CONTENT OF THE ISSUE
Development of a new model of health care: a conceptual approach and pilot implementation
This paper presents an extended understanding of preventive healthcare model as a set of measures ad¬dressing risk factors (primary prevention), early detection of diseases (secondary prevention) and prevention of their complications (tertiary prevention). Four principles of service delivery are formulated to ensure the transition from a primarily curative to a predominantly preventive model, including strengthening the responsibility of citizens for the prevention of diseases, enhancing the role of primary care, overcoming physicians' interest in the volumes of care, as well as quality control based on the indicators of complications and neglected cases. The paper presents these principles pilot implementation in the reorganization of urological care in Voronezh oblast (Russia). Activities for early detection of diseases, strengthening the role of primary care providers, building interregional urological centers have significantly reduced the proportion of complicated cases, changed the structure of medical care towards the low-cost activities and eventually provided substantial clinical and economic benefits
About the requirements of the identification and design of preliminary and clinical diagnoses: what you need to pay attention in a medical organization
The article discusses issues related to the organization of the identification and registration of clinical and preliminary diagnoses in accordance with the requirements of order of Ministry of Public Health from 10.05.2017 № 203н. Practical recommendations for filling approved by the Ministry of the Russian Federation of forms of medical documents (medical card of a patient receiving medical care in outpatient facilities, and medical card of the inpatient), taking into account new requirements for the establishment and design of the preliminary and clinical diagnoses. Brought to the attention of healthcare leaders that we now have a criterion of quality of medical care is the fulfillment of the requirements for the compulsory consultation of doctors in case of difficulty of establishing a clinical diagnosis within the specified time
The Department of Medical and Social Assistance to the Adult Population and the Department of Nursing: the concept and principles of organization
The concept of the organization of medical and social assistance to the most socially vulnerable population contingents (people in the residential and senile age, the disabled and citizens with a temporary restriction of the ability to move and self-care after the transferred diseases and injuries) is proposed. This includes the creation departments of medical and social assistance in medical organizations that provide assistance to the adult population on an outpatient basis
To the question about the strengthening and preservation of health of employees in the enterprises (on the example of the Central Federal district)
Considered the issues of strengthening and preservation of health of people working in enterprises. Studied the role of the leader and trade Union organization in the preventive measures aimed at risk factors that influence the development of chronic noncommunicable diseases. Studied prevention of specific diseases associated with the specific activities of the enterprise, the provision of sanatorium-resort treatment. Examined measures to strengthen and preserve the health of the population, conducted in the territory of the project location. The scheme of interaction of all structures of the region in strengthening health work force
Availability of the medical diagnostic care and continuity in its organization at various stages of exercise of medical and diagnostic process
One of important social problems of a health care system is ensuring availability and quality of a medical care. For the purpose of complex assessment of availability of diagnostic testings reports of federal forms of statis¬tical observation were analysed and expert assessment of medical documentation of the medical organizations in the Republic of Bashkortostan is carried out. As a result of the integrated analysis of data key criteria and indicators of availability of diagnostic testings which indicate the need of differentiation of the medical organizations for levels of the diagnostic help for balancing of the offered nomenclature and ensuring adequate availability of diagnostic testings at various stages of delivery of health care were taped. Centralization of clinical diagnostic laboratories is the confirming result of repeated rising of availability of diagnostic services (by 5-10 times) that proves similar organizational and structural transformations of diagnostic sectionings, forming of three-level system of diagnostics under WHO recommendations that increases the methodical level and quality of medical and diagnostic process, especially at a pre-hospital stage and considerably improves satisfaction of patients.
Experience of use of medico-economic standards for the endovascular treatment of diseases
Endovascular surgery and interventional radiology is the most modern technologies in interventional medicine. The standardization of endovascular methods is the main condition for application in practice.
Materials: Reports of the main specialists on X-ray and endovascular diagnostics and treatment of MZRF and MZ of the Moscow region. Regional medico-economic standards (MES) for endovascular treatment of diseases are developed and implemented by the Ministry of Health of the Moscow Region in 2012-2014. The results of the work showed a significant increase (6,4 times) of the performed endovascular procedures for various diseases in medical organizations involved in the implementation of the Moscow region Medical Insurance Program. This made it possible to increase the efficiency of the work of cardiology, surgery, oncology and gynecology departments, to reduce hospital mortality from acute myocardial infarction in vascular centers from 22 in 2012 to 7-8% in 2015, and mortality from cardiovascular dis¬eases in the Moscow Region from 878.5 in 2012 to 680.5 in 2015 per 100 thousand of the population. The opening of 10 catheterization centers in the Moscow region, the introduction of MES treatment of patients with acute coronary syndrome according to routing, ensured the effective hospitalization of patients in "invasive" centers from 2% in 2012 to 82.8% in 2015. The standardization of the endovascular methods of treatment leads to an increase in the use of hospital beds, improved routing of patients' flows, provision of endovascular care of patients.
Availability and staffing by phthisiatricians in the Udmurt republic, 2011-2015
Provision of human resources represents one of the main problems in the organization of health care. The purpose of the study was to determine the main trends in the provision and staffing of phthisiatricians. The purpose of the study is determination of the main trends in the provision and staffing by phthisiatricians. Material and meth¬ods: official statistics of Udmurt Republic from 2006 to 2015. Mathematical, analytical and descriptive methods were used. Analysis of the availability of outpatient clinics by the phthisiatricians of the Udmurt Republic in the dynamics for 2011-2015 (per 10 000 population) showed the stability of the situation in the provision of specialists with a slight decrease in staffing. A positive trend was noted in the desire of young specialists to work in phthisiatric services. The results of the study of the level of provision and staffing of the phthisiatrics services in Udmurt Republic demonstrate the stability of the situation as a whole across the Republic, although in some administrative regions of the country the data are highly unequal. The arrival of young specialists in the phthisiatric service is encouraging growth in the supply of specialists in the near future
Prospects of health financing in 2018
New 2018 in terms of funding health care will differ from the previous - it is expected a sharp increase in funding from all types of sources. However, this is due not only to increased revenues and the restructuring expenses. It becomes more rational - "saving" (for example, reducing expenditures on more costly inpatient care in the Federal budget). In the system of obligatory medical insurance is the refusal of a number of "non-core" expenditure. All of this should have a positive impact on the development of health care
Questions answered by PhD of Economic F.N. Kadyrov
Focus of problem
Management in health care
Manager of health care consults
Questions and answers