RUSSIAN FEDERATION HEALTHCARE SYSTEM MUNICIPAL LEVEL PUBLIC LAW REGULATION: CONSTITUTIONAL-TELEOLOGICAL ANALYSIS IN THE HEALTHCARE SYSTEM DEVELOPMENT STRATEGY CONTEXT UNTIL 2030

Abstract

Introduction. This article offers a constitutional-teleological analysis of the municipal level of public-law regulation of the healthcare system in the Russian Federation in the light of the Healthcare Development Strategy for the period until 2030 and the Strategy for Scientific and Technological Development of the Russian Federation, drawing on comparative-legal evidence from the Republic of Belarus, the Republic of Kazakhstan, the Federal Republic of Germany, and the Republic of Poland. The relevance of the topic stems from the fact that, following the 2020 constitutional amendments, the municipal level has been incorporated into the unified system of public authority, while the scope of local self-government powers in the sphere of public health protection retains normative indeterminacy that calls for doctrinal resolution.

Materials and methods. The methodological framework rests on the dialectical, formal-dogmatic, systemic-structural, and teleological methods of legal analysis, together with the comparative-legal method applied to foreign and post-Soviet experience in regulating municipal healthcare; the empirical basis comprises the sociological monitoring data of the VCIOM Analytical Centre (2025), official statistics of the Ministry of Health of the Russian Federation, and the law-enforcement practice of the constituent entities of the Russian Federation and of the Member States of the Commonwealth of Independent States.

Results and conclusions. It has been substantiated that the three-tier regulatory system governing healthcare exhibits a structural disproportion: the new generation of strategic-planning instruments has enshrined fundamentally new standards of medical activity that are not supported by an adequate legislative toolkit with respect to the powers of local self-government bodies. A consistent trend towards the centralization of public administration in the healthcare sphere is observed, under which the competence of local self-government bodies with regard to the organization of medical care for the population is being progressively narrowed; the VCIOM monitoring data (2025) record a twofold gap between satisfaction with healthcare in megacities and in small towns (66% versus 33%), which, in its systemic-structural dimension, serves as an indicator of the discrepancy between the regulatory model and the constitutional requirements of territorial equality.

Discussion. The findings have been discussed within three principal directions of Russian municipal-law doctrine. First, the irreversibility of the administrativization trend in public healthcare governance has been substantiated as a structural rather than local feature of the post-constitutional model of competence allocation. Second, the doctrinal competition between the «hard incorporation» view (A. A. Shakhov, M. V. Demidov) and the «preserved autonomy» view (N. S. Koneva, O. I. Bazhenova) on the place of local self-government within the unified system of public power after the 2020 constitutional amendments has been analysed. Third, in the light of contemporary international research from 2024–2026 (Escano-Arias et al., Bisht S., Lilly et al.), the applicability of the «Health in All Policies» strategy to the Russian context as a normative instrument to overcome territorial inequality has been discussed.