Comparative analysis of tariff policy of sanatorium-resort organizations in the compulsory and voluntary health insurance systems as a factor of financial accessibility of rehabilitation

Abstract

Sanatorium-resort rehabilitation is an integral component of the restorative treatment system in the Russian Federation. According to Rosstat data, in 2024 the sanatorium-resort services market volume reached 220.08 billion rubles with 7.3 million consumers; however, existing financing mechanisms through the compulsory (CHI) and voluntary (VHI) health insurance systems are characterized by significant tariff differentiation that reduces the financial accessibility of rehabilitation services for various population categories. The gap between the CHI per capita standard for medical rehabilitation (400.3 rubles for 2025) and the actual cost of sanatorium treatment creates a systemic financing deficit whose scale remains insufficiently studied. To assess the differences in tariff policy of sanatorium-resort organizations within the CHI and VHI systems, to determine the tariff gap coefficient, and to evaluate its impact on the financial accessibility of rehabilitation for the population of the Russian Federation in 2022-2025. A comparative economic-statistical analysis of rehabilitation service tariffs in the CHI and VHI systems was conducted using data from 48 sanatorium-resort organizations across six federal districts (2022-2025). Data from Rosstat, the Federal Compulsory Medical Insurance Fund, the Bank of Russia, and regional tariff agreements were used. Correlation-regression analysis, financial accessibility index (FAI), tariff gap coefficient (TGC), and cost decomposition of sanatorium-resort vouchers were applied. Statistical processing was performed using IBM SPSS Statistics 26.0; significance level p 0.05. The tariff gap coefficient between rehabilitation costs under CHI and VHI was 2.74 (2024), having increased from 2.31 in 2022. The average CHI tariff per rehabilitation case in inpatient conditions of sanatorium-resort organizations was 38,420 rubles (2024) with actual costs of 54,860 rubles (coverage – 70.0%). The average cost of a VHI rehabilitation program reached 105,300 rubles. The financial accessibility index of rehabilitation with out-of-pocket payment decreased from 0.62 in 2022 to 0.49 in 2024. The growing tariff gap between CHI and VHI systems creates a two-tier model of financial accessibility for sanatorium-resort rehabilitation. Improvement of tariff policy is needed to align financing standards with actual service costs, expand the scope of CHI-funded rehabilitation, and integrate insurance mechanisms to enhance the accessibility of restorative treatment.