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Manager Zdravoochranenia 2019 #2
Published: 2019-02-08
992
CONTENT OF THE ISSUE
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Dynamics of morbidity indicators during the reform of the Health Care System of the Russian Federation from 2006 to 2016
Over the past 10 years, it has been possible to achieve positive changes in a number of indicators of public health and resource provision of the health care system. Modernization and reform of the health care system of the Russian Federation today is still not completed and is in the process of implementation. With the aim to study the changes in the state of health of the population against the background of the reform of the health care system of the Russian Federation, taking place in 2006–2016 was used the method of continuous observation based on the forms of state statistical observation. The study showed that over 10 years the death rate of the population decreased by 13%. If in 2006, 2,166,703 people died, then in 2016, 1,891,015 people died. Over 10 years, the life expectancy of Russians has increased by more than 5 years and in 2016 it has exceeded 71.9 years, reaching 77 for women and 66.5 years for men. The analysis of the morbidity over a ten-year period showed a tendency to increase. Thus, the rate of growth of incidence was 3%, and a prevalence of 7%. At the same time, the incidence increased in all Federal Districts, except Central Federal Districts. Over the past ten years, the prevalence of mental and behavioural disorders has decreased by 19%, infectious and parasitic diseases by 17%, diseases of the skin and subcutaneous tissue by 8%. The main line of development of health care system was chosen the strengthening of its preventive orientation, with the primary development of mass and cost-effective community-based forms of activity. In general, the reform of the Health Care System over the past 10 years has had a positive impact on the health status of the Russian population in all age groups.
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Management of a medical organization based on Markov chains with grades
Different aspects of management decision-making based on mathematical models have been actively examined in scientific papers over recent years. The mathematical apparatus of Markov chains with estimations is a perspective mathematical apparatus of management decision-making. The advantage of Markov chains with estimations is that the method adequately works with quantitative, as well as with qualitative data. The modelling based on Markov chains is a variation of imitational modelling using random number generators. Generating models with different scenarios allows to find a management decision that has the best characteristics of the required state of a medical organisation.
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Organizational and methodological basis of the preliminary analysis of the work of outpatient clinics at the stage of the beginning the project «Lean polyclinic
In order to start optimization and structural transformations, the external (questionnaires of patients, n = 200) and internal audit (time-related studies, n=186) of the outpatient clinic participating in the implementation of the priority project «Creating a new model of primary health care». For this purpose, 5 interrelated processes are identified in which the patient participates in the receipt of primary health care: 1 process – «Record for outpatient admission»; 2 process – «Registration»; 2 process – «Waiting for reception »; 4 process – «Medical care of the patient». 5 process – «Analysis of the nearest and remote end points». It is shown that there is a need in the outpatient clinic for information and technical improvement of the polyclinic’s Internet portal; need to improve sanitation in public places; optimizing the activity of outpatient doctors to reduce waiting times in the queue (optimizing the workplace, analyzing the workload of medical personnel, reducing the time spent on medical documentation, personalized approach to patients). Overall, 82,4% of patients were satisfied with the work of the polyclinic, assessing it as «good» (76,5%) or «excellent» (5,9%). In the future, it is planned to monitor morbidity, disability and mortality indicators as a criterion for the effectiveness of the project.
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Influence of socio-economic living standards of the population of the region on the market of paid medical services
The purpose of the study was a comprehensive analysis of the market of paid medical services in the Trans-Baikal Territory, taking into account the influence of regional factors. Using the correlation analysis, the influence of regional socio-economic factors on the change in the volume of paid medical services has been studied. To assess the market of paid medical services, a comprehensive analysis of indicators characterizing consumers and service providers on a reimbursable basis was carried out. Analysis of the activities of medical organizations that provide paid services in the framework of primary health care reflects an increase in the number of visits per shift, specialized medical care – an increase in the number of beds. These data indicate an increase in demand for paid medical services among the population of the region and an increase in their volumes. A demographic estimate of the population of the Trans-Baikal Territory as consumers of paid medical services has revealed a decline in the economically active population, the over-mortality of able-bodied citizens, and the depopulation of the entire population in the region. Socio-economic analysis identified a slight increase in gross regional product, an increase in average per capita incomes, as well as an increase in unemployment, a decrease in the number of employees, etc. Among the factors affecting changes in the volume of paid medical services, indicators characterizing the socioeconomic standard of living of the population were identified. The study made it possible to characterize the market for paid medical services from the perspective of producers and consumers of services, as well as to identify the influence of regional socio-economic factors on the volume of paid medical services.
