Synthesis of institutional and evolutionary and functional approaches to assess the efficiency of the regional health care system functioning

Abstract

The methodology for assessing the dysfunctionality of the regional health care system has been developed on the basis of the synthesis of the principles of the institutional and evolutionary paradigm of scientific cognition and the functional approach. It allows us to assess not only the final result of its functioning in a form of public health condition at a particular territory, but also to assess the behavior of the main actors of regional health preservation or health consumption processes. From the view point of the institutional and evolutionary economic theory the regional health care system is considered in the following regulations: 1) the health care system is considered as an integral system, the influence of certain elements of the institutional health care environment on the functioning of the entire regional health protection system is assessed; 2) the changes of regional health care system dysfunctionality are taken into account at various stages of the industry reformation; 3) the regional differentiation of health care systems is taken into account both by the resulting parameters (medical and demographic situation) and by the factors of the institutional environment (environmental situation, resource support of the industry and behavioral factors), other regional heal care systems with the similar development conditions have been compared. From the view point of the functional approach the health care system is considered in the following regulations: 1) the health care system is considered as a complex of the functions it conducts in order to provide regional demographic and economic security, to increase quality and level of life in a region; 2) indicators that assess the implementation of the health care system functions are chosen and systematized on the basis of operation functions of the public health of the World Health Organisation. Method of interregional comparison is the basis for the synthesis of institutional, evolutionary and functional approaches implementation. This method suggests the performance of comparative assessment of quality indicators of regional health care system functions, the normalization of these indicators in accordance to the beat values, the calculation of integral and general indicators that allow us to characterize the level of the health care system dysfunctionality of the case study regions and to range these systems. The results of this methodology approbation in the case study of the health care systems of Perm Krai, Tatarstan, Bashkiria, Nizhny Novgorod, Samara, Sverdlovsk and Chelyabinsk regions have been presented. The health care system of Perm Krai was characterized by high rate of dysfunctionality during 2007–2015. According to the regression analysis such factors as the quality of the health care system management, the resource provision of the branch and social conditions in the region have greatly contributed to the state of health of residents of Perm Krai. The regression models that assess the impact of the health of the population of Perm Krai on both a regional Human Development Index and a Gross regional product also demonstrate the relations between these variables. Further on the basis of the revealed zones of maximum dysfunctinality the authors will develop a set of measures aimed at an efficiency increase of the regional policy in the field of the health care system of Perm Krai.

Keywords

human capital, health capital, human potential, regional health care system, dysfunctionality, efficiency, institutional and evolutionary approach, functional approach, assessment methodology, regression analysis

For citation

Pepelyaeva A.V., Tretyakova E.A. Synthesis of institutional and evolutionary and functional approaches to assess the efficiency of the regional health care system functioning. Perm University Herald. Economy, 2018, vol. 13, no. 1, pp. 58–74. DOI 10.17072/1994-9960-2018-1-58-74

