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Manager Zdravoochranenia 2022 #1
Published: 2022-02-14
703
CONTENT OF THE ISSUE
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Portrait of regional health authority manager
Competent management is crucial condition for the development and functioning and requires qualified managers. In the Russian Federation over the past few years Federation there were many rotations in management of regional health authorities. These changes will be followed by lack of continuity in management decision-making, high degree of uncertainty and a low level of population and professional community trust.
T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation.
M a t e r i a l s a n d m e t h o d s . This research was designed as observational study with the use of questionnaire which included the characteristics of the age and gender of the respondents, the level of their basic and additional education, additional competencies, occupational background in leadership position.
R e s u l t s . We achieved a response from 81 respondents. We founded that rotation of managers and extremely short occupation period had significant impact on managers’ qualifications. The culture of purposeful formation of the professional skills by the respondents was poor. Only 7% of managers paid attention to their education. About 40% did not have professional retraining for management in healthcare.
C o n c l u s i o n s . It is necessary to develop a standard set of Russian region health managers competencies and responsibilities. -
Features of the state of the network and the provision of a bed fund of medical organizations in Russia
The implementation of the healthcare development strategy, effective management of the healthcare system is impossible without monitoring and comprehensive comparative analysis at various levels of the state and development of the network, resources and activities of medical organizations, individual services and the healthcare system as a whole.
P u r p o s e of the study is scientific assessment of the state of the network of medical organizations providing medical care in outpatient and inpatient settings, as well as analysis of the provision of beds for the population of the Russian Federation in 2012–2019.
M a t e r i a l s a n d m e t h o d s . Within the framework of the conducted research, official statistics data were analyzed, modern trends and trends in the provision of beds and the state of the network of medical organizations in Russia at the regional level were determined. Statistical data processing was carried out using SPSS, Excel‑2007 packages. Such methods as analytical, statistical methods, study and generalization of experience, comparative analysis were used.
R e s u l t s . The analysis has shown that the unevenness and the level of high differentiation of indicators of provision of beds by subjects of the Russian Federation remains. Thus, over the period 2012–2019, the provision of specialized beds for all the main profiles of beds is decreasing, the largest reduction affected socially significant beds – dermatovenerological – by 1,5 times, as well as therapeutic – by 32,5%, gastroenterological – by 28,2%, pediatric – by 24,4%, and infectious – by 20,3%.
F i n d i n g s . The results of this study confirm the reduction in the number of beds of the main profiles, as well as the conversion of part of the bed stock, especially in the context of a pandemic of a new coronavirus infection, which showed the need for structural and functional transformations of health resources in general and the bed stock in particular. -
Experience of increasing the availability high-technological ophthalmic care in the organization of the diagnostic department of the federal clinic in the Smolensk region
P u r p o s e – to analyze the development of the availability of ophthalmological care in the Smolensk region after the organization
of the work of the Smolensk medical diagnostic department.
M a t e r i a l s a n d m e t h o d s . The analysis was carried out on the basis of data from the medical records of patients insured in the Smolensk region and received medical care at the Smolensk medical diagnostic department, as well as directly at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution.
R e s u l t s . During the period of 2016–2021 activity of the Smolensk medical diagnostic department, diagnostic studies were carried out in 43274 patients, of which 2457 were children from 3 years old, the volume of ophthalmological care to residents of the Smolensk region was increased and expanded: 25972 surgical and laser interventions were performed in a one-day day hospital, of which 10692 were interventions in the treatment of cataracts, 8675 laser interventions were performed, 2689 interventions for various vitreoretinal pathologies, 2043 refractive and 694 anti-glaucomatous operations, 457 scleroplasty, 232 operations for strabismus, 246 oculoplastic operations, 132 implantations of corneal segments and 112 keratoplastics.
C o n c l u s i o n . For residents of the Smolensk region, the staging period between the initial appointment with an ophthalmologist and the period of hospitalization has been reduced, which makes it possible to minimize the waiting time for the necessary treatment. -
Irregular antibodies to red blood cells in patients of a multidisciplinary clinic
We studied the practice of transfusion therapy for patients at the Pirogov National Medical and Surgical Center, who
were diagnosed with irregular antibodies to red blood cells (RBC) in 2020. Among hospital patients, the part of such
immunized persons was 1,62% (200 people). Of these, the selection of donor RBC was performed in 29 (14,5%) patients.
