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Article

Financial Risk Management in Healthcare in the Provision of High-Tech Medical Assistance for Sustainable Development: Evidence from Russia

by
Abdula M. Chililov
1,2
1
National Medical Research Center of Surgery Named after A. Vishnevsky, Moscow 117997, Russia
2
Russian Research Institute of Health, Moscow 127254, Russia
Risks 2024, 12(9), 134; https://doi.org/10.3390/risks12090134
Submission received: 29 June 2024 / Revised: 15 August 2024 / Accepted: 20 August 2024 / Published: 26 August 2024

Abstract

:
The research determines the level of financial risk in the Russian healthcare system and identifies prospects for improving the current Russian practice of financial risk management in healthcare when providing high-tech medical care for sustainable development (using Russia as an example). The author summarizes the advanced experience of the top 20 largest healthcare organizations in Russia by revenue in 2022. Based on this experience, the author developed an SEM model of the financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective. The theoretical significance of the developed model lies in uncovering the previously unknown causal relationships between the implementation of the ICT, sustainable development support, and financial risks in healthcare. The model reveals a new market dimension of financial risks for healthcare organizations in Russia. The main conclusion is that implementing the ICT and support for sustainable development helps to reduce the financial risks in healthcare. The identified potential for reducing financial risks in providing high-tech medical care in Russia until 2026 is practically significant. This prospect can be practically applied as a roadmap for the digital modernization and sustainable development of healthcare until 2026, enhancing the state healthcare policy in Russia. The established systemic relationship between ICT implementation, sustainable development support, and financial risks in healthcare is of managerial importance because it will increase the predictability of the financial risks in the market dimension of healthcare in Russia. The newly developed approach to risk management in healthcare during the provision of high-tech medical care in Russia has expanded the instrumental framework of risk management for healthcare organizations in Russia and revealed further opportunities for improving its efficiency.

1. Introduction

Healthcare is a top priority for socio-economic systems because the availability and quality of medical care directly affect the quality and longevity of life for the population and the attractiveness of regions for living. Furthermore, the recent experiences of economic systems, especially during the COVID-19 pandemic, one of the major global challenges of the early 21st century, have demonstrated that the quality of healthcare also affects the economic potential of countries.
Numerous recent studies, such as those by Park and Koch (2024), Saha et al. (2024), and Zhou et al. (2024), re-examined the experience of the COVID-19 pandemic and revealed a pattern: the higher the level of healthcare in a country, the more successfully its economy handles the challenges of epidemics and pandemics, demonstrating greater resilience.
The international practices of 2020–2021 demonstrated that the readiness of national healthcare systems for the pandemic and their successful adaptation (infection spread rate, morbidity, severity of diseases, recovery speed, and COVID-19 mortality rate) determined the social (e.g., self-isolation, strict mask mandates, and social distancing) and economic (e.g., production halts and closures and forced transition to remote work) restrictions.
While traditional healthcare development measures (e.g., increasing the number of medical professionals, revising norms and stimulating their labor, and expanding the number of medical facilities and their capacity) provide only limited positive effects, manifesting only in the long term, the pandemic has heightened interest in the technological modernization of healthcare as an innovative development measure.
The advantages of healthcare digitization include a sharp increase in labor productivity in providing medical services. For instance, the use of artificial intelligence (AI) helps to automate and significantly accelerate the processing of medical information with high accuracy in diagnostic support. The other benefits of healthcare digitization include the increased accessibility of medical care (e.g., through telemedicine). The quality of the medical care also improves with digitization because high-tech medical equipment enables more complex and precise procedures and surgeries.
Given the critical importance of healthcare and the drive to ensure its universal accessibility in many countries, including Russia, the state plays a central role in the public healthcare system. However, the consequences of a state-run public healthcare system are contradictory from a sustainable development perspective. On the one hand, the state addresses “market failures” by providing large-scale budgetary funds for financing infrastructure projects and national programs for the technological modernization of healthcare.
On the other hand, the pace of technological modernization in healthcare is slow because it is driven more by the budgetary capabilities of the state than by the needs of society. Limited and targeted funding, coupled with the low flexibility of management in state healthcare organizations, results in only isolated successes in providing high-tech medical care characterized by low service quality, convenience, and customer orientation.
Lastly, and perhaps even more significant than the previously mentioned drawbacks, state funding does not ensure a return on the investment in healthcare digitalization. The activity of public healthcare organizations is often unprofitable, reducing their competitiveness. This underscores the scientific and practical problem of attracting private investments for the digital modernization of healthcare.
To address this issue, this research proposes improving the financial risk management practices in healthcare when providing high-tech medical care. The novelty of this research lies in developing a new approach to the risk management in healthcare for high-tech medical care, where the key role is played by private businesses. The research aims to determine the level of financial risk in the Russian healthcare system and identify prospects for improving the current Russian financial risk management practices in healthcare during the provision of high-tech medical care for sustainable development.
The research is organized as follows. The author identified the financial risks in Russian healthcare (using the largest market players in healthcare as an example) and constructed a model of financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective. The research also reveals prospects for improving the financial risk management in healthcare during the provision of high-tech medical care in Russia to support sustainable development.