References

1. Bell D. The coming of post-industrial society. A venture in social forecasting. New York, Basic Books Publ., 1973. 507 p.
2. Becker G.S. Human capital. New York, Columbia University Press, 1964. 745 p.
3. Grigor'eva N.S., Chubarova T.V. Sovremennoe zdravookhranenie: politika, ekonomika, upravlenie [Modern health care: Politics, economics, management]. Moscow, Avtorskaya akademiya Publ., 2013. 144 p. (In Russian).
4. Grossman M. On the concept of health capital and the demand for health. Journal of Political Economy, 1972, vol. 80, no. 2, pp. 223–255.
5. Aslanov D.I. Sistemnye predstavleniya o zdorov'e kak osnovnom komponente chelovecheskogo kapitala [System of submission of health as the main component of the human capital]. Fundamental'nye issledovaniya [Fundamental Research], 2012, no. 12, pp. 202–206. (In Russian).
6. Blaug M. Metodologiya ekonomicheskoi nauki, ili Kak ekonomisty ob"yasnyayut. Per. s angl.; Nauch. red. i vstup. st. B.C. Avtonomova [The methodology of economics or How economists explain. Transl. from Engl. Scient. ed. and pref. by B.C. Avtonomov]. Moscow, NP Zhurnal Voprosy ekonomiki Publ., 2004. 416 p. (In Russian).
7. Cherkovets V.N. Kategoriya “chelovecheskii capital” v obshchei ekonomicheskoi teorii: istoricheskii vzglyad, soderzhatel'noe opredelenie [The category of "human capital" in general economic theory: A historical view and a meaningful definition]. Rossiiskii ekonomicheskii zhurnal [Russian Economic Journal], 2010, no. 7-8, pp. 88–107. (In Russian).
8. Moseiko E.E. Teoreticheskie podkhody k analizu zdorov'ya kak elementa chelovecheskogo kapitala [Theoretical approaches to the analysis of health as an element of human capital]. Vestnik Volgogradskogo gosudarstvennogo universiteta. Serija 3. Ekonomika. Ekologiya [Science Journal of VolSU. Global Economic System], 2012, no. 2 (21), pp. 17–21. (In Russian).
9. Bulanov V., Kataytseva E. Chelovecheskii kapital kak forma proyavleniya chelovecheskogo potentsiala [Human capital as a form of human potential demonstration]. Obshchestvo i ekonomika [Society and Economy], 2011, no. 1, pp. 13–22. (In Russian).
10. Medik V.A., Osipov A.M. Obshchestvennoe zdorov'e i zdravookhranenie: mediko-sotsiologicheskii analiz [Public health and health care: A medical and sociological analysis]. Moscow, RIOR INFRA-M Publ., 2012. 385 p. (In Russian).
11. Pepelyaeva A.V. Disfunktsii regional'nogo zdravookhraneniya kak ugroza sotsial'noi bezopasnosti regiona [Dysfunctions of regional health care as a threat to social security in the region]. Vestnik Prikamskogo sotsial'nogo instituta [Bulletin of Prikamsky Social Institute], 2017, no. 1 (76), pp. 109–117. (In Russian).
12. Rozmainskii I. Pochemu kapital zdorov'ya nakaplivaetsya v razvitykh stranakh i “proedaetsya” v postsovetskoi Rossii? (Opyt postkeinsianskogo analiza) [Why is the "Health Capital" accumulated in developed countries but is "eaten" in post-Soviet Russia? (the experience of post-Keynesian analysis)]. Voprosy ekonomiki [Issues of Economics], 2011, no. 10, pp. 113–131. (In Russian).
13. Pepelyaeva A.V. Primenenie institutsional'no-evolyutsionnogo podkhoda v izuchenii sistemy zdravookhraneniya regiona [Application of institutional and evolutionary approach in the study of the region’ health care system]. Upravlenie ekonomicheskimi sistemami (elektronnyi nauchnyi zhurnal) [Management of Economic Systems (scientific electronic journal)], 2014, no. 2 (62). (In Russian). Available at: http://uecs.ru/regionalnaya-ekonomika/item/2753-2014-02-13-12-04-06 (accessed 25.12.2017).
14. Kuklin A.A., Shipitsyna S.E., Naslunga K.S. Sopostavlenie effektivnosti byudzhetnogo finansirovaniya i sotsial'noi bezopasnosti regiona [Comparison of the efficiency of budget financing and the social security of a region]. Ekonomika regiona [Economy of Region], 2016, vol. 12, no. 3, pp. 638–653. doi: 10.17059/2016-3-3. (In Russian).
15. Kuklin A.A., Shorikov A.F., Tyulyukin V.A., Cherepanova A.V., Vasil'eva E.V., Nekrasova E.V. Diagnostika i modelirovanie rezul'tativnosti upravleniya sistemoi zdravookhraneniya dlya obespecheniya sotsial'no-demograficheskoi bezopasnosti regionov Rossii [Diagnosis and modeling of the effectiveness of the health care system management to ensure the socio-demographic security of Russian regions]. Prostranstvennaya ekonomika [Spatial Economics], 2011, no. 4, pp. 72–92. (In Russian).
