Valid Editorial from 05.11.1997

Name of document	Decree of the Government of the Russian Federation dated 05.11.97 N 1387 "ON MEASURES FOR STABILIZATION AND DEVELOPMENT OF HEALTHCARE AND MEDICAL SCIENCE IN THE RUSSIAN FEDERATION"
Document type	resolution, concept
Receiving authority	Russian government
Document Number	1387
Acceptance date	01.01.1970
Revision date	05.11.1997
Date of registration with the Ministry of Justice	01.01.1970
Status	valid
Publication	Document in electronic form FAPSI, STC "System" "Rossiyskaya Gazeta" dated November 19, 1997 N 223
Navigator	Notes

Decree of the Government of the Russian Federation dated 05.11.97 N 1387 "ON MEASURES FOR STABILIZATION AND DEVELOPMENT OF HEALTHCARE AND MEDICAL SCIENCE IN THE RUSSIAN FEDERATION"

CONCEPT FOR THE DEVELOPMENT OF HEALTHCARE AND MEDICAL SCIENCE IN THE RUSSIAN FEDERATION

I. Introduction

In recent years, the health status of the population has deteriorated. The crisis in the activities of medical institutions is approaching the point followed by the collapse of the entire healthcare system.

The amount of healthcare financing from budgets at all levels and from compulsory health insurance does not provide the population with free medical services. At the same time, available financial and material resources are used ineffectively, and disparities in the provision of medical care are increasing. Social tension is growing in the industry. The shadow side of payment for medical services is becoming increasingly widespread.

In this regard, a well-thought-out strategy for health care reform is needed.

II. Main directions of development of the healthcare system

The goal of the Concept for the Development of Healthcare and Medical Science in the Russian Federation (hereinafter referred to as the Concept) is to preserve and improve people's health, as well as reduce direct and indirect losses to society by reducing morbidity and mortality of the population.

The main objectives of the Concept are:

increasing the scope of disease prevention activities;

reducing the time required to restore lost health of the population by introducing modern methods of prevention, diagnosis and treatment into medical practice;

improving the efficiency of resource use in healthcare.

The implementation of the Concept is based on the following principles:

universality, social justice and accessibility of medical care to the population, regardless of the social status of citizens, their income level and place of residence;

preventive focus;

economic efficiency of the functioning of medical institutions;

unity of medical science and practice;

active participation of the population in solving health issues.

In the current conditions, the following become important:

formation of state policy in the field of healthcare and medical science and increasing the responsibility of all government bodies for its implementation;

ensuring the adequacy of financial resources to state guarantees in the healthcare sector, gradually increasing the share of funds allocated to finance healthcare to 6-7 percent of gross domestic product;

development of the non-state sector in healthcare;

improving the legal regulation of activities in the healthcare sector;

development and implementation into practice of advanced forms and methods of organizing state sanitary and epidemiological supervision, hygienic and epidemiological examination, monitoring of human health and the human environment;

implementation of an investment policy that ensures high efficiency of investments - maximum medical, social and economic effect per unit of cost;

increasing the level of qualifications of medical workers, improving the system of their training and retraining;

increasing the social protection of medical workers, including increasing wages;

involving professional medical associations in the implementation of state policy in the field of healthcare and medical science;

improving state regulation in the field of provision of medicines, medical products and medical equipment;

increasing citizens' interest in maintaining and strengthening their health.

III. Improving the organization of medical care

The main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.

Primary health care is the main link in providing medical care to the population.

A special role is given to the development of the institute of general (family) practice doctor. Consultative and diagnostic services should be developed in clinics. On their basis, departments of medical and social rehabilitation and therapy, nursing services, day hospitals, outpatient surgery and medical and social care centers, etc. can be deployed.

Reorganization of inpatient care will ensure a reduction in the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the diagnostic and treatment process as follows: intensive treatment - up to 20 percent;

restorative treatment - up to 45 percent;

long-term treatment of patients with chronic diseases - up to 20 percent;

medical and social assistance - up to 15 percent.