2. Literature Review

2.1. The Existing Approach to Risk Management in Healthcare When Providing High-Tech Medical Care in Russia

The fundamental basis of this research is the scientific concept of risk management in healthcare (Stancea and Muntean 2024; Yang et al. 2024). According to this concept, there are the following risks in healthcare when providing high-tech medical care:
-
Social risks, which relate to the accessibility and quality of the medical services and the level of patient satisfaction with these services (Przhedetsky et al. 2018);
-
Labor risks, involving changes in the workload of the medical staff and its functional designation, the need to fill gaps in digital competencies, and the release of certain medical personnel as medical care becomes automated (Umair et al. 2024);
-
Technological risks associated with the moral and physical depreciation of equipment, protection of personal data, ensuring cybersecurity, errors and disruptions in the operation of automation tools, and the ethics of using AI and big data in healthcare (Ishaq et al. 2024);
-
Epidemiological risks, which refer to the sharp increase in demand for medical services due to epidemics and pandemics (Arianpoor and Naeimi Tajdar 2024);
-
Financial risks are linked to the misuse (embezzlement) of budget funds allocated for technological modernization (Morozova et al. 2018).
The existing approach to risk management in healthcare when providing high-tech medical care in Russia assumes that the state acts as the subject of financing the healthcare digitalization. This approach enables the relatively successful management of the aforementioned risks but does not encompass financial risks in healthcare within its managerial measures.

2.2. Corporate Social Responsibility in Healthcare in Support of Sustainable Development

In the existing approach to risk management during the provision of high-tech medical care in Russia, leaders of public healthcare organizations bear corporate social responsibility
-
To consumers for the accessibility, quality, continuity, and ethical provision of high-tech medical care, in managing social, technological, and epidemiological risks in support of SDG 3 (Ding et al. 2024; Korah et al. 2023);
-
To healthcare workers for providing employment opportunities and fostering human potential, in managing labor risks in support of SDG 8 (Bolisetty et al. 2023; Chen et al. 2023; Udekwe et al. 2024);
-
To the state for the correct and targeted use of the budget funds allocated for technological modernization, in managing the financial risks in support of SDG 16 (Mohamad Taghvaee et al. 2023; Rahman et al. 2022; Shuyong et al. 2024).
However, there is no corporate social responsibility of healthcare organizations for the efficiency of financial resource expenditure and the return on investment in the technological modernization of healthcare. This results in a narrow interpretation of financial risks and limited management of these risks, enabling only partial mitigation.

2.3. Financial Risk Management in Healthcare: Theoretical Review and Gap Analysis

Frimpong et al. (2022) and Kahouli et al. (2024) highlight the risk of reducing the investment attractiveness of healthcare organizations for private investors as an additional dimension of financial risk in healthcare when providing high-tech medical care. This dimension considers the market nature of financial risks. The primary indicator of financial risk measurement in this market dimension is the decline in the value of stock indices (Wilson-Nash et al. 2024).
While the essence of financial risks in their market dimension is defined in existing publications by D’Amico et al. (2024) and Tong (2024), they do not explain the specifics of the financial risks in healthcare when providing high-tech medical care, nor do they reveal their connection to sustainable development. This gap in the literature hampers the management of market-related financial risks in healthcare. The research question is as follows:
RQ: How are ICT implementation and support for sustainable development interconnected with financial risks in healthcare?
Based on various sources that note the bidirectional links between the reduction in financial risks and an increase in the high-tech nature of medical care (Chen and Tang 2023; Geng and Shi 2024), the growth of healthcare sustainability as financial risks decrease (Bobylev et al. 2023; Wu et al. 2023), and the increase in healthcare sustainability as high-tech medical care becomes more widespread (Molleví Bortoló et al. 2023; Zhou and Jamaani 2023), the author proposes the following hypothesis:
H: 
There is a close relationship between ICT implementation, support for sustainable development, and financial risks in healthcare.
This hypothesis is tested by establishing complex interconnections between the financial risk management in healthcare, the provision of high-tech medical care, and the sustainable development of healthcare.