16. Kozlova O.A., Makarova M.N., Tukhtarova E.Kh., Belenkova T.V. Usloviya truda kak faktor vliyaniya na pokazateli smertnosti naseleniya v trudosposobnom vozraste [The labor conditions as a factor of the working age population mortality]. Fundamental'nye issledovaniya [Fundamental Research], 2015, no. 7, pp. 161–165. (In Russian).
17. Korobitsyn B.A., Kuklin A.A., Manzhurov I.L., Nikulina N.L. Otsenka ushcherba ot sokrashcheniya ozhidaemoi prodolzhitel'nosti zhizni v rezul'tate onkologicheskikh zabolevanii [Assessment of damage caused by the reduction of the expected life expectancy due to cancer]. Ekonomika regiona [Economy of Region], 2013, no. 3, pp. 257–264. (In Russian).
18. Artemova O.V., Logacheva N.M. Metodicheskie podkhody k otsenke urovnya razvitiya sotsial'noi infrastruktury regionov [Methodical approaches to assessing the level of development of the social infrastructure of the regions]. Regional'naya ekonomika: teoriya i praktika [Regional Economics: Theory and Practice], 2011, no. 20 (203), pp. 12–18. (In Russian).
19. Logacheva N.M., Pilipenko E.V. Sotsial'naya infrastruktura regionov Rossii v sovremennykh usloviyakh [Social infrastructure of Russia’s regions in modern conditions]. Voprosy regional'noi ekonomiki [Problems of Regional Economy], 2015, vol. 22, no. 1, pp. 35–39. (In Russian).
20. Zhikharevich B.S., Logacheva N.M. Sotsial'naya infrastruktura i chelovecheskii kapital rossiiskikh regionov: podkhod k otsenke vzaimovliyaniya [Social infrastructure and human capital of Russian regions: An approach to the assessment of interaction]. Ekonomika i upravlenie [Economics and Management], 2012, no. 3 (77), pp. 150–156. (In Russian).
21. Rimashevskaya N.M., Rusanova N.E. Zdorov'e rossiiskogo naseleniya v usloviyakh sotsial'no-ekonomicheskoi modernizatsii [Health of the Russian population in conditions of socio-economic modernization]. Narodonaselenie [Population], 2015, no. 4, pp. 96–105. (In Russian).
22. Shabunova A.A., Duganov M.D., Kalashnikov K.N. Prezhdevremennaya smertnost' kak prichina ekonomicheskikh poter' regiona [Untimely death as a reason of economic losses in a region]. Zdravookhranenie Rossiiskoi Federatsii [Health Care of the Russian Federation], 2012, no. 3, pp. 26–30. (In Russian).
23. Wang K.-M. Health care expenditure and economic growth: Quantile panel-type analysis. Economic Modelling, July 2011, vol. 28, iss. 4, pp. 1536–1549.
24. Lago-Peñasabc S., Cantarero-Prietod D., Blázquez-Fernándezd C. On the relationship between GDP and health care expenditure: A new look. Economic Modelling, May 2013, vol. 32, pp. 124–129.
25. Bloom D.E., Canning D., Sevilla J. The effect of health on economic growth: A production function approach. World Development, January 2004, vol. 32, iss. 1, pp. 1–13.
26. Weil D.N. Health and economic growth. Handbook of Economic Growth, 2014, vol. 2, chapter 3, pp. 623–682.
27. Veblen T. Why economics not an evolutionary science? The Quarterly Journal of Economics, 1898, vol. 12, no. 4, pp. 373–397.
28. Nelson R., Winter S. An evolutionary theory of economic change. Cambridge, Harvard University Press, 1982. 452 p.
29. North D. Instituty, institutsional'nye izmeneniya i funktsionirovanie ekonomiki. Per. s angl. A.N. Nesterenko; predisl. i nauch. red. B.Z. Mil'nera [Institutions, institutional change and economic performance. Transl. from Engl. by A.N. Nesterenko; preface and scient. ed. by B.Z. Mil'ner]. Moscow, Fond ehkonomicheskoi knigi “Nachala” Publ., 1997. 180 p. (In Russian).
30. Williamson O.E. The new institutional economics: Taking stock, looking ahead. Journal of Economic Literature, 2000, vol. 38. iss. 3, pp. 595–613. doi: 10.1257/jel.38.3.595.
31. Hodgson G. Evolyutsionnaya i institutsional'naya ekonomika kak novyi meinstrim? [Evolutionary and institutional economics as the new mainstream?]. TERRA ECONOMICUS, 2008, vol. 6, no. 2, pp. 8–21. (In Russian).

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