Health system reform under the Russian health insurance legislation.

The Russian (1993 amended) health insurance legislation initiated a far-reaching reform in the financing, organization and management of the Russian health system. However, the implementation of the legislation has been slow and unstructured due to a lack of appropriate administrative and financial mechanisms: these concern entitlement, private-public mix, financial responsibilities of government at all levels, investment instruments, reimbursement and compensation systems, and a well-defined role of government. These issues are discussed in this article in the context of the Russian economy, the state of the health system, and the reform effort in the system.