Abstract: The subject of the study is the sources of financial support for state guarantees of free medical care to citizens in the Russian Federation. Particular attention is paid to the analysis of the composition and structure of the financial support of state guarantees of free medical care to citizens (including the volume of contributions received by the budget of the Federal Compulsory Medical Insurance Fund for working citizens and for non-working citizens). The authors also assessed the potential volume of MHIF budget revenues from the payment of insurance premiums and compared the results obtained with actual data. Research methods used: structural and dynamic analysis, synthesis, comparison, as well as graphical presentation of the results obtained. Based on the results of the study, it was revealed that contributions for the non-working population are paid from regional budgets. Taken together with the use of funds from the federal budget for the implementation of the program of state guarantees for the provision of free medical care to citizens, this allows us to conclude that the budgetary financial mechanism is predominantly used in financial support for the implementation of state guarantees of free medical care to citizens in Russia. In order to maximize the volume of funds for solving problems in the field of healthcare, as well as ensuring their more efficient use, the authors propose expanding the list of objects subject to insurance premiums, as well as a more reasonable approach to establishing various preferential regimes that reduce the volume of budget revenues of the Federal Compulsory Health Insurance Fund. The author’s calculations showed that the actual revenues of the MHIF budget are approximately half of the potential ones.

Keywords: insurance financial mechanism, health financing models, social sphere, social development, budget financial mechanism, health financing, healthcare, health, free medical care, medical care

Abstract: Assessment of the efficiency of health expenses requires an accurate cost estimate. Assessment of the results (effects), reflected in qualitative and natural indexes (health, life expectancy, quality of life) does not permit giving their cost estimate. The subject of this research is the economic assessment of losses from reduction in life expectancy due to harmful and hazardous work conditions. The goal of this work lies in formulation of methodological approaches towards economic assessment of the impact of work environment on life expectancy of the employees. The proposed in the article algorithm of economic assessments relies on accepted in the Russian Federation Methodology of Assessment of Economic Losses Caused by Mortality of the Population. Reduction in life expectancy due to harmful or hazardous work conditions was calculated as the difference in average life expectancy without harmful and hazardous work conditions or with them presents. The indexes mortality rate among men growth proportionally with the increase of length of their employment for subcategories of 3.1 and 3.2; maximal deviation from average life expectancy in the comparison category comprised 8.3 years less for subcategories 3.3 for men; the largest deviation from life expectancy among women is observed under the subcategory 3.1 (6.6 years less). Economic losses from reduction from shortening of life expectancy for men who worked in harmful conditions comprised 136.6 million RUB in GDP (for 98 people), while for women it comprised 20.8 million RUB in GDP (for 14 people).  

Keywords: unhealthy work, harmful exposure, working conditions, reduction in life expectancy, value for money, economic losees from mortality, economic evaluation, economic losees, efficacy evaluation, GDP losses