Design of the Economic Mechanism of Sustainable Development of
the Socio-economic System of the Region
Evgenii V. Gradoboev
and Irina Yu. Solskaya
Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Federal State Budgetary Educational
Institution of Further Professional Education «Russian Medical Academy of Continuing Professional Education»,
Yubileiny, 100, Irkutsk, Russia
Irkutsk State Transport University, Chernishevsky Str. 15, Irkutsk, Russia
Keywords: Socio-Economic System; Stability of the Regional System; Economic Mechanism; Health Financing.
Abstract: The significance of the influence of exogenous factors on the stability of the state of the socio-economic
system (SES) necessitates the development of a methodological framework for regulating regional systems.
One of the most important criteria for assessing the sustainability of SES is the state of human capital, which
presupposes, first of all, the sufficiency of medical services in accordance with the necessary dynamics of
natural reproduction of labour resources. The results of the research presented in the article summarize the
author's ideas in the possibility of modelling the choice of an economic mechanism for financing the regional
health care subsystem that provides the required level of sustainability based on the adequacy of financing of
medical services. The basic theory of formalization of the problem of the design of the economic mechanism
was the mathematical theory of games. The model for choosing the economic mechanism of the regional
health care subsystem is formulated in terms of the design problem for economic mechanism.
Studies of theoretical provisions that determine the
content of economic mechanisms (Burkov et al.,
2008) revealed the ambiguity of ideas about the
current economic mechanism for managing the
territorial health care system, as a condition and factor
of a stable state of the socio-economic system (SES)
of the region. S.A. Livshits emphasizes that an
effective economic financing mechanism is “an
important task facing health care in modern socio-
economic conditions, and providing health care with
the necessary economic resources is a complex
problem that can be solved within the framework of
economic regulation ”(Livshits, 2003).
The main problem of the effectiveness of such
mechanisms is, from our point of view, discrepancies
in the formation of the model itself, namely, the
existence of different approaches to the definition of
the concept of "economic mechanism". In most
studies, as a basic approach to the content and
structure of the economic mechanism, the view of A.
Kulman (Kulman, 1993) is taken. Akindinova N.V. et
al. (Akindinova, 2018) note the identification at the
international level of a positive relationship in the
long term between the level of health care spending
and key indicators of national health (infant mortality,
life expectancy), first of all, a direct relationship was
established between the level of funding for the
industry and mortality. Considering that many factors
influence life expectancy, this indicator, as shown in
the studies of M.A. Rizvanova, most sensitively
reacts to the growth of health care costs in less
developed countries (Rizvanova, 2006).
From the standpoint of theoretical studies, stability is
considered as a fundamental property of the system,
considering stability as a fundamental property of
systems, allows us to assess the priority of stability
factors from the position of the structure of the
Gradoboev, E. and Solskaya, I.
Design of the Economic Mechanism of Sustainable Development of the Socio-Economic System of the Region.
DOI: 10.5220/0010593405270532
In Proceedings of the International Scientific and Practical Conference on Sustainable Development of Regional Infrastructure (ISSDRI 2021), pages 527-532
ISBN: 978-989-758-519-7
2021 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
Thus, the study of the sustainability of the
development of the socio-economic system (SES) of
the region implies that in its structure it is possible to
distinguish subsystems that affect the state of
sustainability, namely: society, material and technical
complex and natural resources, while it is assumed
that the sustainability of development should be
characteristic of each of them. The special place of
society is not only because the ability of residents of
the territory to maintain life well-being and social
stability is the goal of the development of the system,
but also because society is a decisive element in the
development of productive forces.
Assessing the sustainability of the socio-
economic development of the region as opposed to its
crisis state, it is necessary to pay attention to two
the ability to function as a self-developing
system is the most important functional
characteristic of the region (Gutman, 2002);
in the list of indicators of sustainable
development of the territory, which determine
the main forms of security - social, economic,
environmental, a special place is occupied by
health care as a subsystem playing a leading
role in maintaining the state of society.
For many years, health care in the studies of
Soviet and Russian scientists was defined as a branch
of the non-production sphere, which is characterized
by the spending of budgetary funds, without
participation in the formation of the national product.
A preliminary assessment of the results of the
implementation of specific economic mechanisms
that ensure the solution of urgent problems of
preserving the health of the population showed the
nature of their impact on the state of sustainability of
the SES in the region.
Leading experts in the field of healthcare have
repeatedly considered the need for a more dynamic
change in the financing system (Panurin and Khan,
2017; Martynova, 2019; Pyatakovich et al., 2004;
Rizvanova, 2006). The formulated requirements for
the content of measures to improve the effectiveness
of health care financing also include the need to
change the funding mechanism, taking into account
the strategic goal of increasing the level of motivation
of participants.
