Medico-Economic Standards in Russia: Balancing Legal Requirements and Patients Needs

  • Alena KamenshchikovaEmail author


Medico-economic standards (MES) are a relatively recent innovation in the Russian public health-care system. MES specify the kinds and quantities of diagnostic and treatment services a patient with a particular health condition should receive. They are meant to simultaneously control costs and quality of care, and medical professionals in public institutions have a legal obligation to follow these standards. This chapter explores how MES work in practice and how health-care practitioners attempt to reconcile demands of MES, realities of their practice, and demands of patients. The chapter stresses that in mediating these, health-care practitioners place themselves in a precarious position of balancing between being legally sanctioned and providing inadequate medical help.



I would like to express my deep gratitude for the paediatricians who agreed to participate in my study and share their stories and experiences of working with medico-economic standards. I would also like to thank the editors of this book, Klasien Horstman, Olga Zvonareva, and Evgeniya Popova for their relevant comments, helpful advices, and moral support. Another person whom I would like to thank is Olga Federova for her expertise and very helpful comments on my work. In addition, I would like to acknowledge Lloyd Akrong for his help in proofreading the English of parts of this chapter.


  1. Allen, D. (2014). Lost in translation? ‘evidence’ and the articulation of institutional logics in integrated care pathways: From positive to negative boundary object? Sociology of Health & Illness, 36(6), 807–822.CrossRefGoogle Scholar
  2. Bowker, G., & Star, S. L. (2000). Sorting things out. Classification and its consequences. Cambridge, MA: The MIT Press.Google Scholar
  3. Busse, R., Geissler, A., Quentin, W., & Wiley, M. (2011). Diagnosis-related groups in Europe: Moving towards transparency, efficiency and quality in hospitals. London: McGraw-Hill Education.Google Scholar
  4. David, G. C., Garcia, A. C., Rawls, A. W., & Chand, D. (2009). Listening to what is said – Transcribing what is heard: The impact of Speech Recognition Technology (SRT) on the practice of Medical Transcription (MT). Sociology of Health & Illness, 31(6), 924–938.CrossRefGoogle Scholar
  5. Fetter, R. B. (1993). Foreword. In M. Casas & M. M. Wiley (Eds.), Diagnosis related groups in Europe: Uses and perspectives (pp. v–vii). Berlin: Springer-Verlag.Google Scholar
  6. Grachёva, A. S. (2010). Standartizatsiia Meditsinskoĭ Pomoshchi kak Chast’ Sistemy Upravleniia Kachestvom v Zdravookhranenii [Medical Care Standardisation as a Part of Health Care Quality Management]. Vestnik ROSZDRAVNADZORA, 5(5), 16–21. [in Russian].Google Scholar
  7. Greenhalgh, T., Howick, J., & Maskrey, N. (2014). Evidence based medicine: A movement in crisis? The BMJ, 348, g3725.CrossRefGoogle Scholar
  8. Horstman, K. (1997). Chemical analysis of urine for life insurance: The construction of reliability. Science, Technology & Human Values, 22(1), 57–78.CrossRefGoogle Scholar
  9. Kucheriavenko, O. (2013). Standarty Lecheniia v RF [Standards of care in the Russian Federation]. Retrieved February 6, 2017, from [in Russian].
  10. Moreira, T. (2012). Health care standards and the politics of singularities: Shifting in and out of context. Science, Technology & Human Values, 37(4), 307–331.CrossRefGoogle Scholar
  11. Rodrigues, J. M. (1993). DRGs: Origin and dissemination throughout Europe. In M. Casas & M. M. Wiley (Eds.), Diagnosis related groups in Europe: Uses and perspectives (pp. 17–29). Berlin: Springer-Verlag.CrossRefGoogle Scholar
  12. Rothman, D. J. (1991). Strangers at the bedside: A history of how law and bioethics transformed medical decision making. New York: Basic Books.Google Scholar
  13. Sheiman, I., & Terent’eva, S. (2015). Mezhdunarodnoe Sravnenie Effectivnosti Biudzhetnoĭ i Strakhovoĭ Modeleĭ Finansirovaniia Zdravookhraneniia [International Comparison of the Efficiency of Tax-Financed and Social Health Insurance Models of Health Care Financing]. Ekonomicheskaia Politika, 10(6), 1–23. [in Russian].Google Scholar
  14. Sheiman, I. M., & Shishkin, S. V. (2009). Rossiĭskoe Zdravoohranenie: Novye Vyzovy i Novye Zadachi [Russian Health Care: New Challenges and New Objectives]. Moscow: HSE Publishing House. [in Russian].Google Scholar
  15. Shishkin, S. V., Zaborovskaia, A. S., & Chernets, V. A. (2005). Organizatsiia Finansirovaniia i Upravleniia Zdravoohraneniem v Regionakh Rossii: Obshchaia Kharakteristika [Organization of Financing and Management of Health Care in the Regions of Russia: General Characteristics]. Retrieved February 10, 2017, from [in Russian].
  16. Skliar, T. M. (2011). Rol’ Mediko-Economicheskikh Standartov v Finansirovanii Meditsinskikh Uchrezhdeniĭ [The Role of Medico-Economic Standards in the Financing of Health Care Institutions]. Voprosy Ekonomiki, 8, 132–143. [in Russian].Google Scholar
  17. Star, S. L. (2010). This is not a boundary object: Reflections on the origin of a concept. Science, Technology & Human Values, 35(5), 601–617.CrossRefGoogle Scholar
  18. Star, S. L., & Griesemer, J. R. (1989). Institutional ecology, translations and boundary objects: Amateurs and professionals in Berkeley’s museum of vertebrate zoology, 1907–1939. Social Studies of Science, 19(3), 387–420.CrossRefGoogle Scholar
  19. The Ministry of Health of Sverdlovsk Region. (2012). Medico-Economicheskiĭ Standart Meditsinskoĭ Pomoshchi Bol’nym s Serdechnoĭ Nedostatochnost’iu [Medico-Economic Standard of Care for Patients with Heart Failure]. Sverdlovsk: The Ministry of Health of Sverdlovsk Region. [in Russian].Google Scholar
  20. The Ministry of Health of the Russian Federation. (2011). Informatsionnoe Pis’mo Minzdravsotsrazvitiia Rossii №14-3/10/2-11668 24 Noiabria 2011 [Informational Letter of The Ministry of Health of the Russian Federation №14-3/10/2-11668 on November 24, 2011]. Retrieved April 27, 2016, from [in Russian].
  21. Timmermans, S., & Berg, M. (2003). The gold standard: The challenge of evidence-based medicine and standardization in health care. Philadelphia: Temple University Press.Google Scholar
  22. Tompson, W. (2007). Healthcare reform in Russia: Problems and prospects. Economics Department Working Papers, 538, 1–39. Retrieved February 22, 2017, from
  23. Twigg, J. L. (1998). Balancing the state and the market: Russia’s adoption of obligatory medical insurance. Europe-Asia Studies, 50(4), 583–602.CrossRefGoogle Scholar
  24. Van der Weijden, T., Legare, F., Boivin, A., Burgers, J. S., van Veenendaal, H., Stiggelbout, A. M., et al. (2010). How to integrate individual patient values and preferences in clinical practice guidelines? A research protocol. Implementation Science, 5(10), 1–9. Retrieved February 22, 2017, from

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© The Author(s) 2018

Authors and Affiliations

  1. 1.Department of Health, Ethics and SocietyMaastricht UniversityMaastrichtthe Netherlands
  2. 2.Research Centre for Policy Analysis and Studies of TechnologyNational Research Tomsk State UniversityTomskRussia

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