2019 № 3 Historical background the scientific organization of labour in health care: the experience of the early twentieth century
The active introduction of lean production technologies in the activities of medical organizations, conducted in recent years, was the occasion to study the history of the origin and formation of management science in Russia, as well as the study and rethinking of the Russian and Soviet experience of health care organization. Analysis of documents and literature related to 20–30 years of the last century, a period when the rapid pace of construction and development of the national economy of the USSR makes rethink the place and role of the Soviet experience of production management, which was at one time called “scientific organization of labor and production”, and later – “rationalization”. The universality of technologies and methods of scientific organization of labor (SOL) allows to use them both in production and non-production spheres, including health care. Note that the Soviet experience, as a rule, is not reflected in Western textbooks on management, or only mentioned, although the achievements of Soviet scientists 20-ies of the last century anticipated many areas of modern management and remain relevant even after almost a hundred years.
2013 № 7 Special interest groups in the Russian health care system (The Graduate School of Management, Saint-Petersburg State University, Russia)
The article deals with the role of special interest groups in the health sector. The attention is focused on classification of special interest groups, the approaches to the analysis of the motives of collective action and the formation of special interest groups. The activit ies of special interest groups in the Russian system of health insurance are analysed.
2022 № 3 Epidemiology of disability of the able-bodied population in Tver on the example of surgical patients
The health of the nation is the main marker of the successful development of the state. Maintaining and improving the health of citizens are the main tasks of social policy in every country. Morbidity and disability are among the main indicators of the state of public health. They reflect the demographic situation and the level of socio-economic development of the country.
Every year the number of persons with disabilities increases, which makes the problem of disability of the able-bodied population extremely relevant. Monitoring of disability, as one of the medical and demographic indicators, is the basis for ensuring the protection of the health of citizens. Research on the epidemiology of disability is the key to preventing an increase in the number of disabled citizens. In addition, it plays an important role in the distribution of the state budget to improve the quality of life of people with an assigned disability group and to carry out preventive measures aimed at reducing the impact of risk factors for disability.
Purpose. Assessing the degree, structure and dynamics of disability among residents of the city of Tver using the example of surgical patients observed in the “City Clinical Hospital No. 7”, and detection the main number of diseases that caused the setting of a disability group.
Methods. An analysis was carried out regarding the data on the official reports of the surgical department polyclinic No. 1 of the state budgetary healthcare institution “City Clinical Hospital No. 7” in Tver for the period from 2010 to 2020. The dynamics of the frequency of registration of persons with disabilities was studied among surgical patients, the main groups of diseases that caused disability were identified, the structure of disability by groups was analyzed. The degree of reliability of the obtained data was assessed.
Results. The growth of citizens with disabilities in the outpatient surgical department increased 3,3 times from 2010 to 2020. The dynamics was wave-like. There was a sharp rise in the number of people who received a disability group for the first time from the beginning of 2010 to the end of 2013. The indicators did not change much from 2014 to 2020. However, the dynamics of the percentage of the working population among persons with disabilities developed in inverse proportion. Those who received a disability group for the first time mainly had pathologies of the musculoskeletal system and vascular diseases.
Conclusion. Based on the data of the surgical department of the polyclinic in the city of Tver, the number of persons with
disabilities tends to increase. It requires constant monitoring. The number of persons with disabilities tends to increase. It was illustrated through an example of a study in Tver. All that leads to a decrease in the able-bodied population and an increase in social inequality. It is an urgent problem in the region.
2021 № 1 Emotional burnout of a district doctor
Based on the results of assessments of the dependences of the level of psychoemotional load of a primary care
physician (PHC) (district physician) on medical and social problems related to the conditions of his activity, measures have been developed for stress resistance and health saving of a district physician (VTU). The Orenburg region with a population of almost 2 million people was the pilot territory (base) for the study. The region has 12 cities and 35 rural districts, the share of the rural population is 40.1%.
Research materials und methods: sociological, direct observation, statistical: 1014 questionnaires of survey of district
physicians (93% of the total number of VTU) were subjected to statistical processing. The study included 4 stages. At the first stage, sociological surveys of district physicians working in medical organizations located in urban and rural settlements were carried out (568 and 446 VTU, respectively). At the second stage of the study, the level of psychoemotional burnout was assessed using the modified method of V. V. Boyko (2010) “Diagnostics of the level of emotional burnout”. At the third stage of the study, we calculated the statistically significant correlation of the symptom of professional burnout (SPEV) with factors related to medical and social problems of the professional activity of the local GP. At the fourth stage of the study, a set of measures has been developed and is being implemented to increase emotional stability in the professional activity of the local GP.
