the increase in salaries for medical workers according to the governmental targets. The problem statement of further reduction of existing differences in tariffs is derived from analyzing the possibilities of long-term modernization of regional health care systems to smooth out existing interregional differences in the spatial, territorial, material and financial factors of ensuring state guarantees for the provision of free medical care to the population.