3. Materials and Methods

The research subjects are the largest healthcare organizations in Russia in terms of revenue. This research is based on the systems approach, applying the methodology of systems analysis in economics. The author set and consistently addressed three research tasks.
The sample of this research includes the top 20 largest (by the level of revenue) healthcare organizations in Russia in 2022. According to the Ministry of Healthcare of the Republic of Tatarstan (2024), the volume of the total market of high-tech healthcare services in Russia exceeds RUB 6 billion. The Industry Consumer Sector Index as of 13.06.2024 was RUB 5.52501 billion (MOEX 2024a).
This indicates that the share of the top 20 largest (by the level of revenues) healthcare organizations in Russia in 2022 in the market of high-tech healthcare services in Russia is around 92.08%. This confirms the adequacy of the sample (20 largest healthcare organizations) to represent the entire system of high-tech healthcare of Russia.
According to the World Bank (2024), Russia’s GDP was USD 2,021,421.48 million, i.e., RUB 185,728.21 billion. According to Rosstat (2024), the share of healthcare in the structure of Russia’s GDP is 3.8%; i.e., the volume of the healthcare market in Russia equals RUB 7057.67 billion. Therefore, on the whole, the level of ICT adoption in healthcare organizations in Russia equals 0.08% (6 × 100%/7057.67).
In the materials of the IMD Business School (2024) in 2021, the level of the development of healthcare infrastructure is assessed at 4.64 points out of 10. Given the fact that infrastructure plays a decisive role in the development of high-tech healthcare and the provision of services, it is possible to state that ICT adoption in healthcare organizations in Russia is at the level of 4.64 points out of 10. According to BusinessStat (2024), the level of ICT adoption in the 20 largest (by the level of revenues) healthcare organizations in Russia in 2022 has this value and is uniform.
Thus, the compiled sample of the top 20 largest (by the level of revenues) healthcare organizations in Russia in 2022 is adequate to represent the entire system of Russia’s healthcare, and the final findings will have general applicability across all high-tech healthcare service organizations.
The research methodology involves the study of the dynamics of revenues of healthcare organizations from the sample. The indicator of financial risk is revenue reduction. It should be noted that change in the revenue of healthcare organizations is subject to the influence of a wide range of factors, which include the change in the volume of effective demand and consumer preferences, in particular, under the influence of the COVID-19 pandemic and its end; the volume of state financing of the system of mandatory medical insurance; the popularity of additional medical insurance and demand for the services of private medical organizations; and inflation.
To clear the research model from the influence of other factors and to characterize—most correctly—financial risks, this paper takes into account, during modeling, the data for a long period, which covers several years (three years): 2022–2024.
The first task is to determine the financial risks in Russian healthcare. For this, the author conducted a dynamic (horizontal) analysis of the revenue changes of the top 20 largest healthcare organizations in Russia in 2022 compared to 2021 based on Forbes statistics (Forbes 2024). A negative annual change in revenue indicates the occurrence of financial risks in the market dimension. A positive annual change in revenue indicates the prevention of financial risks in the market dimension.
The second task is to model financial risks in healthcare when providing high-tech medical care in Russia from a sustainable development perspective. The variables used in the modeling include the following official statistics indicators:
-
Sectoral Consumer Index, measured in billions of rubles, indicates the profitability of healthcare organizations as a reflection of their financial risk in the market dimension, denoted as HLT (MOEX 2024a);
-
Sectoral Information Technology Index (ICT), measured in billions of rubles, shows the activity of the ICT use in the economy and the return on investment, denoted as ICT (MOEX 2024b);
-
Sustainable Development Index, measured in billions of rubles, indicates the level of support for sustainable development by companies, denoted as SST (MOEX 2024c).
Empirical data are provided in Table A1. To reflect the systemic relationship between ICT implementation, support for sustainable development, and financial risks in healthcare, the author performed modeling using the structural equation modeling (SEM) method. First, the author conducted a regression analysis of the dependence of each variable on the other two variables. Then, the regression equations (showing the interdependencies of the indicators) are supplemented with variation coefficients (showing the model errors) and combined into a general SEM model. The research model is presented in Figure 1.
The third task is to determine the prospects for improving financial risk management in healthcare when providing high-tech medical care in Russia. First, based on the data from Table A1, the author applied a trend analysis method to determine the changes in the values of the variables ICT, SST, and HLT from 13 June 2024 compared to 14 June 2022 (a two-year trend).
Then, the forecast values of the variables ICT and SST are determined by finding the product of their values on 13 June 2024 with their identified two-year trend. These forecast values are substituted into the equation for HLT to determine its forecast value and projected two-year trend as of 13 June 2024. The prospect of reducing financial risks in healthcare when providing high-tech medical care in Russia until 2026 is also determined.