Relevance. WHO classifies occupational stress as a disease of the twentieth century, which can manifest itself in any
profession and can reach the size of a “global epidemic”. The accumulation of negative emotions in the profession of a
doctor can lead to psycho-emotional exhaustion and the formation of the syndrome of “emotional burnout”. A necessary quality of a primary care physician is emotional stability. This is the ability to overcome a state of excessive emotional arousal. Of particular importance is the development of professional burnout and the assessment of professional stability for district physicians who make first contact with the patient.
Results. Measures have been developed to increase the effectiveness of emotional (professional) stability in the activities of VTU.
Conclusion: Emotional stability in the doctor’s work allows you to maintain and further increase the effectiveness of professional activities. The obtained research results were used for the development of the “program for the modernization of health care in the Orenburg region”. They were used in the development of the Software product of the Ministry of health of the Orenburg region.
2016 № 2 Structure and challenges of the medical division of the new programme of fundamental scientific research of state science academies
The article considers the questions of planning and financing the scientific-research activity in the field of medical science, realized at the cost of the state budget. Authors demonstrate that disintegration of scientific processes leads to a decrease of intensity of scientific search and implementation of achievements in medical sciences in the health care practice. Authors conclude that it is necessary to increase the effectiveness of the management of scientific research and more clearly define the priorities of the medical sciences development.
2020 № 10 Questions related to the procedure for allocating volumes of medical care to regional medical organizations
The arrival of a new wave of the spread of COVID‑19 coronavirus infection made it obvious that the fight
against coronavirus infection will last for quite a long time. For a number of reasons, incentive payments for employees
related to the treatment OF covid‑19 coronavirus infection did not fully suit either employees or the state. Therefore, the
state has made a serious transformation of the system of payments, which have turned from a salary element into a
“non-salary” element of social support.
2018 № 4 The sources of financial provision of rendering emergency medical care
Free provision of emergency medical care is provided by the legislation. This requires a clear definition of the source of cost recovery for medical organizations that provide this assistance, In a particular situation, how¬ever, there are often situations where law enforcement officials refuse to pay for emergency assistance provided to their employees, referring to the above-mentioned legislative requirement. Many problems in the provision of emergency arises in the system of compulsory health insurance. Payment for emergency medical care rendered in excess of the approved amounts remains an unresolved problem. The problem of compensation for emergency assistance to uninsured citizens is not settled either. These problems are especially urgent for private medical organizations
2020 № 5 Russian Health Care in the background coronavirus COVID-19: Opportunities and Threats
The effectiveness of any public system, including health care, is determined by the adequacy of its legal regulation. The situation with coronavirus exposed many problems in this area, a number of which were quickly resolved with varying degrees of success. However, there are still many unresolved issues and the need to further improve the legal regulation of health care. This applies, among other issues, to the remuneration of medical workers engaged in providing medical care to patients who have been diagnosed with COVID‑19 coronavirus infection. The article presents an analysis of the procedure for implementing incentive payments at the expense of Federal funds, and suggests measures to improve it. The article presents a SWOT analysis of the state of Russian healthcare against the background of the spread of COVID‑19 coronavirus.
2020 № 4 The effect of coronavirus Сovid-19 on the situation in Russian healthcare
The relatively slow initial rate of spread of COVID-19 coronavirus in Russia has its own objective reasons related to the size of the territory, population density, tourist activity of the population, etc. They have played a positive role in making it possible to better prepare for the fight against it, taking into account, among other things, the experience of countries where the rate and scale of the spread of the coronavirus was much higher.
Despite the serious damage to the economy, there are no global financial threats to health care yet. However, it is important that resources arrive in time to medical organizations in the context of large-scale conversion of beds, etc. Unavoidable periods of downtime during periods of re-profiling, being in standby mode, etc., lead to the fact that many medical organizations risk finding themselves in a difficult financial situation, even with sufficient resources in the industry. Therefore, at this stage, it is sometimes more important than serious financial infusions, and mechanisms aimed at com- pensating for the loss of income.