Make wider use of day-time forms of hospital stay for patients.

It is necessary to revive interregional and interdistrict specialized medical centers.

To provide high-quality medical care, it is necessary to ensure continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of medical care, as well as between different types of medical institutions, becomes important. This involves creating a higher level of financing and management of health care institutions.

Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.

It is necessary to take effective measures to develop maternal and child health services while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating maternity institutions with the general medical network.

It is necessary to implement comprehensive measures to further develop psychiatric and drug treatment services for the population, combat tuberculosis and sexually transmitted diseases.

Measures to introduce modern technologies in the departments of intensive care, cardiology and cardiac surgery, oncology, diagnosis and treatment of socially significant diseases require state support.

It is necessary to strengthen the emergency medical service, make it more mobile and equipped with modern means for providing emergency medical care and emergency hospitalization of patients.

It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.

It is necessary to take government support measures to improve rehabilitation care, develop sanatorium and resort organizations of the healthcare system, health institutions and organizations.

To improve the quality and accessibility of medical care for the rural population, it is necessary to create diagnostic and treatment complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of treatment, diagnostic and advisory assistance, and create inter-district clinical and diagnostic centers.

It is necessary to integrate departmental medical institutions into the general healthcare system on a unified regulatory and legal basis, taking into account their sectoral characteristics and location.

While the dominant role of state and municipal healthcare continues, the emerging private sector will play an important role. Creating conditions for its development is an essential element of structural changes in healthcare.

It is necessary to ensure that medical organizations, persons engaged in private medical activities, and state and municipal organizations have equal rights to work in the compulsory health insurance system and participate in the implementation of state and municipal target programs. The participation of medical organizations of various forms of ownership in the implementation of state healthcare programs and municipal orders should be carried out on a competitive basis.

State and municipal medical and preventive institutions that perform functions that are not bound by the framework of a unified technology for providing medical care should have broad powers in matters of the use of property and remuneration of personnel.

IV. Improving the health care financing system

Improving the healthcare financing system implies a close dependence of the amount of funding for medical institutions on the volume and quality of services they provide.

The financing system must ensure increased efficiency in the use of resources and the quality of medical care.

For these purposes it is necessary:

develop legal mechanisms to ensure unconditional compliance with the volumes and conditions of compulsory health insurance for the population and financial support;

establish a procedure for the distribution of federal budget funds allocated to equalize the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation;

improve methods for setting tariffs for medical services;

introduce a unified system of payments for the provision of medical care provided within the framework of the state guarantee program to provide citizens of the Russian Federation with free medical care;

determine mechanisms for financial coverage of part of the costs of providing medical care to citizens based on the development of voluntary health insurance;

contribute to the creation of a competitive environment in the medical services market.

The existing procedure for compulsory health insurance needs to be improved. There are two possible financing schemes for medical organizations in the compulsory health insurance system:

financing through medical insurance organizations providing compulsory medical insurance;

financing of medical organizations by branches of territorial compulsory health insurance funds.

The use of the second scheme is advisable for rural areas and areas with low population density, where the activities of insurance organizations and their competition with each other are objectively difficult.

To ensure targeted and effective use of funds allocated by the state for healthcare, it is necessary:

supplement the current legislation on health care with norms that ensure stricter control over their expenditure, as well as over the financial and economic activities of health care institutions and organizations;

improving the system for recording funds received by healthcare institutions, including for the provision of paid medical services, as well as their use;

improvement of the competitive procurement system for medicines, medical products and medical equipment, widespread use of financial leasing to equip healthcare institutions with medical equipment;

increasing the responsibility of compulsory health insurance funds for the results of their activities;

executive authorities and local governments, compulsory health insurance funds, medical insurance organizations, medical institutions must publish annual reports on the expenditure of compulsory health insurance funds and budget funds.