The measures presented to address the challenge
of changing the funding mechanism in accordance
with the recommendations should include:
strengthening the reasonableness of the
allocation of funds allocated to health care;
greater transparency in the use of financial
development of competition between medical
organizations in the compulsory health
insurance fund (CIHF) system (where
widespread introduction of new ways to pay for
medical care in the CIHF.
At the same time, an analysis of the practice of
financing the health care system in the region, carried
out on the example of the Irkutsk region, showed that
financing of health care is carried out at different
levels of management with the implementation of
signs of several economic mechanisms. However, the
main, from the point of view of implementation
efficiency, is the approach to the design of the
economic mechanism as a tool for managing facilities
(Kulman, 1993), which is implemented within the
framework of the State Program “Healthcare
Development” (State program «Development of
health care», 2017). Such a mechanism assumes:
1. Coordination of resources, providing an
effective solution to the problems of managing the
economic system. In almost every health care system,
there is inevitably a combination of public and private
funding, however, the issue of forming an economic
mechanism is mainly in the competence of the state,
regardless of the share of public funding. In the
proposed model, one-channel financing is considered
as the basic situation established in connection with
the existing regulatory instruments (Martynova,
2. The state reacts to changes in the values of
criterion indicators characterizing the state of
sustainability of the regional socio-economic system
through monitoring key indicators of national health
(Martynova, 2019). The achievement of the objective
function is assessed by numerical criteria, based on
reports. In accordance with the state program
"Development of health care", target indicators and
indicators have been established, the value of which
characterizes the level of sustainability of SES:
“satisfaction of the population with the quality
of medical care, percentage”;
“mortality of the population of working age
(per 100 thousand of the population of the
corresponding age)”;
“mortality from neoplasms (including
malignant ones) (per 100 thousand
“life expectancy at birth, years”;
“mortality from diseases of the circulatory
system (per 100 thousand population)”.
3. The control subsystem determines the rules
for the functioning of the SES.
ISSDRI 2021 - International Scientific and Practical Conference on Sustainable Development of Regional Infrastructure
The presence of a system of administrative
management of health care in the Russian Federation,
which sets formal rules for the functioning of the
system, as well as a strict dependence on the
reliability, relevance and quality of incoming
information about the state and changes in control
objects, which have their own goals, the rules of
functioning determine the possibility of using the
mathematical apparatus of game theory (Neumann J.
Von, 1970; Dixit, 2020) to formalize the task of
choosing (design) economic mechanisms (Kulman,
1993, McCollell, 2016).
The key component of the analysis of economic
mechanisms, in particular, and including games with
asymmetric (incomplete) information in general, is
the incentive compatibility condition introduced into
scientific circulation by Hurwitz (Hurwicz, 1960).
This condition is nothing more than a formal
interpretation of the assumption about the rationality
of the behavior of economic agents: everyone chooses
what he considers best for himself, namely, a strategy
is chosen, while everything that concerns the
alignment of interests within the framework of the
strategies chosen by agents is determined by the
conditions games.
The structure of game dynamics can be
summarized by two elements:
Participant design: Forward game theory can
be used to optimize the decision of each
participant to choose an individual strategy in
order to obtain maximum individual utility.
Mechanism design: "inverse" game theory
focuses on designing a game for a group of
stakeholders, acting according to a chosen
strategy. Auctions are a classic example of
mechanism design.
We are interested in inverse game theory
formulated from the point of view of artificial
intelligence (AI) under the following constraints:
the task of formalizing the game is not to
optimize the strategy of each participant in the
game, but to design the game around the
behavior of rational participants (main
example: auctions).
multi-agent AI system - in our case, the number
of agents is quite large, moreover, depending
on the specific socio-economic system
(specific region) and the moment of the
formation of the game situation, the number of
agents is different.
The most general definition, which can be applied
to any interaction between economic actors, considers
such interaction as a strategic game and calls the form
of the game itself a mechanism.
A game is a description of how players (agents)
can act, and what any set of their actions (strategies)
will lead to. For example, if the formulation of the
mechanism design problem is aimed at choosing an
economic mechanism for financing health care, then
from the point of view of the reverse game theory, the
choice of the strategy of each medical organization
(MO) is determined by the following features:
a plurality of sources for the formation of
monetary resources for the purchase of medical
care by patients;
a wide variety of financing systems and
models: in addition to private financing, where
the source of funds is direct payments by
patients for their care and contributions from
citizens and employers (in favor of their
employees), it can be voluntary health
insurance carried out by private insurers;
there is a system of state financing of health
care; it includes a system of compulsory
(social) health insurance and a system of
budgetary financing.
A more rigorous formulation proposed by
Hurwitz (Hurwicz, 1960) defines the economic
mechanism as the interaction between subjects
(agents) and the center.