45 cross-matching procedures were performed, which involved 177 units of RBC. 121 units were found compatible and
56 – incompatible. Of 29 patients with matched blood, transfusion of matched RBC was received by 14 (48,3%) people.
They received 54 units of RBC compatible in the indirect antiglobulin test. In 2 patients, antibodies were detected during
transfusion therapy. It is advisable to: a) create a centralized laboratory for federal medical organizations with the possibility of identifying irregular anti-RBC antibodies and individual selection of compatible donors; b) include identification of antibodies in the range of medical services; c) standardize the number of segments of the donor container tube from which RBC can be taken for cross-matching; d) establish the frequency of screening for irregular antibodies while continuing transfusion therapy; e) in a clinic of comparable scale, it is sufficient to maintain a daily supply of RBC in the amount of 2,1% – 2,8% of the annual consumption in order to provide an individual selection of blood for patients with irregular anti-RBC antibodies. -
New classification of national public health financing systems
R e l e v a n c e : The variety of methods and approaches to the financing of medical care accumulated by the world experience determines the importance of classification. However, the existing capabilities of classification systems seem to be limited and unsuitable for practice and management decision-making.
P u r p o s e : development of a new classification of health care financing systems to improve the efficiency of managerial decisions taken when modeling long-term strategies for the development of health care in the Russian Federation.
M e t h o d s : A method was used based on a functional and structural analysis of the main links of the technological cycle of financing public (free at the place of delivery) medical care: coverage, determination of sources of revenues, their redistribution, consolidation, payment for medical care and management expenses for creating a new classification of health care financing systems.
R e s u l t s a n d c o n c l u s i o n s : A new classification has been developed and tested to analyze the national health systems of different countries and model the most relevant changes in the health financing system.
A p p l i c a t i o n o f t h e r e s u l t s : public health, public financial management, consolidation of revenues. -
Assessment of economic losses due to the development of infection in the surgical intervention area
The development of infection in the field of surgical intervention is inextricably linked with financial costs and the public reputation of the institution. The medical and preventive institution needs to allocate additional funds from the hospital budget for diagnostic studies, as well as for medicines for the treatment of frolicking purulent-septic complications. As a result, medical and preventive institutions experience annual additional economic losses.
P u r p o s e of the study is to assess the economic damage caused to medical and preventive institutions due to the development of infections in the field of surgical interventions.
M a t e r i a l s a n d m e t h o d s . In the course of this study, an analysis of domestic and foreign literature sources on the issue of economic damage from purulent-septic complications in surgical practice was carried out.
R e s u l t s . The damage caused by the development of infections in the area of surgical intervention is quite significant, and even the introduction of new technologies and therapies does not relieve patients from their possible appearance. The estimated costs of infection of the surgical intervention area vary depending on the region, the type of operation and the degree of infection.
Economic analysis in this case is necessary to study the activities of organizations from the point of view of evaluating their work in order to monitor and subsequently better manage the processes of supplying the institution itself with material resources, as well as the use of internal reserves and their rational use.
F i n d i n g s . The distribution of funds in medical and preventive facilities should be carried out rationally to ensure the full-fledged activity of the institution. In the absence of measures taken to prevent the development of nosocomial infections, infections of the surgical intervention area may occur after a certain period of time after the patient is discharged from the hospital, thereby contributing to the spread and contamination of healthy people, which from a socio-economic point of view is unprofitable. -
Analysis of medical organization website during the Covid-19 pandemic
The Web site has become an integral part of organizations that use the power of the Internet and online communication platforms to build trust and strengthen relationships with stakeholders during and after a crisis.
The COVID‑19 pandemic is an uncertain risk factor that requires ongoing analysis of interventions in order to make effective decisions.
P u r p o s e of the study is to analyze user behavior pattern at medical organization website.
M a t e r i a l s a n d m e t h o d s . The analysis of the website of the SamSMU Clinics performed using the web-analytics tool Yandex Metrics. The measurement periods has been done between January 2020 and June 2021.
R e s u l t s . The results showed a change in visitor behavior during the pandemic in the direction of an increase in visits, a decrease in time and depth of browsing, and a change in the type of device used to access the site in favor of the smartphone. The main result was the need to make decisions to improve interaction with patients as part of the development of mobile health.
