The system of birth certificates was planned to be one of the most important instruments of Russian demographic policy, and was a major tool in the shaping of the healthcare system. The essence of this innovation consists of creating financial instruments, which provide for the possibility of prenatal services and obstetrics “follows” the patient. At the same time, it presupposes that the women will be able to pick a medical facility and a doctor which she finds the most trustworthy and convenient.
Three years after the start of the program, the Institute for the Rule of Law analyzed the real work of the birth certificate system and detected key barriers standing in the way of its successful functioning.
Throughout program implementation, reformers realized that the majority of administrative technologies and financial mechanisms that provide for the functioning of the health system are up to this day planned. In spite of the introduction of the system of Obligatory Medical Insurance, the actual work of medical facilities is organized around the principle of budget allowances, based on the achievement of planned indicators (such as the number of examined patients, workload of a specific doctor). The plan is set up on the basis of the number of registered citizens on the assigned territory and medical service standards, which were established primarily during the Soviet period.
For this reason, the key goals of the birth certificate program – individualization of medial service, creation of a system of conscious choice of doctor and medical facility – were not achieved. A significant number of patients are still compelled to receive medial care in connection with the address of their registration and have no opportunity to pick a doctor etc. Moreover, introduction of the system of birth certificates has led to the further bureaucratization of the system of maternity welfare centers (due to the necessity to keep records in accordance with two logics.)
On the other hand, positive developments came about in terms of the provision of maternity welfare centers with medical equipment. The quality of pharmaceutical products provided to the patients also rose. But it is precisely these results that could be achieved without introduction of the birth certificate system, but simply by provision of budget allowances.
The reason for this situation is that within one organization two systems of financing and record keeping function alongside each other. The logical ending of the reform: separation of the employees working with gynecology patients and with pregnant women, full abolition of the budget allowance system . Additionally, a stable number of employees in each maternity welfare center could be conducive to a radical improvement of the situation.
It is abstract in English of Russian-language text by Ekaterina Borozdina.
You can download this abstract (PDF) and full text in Russian (PDF)
