Evaluation of health care delivery integration: The case of the Russian Federation
This case study explores the current state of affairs within Russia's health system providing care for increasingly complex chronic conditions from the perspective of providers, namely physicians. A survey was developed by a group of experts and later distributed by the Russian center for public opinion research in August 2012. It focused on the interactions between providers at different levels of the health system often working in different organizational models such as primary care offices, polyspecialty clinics as well as hospitals. The survey focused on three areas crucial to integration, namely: teamwork, coordination and continuity of care. The results from the survey showed that the level of integration was low by nearly every measure across the different levels of the health system. The authors note that little emphasis has been placed on this issue since the 60/70's "when quite a lot of regulation was issued on district physicians’ coordination role and continuity of care." Since that time, there has been a reorientation away from coordination by district physicians to services provided by specialists in the 70/80's followed by a subsequent division of the national system "into four sub-systems – federal, regional, community and private – with poor coordination between them" and finally a transition to mandatory health insurance in 1994 which changed the funding of health care from integrated payment mechanisms to fee for service. These changes have deflected attention from the coordination of care to the provision of highly detailed and specialized services. The authors encourage a stronger regulatory role of the government while providing three concrete recommendations, namely: developing information technologies focused on integration, strengthening PHC providers’ coordination function and introducing economic incentives to promote integration.