2020 № 6 Assessment of public policy in relation to certain issues of healthcare functioning during the spread of COVID-19 Coronavirus
Health care, as a predominantly public system, is objectively subject to serious regulation in special operating conditions, which include the spread of COVID-19 coronavirus infection. It is also important that the private healthcare system is also subject to direct or indirect regulation. At the same time, public authorities are sometimes forced to resort to "manual management", the consequences of which are not always clear for both public and private health care.
2017 № 2 The ways to counter the "consumer (patient) extremism" in the provision of paid medical services
The medical organization in the provision of paid medical services are faced not only with a large number of inspectors, with unreasonable restrictions (which usually applies to state and municipal institutions), the discontent of the population by the fact of payment for medical care, etc., but with the incorrect behavior of patients seeking unreasonably to obtain the benefits that they are not guaranteed. We are talking about the phenomenon called «patient extremism». The position of the regulators is often in almost unconditional support for patients. The current mentality is based on the incorrect position of «the patient is always right». Meanwhile, the provision of paid medical services is a sphere of civil relations where there should rule the law. In recent years adopted laws (including amending the Civil code) allow healthcare organizations to more successfully assert their legal rights when lawful execution and performance of contracts for the provision of paid medical services to patient and resist extremism. The analysis of the legislation addressed in this article.
2019 № 1 Financing health care in 2019: new priorities and channels for the movement of funds
Analysis of the future financing of health care shows that in 2019–2021, despite the difficult financial situation, the volume of financial support for the industry will continue to grow. Thus, the size of health care spending from the Federal budget is growing not only in absolute terms, but also occupies all a large share in the structure of Federal budget expenditures. The increase in expenses in the system of compulsory health insurance (CHI) in absolute terms is still quite large. Among the priorities of 2019 are the increase in funding for cancer care, as well as high-tech medical care, which directly follows from the provisions of the Decree of the President of the Russian Federation May 7, 2018 № 204 "The national goals and strategic objectives of the Russian Federation for the period up to 2024" (presidential Decree № 204). The distribution of funds to the compulsory medical insurance system is based on these priorities, and based on the results of implementation of decrees of the President 2012 for leveling a series of problems, such as unreasonable reductions in personnel. All this should have a positive impact on the further development of health care.
2019 № 5 Modern aspects of marking of medicinal products: organization model introduction marking «DataМatrix» drug
The introduction of an automated system for monitoring the movement of drugs from the manufacturer to the end user is one of the priorities of the “Health”, which in the future will provide full protection of the population from counterfeit drugs and prompt removal from circulation of counterfeit and substandard drugs. Many participants in the commodity distribution chain are not fully aware of the peculiarities of registration in the system of monitoring the movement of medicines, the purchase of equipment for their labeling and subsequent inclusion in the life cycle of the goods. The aim of the study is to develop an organizational model for the introduction of “DataMatrix” labeling on the drug, which is a modern element of the system for monitoring the movement of the drug from the manufacturer to the end user and contributes to the proper step-by-step inclusion of “DataMatrix” marking at each stage of the commodity chain.
In the course of the research the methods of analysis and synthesis, the method of observation were used, the monitoring of legal documentation in the current edition was carried out, the algorithm was compiled using logical modeling.
As a result of the work, an organizational model for the implementation of a system for monitoring the movement of medicines was created, which provides preventive measures for the entry into circulation and simultaneous withdrawal from circulation in an automated mode of counterfeit, substandard and counterfeit medicines at any stage of their circulation; control of the targeting of the movement of drugs purchased from the budget, the cost of their acquisition; monitoring of pricing and maximum retail prices for medicines from the list of vital and essential medicines.
2018 № 2 Development and implementation of a standard for the organization of work of registries medical organizations: the project «Entrance group»
Regional project “Front-office” was set up and implemented in Tomsk oblast (Siberia, Russia). The aim of the project was launch a front-office of out-patients departments standard for improvement patients satisfaction in medical institutes. There are five directions in the project: providing affordable telephone service, front-office infrastructure, staff training, medical documents logistic, corporative style creation. Using of holistic project approach has led to significant improvement of availability and quality of health care in Tomsk oblast
2013 № 4 Self-regulation in the health care sphere (Penza State University, Penza, Russia)
In the article prospects of transition of the sphere of health care on self-regulation principles are considered. The principle of a professional autonomy of the doctor is analyzed. Distinctions in the maintenance of some models of reform of public administration in the medicine sphere are carried out.