In 1998, in order to equalize the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation, it is proposed to establish the distribution of insurance premiums in the following ratio: Federal Compulsory Medical Insurance Fund - 0.5 percent, territorial compulsory medical insurance funds - 3.4 percent or 2 percent of the fund wages if citizens' incomes are respectively more or less than 60 million rubles per year.

In the future, it is planned to combine funds allocated for social and compulsory health insurance to ensure their more efficient use within the framework of a unified system of compulsory medical and social insurance.

V. Healthcare organization

In order to improve the provision of medical care, it is necessary to adopt, as a matter of priority, federal laws on state, municipal and private healthcare. This will ensure the implementation of state health policy at a modern level.

To implement a unified state policy in the field of healthcare, the management structure of the industry should be modernized.

The main tasks of healthcare organization at the federal level should be considered:

determining the strategy for the development of healthcare in the country;

development and implementation of federal targeted health care programs;

development of the legislative, regulatory and methodological framework for healthcare;

coordination of the activities of government authorities to address health issues;

development of mechanisms for the control and licensing system in the field of circulation of medicines.

At the level of the constituent entity of the Russian Federation, the main objectives of the healthcare organization should be:

development of healthcare taking into account regional characteristics;

development and implementation of territorial target health care programs and state guarantee programs to provide citizens with free medical care on the territory of the constituent entities of the Russian Federation.

The main task of organizing healthcare at the municipal level should be considered the formation and implementation of municipal healthcare programs.

The main direction of improving the healthcare organization is to ensure its integrity through unified approaches to planning, regulation, standardization, licensing and certification. At the same time, the system of compulsory health insurance as the basis for financing medical care within the framework of state guarantees should have a positive impact.

The basis for planning will be federal health care development programs that implement the goals and objectives of state policy for a certain period and include:

federal target programs for healthcare development;

state guarantee programs to provide citizens of the Russian Federation with free medical care.

These federal programs must be approved simultaneously with the allocation of appropriate financial resources for their implementation.

To ensure a unified (basic) level of state guarantees in healthcare, medical and social standards must be approved at the federal level, including:

main indicators of the provision of the population with hospital and outpatient clinics, as well as doctors and paramedical personnel;

standards for per capita financing of health care.

In addition, methods for calculating standards for providing healthcare institutions with material, labor and financial resources are approved at the federal level.

Health care programs of the constituent entities of the Russian Federation include programs of state guarantees to provide citizens with free medical care, which must define:

health indicators that should be achieved as a result of improving the health care system;

volumes of financing from the health care budget and compulsory health insurance, ensuring the implementation of state guarantees;

general principles of financing and performance indicators of health care institutions;

measures to improve the efficiency of health care institutions;

main directions of preventive activities.

In the constituent entities of the Russian Federation, cost standards for outpatient and inpatient treatment must be approved. Based on these standards and morbidity indicators, the structure of medical care to the population is determined.

Health care programs of the constituent entities of the Russian Federation serve as the basis for the formation of municipal programs containing indicators of the volume of activities of health care institutions and their financing at the municipal level.

Executive authorities at all levels monitor the implementation of relevant programs, which will increase the efficiency of the healthcare organization.

In order to more rationally use financial and material resources in healthcare, it is necessary to establish that the largest investment projects for which budget funds are allocated are subject to mandatory examination by the Ministry of Health of the Russian Federation.

In conditions of insufficient healthcare funding, duplication of work of public sector medical institutions, especially departmental healthcare institutions, should be eliminated. It is necessary to attract departmental medical institutions to implement the state guarantee program, which will allow for the effective use of financial and material resources, implement the principle of equal treatment of the state towards all citizens, regardless of their place of work, and reduce the financial burden on departmental budgets. Individual departmental healthcare institutions should be transferred to the ownership of the constituent entities of the Russian Federation or to municipal ownership.

The priorities of international cooperation are the expansion and deepening of cooperation with the CIS member states, support of compatriots abroad (primarily on issues of providing medical care) both at the intergovernmental level and through the provision of humanitarian assistance.

