State guarantees of free medical care: What has changed in 20 years?

Cover Page
Open Access Open Access
Restricted Access Subscription Access


Over the past two decades, state guarantees of free medical care remain the most uncertain type of state guarantees, which leads to an increase in public payments for medical services. The authors believe that state guarantees are necessary not by themselves, but for the most complete implementation of human rights to ensure health care and health in real life. The compulsory health insurance system in Russia that primarily imitates insurance resembles a distribution (budget) financing model based on the organized purchase of guaranteed medical care by private entities, which are not subject to political and economic control. Therefore, in Russia, the share of private expenditure on health care in the structure of total expenditure is almost three times higher than that found in economically developed foreign countries that implement the insurance model in health care. The health care system must be equipped with a “medical policy” that has a strategic focus and covers all levels and components of the health care system. Moreover, this policy must create conditions where the circle of strategic decision-makers in health care will be separated from the circle of people who develop and implement tactical tools.

Vladimir I. Perkhov

Central Research Institute for the Organization and Informatization of Health Care; Federal Research and Clinical Center for Intensive Care Medicine and Rehabilitology

Author for correspondence.
ORCID iD: 0000-0002-4134-3371

Russian Federation, 11, Dobrolubov street, Moscow, 127254; 25-2, Petrovka street, Moscow,107031

MD, PhD, Chief Research Worker

Dmitriy S. Yankevich

Federal Research and Clinical Center for Intensive Care Medicine and Rehabilitology

ORCID iD: 0000-0001-5143-7366

Russian Federation, 25-2, Petrovka street, Moscow,107031

MD, PhD, Deputy Head for Innovations of the Scientific and Research Institute of Rehabilitology

  1. Шишкин С.В., Богатова Т.В., Потапчик Е.Г., и др. Неформальные платежи за медицинскую помощь в России // Главный врач. - 2003. - № 3. - С. 189. [Shishkin SV, Bogatova TV, Potapchik EG, et al. Neformal’nye platezhi za meditsinskuyu pomoshch’ v Rossii. Glavnyy vrach. 2003;(3):189. (In Russ.)]
  2. Постановление Правительства Российской Федерации № 41 от 23 января 1992 г. «О мерах по выполнению Закона РСФСР «О медицинском страховании граждан в РСФСР». [Resolution of the Government of the Russian Federation № 41 of 1992 Jan 23 “O merakh po vypolneniyu Zakona RSFSR “O meditsinskom strakhovanii grazhdan v RSFSR”. (In Russ.)]
  3. Постановление Правительства Российской Федерации № 1096 от 11 сентября 1998 г. «Об утверждении Программы государственных гарантий оказания гражданам Российской Федерации бесплатной медицинской помощи». [Resolution of the Government of the Russian Federation № 1096 of 1998 Sep 11 “Ob utverzhdenii Programmy gosudarstvennykh garantiy okazaniya grazhdanam Rossiyskoy Federatsii besplatnoy meditsinskoy pomoshchi”. (In Russ.)]
  4. Платное обслуживание населения в России. 2017: Статистический сборник. - M., 2017. - 110 c. [Platnoe obsluzhivanie naseleniya v Rossii. 2017: Statisticheskiy sbornik. Moscow; 2017. 110 p. (In Russ.)]
  5. [Internet]. Global Health Expenditure Database [cited 2019 Feb 20]. Available from:
  6. [Интернет]. Бюджетные ассигнования по расходам федерального бюджета на 2017 год и на плановый период 2018 и 2019 годов (по состоянию на 15.12.2017) [дата обращения: 20.02.2019]. Доступ по ссылке: [ [Internet]. Budget allocations for Federal budget expenditures for 2017 and the planning period of 2018 and 2019 (as of 15.12.2017) [cited 2019 Feb 20]. Available from: (In Russ.)]
  7. [интернет]. Бедность: где грань? [дата обращения: 20.02.2019]. Доступ по ссылке: [ [Internet]. Poverty: where is the line? [cited 2019 Jan 20]. Available from: (In Russ.)]
  8. [Internet]. Health Status [cited 2019 Jan 20]. Available from:
  9. Постановление Правительства Российской Федерации № 1006 от 4 октября 2012 г. «Об утверждении Правил предоставления медицинскими организациями платных медицинских услуг». [Resolution of the Government of the Russian Federation № 1006 of 2012 Oct 4 “Ob utverzhdenii Pravil predostavleniya meditsinskimi organizatsiyami platnykh meditsinskikh uslug”. (In Russ.)
  10. Тихомиров А.В. Законодательные унификаты и деликт в сфере охраны здоровья // Медицинская экспертиза и право. - 2016. - № 3. - С. 10-17. [Tikhomirov AV. Legislative unifications and delict in health sphere. Medical examination and law. Meditsinskaia ekspertiza i pravo. 2016;(3):10-17. (In Russ.)]


Abstract - 78

PDF (Russian) - 0



  • There are currently no refbacks.

Copyright (c) 2018 Perkhov V.I., Yankevich D.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.