Manager Zdravoochranenia 2021 #5
CONTENT OF THE ISSUE
FROM MULTI – TO THE MONOPAYER IN THE RUSSIAN SYSTEM OF OBLIGATORY MEDICAL INSURANCE
Since January 1, 2021 amendments to the law “About Obligatory Medical Insurance in the Russian Federation” according to which medical insurance companies are excluded from the system of financing of medical care in federal clinics came into force. The logic of these changes provides creation in each territorial subject of the Russian Federation of a system of “the uniform payer” not only for federal, but also for other medical organizations that can regard as the beginning of centralization and restoration of integrity of a health care system that demands carrying out the analysis and forecasting of consequences of these innovations.
Research objective – the analysis and the forecast of consequences of the changes in the legislation on obligatory medical insurance providing creation of “the uniform payer” of the medical care provided in federal clinics.
Materials and methods. Content analysis methods, information and analytical materials of the Russian and foreign news agencies, expert estimates are used.
R e s u l t s . The federal law of December 8, 2020 № 430-FZ “About introduction of amendments to the Federal law “About Obligatory Medical Insurance in the Russian Federation” provides creation of two parallel systems of financial security of activity of the federal medical organizations – the first for directly from the compulsory health insurance Federal fund, the second – through the compulsory health insurances territorial funds and medical insurance companies. The law provided development of an order of distribution of volumes of the medical care provided at the expense of means of obligatory medical insurance in the federal medical organizations, taking into account capacities of such organizations and volumes of the provided medical care at the expense of other sources of financing. It can lead to division of the federal medical organizations into groups taking into account their dependence on treasury which force is inversely proportional to a share of paid services in revenue breakdown of these organizations.
Conclusions. Application in the system of obligatory medical insurance of the principles of “the uniform payer” of medical care is economic due to reduction of administrative expenses and elimination aspiration of commercial insurers to receiving profit. This decision also corresponds to global trends and will promote ensuring intrasystem efficiency in the industry, to development of network of the medical organizations as the “uniform organism” providing need of citizens for medical care. Division of the federal medical organizations into groups taking into account their dependence on treasury can have ambiguous consequences, including lead to strengthening of commercialization of federal clinics, many of which have legal status of autonomous budgetary institutions that causes need of creation of a system of protection of the population against catastrophic payments for medical care.
Organization of medical care for patients with cancer on the basis of lean production in the interests of developing organizational health-saving technologies during the pandemic
The article presents the results of the application of lean manufacturing (LM) technologies for the successful implementation of the state task of a clinical medical organization to provide high-tech medical care during the restrictions caused by the COVID19 pandemic. The highest degree of implementation of LM values and technologies was achieved in the section of respect for the person and corporate culture – 89%, compliance with specialized standards – 86%, satisfaction with quality and safety, as well as quick response to changes‑85% for each,
which allows implementing organizational health-saving technologies. The most accessible and widespread health-saving technology can be considered specialized information on the prevention of non-communicable diseases posted on the website of a medical organization in a special section and attracting the attention of patients in a voluntary informed consent. The organizational and methodological department can become the organizing structural unit of a medical organization for testing the introduction of lean production technologies and testing organizational health-saving technologies, whose specialists should be engaged in improving the level of professional training of doctors,
specialists in clinical profile and secondary medical personnel on health-saving issues, conducting communication campaigns aimed at increasing the responsibility of patients who come for examination and treatment for their health, their relatives and relatives, awareness of the value of human life and health, the formation of a culture of health in various age and social groups.
Methodology of creating Proposals (Practical recommendations) on the organization of internal quality control and safety of medical activity in medical organizations providing care in the profile of nephrology (renal replacement therapy)
Until 2020 in the Russian Federation there were no general approaches to the quality and safety management system in dialysis centers, which take into account the specifics of the organization of centers and allow to minimize the risks of adverse events associated with the conduct of replacement renal therapy.
An urgent problem of healthcare organization in the Russian Federation is the creation of a methodology for organizing internal control and approaches to building a quality and safety management system in dialysis units and dialysis centers.
Purpose is to design and prove the effectiveness of practical recommendations for quality and safety of medical practice in organizations providing care in the field of nephrology by methods of replacement kidney therapy.
