Peculiarities of Health Care System in the Union State Countries and

Priority Directions of Their Marketing Development and Interaction

Tatiana S. Malakhova

, Natalia N. Zubareva

and Marina E. Botalova

kuban State University, Krasnodar, Russia

belgorod State National Research University, Belgorod, Russia

Keywords: Union State, Foreign Economic Relations, Health System, Morbidity, Outpatient Facilities, Sanctions

Regime, Risks and Threats.

Abstract: The modern health care system is transforming, not only in the Union State countries but also worldwide. The

introduction of new technologies, digitalization, and the transition to a new technological way of life are

giving states a different perspective on the healthcare system, its key gaps, and problems of development. The

presented article is aimed at the research of the key indices in the health care system of the Union State

countries, construction of the econometric model of the correlation between the indices of physical volume

of paid medical services to the population and the volume of paid services to the population of Russia as well

as calculation of forecasts of some economic indices in the mentioned sphere. In addition, the relations of the

Union State countries in the field of health care are investigated, and, on this basis, the directions of their

cooperation are improved. As a theoretical and methodological basis, the article uses historical, logical,

dialectical principles and contradictions, the scientific abstraction method. The process-system approach,

which was used in an in-depth analysis of key indicators in the given area, has become essential in the

argument about the need to strengthen the relations between the countries of the integration group in the socio-

economic sphere. Based on in-depth economic analysis and econometric model formation, the priority

directions of healthcare development in the Union State countries are outlined. The emphasis is shifted to the

development of large-scale projects between the countries of the Union State in the field of healthcare, with

the attraction of public and private investments, development of new technologies for the dynamic

development of this sphere and reduction of import dependence. The study of the health care system of the

Union State countries, identification of problems and contradictions in this field open up opportunities for

further elaboration of the priority directions of development of the mentioned field.

1 INTRODUCTION

In the current context, a new world economic order is

taking shape globally (Malakhova and Kolesnikov,

2019). Russian-Belarusian relations in the format of

the Union State have always implied a balance of

interests of the two countries, which were formed

taking into account political and economic

transformations and upheavals at the end of the XX

century. Today the Union State is more than 20 years

old. The partner countries strive not only to maintain

the mentioned format but also to strengthen mutual

https://orcid.org/0000-0002-5971-8178

https://orcid.org/0000-0002-4872-3377

https://orcid.org/0000-0003-0265-2750

relations in various spheres, including the healthcare

system.

2 RESEARCH METHODOLOGY

In modern conditions, the research in health care is

carried out by the famous Russian scientists A.A.

Redko, V.N. Anisimov, A.V. Finagentov, V.H.

Khavinson, A.V. Shabrov (Redko, Anisimov,

Finagentov, Khavinson & Shabrov, 2020),

considering the problems of creating a system of

integrated medical and social care in Russia, T.V.

Malakhova, T., Zubareva, N. and Botalova, M.

Peculiarities of Health Care System in the Union State Countries and Priority Directions of Their Marketing Development and Interaction.

DOI: 10.5220/0010666800003223

In Proceedings of the 1st International Scientiﬁc Forum on Sustainable Development of Socio-economic Systems (WFSDS 2021), pages 247-253

ISBN: 978-989-758-597-5

247

Chubarova, E.E. Shestakova (Chubarova and

Shestakova, 2019), denoting that the state remains the

key regulator of social relations and social support for

citizens, G.E. Ulumbekova, A.V. Moklyachenko

(Ulumbekova and Moklyachenko, 2017), exploring

the current state of the Russian healthcare system and

analyzing indicators to assess the performance of

medical organizations, etc. Also, special attention to

this topic is paid by B. Rozenfeld (Rozenfeld, 2021),

who notes that the uneven development of the health

care system has become increasingly evident, the

dissatisfaction of the population with medical

personnel, and the quality of services provided has

increased, P.L. Ferreira, A.I. Tavares, C. Quintal, P.

Santana (Ferreira, Tavares, Quintal and Santana,

2018), highlighting that to date, a significant number

of tools and analytical tools have been developed and

used to classify health systems, but most proposed

typologies include a small number or incomplete set

of countries, etc. On this basis, it can be noted that the

mentioned topic is researched and considered by

scientists from different positions, which makes it

possible to analyze the healthcare system using both

Russian and foreign experience.

