This article is devoted to improving the strategizing of the development of domestic health care. Acceleration of population aging brings new challenges to the national health systems of most countries, primarily in the middle-income ones, since the older generation gets sick much more often, and their treatment requires much more investment. Strategic challenges such as the coronavirus pandemic provide a fork in the scenario for the implementation of public health policy. This circumstance requires an analysis of various scenarios for the development of the situation in the healthcare sector at the national and regional levels. In accordance with the methodology of the foreign member of the Russian Academy of Sciences Academician V.L. Quint, first of all, in this process, it is necessary to take into account global trends and their national and regional projections. The purpose of this work is to identify the role of scenario analysis in the formation of a strategy for the development of Russian healthcare at the regional and federal levels. The object of the study is the Russian healthcare industry, and the subject is the patterns of changes in the efficiency of healthcare in the regions of Russia, which are important for taking into account in the process of strategic planning using scenario analysis. A comparative analysis of the factors affecting the preservation and improvement of public health in Russia and some foreign countries shows that the most serious negative pressure on the effectiveness of the healthcare system in Russia is due to socio-economic, natural and climatic features, insufficient healthy lifestyle culture of the population, which has also been declining in recent years. In particular, the increase in demand for private medical services is an indicator of the increasing attention of the population to their health. At the level of Russian regions, the dependence of the overall effectiveness of health care (reflected in the value of life expectancy) on the level of the economy is shown. At the same time, the dependence of this indicator on the provision of the system with medical personnel and the financing of the industry in the regional context is not directly visible, however, it can be confidently stated that the development of private medicine has a positive effect on the efficiency of the healthcare system as a whole. The coronavirus pandemic has become a serious destabilizing factor in ensuring the effectiveness of healthcare, which requires considering such challenges when planning healthcare development under various scenarios. For the formation of successful strategic scenarios, and then for their successful practical implementation, it is necessary to digitalize healthcare systems both at the national and regional levels, which solves the key task of the strategizing process – ensuring scenario forecasting. The role of scenario analysis in shaping the strategy for the development of Russian healthcare is becoming key for successful strategic management of the healthcare system.