ИСТИНА

Problems of effectiveness of public finance is on the political agenda in many countries raising the issues of correlation between the goals set by public policy and public money allocated to reach them. Health care is a good case as limits of public funds that can be mobilized and allocated to health care in modern capitalist society give rise to dual problem of, on one hand, how to find resources to cover raising health care needs and, on the other hand, to use the available resources more effectively. The trend that nowadays manifests in Russia is increasing share of private finance in total health expenditures that questions effectiveness as well as sufficiency of public finance to meet the objectives of health policy. The paper analyses the existing public-private mix in health finance in Russia, first of all the growth of out of pocket payments (OOP) that constitute the major share of private health expenditures. It discusses the two paradoxes of healthy policy that are connected with the role of OPP, including introduction fee for service in state owned health services. The authors describe major developments in public finance in Russian health care, namely introduction of programme based budgeting and changing financial flows in health care in the context of budget federalism to understand how they might influence the effectiveness of public finance. It is suggested that mechanisms of implementation of health policy lead to individualization of health finance. If Russian government is not prepared to expand its health responsibilities, prepayment mechanisms need to be developed if universal health coverage is to be a reality in Russia.