Presentation (CTI)

OBJECTIVES: Population ageing may negatively affect public healthcare financing by increasing healthcare use while reducing earnings, tax revenues, and health insurance contributions. Healthcare costs also usually outpace inflation because demand for more expensive care rises with income and medical innovation is resource-intensive. This study aimed to develop a long-term budget forecast for the Russian Compulsory Health Insurance Fund accounting for these effects.
METHODS: We forecast revenues, expenditures, and the deficit of the Russian Compulsory Health Insurance Fund through 2046, reflecting current demographic and economic trends. Projections used the official demographic forecast for Russia by single-year age and sex groups to estimate employed and non-employed insured populations. Employer-paid contributions for employed individuals were modeled using nominal wage growth of 7.3% annually. Regional contributions for non-employed individuals were projected using the current contribution growth trend of 6.8% annually. Expenditures were projected based on age- and sex-specific healthcare consumption per insured person observed in one region, with per-insured expenditure norms assumed to grow by 8.6% annually, consistent with the observed three-year average. The deficit equaled expenditures minus revenues.
RESULTS: By 2046, the employed-to-non-employed ratio is projected to decline from 0.87 to 0.82, while population decreases by 4.4%. Contributions for employed and non-employed populations are projected to increase by 283% and 267% nominally, respectively; expenditures increase by 484%. The deficit rises from 2.3% to 62% of revenues, indicating no long-term sustainability under current trends. Closing the gap would require additional budget transfers, higher contributions, or reducing annual expenditure growth per insured person from 8.6% to 5.9%. The direct demographic effect is limited: age-sex structure changes increase healthcare consumption by 1.7% and reduce revenues by 4% for employed and 2% for non-employed individuals.
CONCLUSIONS: Under unchanged revenue trends, sustainability is achievable only if real expenditure growth per insured person remains about 1.4 percentage points below long-term economic growth.