F i n d i n g s . The COVID‑19 pandemic has had an impact on medical organization digital marketing. A behavioral shift of site visitors toward increased activity in the use of electronic registration and mobile devices has been revealed. To improve interaction with the target audience, it is necessary to categorize website content into different categories: for the patient, for medical students, and for medical staff. -
About the ability of the Uniform State Health Information System to solve management problems
The unified state health information system (UHISZ) is becoming a state-significant information system (IS), which is capable of solving any problems of preserving and strengthening the health of citizens.
Purpose of the study is to substantiate the problems of the construction and functioning of the Unified State Health Information System, the solution of which will multiply the capabilities of the Unified State Health Information System to solve the problems of preserving and strengthening the health of citizens and look for new non-traditional ways to improve their health.
Results. I n the article, the authors distinguish three levels of problems to be solved. The first level of problems is problems that can be solved at the highest (legislative) level. The second level of problems is the problems that must be solved at the regional level. The third level of problems is the problems faced by ordinary users of the Uniform State Health Information System – doctors and other medical workers.
The article initially uses the position – “Any information system is a tool for solving management problems.” The authors trace the stages of creating informatization in the Russian Federation from the complex program “Development and implementation of automated consultative systems for diagnosis, prognosis and choice of treatment tactics in emergency conditions”, which substantiated the development of automated systems for the period 1978–1990 until 2018, when Russia was the National Healthcare Project was launched, which includes the Federal project “Creation of a unified digital circuit in health care based on the unified state health information system (Unified State
Health Information System) ”. The article discusses the problem of the privacy of data on the health of a resident of the region and the privacy of knowledge of the factors that determine both the health of a particular resident of the region and those around him. Preserving the complete privacy of a citizen’s “personal space” will lead to the fact that the Unified State Health Information System will have the most general data on the health of a resident of the region. In this case, it will only be possible to solve those problems that characterize the health of the region’s inhabitants, which were solved without any digitalization. The second level of problems is associated with the work of “Uniform State Health Information System” and support programs operating at the level of the regional health care system. The main
regional problems associated with “EGISZ” are: problems of licensing of auxiliary programs; problems of accounting for the quantitative parameters of the development of the Uniform State Health Information System and auxiliary programs; problems of control over the work of auxiliary programs; problems of control over the filling of the Uniform State Health Information System; the problem of “user-friendliness of the interface” (especially for departments with cases of “peak work” – emergency departments).
Separately, it should be noted the issues that are not problems of the functioning of the Uniform State Health Information System, but more characterize the new opportunities that arise in the presence of the Unified State Health Information System, which has a wide range of knowledge about human health. Uniform State Health Information System allows to solve in a different way the traditional tasks of an informational, organizational, medical, economic, scientific and educational nature that exist in the region. The noted fact prompts to look for new problems of assessing the health of residents of the region and ways to solve them, which were previously unavailable due to the lack of systematized data on the treatment and diagnostic process, other aspects of the activities of medical organizations, as well as information on factors affecting the health of residents of the region.
Conclusions. Any information system is a tool for solving management problems. Without eliminating the problems of replenishing the Uniform State Health Information System with data on the factors influencing the health of the inhabitants of the region, it is impossible to effectively solve the problems of preserving and strengthening the health of the citizens of the region. The data, which, in accordance with the Federal Law “On Personal Data”, are included in the list of closed data, are encrypted in the EGIZS. To oblige the regional health authorities to introduce a licensing mechanism for programs interacting with the regional Unified State Health Information System.
The development of regional Uniform State Health Information System will lead to a radical change in the view of the traditional tasks of information, organizational, medical, economic, scientific and educational nature, solved in the region. -
Financing of the compulsory health insurance system in 2022
The most important factor affecting the amount and methods of financial support of the compulsory medical insurance system, as in the last two years, continues to be the spread of coronavirus infection COVID‑19.
In the proposed paper discusses not only the indicators of the budget of the Federal compulsory medical insurance Fund, but the dynamics of indicators, including, in comparison with the rate of inflation, and other factors.
New directions of the use of compulsory medical insurance funds are identified, the reasons for their appearance are considered. -
Financing of the compulsory health insurance system in 2022
The most important factor affecting the amount and methods of financial support of the compulsory medical insurance system, as in the last two years, continues to be the spread of coronavirus infection COVID‑19.
In the proposed paper discusses not only the indicators of the budget of the Federal compulsory medical insurance Fund, but the dynamics of indicators, including, in comparison with the rate of inflation, and other factors.
New directions of the use of compulsory medical insurance funds are identified, the reasons for their appearance are considered.
