1993 - Dov Chernichovsky


Traditional assessments of the impact and cost-effectiveness of various contraceptive methods, using couple-years of protection (CYPs) per dollar spent, do not accurately measure the level of protection offered by each method. An alternative measure--adjusted CYPs--that takes into account the relative risk of pregnancy among the users of each method is proposed here. Calculations show how cost recovery and reinvestment of the proceeds from family planning programs lead to the cross-subsidization of methods. In general, the more subsidized contraceptive methods are supported by the less subsidized methods. An examination of data from Colombia's Profamilia family planning program indicates that because of the differences in the relative risk of pregnancy of women of different ages, sterilization, the most effective contraceptive method, is not necessarily the most cost-effective method in terms of the number of CYPs it provides per unit cost.


The reforms that have affected the Russian health care system since the breakup of the Soviet Union, principally those in the general administration of the Russian Federation, have suffered from inconsistency and the absence of a strategy. The various reforms have caused a shift from a national health system characterized by highly centralized management and control, typical of the totalitarian uniform state, to a highly decentralized but fragmented multitude of state systems. Each of these systems is relatively centralized at the local level and run by local administrations with limited government infrastructure and experience. The role of government in the emerging system, and in particular the role of the federal government, remains ill defined. As a result, there is a grave risk that the Russian health care system may disintegrate as a national system. This undermines (a) the prevailing universal and fairly equitable access to care, (b) stabilization of the system following a long period of transition, and (c) the long-term reform that is required to bring the Russian health care system up to par with the health care systems in other developed countries. A rapid transition to a genuine federal health system with well-articulated roles for different levels of government, in tandem with implementation of the 1993 Compulsory Health Insurance System, is essential for the stabilization and reform of the Russian health care system.

  • Country: Russia
  • # Pages: 76
  • Publication Year: 1993
  • Type of Media: Mimeo
  • Country: General
  • # Pages: 7
  • Publication Year: 1993
  • Type of Media: Article