Analysis of the dynamics and structure of financing of the national Healthcare project

Pershina Tat'yana Alekseevna ORCID: 0000-0003-3415-9020 PhD in Economics Associate Professor; Department of Statistics; State University of Management 99 Ryazansky ave., office 350, Moscow, 109542, Russia tatypershina@yandex.ru

Avilova Aleksandra Sergeevna specialist in educational and methodological work; Department of Statistics; State University of Management 99 Ryazansky ave., office 320, Moscow, 109542, Russia as_avilova@guu.ru

Introduction

Financing of national projects (NP) according to the Decree of the President No. 204 of the Russian Federation "On National Goals and Strategic Objectives of the Development of the Russian Federation for the period up to 2024", is included in the classification of target expenditure items. Control and regulation of budget expenditures is an essential part of the monitoring system, since the implementation of these actions allows for the analysis of planned and actual data, so that it is possible to identify reserves for income growth and budget cost savings {2}.

Within the framework of the implementation of national projects, financing is carried out in three forms {3}:

- subsidies to the budgets of the subjects of the Russian Federation,

- consolidated subsidies to regional budgets,

- other inter-budgetary transfers.

The National Health Care Project is one of the three projects for which most of the funding was allocated throughout the period of implementation of the NP. In 2024, more than 58% of budget allocations fall on three national projects: "Demography", "Safe high-quality roads" and "Healthcare" (Table 1 according to {1}). In the process of implementing social projects, it is impossible to achieve good financing from extra-budgetary sources, which is why such a distribution structure of funds is observed.

On average, the National Healthcare Project received 10% of the allocated budget funds to achieve performance indicators and socially significant results. Due to the significant share of financing, the project requires particularly careful monitoring of spending, in order to avoid the risks of not achieving indicators and results, as well as incomplete disbursement of budget funds and corruption risks {4}.

The purpose of the study is to analyze the structure and dynamics of budget expenditures within the framework of the national Health Care project and develop measures to improve the effectiveness of the project.

To achieve this goal, it is necessary to solve the following tasks:

- to assess the structure of budget allocation for federal projects;

- to identify the main trends in the allocation of budget funds for federal projects;

- to draw conclusions about the nature of budget expenditures allocated for the implementation of NP "Zdravohranie".

Let's consider the results of the analysis.

Table 1 – Structure of allocation of federal budget funds for national projects

Source: compiled by the authors

Analysis of the structure of budget allocation for federal projects included in the NP "Healthcare"

During the implementation of the national project, it is planned to implement 9 federal projects covering various aspects of improving the quality of patient care and the effectiveness of the work of medical specialists {1}.

Table 2 shows the distribution of the structure of the volume of financial support for federal projects that are part of the national Healthcare project for the period from 2019 to 2024.

Table 2 – Structure of financial support for federal projects that are part of NP "Healthcare"

Source: compiled by the authors

As can be seen from the data in table 2, most of the funding for the national project is directed to the implementation of the federal project "Fight against oncological diseases". In 2021, almost 70% of all funds of the national project were allocated for the treatment of patients with cancer, which in absolute terms amounts to 181.85 billion rubles. This structure is explained by the high cost of equipment and medicines, many of which have to be purchased abroad, since Russian manufacturers do not yet have analogues. In addition, cancer treatment is a long-term process, which is also a factor in increasing the cost of treatment. In addition, among the factors, the costs of scientific research to combat cancer should be highlighted.

In 2022, significant changes took place in the structure of budget allocation, which is associated with the launch of a new federal project "Modernization of primary health care in the Russian Federation", aimed at improving the availability and quality of medical care in rural areas, as well as eliminating the problem of staff shortages.

It is also worth noting that the appearance of a new project has not reduced the volume of financial support for existing federal projects. In fact, some of the projects, for example, such as "Fighting cancer" and "Development of children's healthcare, including the creation of a modern infrastructure for providing medical care to children", etc., received more from the budget than in the previous year, which indicates increased attention to healthcare from the state.