To ensure gradual integration into the world community on an equal basis, it is necessary to continue cooperation with international health organizations in the following areas:

protection of national interests in the implementation of international projects in the field of healthcare and health protection;

expanding participation in such international projects;

participation in medical assistance programs for citizens of individual countries;

adaptation of international criteria for the classification of diseases and standards of medical care for the Russian Federation;

international examination of Russian bills in the field of protecting the health of citizens;

study and application of international experience in legal regulation in the field of healthcare;

expanding the scope of medical care to Russian citizens abroad and foreign citizens in Russia.

VI. Ensuring sanitary and epidemiological well-being

The development and improvement of the state sanitary and epidemiological service of the Russian Federation (hereinafter referred to as the service) is the most important condition for improving the health of the country's population.

Ensuring the effective functioning of the service consists of developing and implementing a state program for its development, which provides for bringing the organizational structure, management, resource and scientific support of the service, and the organization of its activities in accordance with the tasks and functions.

It is necessary to continue the reorganization of the structure of service institutions in accordance with the previously approved concept of restructuring the centers of state sanitary and epidemiological surveillance by creating departments (departments) for studying the influence of environmental factors on health, departments of hygienic education and education of the population.

It is necessary to provide:

a clear delineation of the functions of state sanitary and epidemiological supervision and sanitary and epidemiological activities between service organizations and medical institutions;

protection of the territory of the Russian Federation from the importation and spread of especially dangerous infectious diseases of people, animals and plants, as well as toxic substances;

introduction of new scientific developments;

strengthening interaction with other control and supervisory authorities;

improving the economic mechanism of activity and developing criteria for regulatory financing of institutions;

improving the legislative framework in the field of state sanitary and epidemiological surveillance, strengthening the organizational and legal status of the service;

reorganization of the system of hygienic education and training of the population, formation of a system of self-healing of the population.

VII. State guarantees for the provision of free medical care and protection of patients’ rights

State guarantees for the provision of free medical care must be provided from the corresponding budgets, payments for compulsory health insurance and other revenues. To do this, it is necessary to adopt a program of state guarantees to provide citizens of the Russian Federation with free medical care, which should contain:

a list of appropriate types of medical care;

volumes of medical care;

a basic compulsory health insurance program as an integral part of the state guarantee program;

per capita standard for healthcare financing, ensuring the provision of guaranteed volumes of medical care.

In order to ensure the rights of citizens to health care, the adoption of a law on the rights of patients is required.

VIII. Development of medical science

The main objectives of medical science should be:

formation of a strategy for preserving and strengthening the health of the population, development of the scientific basis for combating the most common diseases;

obtaining, on the basis of fundamental research, new and deepening existing knowledge about the healthy and sick human body, its vital functions and adaptation to environmental conditions;

development of new methods for the prevention, diagnosis and treatment of diseases, restoration of lost health, increasing the duration of a person’s active life;

development of new schemes for organizing medical care and healthcare management.

The development of medical science will be carried out on the basis of the following principles:

concentration of scientific and technical potential and resources in priority areas of medical science;

increasing the role of program-target planning, improving the quality of examination of scientific research, ethical control over its conduct;

budgetary funding of fundamental and applied research on a competitive basis;

state support for scientific teams making a great contribution to the development of domestic and world medical science, the use of extra-budgetary sources of funding (international projects, foundations, etc.);

development of regional scientific and practical units, development of programs and research;

expanding links between science, technology and production;

legislative consolidation of legal mechanisms for the development of medical science;

development of scientific and technical entrepreneurship, creation of small innovative enterprises and pilot production;

protection of intellectual property rights of researchers on the results of scientific activities.

Budgetary financing of scientific developments should be carried out on the basis of competitive allocation of grants, creating interdepartmental competition commissions for this purpose. To carry out theoretical and practical developments, it is necessary to use a multi-channel financing system with the involvement of extra-budgetary sources.