Then the design of economic mechanisms
(mechanism design) is a constructive approach that
allows you to create such a mechanism of interaction
in which the egoistic actions of each of the agents in
the sum will lead to a solution that is optimal from the
point of view of the overall objective function
formulated by the center.
State bodies (SB) exert an indirect influence on
a medical organization (MO) through the territorial
compulsory health insurance fund (TCIHF) and
medical insurance organizations (MIO). Thus, in
accordance with the current legislation of the Russian
Federation, the dynamics of the strategies of the main
stakeholders is determined according to the results of
the interaction of the SB, MO, MIO and the patient
(On Compulsory Medical Insurance in the Russian
Federation, 2010; On the Fundamentals of Health
Protection of Citizens in the Russian Federation,
2011) (Figure 1).
Design of the Economic Mechanism of Sustainable Development of the Socio-Economic System of the Region
Figure 1: Scheme of information interaction of the main
stakeholders in the CHI system at the regional level
(Compiled on the basis of Vostropyatova and Levkevich,
The essence of the strategy game is the
dependence of the appropriate choice of actions of
each participant on the expectations of what the other
will do. Game theory is traditionally divided into two
branches: non-cooperative and cooperative.
Cooperative game theory deals with situations where
there are institutions that enter into agreements
between players obliging them to implement the
terms of the agreement. In such a game, the central
issue becomes the question of agreeing on the best
joint course of action (a set of individual strategies)
of all players (stackholders), in which the best can
have different values, for example, acceptable to all
players and coalitions of players, or ensuring that
some desired properties of the entire set of
participants in the game, including the institution
itself, which initiates the agreement.
General problem statement:
The payoff of each of the agents - medical
organizations (MOk) - depends on the volume of the
produced public good Uk, which for a period of time
T is determined by the quasilinear function of social
Uk = f (Bk, T, F
Here, the quasilinear of the choice function is due
to the fact that the total number of medical services
Вк provided by MOk during the time period T is
calculated as an algebraic sum:
Вk = ∑ H
+ Qк,
- the volume of medical services provided
by the MOk and paid from a single determining
source in accordance with the invoices;
Qk is the volume of medical services provided
by the MOk and paid for from all other sources;
tni - type MOi (t1 - private medical organization;
t2 - budgetary medical organization)
is the total amount of financing of the
Ministry of Défense; F
is determined by the
normative amount of funding from a single
centralized source (currently:
) F
minus the
fines imposed on the MO.
G (S1, S2 - Sn-1, Sn) - the result of the
implementation of the control functions of the civil
defence, determined on the basis of the MO strategies
(for example, control of the volume, timing, quality
and conditions of medical care), which forms the
amount of fines.
MOi provide medical care (to patients) in
accordance with the chosen strategy Si ⸦ {S1, S2, ...
The content of the economic mechanism: the
economic mechanism (EM) consists of (Figure 2):
- sets of strategies {S k} for each of the agents of
the MO;
- G (S1 - Sn-1, Sn) - the function of outcomes,
which determines the outcome of the game situation,
provided by the economic mechanism for the input
profile of strategies;
- values of fines (assigned by the state).
Figure 2: Formalized representation of the game situation.
In these keys, a version of a static game with
complete information (McCollell, 2016) is
considered in relation to determining the required
amount of funding for the territorial health care
system, assuming that agents (players) make
decisions simultaneously and their decisions are not
subject to revision.
ISSDRI 2021 - International Scientific and Practical Conference on Sustainable Development of Regional Infrastructure
The state of sustainable development of SES in the
region presupposes the presence of a definite outcome
of the game. As a result of the game, the Pareto SES
equilibrium is established.
The economic mechanism that ensures
equilibrium is a condition for the sustainability of the
development of the socio-economic system, since it
provides the necessary level of public good Uk.
Equilibrium state: an economic mechanism that
for a set of strategies (S1, S2 - Sn-1, Sn) and the
normative level of financing the provision of medical
services to the population Fk n ensures the
equilibrium of the socio-economic system (Neck,
1983), diagnosed on the basis of the criterion of the
produced public good Uk (Gorbunov, 2019). The
“life expectancy at birth” is used as a criterion
Imbalance: the total funding Fk is less than the
value of the minimum admissible level of funding
MOk required to ensure the lower limit of the
criterion indicator Uk; This situation does not allow,
without attracting additional funding sources, the
provision of the socially necessary volume of public
goods - the provision of medical services.
A preliminary assessment of the possibility of
designing specific economic mechanisms that ensure
the solution of urgent problems of preserving the
health of the population, showed the presence of a
stable interaction between health financing and the
level of sustainable development of the SES in the
region. The issues of health care efficiency as a
condition for sustainable development were
considered, first of all, from the standpoint of
assessing the dynamics of indicators of the national
accounting system.
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ISSDRI 2021 - International Scientific and Practical Conference on Sustainable Development of Regional Infrastructure