ИСТИНА

Abstract Health reforms are at the forefront of modern health care systems development for many well-documented reasons. The limits of public funds that can be mobilized and allocate to health care in modern capitalist society put high on political agenda the problem of finding resources enough to satisfy raising health needs and using the available funds more effectively. One way is to increase the share of private finance and delivery in more or less “socialized” (tax-funded or social insurance) health systems, but this is likely to negatively affect access to health care without significantly improving quality of treatment. Development of public/private mix in Russia is influenced by both the Soviet history of health system development and societal reforms undertaken during transition period, the general trend however being less state participation and increased private mostly out-of-pocket spending. The paper analyses the existing public-private mix in health finance and delivery in Russia including introduction of fee for services in state health services and raise of private sector in health care delivery and how it might affect access. The research is based analysis of both literature and official statistical data available on the subject and results of various sociological survey conducted by research groups or commissioned by official bodies, such as Ministry of Health and Federal State statistical agency (Rosstat). Taking into account the “sustainability” low level of public health expenditures coupled with high income inequality, it is suggested that certain groups of low-income people in Russia, first of all low income and living in remote areas are likely to experience problems in obtaining medical care. This situation provides for a new role for the government to control not only public but also private health expenditures as well in strengthening state administrative capacity in the course of public sector reforms with the view of securing people's access to health care.