CAUGHT IN THE TRAPS OF MANAGED COMPETITION - EXAMPLES OF RUSSIAN HEALTH-CARE REFORMS FROM ST-PETERSBURG AND THE LENINGRAD REGION

Elements of a ''managed market'' for health services have been introdu ced into the Russian health care system, which under the Soviet regime was run as a comprehensive state-managed system. The authors examine the recent development of health service reforms in a case study of th e city of St. Petersburg and the surrounding Leningrad region. Evidenc e from key informants and a local survey of service users shows how al ternative models of the managed market are being introduced in differe nt parts of the study area. A critical review of the market-oriented s trategies for reform emerging in the case study suggests that such ref orms carry risks associated with the ''traps of managed competition.'' Future policy for health service systems in Russia must take these ri sks more fully into account.