ИСТИНА

The paper focuses on problems of developing and implementing health policy in a federal state. Comparative approach allows for a better understanding of patterns of sub-state activities across European countries, enabling to evaluate claims about how federal systems do (or ought to) operate, including the roles of political actors, issues of accountability, financing and service provision. The idea is that federations are dynamic rather than static systems and focusing on the dynamic relationships between various levels of governance a much more nuanced account of health policy formulation and the politics behind it might be developed. It is suggested that the relative level of centralisation or decentralisation established by the particular institutional framework of federalism does, to a large degree, explain the capacity for substantial policy changes and why health policy outcomes differ substantially from country to country. Thus, the aim of the paper is to analyse different European experiences of sharing institutional power and responsibilities between “federal layers” in health care. Russia represents a good case as one of the biggest European federal states where on one hand, there are long term traditions of the division of state powers and, on the other hand, the process of forming viable center-region relations in health care against the background of transformation of the Russian society is still underway.