4. Results

4.1. Financial Risks in Russian Healthcare

In addressing the first task and determining the financial risks in Russian healthcare, the author conducts a dynamic (horizontal) analysis of the revenue changes among the top 20 largest healthcare organizations by revenue in Russia in 2022 compared to 2021. The statistical revenue data, which characterize the financial risks of the healthcare organizations, are presented in Table 1.
According to the results of the horizontal analysis from Table 1, only two of the top twenty largest healthcare organizations by revenue in Russia experienced a negative annual revenue change in 2021–2022. Consequently, the actual occurrence of financial risks in their market dimension is rare among the healthcare organizations in Russia despite overcoming the surge in demand for medical services due to the end of the COVID-19 pandemic.
The positive annual revenue change for most healthcare organizations in Russia indicates the prevention of financial risks in their market dimension in 2021–2022. However, financial risks in their market dimension persist and require management because the current risk management practices of Russian healthcare organizations cannot fully guarantee the avoidance of risky events.

4.2. A Model of Financial Risks in Healthcare during the Provision of High-Tech Medical Care in Russia from a Sustainable Development Perspective

In addressing the second task and modeling the financial risks during the provision of high-tech medical care in Russia from a sustainable development perspective, the author conducted a regression analysis of the data from Table A1. The results are compiled in Table 2.
The results obtained in Table 2 indicate that the profitability of the healthcare organizations is, by 49.66%, determined by the activity of the ICT implementation and support for sustainable development in Russia from 2022 to 2024. The profitability of the ICT organizations is, by 46.91%, determined by the consumption of high-tech medical care services and support for sustainable development in Russia from 2022 to 2024. The profitability of the organizations included in the “Sustainable Development Vector” index is, by 43.85%, determined by the activity of the ICT implementation and the consumption of high-tech medical care services.
All the standard errors are relatively small. Fisher’s F-test and Student’s t-test were passed at the highest significance level of 0.01, confirming the high quality, reliability, and validity of the regression statistics obtained and making it possible to include them in further modeling. To reflect the systemic relationship between ICT implementation, support for sustainable development, and financial risks in healthcare, this relationship was modeled using the structural equation modeling (SEM) method. The composed regression equations (showing the interdependencies of the indicators) were supplemented with variation coefficients (showing the model errors) and combined into an overall SEM model (Figure 2).
The SEM model from Figure 2 showed that, with an increase in the profitability of the ICT organizations by RUB 1 billion, the profitability of the organizations included in the “Sustainable Development Vector” index increases by RUB 0.0622 billion, and the profitability of the healthcare organizations grows by RUB 0.4553 billion. When the profitability of the organizations included in the “Sustainable Development Vector” index increases by RUB 1 billion, the profitability of the ICT organizations rises by RUB 0.7754 billion, and the profitability of the healthcare organizations grows by RUB 1.3633 billion.
With an increase in the profitability of the healthcare organizations by RUB 1 billion, the profitability of the organizations included in the “Sustainable Development Vector” index increases by RUB 0.0592 billion, and the profitability of the ICT organizations rises by RUB 0.2466 billion. The variation in the profitability of the ICT organizations is 92.62%, the variation in the profitability of the organizations included in the “Sustainable Development Vector” index is 47.95%, and the variation in the profitability of the healthcare organizations is 76.86%.
Thus, the developed SEM model highlighted the close systemic relationship between ICT implementation, support for sustainable development, and financial risks in healthcare. This opens up the possibility of further improving the financial risk management in healthcare through increased activity in providing high-tech medical care and supporting sustainable development in Russian healthcare.