Particular attention must be paid to research and development work, which requires government support aimed at financing research that will ensure import substitution and will contribute to the development of the domestic medical industry.

The Russian Academy of Medical Sciences will carry out the functions of identifying and developing the most important areas of fundamental and applied research, their organization and coordination in the Russian Federation, training highly qualified scientific personnel, and also participate in the development and implementation of scientific sections of federal and other programs.

The Ministry of Health of the Russian Federation must determine priorities in applied scientific developments and coordinate federal programs in terms of scientific support for human health protection and state sanitary and epidemiological surveillance.

The Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences must jointly carry out a comprehensive examination of federal and other scientific programs, present their recommendations for the implementation of the achievements of medical science in practice and effective use.

The Ministry of Health of the Russian Federation, together with the Ministry of Science and Technology of the Russian Federation and with the participation of the Russian Academy of Medical Sciences, will coordinate the interaction of state executive authorities and local governments with research institutes, institutions and organizations of the medical and biological profile, develop and implement a system of measures to strengthening international relations in order to solve pressing problems of domestic science.

IX. Improving medical education and personnel policy

Personnel policy issues must be resolved taking into account the changes occurring in all areas of healthcare. It is necessary to develop a program for reforming the medical education system, which provides for a reduction in the training of medical workers in traditional specialties and a revision of the structure of specialist training. It is necessary to improve the system of planning, forecasting and monitoring the training of healthcare professionals, including in such new areas as general practitioner, clinical pharmacologist, medical psychologist, nurse with higher education, social work specialist, healthcare economist, healthcare manager.

It is necessary to improve the system of final state certification of graduates of medical and pharmaceutical educational institutions, as well as the certification of healthcare professionals.

In international relations in the field of personnel training one should:

restore professional medical ties with the CIS member states;

develop work on concluding international agreements

of the Russian Federation on the mutual recognition of medical diplomas and other documents on professional training, as well as the internship of specialists, the training of doctors and nurses abroad on the principle of exchange.

The system of planning and distribution of human resources is subject to reorganization, which should change the ratio of doctor to mid-level medical worker in the direction of increasing the number of the latter.

The practice of forming targeted orders for the training of specialists by health authorities should be extended, with them concluding relevant agreements with educational institutions and applicants.

In order to include medical workers in health care reform efforts, it is necessary to:

improve the system of remuneration for healthcare workers, taking into account harmful working conditions, complexity, volume and quality of medical and preventive work;

establish and index the wages of healthcare workers at levels not lower than the subsistence level;

regularly review tariffs for medical services on the basis of tariff agreements with professional medical associations;

expand the list of categories of health care workers, regardless of the departmental affiliation of the institutions in which they work, who have the right to a pension for long service, working with a special risk to their health.

In the field of ensuring labor protection for medical workers, it is necessary:

develop regulatory documents on occupational safety in healthcare institutions;

organize training on labor protection issues for managers of government bodies and healthcare institutions, students of medical educational institutions;

pursue a unified policy on establishing compensation and benefits for special working conditions of medical workers.

X. Improving drug supply, guarantees in the field of drug assistance to the population

The state policy of providing the population with medicines and medical products is aimed at providing them to consumers in a sufficient quality range and volume at affordable prices.

This policy should be implemented through the development of the pharmaceutical services market.

In order to ensure the safe use of medicines and medical products, it is necessary to improve the existing control and licensing system of examination, standardization and state control both at the federal level and at the level of constituent entities of the Russian Federation.

The main direction of implementation of state policy in the field of drug assistance to citizens should be the provision of drugs, including preferential ones, to the population when providing medical care within the framework of state guarantee programs.

At the outpatient treatment stage:

formation, within the framework of state and municipal orders, of lists of medicines and medical products for preferential provision of citizens;

formation, within the framework of state and municipal orders, of lists and volumes of medicines and medical products for the treatment of socially significant diseases.