M a t e r i a l s a n d m e t h o d s . Methodology of creation of a system of internal control of quality and safety of medical activity is based on practical recommendations for the organization of internal control of quality and safety of medical activity in a polyclinic and in a hospital.
R e s u l t s . On September 29, 2020, experts of FGBU “National Institute of Quality” of Roszdravnadzor assessed the system of organization and implementation of internal control of quality and safety of medical activity in separate subdivision № 1 of “B. Brown Avitum Russland Clinics” LLC in Saint Petersburg (Nevsky Nephrological Center).
According to evaluation results experts made a unanimous decision on correspondence of the system of internal control of quality and safety of medical activity of “B. Braun Avitum Russland Clinic” LLC to standards of the system of voluntary certification “Quality and Safety of Medical Activity”.
The cooperation of B. Braun Avitum Russland Clinic LLC and FGBU “National Institute of Quality” of Roszdravnadzor resulted in the development and successful practical application of propositions (Practical Recommendations) on the organization of internal control of quality and safety of medical activity in medical institutions providing nephrological care (Renal Assisted Therapy).
F i n d i n g s . The proposed methodology has proved its practical orientation and can be used in medical organizations irrespective of their geography, size and form of property.
Experience and prospects of palliative care in a multidisciplinary hospital
Experience of rendering palliative medical (PMC) care in a versatile hospital is presented – in the St. Petersburg City geriatric medico-social center (CGMSC). Clinical records of 4561 patients receiving treatment on office of PMC CGMSC during 2015–2020 underwent the analysis. Characteristic of stages of hospitalization of oncological patients, patients with somatic pathology and patients with neurodegenerative diseases in office of palliative medical care is given. Presented clinical cases from the practice of managing difficult patients. The prospects of rendering palliative medical care in the conditions of a versatile hospital are described.
The conclusion is drawn that only during creation of offices of palliative medical care in versatile hospitals it is possible to render this type of specialized medical care for patients adequately and in full.
The purpose of the study is to analyze the activities of the Department of palliative care in the City Geriatric Medical and Social Center of St. Petersburg.Materials and methods.
A n a n a l y t i c a l s t u d y of the medical records of patients of the Department of Palliative Care of St. Petersburg State Medical Institution City Geriatric Medical and Social Center was conducted. The case histories were selected for three nosologies typical for geriatric patients.
R e s u l t s . The analysis included the medical records of 4,561 patients treated in the department of PMP GHZ in the period from 2015 to 2020. The article describes the stages of hospitalization of cancer patients, patients with somatic pathology and patients with neurodegenerative diseases in the department of palliative care. Clinical cases from the practice of managing difficult patients are presented. The prospects of providing palliative care in a multidisciplinary hospital are described.
C o n c l u s i o n s . Only with the establishment of palliative care units in multi-specialty hospitals is it possible to provide this type of specialized medical care to patients adequately and in full.
Health centers – a tool for improving the prevention of chronic non-communicable diseases in the Russian Federation
There are Health Centers in Russia that deal with the early diagnosis and prevention of risk factors for chronic non-communicable diseases (NCD).
M a t e r i a l a n d m e t h o d s : the data of 9505 visitors who applied to the Health Centers of Tomsk were analyzed.
Purpose to identify the most significant combinations of risk factors for the development of NCD among visitors to Health Centers.
R e s u l t s : 70% of people had two or more behavioral risk factors. Two or more metabolic risk factors were identified in 37% of people. The prevalence of combinations of behavioral risk factors remains almost constant in all age groups, while the prevalence of metabolic risk factors significantly increases starting from the age of 30–34 years. The combination of physical inactivity and inappropriate nutrition is most significant for the development of high blood pressure, hypercholesterolemia and excess body weight in persons under 30 years of age. Individuals under 30 years of age have a higher risk of developing coronary artery disease and diabetes in the presence of combinations of metabolic risk factors (excess body weight, increased blood pressure and hypercholesterolemia). The risk of developing hypertension, ischemic heart disease and diabetes mellitus significantly increases with an increase in BMI for each unit, starting from a BMI of 22 kg/m2. It is noteworthy that this is still within the normal range. The risk of developing hypertonic disease and coronary artery disease significantly increases with an increase in cholesterol for every 0.5
mmol/l, starting from normal values.