4.3. Improving Financial Risk Management in Healthcare during the Provision of High-Tech Medical Care in Russia

In addressing the third task and determining the prospects for improving the financial risk management in healthcare during the provision of high-tech medical care in Russia, the author used a trend analysis method based on the data from Table A1 to determine the changes in the values of the ICT, SST, and HLT variables by 13 June 2024 compared to 14 June 2022 (a two-year trend).
The forecast values of the ICT and SST variables were also determined by multiplying their values on 13 June 2024 with their identified two-year trend. These forecast values were substituted into the equation for HLT to determine its forecast value and projected two-year trend by 13 June 2024. The prospects for reducing the financial risks in healthcare during the provision of high-tech medical care in Russia until 2026 were also identified (Figure 3).
As demonstrated in Figure 3, the two-year trend in the profitability of the ICT organizations in 2024 compared to 2022 (as of mid-year, specifically 13 June) was 9.24%. Therefore, for 2026 (as of mid-year, specifically 13 June), a similar increase in the profitability of the ICT organizations is projected, which is forecasted to reach RUB 54.82 billion.
The two-year trend in the profitability of the organizations included in the “Sustainable Development Vector” index in 2024 compared to 2022 (as of mid-year, specifically 13 June) was 2.43%. Therefore, for 2026 (as of mid-year, specifically 13 June), a similar increase in the profitability of the organizations included in the “Sustainable Development Vector” index is projected, which is forecasted to reach RUB 165.19 billion.
The two-year trend in the profitability of the healthcare organizations in 2024 compared to 2022 (as of mid-year, specifically 13 June) was 9.24%. Therefore, by 2026 (as of mid-year, specifically 13 June), a similar increase in the profitability of the healthcare organizations can be achieved. However, this forecast does not consider the systemic connection between ICT implementation, support for sustainable development, and financial risks in healthcare identified in this research.
Considering this systemic connection, solely due to the projected growth in the profitability of the ICT organizations and organizations included in the “Sustainable Development Vector” index, the profitability of the healthcare organizations by 2026 will increase by 3.88%—to RUB 21.44 billion. This increase represents a synergistic effect that will complement the standard growth in the profitability of the healthcare organizations, resulting in a total increase of 13.65% (9.77 + 3.88), reaching RUB 75.48 billion (5.53 × 13.65).

5. Discussion

The contribution of this research to the literature (Stancea and Muntean 2024; Yang et al. 2024) lies in the development of the scientific concept of risk management in healthcare by substantiating the significance of a new market dimension of financial risks for improving the accessibility and quality of high-tech medical care and sustainable development of healthcare in Russia. This evidence forms the basis of the new approach to risk management in healthcare during the provision of high-tech medical care in Russia proposed in the research, which is compared with the current approach in Table 3.
As shown in Table 3, the new approach emphasizes the market dimension of financial risks (i.e., risks of obtaining and utilizing private investments) rather than the regulatory dimension (i.e., risks related to the provision and expenditure of budget funds), unlike Stancea and Muntean (2024). In contrast to Yang et al. (2024), the new approach identifies private investors, rather than the state, as the primary financers of healthcare.
Unlike Bolisetty et al. (2023), Ding et al. (2024), Korah et al. (2023), and Mohamad Taghvaee et al. (2023), the new approach expands the range of the beneficiaries of risk management beyond just consumers, healthcare workers, and state healthcare regulators to include investors in ICT and sustainable healthcare development.
In contrast to Arianpoor and Naeimi Tajdar (2024), Ishaq et al. (2024), Morozova et al. (2018), Przhedetsky et al. (2018), and Umair et al. (2024), the new approach does not limit the risks in healthcare when providing high-tech medical care to social, technological, epidemiological, labor, and regulatory financial risks and also includes financial risks in the market dimension.
Unlike Chen et al. (2023), Rahman et al. (2022), Shuyong et al. (2024), and Udekwe et al. (2024), the new approach does not support the SDGs individually and is not limited to SDG 3, SDG 8, and SDG 16, but it systemically supports SDG 3, SDG 9, and SDG 12. Accordingly, the risk management method involves ensuring the return on the private investments in ICT and sustainable healthcare development.
The theoretical contribution of this research to the literature lies in proving hypothesis H and confirming the existence of a close relationship between ICT implementation, support for sustainable development, and financial risks in healthcare, thus advancing the scientific discussion initiated by Bobylev et al. (2023), Chen and Tang (2023), Geng and Shi (2024), Molleví Bortoló et al. (2023), Wu et al. (2023), and Zhou and Jamaani (2023).

6. Conclusions

Thus, the main conclusion of this research is that implementing the ICT and support for sustainable development reduces the financial risks in healthcare. This conclusion is supported by the evidence gathered from summarizing the advanced experience of the top 20 largest healthcare organizations by revenue in Russia in 2022 and developing the SEM model of financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective.
The theoretical significance of the author’s model lies in uncovering the previously unknown causal relationships between ICT implementation, support for sustainable development, and financial risks in healthcare. This model highlights a new market dimension of financial risks for healthcare organizations in Russia.
The practical significance of the author’s findings and results is that they outline the prospect of reducing the financial risks in healthcare during the provision of high-tech medical care in Russia until 2026. This prospect can be practically applied as a roadmap for the digital modernization and sustainable development of healthcare until 2026, aimed at improving the state healthcare policy in Russia.
The established systemic relationship between ICT implementation, support for sustainable development, and financial risks in healthcare holds managerial significance because it will enhance the predictability of the financial risks in the market dimension of healthcare in Russia. The new approach to risk management in healthcare during the provision of high-tech medical care in Russia, proposed in this research, expands the toolkit for risk management in Russian healthcare organizations and improves its efficiency.
A limitation of this research lies in its focus on the Russian experience. Although many other countries also implement state-run public healthcare models and state financing of high-tech medical care, the Russian experience cannot be confidently generalized to other countries without further verification and refinement. Therefore, future research should include applied and case studies on the financial risk management in healthcare during the provision of high-tech medical care aimed at sustainable healthcare development in various countries worldwide.