3 RESEARCH RESULTS

In modern conditions, the health care system in

Russia and Belarus is undergoing a significant

transformation. On this basis, let us analyze some

indicators characterizing the current state of

healthcare in the Union State countries. It should be

noted that the number of hospital facilities in Russia

and Belarus is decreasing every year. For example, in

Russia, the number of hospital facilities in 2000 was

10,704, 6,308 in 2010, 5,433 in 2015, 5,293 in 2017

and 5,257 in 2018. In 2018, compared to 2000, the

number of hospital facilities decreased by 5,447 units.

A similar trend was observed in the Republic of

Belarus. In 2000, the number of hospital facilities was

830, in 2015 - 640, in 2016. - 636, in 2017. - 622, in

2018. - 612 units. In 2018, compared to 2000, the

number of hospital facilities decreased by 218 units.

If we examine the CIS countries by this indicator,

only Tajikistan and Uzbekistan showed a positive

trend in this indicator for the specified period of time.

For example, in Tajikistan, the number of hospitals in

2000 was 441, in 2010 - 444, in 2015 - 474, in 2017 -

484, in 2018 - 490. In Uzbekistan, this indicator is

unstable, but no significant reductions in the number

of hospitals have been observed. In 2000 there were

1,162 units, in 2010 - 1,158, in 2015 - 1,071, in 2017

- 1,135, in 2018 - 1,165 units. In 2018, compared to

2000, the number of hospitals increased by 3 units. In

the rest of the CIS countries, a decrease in hospital

facilities was observed over the specified period.

Based on this trend, the number of hospital beds in

Russia and Belarus is also decreasing. There were

126,000 hospital beds in Belarus in 2000. A sharp

decline occurred in 2015. So, in 2015 the number of

hospital beds was 82 thousand, in 2016 - 80, in 2017

- 80, in 2018 - 80 thousand. In 2018, the number of

hospital beds decreased by 46,000 compared to 2000.

A similar trend was observed in Russia. In 2000, the

number of hospital beds was 1,672 thousand, in 2010

- 1,339, in 2015 - 1,222, in 2017 - 1,183, in 2018 -

1,173 thousand. Compared to 2000, in 2018 the

number of hospital beds in Russia decreased by 499

thousand. The number of hospital beds, including for

children, in the Union State countries was also

decreasing. In Russia in 2000 there were 229

thousand of them, in 2010 - 179, in 2015 - 163, in

2017 - 158, in 2018 - 157 thousand. The number of

hospital beds for children decreased by 72,000 in

2018 compared to 2000. In the Republic of Belarus,

there were no significant reductions in this indicator.

