Free medical services in Russia as a merit good

Introduction. The problem of improving the quality of health capital creates motivation for a more detailed study of the theoretical justification for the emergence of merit goods and correlation of their current interpretation with the key features of modern Russian healthcare.

The purpose of the research work is to substantiate the methodological approach to the study of medical services provided to Russian citizens within the framework of free medical care as a merit good. To reach this aim, the following research objectives have been achieved: the content and fundamental characteristics of the concepts “merit good” and “merit need” have been analyzed; the relationship of these concepts with key concepts of modern economics describing individual and collective choice has been explored; the existing institutional structure of providing free medical care to Russian citizens is correlated with the concepts of merit needs and goods.

Research methods include the analysis of relevant domestic and foreign scientific publications, the Russian legislative framework, synthesis, as well as analytic and graphic modeling.

Results. The concept of merit goods proposed by R. Musgrave came into conflict with one of the key provisions of the economic mainstream – methodological individualism. Attempts to eliminate this contradiction gave rise to a scientific debate, which over time influenced ideas about the independence of individuals' preferences and created the need to partially rethink the nature and role of the public sector of the economy, complementing the toolkit of supporters of state paternalism. Public choice in the case of merit goods represents (aggregates) individual political preferences. These policy preferences, in turn, can be seen as higher-order preferences that override the individual preferences that are revealed by market mechanisms. The healthcare for Russian citizens, to the extent that it is guaranteed by the state, is an example of such preferences. The list of free medical services (merit benefits) included in it is fixed in each subject of the Russian Federation by a program of state guarantees for the provision of free medical care to citizens, however, the actual content of such programs depends to a greater extent on the financial security of the subject than on the real merit needs.

Conclusion. The volume and range of merit goods are determined by normative procedures for making collective decisions. In the case of the Russian healthcare system, they are recorded in the program of state guarantees for the provision of free medical care, which do not always serve as a mechanism for identifying and satisfying merit needs due to institutional and resource limitations.