Funding

This research received no external funding.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. This research uses data from (Forbes 2024; IMD Business School 2024; Ministry of Healthcare of the Republic of Tatarstan 2024; MOEX 2024a, 2024b, 2024c; Rosstat 2024; World Bank 2024).

Conflicts of Interest

The author declares no conflict of interest.

Appendix A

Table A1. MOEX trade data in 2022–2024.
Table A1. MOEX trade data in 2022–2024.
Trade DateSectoral Consumer Index, Billions of RublesSectoral Information Technology Index, Billions of RublesMoscow Exchange Index—RSPP Sustainable Development Index, Billions of Rubles
14 June 20220.565640.6417227.99602
15 June 20220.856000.9911528.38763
16 June 20221.047201.2642530.57209
17 June 20220.535811.0201418.63946
20 June 20220.578481.1191930.49453
21 June 20220.664511.1670842.99464
22 June 20220.970410.6768139.50449
23 June 20220.905831.1172844.13567
24 June 20221.241810.5985628.92149
27 June 20220.968181.3066726.97536
28 June 20221.167651.2359431.98768
29 June 20220.928910.8141031.40814
30 June 20221.267431.18954105.31335
1 July 20220.604380.5342645.17525
4 July 20220.683900.8157934.83523
5 July 20220.850700.8232941.39075
6 July 20220.817731.2821037.24500
7 July 20221.651861.5408326.15761
8 July 20221.105391.2330819.50443
11 July 20220.746871.6547726.57320
12 July 20220.752201.4044029.53024
13 July 20220.841021.0345525.20407
14 July 20220.661300.8986622.47313
15 July 20220.765450.7020721.24793
18 July 20220.927401.7182617.86446
19 July 20221.172541.0927619.11111
20 July 20220.881031.4259022.11271
21 July 20220.698950.8094522.54589
22 July 20220.701591.4005219.81628
25 July 20220.775213.8323422.08394
26 July 20221.477298.5053824.54456
27 July 20221.544895.5193527.67511
28 July 20222.339772.3918923.34116
29 July 20222.020403.5763619.45123
1 August 20222.208882.7388028.02166
2 August 20222.028381.9802923.45250
3 August 20221.718683.0363722.90252
4 August 20222.101543.3378417.75422
5 August 20221.695784.4392629.39962
8 August 20221.277412.5612223.67322
9 August 20222.237952.2591222.29464
10 August 20221.277392.9751221.50850
11 August 20222.117603.5680123.18959
12 August 20221.485992.5604217.25031
15 August 20221.551452.0732118.17366
16 August 20221.248951.1030223.34084
17 August 20221.780231.5210123.61313
18 August 20221.242800.7128216.88929
19 August 20222.513670.7813716.19422
22 August 20221.451181.9123018.78926
23 August 20221.242045.3660025.71291
24 August 20221.559732.3778317.99767
25 August 20222.357371.6494119.59143
26 August 20221.045601.1170314.80855
29 August 20221.037780.9908222.13029
30 August 20221.180402.7891043.91562
31 August 20221.435932.1164196.64147
1 September 20220.916921.3892752.40513
2 September 20220.999761.3691952.12463
5 September 20221.168870.9569741.14208
6 September 20221.689133.1935856.24458
7 September 20221.009511.3923734.05352
8 September 20221.201971.0853329.09496
9 September 20220.739291.2616025.11743
12 September 20221.227942.7122828.36995
13 September 20221.230142.2574221.60172
14 September 20221.382771.5678028.85330
15 September 20221.333701.5879830.64729
16 September 20221.113483.2326732.05362
19 September 20220.847063.4729119.55283
20 September 20223.6329313.32335104.77861
21 September 20222.607507.1577664.97510
22 September 20221.522813.7718661.05043
23 September 20221.896664.4622947.75351
26 September 20222.581026.5451267.68958
27 September 20221.329754.5078843.08281
28 September 20221.090945.2243740.03439
29 September 20221.347894.3920134.26735
30 September 20221.685745.5686889.29365
3 October 20222.236873.3238836.43577
4 October 20221.538494.5373038.01856
5 October 20222.086605.4909941.35793
6 October 20221.090952.5266628.70274
