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Better Outcomes through Health Reforms in the Russian Federation : The Challenge in 2008 and BeyondThe purpose of this discussion paper is
 to discuss selected health challenges in the Russian
 Federation, focusing on outcomes, expenditures and options
 for policy and institutional reforms in the health care
 system. The areas covered in the paper draw on recent
 studies and reports, and take into account lessons derived
 from the implementation of the World Bank-funded Health
 Reform Implementation Project (HRIP) at the federal level
 and in the Chuvash Republic and the Voronezh Oblast-the
 pilot regions of the project, over the 2005-2007 period.
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Health Systems Analysis for Better Health System StrengtheningHealth system strengthening and reform
 are often necessary actions to achieve better outcomes. The
 World Bank's 2007 strategy for health, nutrition, and
 population emphasizes the importance of health system
 strengthening for results. This paper proposes 'health
 systems analysis' as a distinct methodology that should
 be developed and practiced in the design of policies and
 programs for health system strengthening. It identifies key
 elements of health systems analysis and situates them in a
 logical framework supported by a wide range of data and
 methods and a sizable global literature. Health systems
 analysis includes evidence on health system inputs,
 processes, and outputs and the analysis of how these combine
 to produce the outcomes. It considers politics, history, and
 institutional arrangements. Health systems analysis proposes
 causes of poor health system performance and suggests how
 reform policies and strengthening strategies can improve
 performance. It contributes to implementation and
 evaluation. Examples from Mexico, Ethiopia, and Turkey
 illustrate the positive contributions health systems
 analysis has made to development of successful health system
 strengthening policies. Health systems analysis should be an
 integral part of good practice in health system
 strengthening efforts, including planning, policy
 development, monitoring, and evaluation. Health systems
 analysis can be conceived in a coherent and logical fashion
 and can be practiced and improved.
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Public Spending in Russia for Health Care : Issues and OptionsThis report examines three critically
 important areas to inform discussions on the appropriate
 level of health care spending in the Russian Federation: (i)
 the efficiency of spending on health care services; (ii)
 distributional impacts of spending on health care services;
 and (iii) the key factors that will influence the growth in
 health care spending over the next 20 years. There are few
 data showing how spending in health care in the Russian
 Federation translates into better health outcomes such as
 improved mortality, improved morbidity, increased economic
 output and productivity, improvements in the number of life
 years gained, or more sophisticated composite measures such
 as Quality Adjusted Life Years (QALYs). There is also
 limited data on outputs of hospitals and other healthcare
 providers which allow controlling for case mix,
 socioeconomic status, supply-side variables, and quality of
 care. Therefore, it is difficult to assess the efficiency or
 distributional impacts of health interventions. While the
 analysis draws on primary data specifically collected for
 the study, the absence of detailed output and outcome data
 necessarily limits the scope of the study and its findings.