In 2000, their number was 15 thousand, in 2015 - 11,

in 2016 - 11, in 2017 - 11, in 2018 - 11 thousand. In

2018, the number of hospital beds for children

decreased by 4,000 compared to 2000. Among the

CIS countries, Kazakhstan, Tajikistan and

Uzbekistan had the most stable indicators. In

Kazakhstan, the number of hospital beds for children

in 2000 was 19 thousand, in 2010 - 19, in 2015 - 18,

in 2017 - 18, in 2018 - 19 thousand. In Tajikistan, in

2010, the number of hospital beds for children was 9

thousand, in 2015 - 9, in 2017 - 11, in 2018 - 10

thousand. In Uzbekistan in 2000 there were 29

thousand hospital beds for children, in 2010 - 29, in

2015 - 27, in 2017 - 27 thousand. It is also important

to analyze the number of outpatient facilities in the

Union State countries. In the Republic of Belarus,

their number has increased over the period under

analysis. In 2000, the number of outpatient clinics

was 1.8 thousand, in 2015 - 2.3, in 2016 - 2.3, in 2017

- 2.2, in 2018 - 2, 2 thous. In 2018, the number of

outpatient facilities in the Republic of Belarus

increased by 0.4 thousand compared to 2000. In

Russia, the number of outpatient clinics in 2000 was

21 thousand, in 2010 - 16, in 2015 - 19, in 2017 - 20,

in 2018 - 20 thousand. Compared to 2010, the number

of outpatient clinics increased by 4,000 in 2018. The

capacity of outpatient clinics (number of visits per

shift) in Russia is increasing every year. In 2000, this

indicator was 3,534 thousand, in 2010 - 3,696, in

2015 - 3,861, in 2017 - 3,967, in 2018 - 3,998

thousand. The number of visits per shift increased by

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248

464,000 in 2018 compared to 2000. As statistics and

calculations show, this indicator has been increasing

over the years in many CIS countries. For example,

in Uzbekistan, the capacity of outpatient clinics

(number of visits per shift) in 2000 was 415 thousand,

in 2010 - 423, in 2015 - 407, in 2017 - 405, in 2018 .

- 441 thousand. The capacity of outpatient clinics in

Kazakhstan was rather unstable. In 2000, this

indicator was 252 thousand, in 2010 - 263, in 2015 -

269, in 2017 - 215, in 2018 - 268 thousand. In 2018,

compared to 2000, this indicator increased by 16

thousand. In Armenia, the capacity of outpatient

clinics in 2000 was 42 thousand, in 2015 - 39, in 2016

- 40, in 2017 - 40, in 2018 - 40 thousand. The

commissioning of health care facilities is of particular

importance in the health care system. Figure 1 shows

statistical data (in dynamics) for Russia and Belarus

on outpatient and polyclinic facilities (visits per shift)

from 2000 to 2019 and forecast calculation till 2025.

Figure 1: Commissioning of health facilities. Outpatient

facilities (visits per shift) from 2000 to 2019 and projection

to 2025. (calculated by the authors)

Calculations showed that outpatient clinics (visits

per shift) in the Republic of Belarus in 2021 will be

824.4, in 2022 - 747.9, in 2023 - 762.7, in 2024 - 499,

0, in 2025 - 651.2. Compared to 2015, this indicator

may increase by 195.2 in 2025. In Russia, based on

the calculations carried out, in 2021 this indicator will

be 24,013.2, in 2022 - 23,525.3, 2023 - 24,577.1, in

2024 - 25,064.7, in 2025 - 24,301.5. Compared to

2015, it could increase by 592.5 in 2025.

The number of medical personnel is an important

indicator when assessing the health care system in the

Union State countries. Let us analyze this indicator in

more detail in the dynamics from 2000 to 2018. The

number of medical personnel will be represented per

10,000 people in Russia and Belarus. Overall, Russia

and Belarus did not experience a significant reduction

in this indicator. In the Republic of Belarus in 2000

this indicator was 46 people, in 2010 - 54, in 2015 -

43, in 2017 - 44, in 2018 - 45 people. There were 12

general practitioners in 2000, 14 in 2010, 18 in 2015,

19 in 2017 and 20 in 2018. There were also more

surgeons during the analyzed period of time. In 2000

there were 6 of them, in 2010 - 7, in 2015 - 13, in 2017

- 13, in 2018 - 14 people. A similar trend was evident

with pediatricians. In 2000, there were 18 of them in

Belarus, in 2010 - 21, in 2015 - 22, in 2017 - 22, in

2018 - 22 people. The number of pediatricians

increased by 4 per 10,000 population in 2018

compared to 2000. The number of nursing staff is

gradually increasing. In general, the total number of

nursing staff includes all persons with a secondary

medical education. In addition, they are employed in

medical and sanitary organizations, social welfare

institutions, preschools, schools, orphanages, etc. In

2000, the number of nursing staff was 123 people, in

2010 - 129, in 2015 - 133, in 2017 - 133, in 2018 -

134 people. In 2018, the number of nursing staff

increased by 11 compared to 2000. Of these, the

number of nurses was also increasing. In 2000, this

indicator was 77 people, in 2010 - 90, in 2015 - 93, in

2017 - 93, in 2018 - 93 people. Compared to 2000, the

number of nurses increased by 16 in 2018. In Russia,

the situation is less stable and positive according to

the indicators presented above. In 2000, the number

of doctors of all specialties per 10,000 thousand

people of the population was 47 people, in 2010 - 50,

in 2015 - 46, in 2017 - 48, in 2018 - 48 people.

