The Economics of Access to High-Technology Medical Care in Emerging Markets: Budget Procurement versus Concession

Citation: Kudinov Dmitrii Sergeevich, "The Economics of Access to High-Technology Medical Care in Emerging Markets: Budget Procurement versus Concession", Universal Library of Business and Economics, Volume 03, Issue 03.

Copyright: This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Regions with limited capital budgets face a recurring choice when a heavy radiotherapy unit must be acquired or replaced: a one-off budget purchase or a concession under which a private investor finances the equipment and recovers the outlay over a fixed term. This study compares the two schemes on primary documents from three projects that equipped public oncology centers in Kazan, Ulyanovsk, and Astana between 2014 and 2018 across seven parameters: budget load in the year of commissioning and in later years, bearer of capital cost, bearer of volume risk, ownership of the equipment, response to equipment failure, and financing of replacement. Cash flows of the Kazan concession, which combines a budget reimbursement of RUB 318.0 million spread over ten years with a per-case payment of 24.3 percent of the regional tariff, are reconstructed and discounted at four rates. The present value of public payments under the concession equals the value of a one-off purchase at a discount rate close to 10 percent, and the concession becomes cheaper at every tested rate once a service contract is added to the procurement scenario. The gain for the public side lies in risk transfer and in the timing of outlays, while the replacement cycle stays unresolved.

Keywords: Public-Private Partnership, Concession, Radiotherapy, Capital Procurement, Risk Allocation, Emerging Markets, Health Financing, Russia, Kazakhstan.

https://doi.org/10.70315/uloap.ulbec.2026.0303008