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  Foreword
  This review of the Russian health system was undertaken at the request of the Council of the OECD within the context of the request by the Russian authorities to accede to the Organisation. Thus, this study forms part of a broader effort to assess the coherence of policies of the Russian Federation with those of OECD member countries. The development of health outcomes in the Russian Federation has contrasted sharply with developments in the OECD area over the last quarter of a century. This report follows on the OECD Reviews of the Health Systems of Korea (2003), Mexico (2005), Finland (2005), Switzerland (2006 and 2011) and Turkey (2008).
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  Acronyms and abbreviations
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  Introduction
  The Russian Federation has faced a difficult period of economic and social transition since the move to a market economy. Severe recessions in the 1990s were accompanied by reduced financing of the health system and consequent reductions in the availability of health care services. Partly as a consequence, indicators of health outcomes weakened sharply and the overall size of the population declined. Recent improvements in the overall economic climate, increased financing for the public health system and a strengthening of broader health care policies in a number of areas appear to be having a positive impact on broad indicators of population health. The decline in the population has progressively slowed; and there was actually an increase in 2010. Mortality has also fallen somewhat and life expectancy at birth has increased starting from around 2004 onwards. Despite these improvements, the Russian Federation still lags behind OECD countries by a considerable margin. For example, Russian average life expectancy at birth – at 69 years in 2010 – is around ten years lower than the average of the OECD countries. The Russian authorities are placing great emphasis on achieving further improvements in the future.
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  Assessment and recommendations
  It is a fact that Russian health outcomes fall well below those of OECD countries. Russian life expectancy at birth averaged 69 years in 2010 (63 years for men and 75 for women) and lags behind the OECD average by slightly more than ten years. The Russian Federation’s life expectancy is also low when compared with OECD countries with similar levels of income per capita – e.g. average life expectancy is about seven years less in the Russian Federation than in Chile and Poland. A similar picture emerges using other concepts of longevity such as disability-adjusted life expectancy (DALE) and healthy life expectancy (HLE) (see Chapter 3).
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  The organisation of the Russian health system
  This chapter provides background material aimed at helping to understand better the context of current health policy in the Russian Federation and its recent development. It then goes on to describe the economic size of the health sector and key features of the Russian health care system, in particular the arrangements for the financing and supply of health care and public health services.
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  Recent health policy developments in the Russian Federation
  This chapter provides a short critical overview of recent developments in Russian health policy and the progressive shift away from shorter run policies towards the resolution of deeper structural issues. This chapter regroups these measures into five broad categories: i) restoring the capacity of the health system to provide quality care; ii) reducing mortality through prevention; iii) enhancing access; iv) financial sustainability, and v) more systemic reforms. Thus, under each heading more than one programme can be at play. This discussion demonstrates that the health care debate is evolving rapidly to palliate some of the problems of existing arrangements.
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  The performance of the Russian health system
  This chapter first examines how the Russian Federation compares internationally over a range of health-related indicators. It then looks in more detail at the performance of the health system as seen from four different vantage points that broadly correspond to the key objectives of health systems. The first objective concerns ensuring that patients can access the care that they need under the Government Guarantee Package on a timely basis. The second concerns the quality of care and whether it is adapted to patient needs. The third key goal concerns the resources allocated to the public health care system and whether this is sustainable over the longer haul. The final key issue concerns the scope for easing any overall resource constraints on the public health care system through improved efficiency of health care provision. The chapter concludes with a discussion of policies that can help improve system performance.
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