Compared to 2010, in 2018 the number of specialty

doctors decreased by 2 persons. Let us analyze this

indicator in more detail with a breakdown by

specialty. In general, the number of general

practitioners has not changed significantly. In 2000,

this indicator was 11 people, in 2010 - 12, in 2015 -

11, in 2017 - 12, in 2018 - 12 people. Compared to

2000, the number of general practitioners in 2018

increased by 1 person. The number of surgeons in

Russia also did not increase significantly (in 2000 - 4

people, in 2010 - 5, in 2015 - 5, in 2017 - 5, in 2018 -

5 people). There has been a fairly significant

reduction in the number of pediatricians over the

period under analysis. In 2000, there were 28 of them

per 10,000 people of the population of Russia, in 2010

- 32, in 2015 - 23, in 2017 - 23, in 2018 - 20 people.

In 2018, the number of pediatricians decreased by 8

compared to 2000. The number of dentists during the

analyzed period has not changed. In both 2000 and

2018, there were 4 per 10,000 people in Russia. There

were 2 psychiatrists and narcologists in 2000, 2 in

2010, 1 in 2015, 2 in 2017, and 2 in 2018. It is

important to analyze the number of nursing staff. As

in the Republic of Belarus, Russia saw a decrease in

this indicator. In 2000, the number of paramedical

personnel was 108 people, in 2010 - 106, in 2015 -

400

900

1400

1900

10000

20000

30000

1996 2006 2016 2026

Russia Belarus

Peculiarities of Health Care System in the Union State Countries and Priority Directions of Their Marketing Development and Interaction

249

106, in 2017 - 104, in 2018 - 102 people. Compared

to 2000, the number of nursing staff decreased by 6

persons in 2018. Of these, there were 70 nurses in

2000, 73 in 2010, 73 in 2015, 73 in 2017, and 73 in

2018. If we analyze individual CIS countries by these

indicators, a negative trend was observed in many

countries. For example, the number of pediatricians

in Kazakhstan in 2000 was 14 people, in 2010 - 16, in

2015 - 12, in 2017 - 1, in 2018 - 3. On this basis, the

number of pediatricians in Kazakhstan in 2018

compared to 2000 decreased by 11 people. A similar

situation took place in Kyrgyzstan. In 2000, the

number of pediatricians was 10 people, in 2010 - 4, in

2015 - 4, in 2017 - 4, in 2018 - 4 people. In 2018,

compared to 2000, the indicator decreased by 6

persons. The number of ambulance stations

(departments) in Belarus in 2018 was 147 units, and

in Russia - 2,276 units.

Particular attention should be paid to final

consumption expenditures of public administration

by function (Table 1). Let us compare the health care

system with other socio-economic and political

spheres. Based on the data presented in Table 1, it

should be noted that every year there has been an

increase in public administration final consumption

expenditures. This trend was also observed in defense

(in 2015 - 1,345.6 billion rubles, in 2016 - 1,832.3, in

2017 - 1,892.8, in 2018 - 1,900.4, in 2019 - 2174.0

billion rubles), and on economic issues (in 2015 -

1,381.2 billion rubles, in 2016 - 1,574.3, in 2017 -

1,676.7, in 2018 - 1,881.2, in 2019 - 2,028.9 billion

rubles), etc. The increase was particularly significant

in health care. In 2015, this indicator was 1,987.2

billion rubles, in 2016 - 1,994.1, in 2017 - 2,130.2, in

2018 - 2,487.7, in 2019 - 2,559.2 RUB bln On this

basis, it is important to forecast the future state of the

analyzed indicator (Population, Employment and

Living Conditions in the Countries of the

Commonwealth of Independent States, 2019).

Table 1. As can be seen, the forecast of this

indicator increases under either option. If we consider

the forecast with a low probability, then expenditures

on final consumption of public administration in the

health care sector in 2021 will amount to 2,723 billion

rubles, in 2022 - 2,863, in 2023 - 3,014 billion rubles.

