Inter-Territorial Calculations for Identifying Imbalances and Problems in Health Insurance

The current strategic goals in the national public healthcare require improving its quality and availability, which implies effective financial management in the compulsory health insurance system. Regional compulsory health insurance funds provide citizens with free medical care as part of state healthcare programs. The article introduces an in-depth analysis of the revenue and expenditure budget structure of regional compulsory health insurance funds with a focus on the inter-territorial calculations. The analysis made it possible to propose a system of measures to make the funds more effective by improving their management. A review of various approaches to financial assessment revealed that the formal balance, which supposedly reflects the financial stability of the health insurance system, cannot be considered as a reliable indicator. Only an objective assessment could reveal the obscure imbalances, local financial disproportions, and issues connected with the inter-regional distribution. The authors conducted an in-depth analysis of the dynamics of the budget, income, and expenses provided by the Siberian compulsory health insurance funds in 2009–2024. The assessment of inter-territorial financial flows caused by patient migration revealed a correlation between the indicators of the outflow of patients seeking medical care in other regions and the socio-demographic factors. By optimizing the identified imbalances and increasing the medical attractiveness, regions could improve the financial and economic mechanism of their compulsory health insurance systems, as well as ensure their sustainable development.