7 October 20220.956082.2206235.74923
10 October 20221.571543.9248348.34901
11 October 20221.499812.4377426.59083
12 October 20221.139033.0148922.33467
13 October 20221.000782.9793119.46926
14 October 20220.846182.5663718.99740
17 October 20221.656922.0176627.66319
18 October 20221.210391.8836829.17420
19 October 20221.587983.6803129.66784
20 October 20221.252051.5740230.96174
21 October 20221.091471.2158230.17768
24 October 20221.204911.2212328.45181
25 October 20221.527502.0781936.76357
26 October 20221.384241.6168837.07389
27 October 20221.638631.5476235.73934
28 October 20221.071301.6188438.62707
31 October 20221.043412.3502226.24728
1 November 20220.816382.3816316.55119
2 November 20220.689951.7003418.57346
3 November 20220.970992.3320021.26411
7 November 20224.176142.2005133.49072
8 November 20228.501381.2618226.47281
9 November 20222.704522.0357625.76100
10 November 20222.287853.0250241.78653
11 November 20222.298451.7452927.43098
14 November 20224.849351.9922729.68329
15 November 20224.531472.5841126.66000
16 November 20221.814181.7571523.04922
17 November 20222.380361.2350019.53111
18 November 20222.026111.1144315.08518
21 November 20222.707631.8757421.53472
22 November 20221.503751.3538517.65111
23 November 20221.214092.0825426.61912
24 November 20221.121231.1095116.90852
25 November 20220.837853.8055413.31504
28 November 20220.839714.5477718.91871
29 November 20221.116202.5933817.06443
30 November 20220.567191.7435712.65903
1 December 20220.948791.0113618.02069
2 December 20221.942500.8204118.19417
5 December 20222.741651.6670131.08536
6 December 20223.584311.1021418.87228
7 December 20223.544890.8570224.30727
8 December 20221.626261.0071719.26002
9 December 20221.038660.5623012.26192
12 December 20221.946740.7774015.42742
13 December 20222.329871.1945421.13582
14 December 20221.466641.8650917.30160
15 December 20221.900341.7344225.66545
16 December 20220.998740.6771216.88950
19 December 20221.604661.5151525.97777
20 December 20221.623871.2910629.75309
21 December 20221.329821.5864425.85237
22 December 20221.178811.1835418.20114
23 December 20221.190281.4765314.15360
26 December 20221.327861.0699718.25181
27 December 20221.200991.0751418.19703
28 December 20221.196430.9333915.02767
29 December 20220.881250.6944512.39644
30 December 20221.660640.8992013.45710
3 January 20230.575300.7179110.78736
4 January 20230.512770.628269.87648
5 January 20230.699010.429018.18847
6 January 20230.412390.258676.56940
9 January 20230.803450.7178815.39118
10 January 20230.961010.7164311.78893
11 January 20231.214271.6646630.57844
12 January 20233.888171.2574618.20563
13 January 20231.851071.0287524.40286
16 January 20231.775782.0045721.29005
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20 January 20231.159940.918359.52385
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1 February 20231.146204.3579120.12608
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24 February 20230408610.707127.90013
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1 March 20231.775851.5972626.00092
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17 April 20234.809241.3298124.54848
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21 April 20231.558903.4811417.20861
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25 April 20233.685481.2339415.28662
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27 April 20232.592074.7874922.42026
28 April 20232.357012.0840922.79354
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25 May 20238.804108.2898929.68610
26 May 20236.208694.1712623.58286
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10 June 20244.755937.3487143.78174
11 June 20244.606565.8355648.10045
13 June 20245.525015.9313568.00503

