THE ESSENCE OF THE INSTITUTIONAL ENVIRONMENT OF MEDICAL EXPENSE INSURANCE

Abstract

The article presents a theoretical and methodological study of the essence and specific features of the institutional environment of medical expense insurance as a distinct component of the institutional environment of health insurance. It is argued that the conceptual framework for understanding this category remains insufficiently developed and requires further elaboration. Scientific approaches to the interpretation of the concept of the institutional environment have been systematized at the general theoretical, sectoral, and applied levels. Based on the synthesis of existing approaches, the institutional environment has been defined as a multidimensional system of formal and informal rules, norms, and mechanisms for their implementation that regulates economic relations, shapes the behavior of market participants, and provides the institutional conditions for the development of medical expense insurance. A distinction has been drawn between the concepts of the institutional environment and institutional infrastructure. The institutional environment has been shown to be a broader concept encompassing formal and informal rules, norms, and mechanisms for their implementation, whereas institutional infrastructure represents its organizational and institutional component and comprises a system of institutions, organizations, and other entities that ensure their effective functioning in practice. Five specific features of medical expense insurance as an object of institutional analysis have been identified: the dual nature of the insurance service, heightened information asymmetry, the three-party structure of insurance relations, close dependence on the functioning of the healthcare system, and the significant role of informal institutions in shaping the behavior of market participants. Based on the study findings, a definition of the institutional environment of medical expense insurance has been developed as a multilevel system of formal and informal rules, norms, constraints, and mechanisms for their implementation that determine the conditions for the emergence, functioning, and development of insurance relations in the field of medical expense reimbursement. It has been demonstrated that its structure encompasses four interrelated dimensions: legal, organizational and institutional, regulatory and supervisory, and informal and behavioral. The interaction of these dimensions determines the quality of the institutional environment and its capacity to ensure the effective functioning and sustainable development of the medical expense insurance market.