2014 № 8 Work ethics of physicians, entering the labor force after internship training and clinical studies (Bashkirskiy State Medical University, Ufa, Russia)
There has been a survey conducted on work ethics of physicians, prepared in the system of postgraduate education towards their chosen profession and organization of professional activity. There were validated opinions of physicians on such topics as fulfilling their professional goals, perspectives of career growth in regards to migration and change of work place.
2013 № 12 Social-demographic processes and health care (Federal state budgetary establishment of a science Institute for socio-economic studies population RAS, (ISESP RAS), Moscow, Russia)
Questions of a social inequality concerning health are considered. The importance of problems of maintenance in the Russian Federation validity of a financial payment on public health services is discussed. It is offered to fix legislatively principles of formation of a ratio of the basic parameters of the State expenditure on public health services depending on public revenues at federal, regional levels.
2013 № 12 Some problems of implementation of the Federal law of the Russian Federation dated November 21, 2011 № 323-FZ «On fundamentals of protection of the health of citizens in the Russian Federation » (Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
Annotation. The article proves the necessity to introduce amendments to the Federal law of the Russian Federation dated November 21, 2011 № 323-FZ «On fundamentals of protection of the health of citizens in the Russian Federation». These amendments relate both to clarify used in the law of the conceptual apparatus and concretization of the mechanisms for the implementation of patients rights in receiving medical care.
2022 № 1 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.
2021 № 10 THE MORBIDITY DYNAMICS MODELING AS AN INFORMATIONAL BASE TO MEDICAL CARE MANAGEMENT FOR THE OVER WORKING AGE POPULATION
P u r p o s e o f t h e s t u d y : The substantiation of the need to use modeling of the dynamics of primary and general morbidity of the elderly and old population to improve the management of medical and preventive care for this age group.
R e s e a r c h m e t h o d s : analytical, modeling and mathematical-statistical methods.
R e s e a r c h b a s e . This study was conducted on the basis of the Moscow region with a population of 7,7 million people as of 01.01.2021.
R e s u l t s . Shown, that use of mathematical modeling of the morbidity rate as an information database is one of the most optimal ways for calculating and assessing the needs in the volume of medical care for specific age groups of the population. The use of a nosological approach is proposed, because it allows to assess the required volume of medical care based on the existing pathology not on existing organizational models that may change. Morbidity modeling and forecasting is designed to promote optimization of medical and preventive examinations for elderly and old people in terms of determining the necessary forces and means based on knowledge of the magnitude of the existing need.
C o n c l u s i o n . Taking into account the forecasting data, the use of the proposed models makes it possible to form an idea of the magnitude of the need and to monitor the implementation of state guarantees for the medical provision of elderly and old people.
2013 № 11 Legal representatives in the health care (Penza State University, Penza, Russia)
This article analyzes the legal status of a legal representative in the various models of legal relations in the sphere of health care (with the consent to medical intervention prior to admittance to the patient). The basic challenges that may face a medical professional when determining the authority of the legal representative patient. Particular attention is paid to the guardianship authorities, as well as various organizations authorized to represent citizens under the law.
2020 № 9 On the implementation of certain “medical” amendments to the constitution of the Russian Federation
The article suggests legislative implementation of certain “medical” amendments to the Constitution of the
Russian Federation. The authors propose to add two articles to the Federal law “on the basics of public health protection in the Russian Federation” dated 21.11.2011 N323-FZ. In one article, it is proposed to reveal and specify the
content of the newly introduced in the Constitution of the Russian Federation concept “unified legal bases of the health
care system”. Another proposed article reveals the forms and content of work on the coordination of health issues,
again referred by the Constitution of the Russian Federation to the joint responsibility of the Russian Federation and the
subjects of the Russian Federation. According to the authors, the proposed changes in legislation will allow to ensure
in practice the proper implementation of “medical” amendments to the Constitution of the Russian Federation, which in
turn will ensure the improvement of legal regulation of the organization and activities of health care, and strengthen its
material and technical base.