As for the forecast with a high probability, the

expenditures on final consumption of public

administration in the health care sector in 2021 will

be 3,105 billion rubles, in 2022 - 3,300, in 2023 -

3,494 billion rubles. In the first and in the second

case, costs are projected to increase.

Figure 2 shows the calculation of the forecast

(high and low probability) of public administration

final consumption expenditure in health care. Note

that the calculations were made based on the

dynamics of public administration final consumption

expenditure in health care for 2015-2019 presented in

Table 1: Public administration final consumption

expenditure by function for 2015-2019, bln. rub. (National

Accounts of the Commonwealth of Independent States,

2020).

Public

administration

final

consumption

expenditure

Years

2015 2016 2017 2018 2019

General

government

services

1766.6 1801.0 1978.3 2141.5 2247.4

Defense 1345.6 1832.3 1892.8 1900.4 2174.0

Public order

and safet

2120.7 2148.9 2200.4 2384.2 2424.0

Economic

issues

1381.2 1574.3 1676.7 1881.2 2028.9

Environmental

rotection

22.9 20.9 27.6 29.7 32.0

Housing and

utilities

360.4 365.1 416.8 406.5 434.7

Health 1987.2 1994.1 2130.2 2487.7 2559.2

Recreation,

culture and

religion

147.7 149.4 160.2 172.0 178.3

Educatio

638.0 599.8 620.5 666.4 657.6

Social

rotection

1409.7 1506.8 1569.6 1615.7 1695.6

Other

functions

3580.7 3817.1 4057.8 4708.8 4947.3

Figure 2: Calculation of projected (high and low

probability) public administration final consumption

expenditure on health (calculated by the authors)

On this basis, let us build an econometric model,

which includes the ratio of indices of physical volume

of paid medical services to the population and the

volume of paid services to the population of Russia

(Figure 3).

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250

Figure 3: Econometric model of the ratio of indices of the

physical volume of paid medical services to the volume of

paid services to the population of Russia (calculated by the

authors).

In general, Figure 3 shows the observations'

uniformity presence, also there is the regression

equation and the determination coefficient (R2). The

minimum requirement for model building is for the

coefficient of determination to be greater than 0.5%.

Based on the data provided, this requirement is

complied with.

The equation of the linear pairwise regression

model describing the relationship between the index

of physical volume of paid medical services to the

population and the volume of paid services to the

population is as follows:

y=38.947+0.606*x (1)

It is important to analyze the quality of the

presented model. To do this, we will estimate the

regression coefficients significance using the

Student's t-criteria. Then we will evaluate the model

using variance and correlation analysis.

The Student's test value is 2.262. It is important to

establish the significance of the coefficients a and b,

so we assume that:

No_a: a = 0 - not

statistically

significant

N1_a: a = 0 - not

statistically

nifican

No_b: b = 0 - not

statistically

significant

N1_b: b = 0 - not

statistically

nifican

2.937 > 2.306

Ho_a is rejected with

a probability of 95%

18.462 > 2.306

Ho_b is rejected with

a probability of 95%

Coefficient a is

statistically

nifican

Coefficient b is

statistically

nifican

The next way to analyze the quality of the model

is the Fisher F-criteria or regression dispersive

analysis. The hypothesis is as follows:

Ho: b=0 (there is no linear relationship between

x and

)

F critical

–

5.318

F observed 22.114 > F critical 5.318, hence,

the Ho: b=0 hypothesis is deviated, i.e. there is a

linear relationship between the x and

variables.

The multiple R is the correlation coefficient value

(the linear relationship tightness measure between the

x and y variables). The multiple R was 0.857, i.e., the

relationship between x and y is strong and direct as

the index ranges from 0.7 to 0.9. Next, we transfer the

correlation coefficient into a percentage and it is

73.43%. Variation of the variable y (volume of paid

services to population) by 73.43% is explained by

variability of the variable x (index of physical volume

of paid medical services to population). The effect of

x on y is 73.43%. Consequently, 26.57% is accounted

for by other factors not taken into account in the

model. The average approximation error is 0.625%,

which indicates the quality of the presented model.