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Figure 1. Financial risks of healthcare in the SEM model. Source: Calculated and developed by the author.
Figure 1. Financial risks of healthcare in the SEM model. Source: Calculated and developed by the author.
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Figure 2. SEM model of financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective. Source: Calculated and developed by the author.
Figure 2. SEM model of financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective. Source: Calculated and developed by the author.
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Figure 3. Prospects for reducing financial risks in healthcare during the provision of high-tech medical care in Russia until 2026, billions of rubles. Source: Calculated and developed by the author.
Figure 3. Prospects for reducing financial risks in healthcare during the provision of high-tech medical care in Russia until 2026, billions of rubles. Source: Calculated and developed by the author.
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Table 1. Revenue of the top 20 largest healthcare organizations in Russia by income in 2021–2022 and analysis of its change.
Table 1. Revenue of the top 20 largest healthcare organizations in Russia by income in 2021–2022 and analysis of its change.
Healthcare OrganizationsRevenue in 2022, Billions of RublesRevenue in 2021, Billions of RublesAnnual Change, %
Medsi35.9830.0919.57
Mother and Child25.2225.220.00
European Medical Center (EMC)23.2025.23−8.05
SM-Clinic17.2015.709.55
MedInvestGroup14.2512.4214.73
Dr. Sergey Berezin Medical Institute (MIBS), St. Petersburg10.099.614.99
Medscan8.464.3196.29
Scandinavia and Scandinavia AVA-PETER Clinics8.146.8618.66
Expert7.666.4418.94
Private medical centers “Ekaterininskaya”7.597.018.27
MedSwiss6.946.683.89
Medholding6.054.1745.08
Medicine6.035.3412.92
Semeyanya5.815.1013.92
Family Doctor Medical Network5.504.6418.53
My Medical Center Corporate Group5.145.96−13.76
Bud Zdorov Medical Network4.273.948.38
New Hospital3.883.675.72
UMMC-Health3.693.379.50
XXI Century Medical Center3.303.019.63
Source: Developed by the author based on Forbes’ materials (Forbes 2024).
Table 2. Regression statistics and reliability tests.
Table 2. Regression statistics and reliability tests.
Type of AnalysisElement of AnalysisHLTICTSST
Correlation analysisMultiple R0.49660.46910.4385
Multicollinearity Test (R2)HLT1.00--
ICT0.42491.00-
SST0.38900.34841.00
Variance analysis and Fisher’s F-testSignificance F6.6 × 10−324.4 × 10−283.1 × 10−24
Significance level0.010.010.01
k1 = m222
k2 = n – m − 1 = 510 − 2 − 1507507507
Table F4.64734.64734.6473
Observed F82.991671.506260.3411
F-testpassedpassedpassed
Regression coefficientsY-intercept1.11740.744420.2775
HLT-0.45531.3633
ICT0.2466-0.7754
SST0.05920.0622-
Standard errorY-intercept0.27030.37200.9638
HLT-0.05690.2044
ICT0.0308-0.1530
SST0.00890.0123-
t-statisticsHLT-8.00756.6708
ICT8.0075-5.0671
SST6.67085.0671-
Student’s t-testTable t2.58552.58552.5855
t-testpassedpassedpassed
Source: Calculated and developed by the author.
Table 3. Comparison of alternative approaches to risk management in healthcare in the provision of high-tech medical care.
Table 3. Comparison of alternative approaches to risk management in healthcare in the provision of high-tech medical care.
Comparison CriteriaThe Current Approach in RussiaProposed New Approach for Russia
The main dimension of financial risksRegulatory (Stancea and Muntean 2024)Market-based
Healthcare funding entityState (Yang et al. 2024)Private investors
Beneficiaries of risk management to whom healthcare organizations are accountableConsumers (Ding et al. 2024; Korah et al. 2023)Healthcare workers (Bolisetty et al. 2023)State healthcare regulators (Mohamad Taghvaee et al. 2023)Investors in ICT and sustainable health development
Principal risksSocial risks
(Przhedetsky et al. 2018)
Technological risks
(Ishaq et al. 2024)
Epidemiological risks
(Arianpoor and Naeimi Tajdar 2024)
Labor risks
(Umair et al. 2024)
Financial risks in the regulatory dimension
(Morozova et al. 2018)
Financial risks in the market dimension
Supported SDGsSeparately (Chen et al. 2023; Rahman et al. 2022; Shuyong et al. 2024; Udekwe et al. 2024)systemically: SDG 3, SDG 9, and SDG 12
SDG 3SDG 8SDG 16
Risk management method Ensuring accessibility, quality, continuity, and ethical provision of high-tech medical care Providing jobs and opportunities for realizing the potential of healthcare workers Correctness and purposefulness of spending of budget funds allocated for technological modernization Ensuring a return on private investment in ICTs and sustainable health development
Source: Developed and compiled by the author.
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Chililov, A.M. Financial Risk Management in Healthcare in the Provision of High-Tech Medical Assistance for Sustainable Development: Evidence from Russia. Risks 2024, 12, 134. https://doi.org/10.3390/risks12090134

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Chililov AM. Financial Risk Management in Healthcare in the Provision of High-Tech Medical Assistance for Sustainable Development: Evidence from Russia. Risks. 2024; 12(9):134. https://doi.org/10.3390/risks12090134

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Chililov, Abdula M. 2024. "Financial Risk Management in Healthcare in the Provision of High-Tech Medical Assistance for Sustainable Development: Evidence from Russia" Risks 12, no. 9: 134. https://doi.org/10.3390/risks12090134

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