To assess structural changes in 2022-2024, two coefficients were calculated – the Gatev integral coefficient of structural shifts and the Salai integral coefficient of structural differences, characterizing structural shifts in the proportion of elements of the population. The coefficients are calculated using the following formulas:

(1)

(2)

where d is the share of the volume of financial support for each individual federal project;

n is the number of federal preocts.

Based on the fact that the results of calculating the coefficients are close to zero, it can be concluded that structural changes in the distribution of financial support for federal projects are insignificant.

Based on the analysis of the dynamics of the structure of allocated budget allocations for the implementation of federal projects in the field of healthcare (Table. 2 according to {5}), it can be concluded that significant changes in the structure were brought only by the introduction of a new project in 2022. In addition, changes are noticeable in 2020, when the share of funding for the federal project "Creation of a single digital contour in healthcare based on the unified state information system in the field of healthcare (EGISZ)" increased by 6.4 percentage points, which is associated with the coronavirus pandemic, which required the transfer to a remote format of a large number of employees not only of medical organizations, but also of other fields of activity. The creation of the EGISZ made it possible to simplify and optimize the access of Russian citizens to medical care.

It can be noted that a significant part of the financing of the national healthcare project was allocated to the federal project "Development of children's healthcare, including the creation of a modern infrastructure for providing medical care to children." The reasons for this are: the high importance of children's health for the future of the country, reducing the cost of treating chronic diseases in adults in the long term.

Since 2022, about 30% of the allocated budget has been spent on the implementation of the federal project "Modernization of primary healthcare in the Russian Federation", which is associated with the need to update medical equipment and carry out major repairs, demolish facilities in disrepair, and subsequent construction of primary care facilities.{5}

In the process of project implementation, there is a tendency towards a formal allocation of budget funds. The distribution structure remains the same and does not depend on the actual implementation of national project plans. Therefore, it is necessary to monitor the performance indicators of the implementation of national projects more carefully, for which the federal executive authorities are responsible.

The main trends in the allocation of budget funds for federal projects that are part of the NP "Healthcare"

In the conditions of modern society, where the health of the population is one of the key factors in the development of the state, the issues of financing healthcare are becoming particularly relevant. One of the important aspects of the implementation of the national Health Care project is the effective allocation of budget funds for federal projects that are part of it. This makes it possible to ensure the targeted use of financial resources aimed at achieving the set goals and objectives in the field of healthcare.

In Figure 1, compiled on the basis of data from the unified portal of the budget system of the Russian Federation "Electronic Budget" {1}, you can see the dynamics of the volume of financial support for the national Healthcare project. The nonlinear nature of this dynamics is explained by the impact of the coronavirus pandemic in 2020. {7} Combating it required significant investments in scientific and medical vaccine development and the creation of new hospitals capable of accommodating a large number of patients. Since 2022, there has been a noticeable annual decrease in funding, which is associated with the completion of the implementation of the national project.

Source: compiled by the authors

Figure 1 – Dynamics of the volume of financial support for the national Healthcare project for the period 2018-2024.

A significant increase in funding in 2022 is due to the emergence of a new federal project "Modernization of primary healthcare in the Russian Federation", as well as an increase in the incidence of a new strain of COVID-19. {9} Despite the decrease in funding, starting in 2022, the total amount of budget allocations for the entire period almost doubled and amounted in absolute terms to 150.55 billion rubles. (Fig. 2).

In order to ensure the most qualitative analysis of the dynamics of the volume of financing of the national Healthcare project and the federal projects included in it, the values of the indicators were recalculated into comparable prices, taking into account inflation, for each year of the study period. Conducting an analysis at comparable prices provides a more accurate and objective study of the dynamics of economic processes, which is important for making informed decisions and developing effective economic policy {5}.

The calculation of the indicators of the volume of budget allocations was carried out according to the following formula:

(3)

where is the consumer price index, a statistical indicator showing the change in the cost of a set of certain goods and services;

– the volume of budget allocations at current prices;

– the volume of budget allocations in real prices.