The approximation coefficient should be lower than

7%. It is important to calculate the forecast of the

analyzed data. Thus, x was 104.876% and y was

102.547%. Thus, if x increases by 2% of the average

value, then y will be 102.547%. The intervals of the

predicted value y: min - 100.49%, max - 104.61%.

With a 95% chance of increasing x by 2%, y will be

in the range of 100.49% to 104.61%. The analysis

showed that based on the current situation in the

healthcare system in Russia, the maximum increase

in y is most likely in the future.

The Union State is actively implementing the

priority areas and priorities of its further development

for 2018-2022. Particular attention is paid to

improving the mechanism of health care provision to

Russian citizens in the Republic of Belarus and

citizens of Belarus in the Russian Federation, as well

as health insurance for Russian and Belarusian

citizens temporarily staying in the territory of the

Union State (Figure 4).

Until 2022, the priority task is to ensure sanitary

and epidemiological well-being in the territory of the

Union State. This situation is about cooperation in

sanitary and epidemiological well-being and jointly

overcoming emerging risks and threats. Also, the

development of information technologies and

telemedicine; provision of accessibility and quality of

specialized, including high-tech medical care;

provision of continuous medical and pharmaceutical

education using modern technologies, etc., are of

particular importance in the priority areas of

cooperation in healthcare.

Peculiarities of Health Care System in the Union State Countries and Priority Directions of Their Marketing Development and Interaction

251

Figure 4: Interaction of the Union State countries in

healthcare and improvement of its regulatory framework

(compiled by the authors)

(Priority areas and priorities for further

development of the Union State for 2018-2022,

2018). On this basis, it is important to improve further

the mechanisms of relations between the Union State

countries in health care development, active

involvement of research centers for joint work in this

area (Figure 4).

4 DISCUSSION OF RESULTS

Today it is possible to further form joint

developments and programs in healthcare within the

framework of the Union State. This is a strategically

important area because countries need to move away

from imported technology and medicines. This

problem is especially relevant in the context of the

prolongation of the sanctions regime by the countries

of the European Union and the United States

(Malakhova, 2019). Health care development in both

the Union State and the EAEU countries is a priority

area ensuring their national security. In addition, it

should be noted that further development of the

Eurasian Economic Union involves strengthening

cooperation ties, including in healthcare. Some

private projects directly related to healthcare (e.g.,

Teledoctor, Oriense, Button of Life, Medesc, 3D

Bioprinting Solutions) are developing in Russia

today. In addition to private projects, there are federal

projects for which the Russian government is

responsible (e.g., Demography, Health, etc.)

(Borkova, Napolova, and Orlov, 2019). Undoubtedly,

it is important to develop this key social sphere with

the EAEU partner countries.

5 CONCLUSION

In modern conditions in the Union State countries, it

is important to increase real incomes of the

population, develop a socially-oriented model of

economy, increase financing and efficiency of

healthcare. These areas can lead to an improvement

in the quality of life and, in the long term, allow for

an increase in life expectancy. The statistical data

analysis and construction of the econometric model

showed that in the Union State countries, the number

of hospital facilities, the number of hospital beds,

including those for children, decreases every year.

The capacity of outpatient clinics (number of visits

per shift) in Russia was 3,534 thousand in 2000, and

3,998 thousand in 2018, i.e., the increase was by 464

thous.

Thus, firstly, the number of hospital facilities, the

number of hospital beds, including those for children,

the number of medical personnel, etc., were analyzed

in detail. The problems and contradictions in the

development of health care systems in Russia and

Belarus associated with the reduction of the number

of doctors for certain specialties and a parallel

increase in the morbidity of the population on the

main classes of diseases, including malignant tumors,

respiratory diseases, diseases of the circulatory

system, digestive diseases, etc. have been revealed.

Secondly, the priority areas and priorities of

further development of the Union State for 2018-2022

have been investigated. Particular attention is paid to

the development of cooperation in healthcare, as well

as the improvement of the regulatory framework. On

this basis, the priorities of the priority areas and

options for their solutions are explored. It is proposed

to pay special attention to the development of large-

scale projects between the countries of the Union

State in the field of healthcare with the attraction of

public and private investments, development of new

technologies, etc.

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