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The social significance of chronic hepatitis C drug treatment
The article presents epidemiological data on viral hepatitis, the burden of disease of this pathology and outlines the policy of the World Health Organization (WHO) to control it. A comparison of clinical recommendations on the pharmacotherapy of chronic hepatitis C (CHC) published by the WHO and some other international organizations, as well as adopted in Russia, were carried out. The main vector in the treatment of CHC currently is use of direct-acting antiviral medicines, providing the possibility of almost complete cure of this disease. Provision of the access to the modern pharmacotherapy for all patients in need is the priority in most countries, including Russia. The opportunity to eliminate CHC could have significant positive economic and social effects.
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The sistem of the pushing influences (Nudge) as a factor of increase in efficiency of formation at the population of commitment to a healthy lifestyle
Results of the researches devoted to studying of a role of a system of the pushing impacts on increase in efficiency of prevention of noninfectious diseases and formation of commitment to a healthy lifestyle are presented in the review of literature. These literatures demonstrate that a complex of actions on increases in efficiency of prevention of noninfectious diseases and pushing of the population to maintaining a healthy lifestyle by change of a context of the environment and indirect impact on their representations concerning a healthy lifestyle have the proved efficiency and has a certain potential for reduction of risk of development of noninfectious diseases. Article is constructed on pilot studies of the foreign scientists connected with identification of features of thoughts and behavior of people at assessment and forecasting of uncertain situations within which, in particular, it is shown that people are mistaken at decision-making and their mistakes are subordinated to certain psychological regularities which are revealed and well experimentally proved by researchers. It is about fundamental laws of social psychology in the field of decision-making: heuristics in decision-making, the subjective probability, forecasting psychology, irrational predictability, causal and diagnostic conclusion, the theory of attribution and an error of attribution, tendency to conformality, assessment of difficult probabilities, intuitive forecasting, etc. Most fully the description of experiments in Russian is submitted at D. Kahneman [16], and the applied aspect is most fully presented in [8]. On the basis of the carried-out analysis of foreign and Russian literature of approaches to the organization of prevention in the field of noninfectious diseases and formation of a healthy lifestyle we allocated incentives and factors which do not bear in themselves the direct bans or restrictions, but are capable to have a necessary impact on people in terms of formation of a healthy lifestyle and prevention of noninfectious
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Health resourcing of traumatologic-orthopedic service in the subject of the Russian Federation amidst realization of grant program “Zemsky doctor
Medical staff are one of the crucial factors, which guarantee health care service efficiency. However, Russian national traumatologic-orthopedic service exists under the lack of significant lack of staff. Grant program “Zemsky doctor” became one of the problem solving ways.
Purpose. To evaluate Health resourcing of traumatologic-orthopedic service, and to examine results in completing staff jobs of trauma orthopaedists in medical organization in the subject of the Russian Federation achieved due to “Zemsky doctor” program realization.
Approaches: analytical, statistical.
Results. The research is conducted within Stavropol region. It showed that in 5 municipal districts of 36 trauma orthopedist jobs were either not specificated or completed, 6 of 36 had no traumatologic beds. Within the period 2011–2016 we registered negative dynamics of trauma orthopedists completeness from 94,4% to 88,9%. Comparing to 2011, when excluded trauma orthopedists were 23,3% of the general number of fired and hired, in 2016 they were 42,8%. The most active medical staff change is in town medical organizations. Within the period of 2012 to 2016 in terms of “Zemsky doctor” program 12 trauma orthopedists were hired in Stavropol region, which is 1,9% of all signed contracts under this program and 9,2% of all hired within this time trauma orthopedists.
Conclusion. We revealed significant disproportion of health resourcing in health service centres in the subject of the Russian Federation, which limits traumatologic-orthopedic care accessibility. Despite “Zemsky doctor” program being implemented, the strong deficiency of trauma orthopedists still exists, whereas its efficiency decrease the number of licenses for institutional traumatologic-orthopaedical care in rural areas. -
Failure of the oncologist from the accompanying and supportive therapy means the rendering of services not meeting the safety requirements of oncopatients
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How to arrange the provision of paid medical services anonymously
he article proposes specific mechanisms for the implementation of the right of patients to receive paid medical services anonymously. The authors propose and justify the use in the provision of paid medical services anonymously as the patient’s name alias (fictitious name), which should be reflected in the documentation – in the contract, the patient’s medical record, informed voluntary consent to medical intervention, etc. The Implementation of the proposals expressed by the authors of the article will allow to provide medical care anonymously in compliance with all the requirements of the law.
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About some practical aspects of application of professional standards in the field of health care
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Questions of registration of the informed voluntary consent for medical interventions
