«Public Administration Issues» Journal,

Post. address:
National Research University
Higher School of Economics
20 Myasnitskaya Str., Moscow 101000, Russian Federation
Location address:
of. 307, 4/2, Slavyanskaya sq., Moscow 109074, Russian Federation

Tel./fax: 7 (495) 772-95-90, ext. 12631

E-mail: vgmu@hse.ru 


Major Indexing

Research and educational journal
Published quarterly since 2007
ISSN 1999-5431
E-ISSN 2409-5095

Igor Sheiman1,2
  • 1 National Research University Higher School of Economics, 20 Myasnitskaya Str., Moscow, 101000, Russian Federation
  • 2 PhD (econ), Professor of the Chair of health economics and management, NRU HSE.

Problems of Transition to the Capitation Method of Primary Care Payment

2016. No. 4. P. 143–164 [issue contents]
The paper addresses state policy in the area of primary health care payment methods in the system of mandatory health insurance in Russia. The need for the transition from physicians’ visits reimbursement to capitation payment is substantiated. It is argued that the current payment method hinders disease prevention activities, chronic disease management, integration of service delivery as well as a shift of services from inpatient to outpatient settings. The latest regulatory documents on this subject are critically evaluated with the focus on the attempts to combine the capitation method with the fee-for-service one. Alternative approaches aimed at cost containing and strengthening disease prevention are discussed. Versions of fundholding schemes are suggested as well as the ways to mitigate their excessive financial risks. Various options of the pay-for-performance are seen as the necessary addition to the fundholding scheme. Problems of the capitation rate development under the fundholding are reviewed. It is argued that the budget of a fundholder should include only a manageable part of the inpatient care cost. The methods of planning primary health care utilization should also change – from the current planning of the number of a physician’s visits to the planning of the size of a catchment area in terms of the number of residents served by primary health care providers. Some recommendations on the algorithm of transition to the capitation payment are made.

Citation: Sheiman, I.M. (2016). Problemy perekhoda na podushevoi printsip oplaty pervichnoi mediko-sanitarnoi pomoshchi [Problems of Transition to the Capitation Method of Primary Care Payment]. Public Administration Issues, n. 4, pp. 143–164 (in Russian).
ISSN 1999-5431
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