C o n c l u s i o n s : the primary goal of preventive measures should be persons under 30 years of age without metabolic risk factors and with a combination of behavioral factors.
Error in the regulation of bacteria screening in donor blood components
We searched for standards for monitoring the sterility of donor blood and blood components. The legal nullity of the “Instructions for the control of the sterility of canned blood, its components, preparations, canned bone marrow, blood substitutes and preservative solutions” was established. For proper sterility control of donor blood and its components, the “Standard for equipping a blood transfusion station (blood center)” (approved by Order of the Ministry of Health of Russia No. 1167n dated October 28, 2020) needs to be amended by replacing the “Bacteriological analyzer for the identification of microorganisms” with “Analyzer of blood cultures“.
Role of the “national medical chamber” in coordinating the activities of medical professional communities (for the anniversary of the “National medical chamber”)
The field of healthcare in the modern period of its development is so multifaceted, complex, and also due to the synthesis of professional competencies and skills from various fields of medical science and jurisprudence, which requires a pooling of efforts for its effective functioning.
Purpose of the study is to analyze the current activities of the National Medical Chamber as the main aggregator of medical professional communities and medical associations.
M a t e r i a l s a n d m e t h o d s : materials for the undertaken analysis were literature sources, documents, resolutions. Methods of comparative analysis and systematization of information, content analysis were used in the work.
R e s u l t s . The article provides an analysis of the activities of the “National Medical Chamber”, created ten years ago with the aim of aggregating medical communities in their professional activities towards improving the health care system of the country’s population. It is shown that these trend directions have become key, meeting the modern needs of the effective development of the industry in conjunction with the medical professional communities, the Ministry of Health of the Russian Federation, and world achievements. The article reflects the issues of preserving the problems of self-government in the activities of various medical professional communities and medical associations.
F i n d i n g s . The ten-year period of activity of the “National Medical Chamber”, based on a consistent, reasoned, analytically verified ideology, allows us to calibrate and clearly solve the assigned tasks on the “painful areas” of healthcare.
Modern methods of prevention of aging, antiage programs
u s t i f i c a t i o n : Aging is a natural process. Skin aging is the result of both internal aging due to the passage of time, and external aging – as a consequence of environmental damage, primarily due to ultraviolet (UV) radiation. Chronologically aged skin of the body has fine wrinkles, thin, relatively flattened, dry and unblemished with some loss of elasticity. It shows a General atrophy of the extracellular matrix, which is reflected in a decrease in the number of fibroblasts. In addition, the levels of collagen and elastin are reduced, and their organization is disrupted due to a decrease in the synthesis of collagen types I and III in the dermis and increased breakdown of extracellular matrix proteins. G o a l : to improve and analyze modern programs against skin aging.
M e t h o d s : the subjects performed the skin care procedure twice a day for 28 days. The face was divided along the midline, and Group 1 applied placebo cleanser and placebo moisturizer to the left side of the face and test cleanser and test moisturizer to the right side of the face. Group 2 applied a placebo cleanser and placebo moisturizer to the left side of the face and a positive control cleanser and a positive control moisturizer to the right side of the face. The parameters of TEWL hydration, degree of stretching, elasticity, skin recovery, depth, number and frequency of wrinkles were measured.
R e s u l t s : the study demonstrated that the new skin care system, which is suitable for use on sensitive skin, has a positive effect on several signs of aging, including skin hydration, skin elasticity and wrinkle size, without any side effects for 28 days. These parameters are expected to improve further in future use.
New system of control measures in relation to medical organizations within the framework of compulsory health insurance
One of the most serious innovations in the system of compulsory health insurance is the change in the procedure for conducting control measures. In accordance with the new version of Federal Law No. 326-FZ (in accordance with the provisions of the Federal Law of December 8, 2020 № 430-FZ On Amendments to the Federal Law "On Compulsory Medical Insurance in the Russian Federation"), the procedure for monitoring the volume, timing, quality and conditions of providing medical care for compulsory medical insurance to insured persons, as well as its financial support, is now established not by the Federal Fund for Compulsory Medical Insurance, but by the Ministry of Health of the Russian Federation. At the same time, both the participants of the CMI system who have the authority to conduct control measures, and the procedure for conducting control, are changing.
Questions of the use of remote work in healthcare
Focus of problem
Management in health care
Manager of heath care consults
Questions and answers