The dynamics of the volume of budget funds allocated for the implementation of the national Healthcare project in real prices practically coincides with the dynamics in comparable prices, in connection with which it can be concluded that the rate of depreciation of money is taken into account when financing the national project. Since 2023, the growth rate in comparable prices has even exceeded the growth rate in real prices, which means an increase in financing above the inflation rate. Therefore, we can talk about a real increase in the financing of the national project.

An analysis of the financing of the national Healthcare project from 2019 to 2024 shows a significant increase in the total amount of funds, despite fluctuations caused by external factors such as the COVID-19 pandemic. The main part of the budget is aimed at combating oncological diseases due to the high cost of treatment and the need to purchase expensive equipment and drugs. The introduction of new projects, such as the "Modernization of primary health care", significantly affected the redistribution of funds, but the funding structure remained generally stable, which indicates a formal approach to the allocation of funds.

When considering the growth rate of the financing volume of the project "Development of the primary health care system", the trend towards accounting for inflation is noticeable. In 2023, in contrast to the general reduction in financing of the national project, financing of primary health care increased by 28% in real prices and by 33% for comparable purposes. The project "Fight against cardiovascular diseases" also took into account the consumer price index, with a discrepancy in the growth rate of allocations in real and comparable prices of no more than 5 percentage points. In 2024, despite the overall decrease in the budget for the national project, financing for the fight against cardiovascular diseases increased by 30.5%.

The dynamics of financing the cancer control project shows that inflation is taken into account when forming the budget. The project "Development of children's Healthcare" also demonstrates a sustainable practice of accounting for inflation. The growth rate of the project's allocations aimed at providing medical organizations with qualified personnel varied with a noticeable decrease in 2020 and 2022, but in other years the growth continued, taking into account inflation, from 2023.

The project "Development of a network of national medical research centers and the introduction of innovative medical technologies" took into account the change in the value of money over time, with discrepancies in real and comparable prices of no more than 4 percentage points. The decrease in funding in 2022 may be due to the redistribution of funds to combat the pandemic. In 2024, the volume of allocations increased by 13.5%, despite a general decrease in funding for the national project.

The project "Creating a single digital circuit in healthcare" also showed a decrease in funding in 2021-2023, but by 2024 funding had increased. The project "Development of the export of medical services" clearly shows the importance of accounting for inflation, with the volume of allocations remaining stable in real prices, but increasing in comparable prices in the first four years.{6}

Taking into account all the federal projects described above, it can be concluded that for most of them the inflation rate was taken into account when budgeting projects, since 2023 financing has not only covered the change in the value of money, but also really exceeded the volumes of the previous year. To improve the effectiveness of the project, it is recommended to strengthen monitoring and control over the allocation and use of budget funds, introduce more flexible resource management mechanisms, and review allocation methods.

Conclusion

An analysis of the financing of the national Healthcare project from 2019 to 2024 shows a significant increase in total funding, despite fluctuations caused by external factors such as the COVID-19 pandemic. The main part of the budget is aimed at combating oncological diseases due to the high cost of treatment and the need to purchase expensive equipment and drugs. The introduction of new projects, for example, the project "Modernization of primary health care", significantly affected the redistribution of funds, however, the funding structure remained generally stable, which indicates a formal approach to the allocation of funds.

The inflation rate was taken into account when planning the budget, which allowed for an increase in financing above the inflation rate. However, in some federal projects, such as "Providing qualified personnel to medical organizations", there are significant fluctuations in the amount of funding, indicating the need to review approaches to budget planning.

Recommendations

To improve the effectiveness of the project, it is recommended to strengthen monitoring and control over the allocation and use of budgetary funds, introduce more flexible financial resource management mechanisms, review allocation methods, taking into account project investment, conduct regular assessments of the effectiveness of the use of funds and adjust future allocations depending on the results achieved, taking into account detailed analysis not only of the upper level a national project, but also federal projects, as well as regional ones. It is important to take into account the long-term consequences when planning new projects, develop domestic production of medical equipment and drugs to reduce dependence on imports, and strengthen interagency cooperation to coordinate and improve the effectiveness of project implementation. These measures will help to improve the quality of medical care for the population and achieve the goals of the state health policy.