In recent decades, healthcare in developed countries has followed divergent tendencies in the concentration of power and resources at the national and sub-national levels. Some countries were decentralizing their healthcare management systems, while others were centralizing them. Multiple studies provide controversial evidence of the positive and negative effects of centralization and decentralization.

OBJECTIVE

To determine the impact of pendulum reforms of centralization — decentralization — recentralization that have taken place in Russian healthcare over the past four decades on ensuring regional equalization of public sector funding.

MATERIALS AND METHODS

The study uses a step-by-step methodological approach covering the analysis of foreign and domestic experience in implementing healthcare reforms, the determination of changes in per capita health spending in the regions of the Russian Federation over several years, and the determination of the consequences of centralization and decentralization processes on the alignment of regions in terms of the level of public health financing. The study relied on the following sources of information: international and domestic publications on the healthcare systems’ centralization and decentralization, Russian legislation on healthcare reform, and data from the Russian Treasury and the Federal Compulsory Health Insurance Fund.

RESULTS

The decentralization of Russian healthcare increased regional inequality in public health financing. The subsequent recentralization in the early years contributed to a reduction in regional inequality. In recent years, inequality has begun to increase again, driven by opposing trends in the concentration of power in two systems of public health financing.

CONCLUSION

In order to reduce regional inequality, the main focus should be on increasing the role of the federal center in issues of budgetary financing of healthcare in the regions and the creation of adequate mechanisms for regional equalization within the framework of this system.