Optimization of Tariff Policy in the Area of Compulsory Medical Insurance in the Subject of the Russian Federation

The article is dedicated to the optimization of the tariff policy in the field of compulsory health insurance, the example of the Arkhangelsk region in 2017. The authors described the main climatic and geographical parameters of the region that affect the availability of medical care. The tariff policy is based on the requirements of regulatory acts, taking into account the specifics of medical care. The authors analyzed characteristic aspects of the region, conducted a SWOT-analysis of the tariff policy, and formulated proposals for its improvement. The authors determined the following main shortcomings of this activity: the reduction of tariffs due to the withdrawal of funds to pay for certain medical services and the withdrawal of funds to pay for certain completed cases (appeals), as well as limiting the amount of funding due to the redistribution of funds in favor of medical organizations in which medical specialists who are not included in the per capita method of payment for medical care are concentrated. The authors acknowledged as justifiable the introduction of separate tariffs within the framework of outpatient medical care and the performance indicators of medical organizations — fund holders. They came to the conclusion that it is necessary to introduce differentiated cost-effectiveness factors when paying for inpatient medical care, to introduce a differentiated approach to paying for cases of medical care, to pay for medical care in accordance with the costs incurred and to further develop hospital-substituting technologies.