At the stage of inpatient treatment - free drug provision within the types, volumes and conditions of medical care provided for in state guarantee programs.

In order to effectively spend public funds allocated for preferential provision of citizens with medicines and medical products, it is planned to develop and implement a system for accounting and control of these funds, creating conditions that ensure the interest of citizens in the rational use of drug benefits.

In the field of wholesale purchases and retail sales of medicines, you should:

carry out these purchases and sales on a competitive basis and ensure transparency in the selection of wholesale suppliers of medicines;

ensure the safety, effectiveness and quality of medicines through selection, standardization and monitoring of compliance with standards;

ensure the availability of a wide range of medicines in retail sales, in the stationary network - under state guarantee programs.

In order to ensure accessibility and adequacy of drug care, the population needs to:

improve the mechanisms of state regulation of drug provision;

provide state support for domestic drug manufacturers;

improve the organization of drug supply and management of pharmaceutical activities.

XI. Expanding the social base of healthcare

It is necessary to involve non-professional public organizations and professional medical and pharmaceutical associations, as well as individual citizens, in the work to protect the health of citizens and provide medical and social assistance, which will increase the effectiveness of preventive work, including with socially vulnerable segments of the population, and facilitate rehabilitation work with groups of patients, develop the principle of mutual assistance and skills in solving medical and social problems by the patients themselves.

Work to expand the social base of healthcare should be carried out in the following areas:

searching for effective forms of cooperation with public, charitable and religious organizations;

attracting public attention to health issues, promoting the creation of public associations of patients for medical interests;

creation of a system of medical education and medical information, cooperation with the media in popularizing a healthy lifestyle, strengthening control over the advertising of medical industry products and medical services;

assistance in the implementation of state and public events aimed at preserving and protecting the moral health of society;

work among the population on family planning in order to form a conscious attitude towards family, motherhood and fatherhood;

creation of a training system for employees of the Ministry of Internal Affairs of the Russian Federation, the Ministry of the Russian Federation for Civil Defense, Emergency Situations and Disaster Relief and other special services to provide first aid.

XII. Mechanisms and stages of implementation of the Concept

To ensure consistency in the implementation of the provisions of the Concept, work on its implementation will be carried out in 2 stages.

Stage I (1997-2000)

Implementation of the activities outlined in the program of the Government of the Russian Federation "Structural adjustment and economic growth in 1997-2000".

Taking measures to ensure the stable operation of healthcare institutions, increasing the amount of funding for the industry and increasing the efficiency of use of resources in healthcare.

For these purposes, the provision of medical care to the population, starting from 1998, will be carried out within the framework of state guarantee programs to provide free medical care. At the same time, the amount of financial resources allocated for the implementation of these programs must correspond to the state guarantees provided for in them.

Implementation of structural reforms in the industry during 1997-1999. Carrying out the restructuring of inpatient care with the simultaneous development of outpatient clinics and the creation of day hospitals and hospitals at home. An important area of ​​this work will be the introduction of the institute of general medical practice.

The introduction in 1998 of standardization of medical services, regulation of the provision of hospitals and clinics with medicines, medical products and medical equipment.

Completion by 1999 of work to reorganize and eliminate duplication in the activities of federal health care institutions, including departmental ones.

Development and approval in 1997-1998 of federal target programs to combat tuberculosis and sexually transmitted diseases, to develop cancer care for the population, and to prevent and treat cardiovascular diseases.

The implementation of state anti-alcohol measures, the development and subsequent implementation of a federal targeted program to combat smoking will help reduce morbidity and mortality in the population.

Stage II (2001-2005)

Implementation of federal target programs for the development of healthcare, the implementation of which will create the basis for the introduction into healthcare practice of effective methods of prevention, diagnosis and treatment of diseases and provide the population with accessible qualified and specialized medical care.

Completion of work on structural restructuring of the industry. As a result, a private sector should be formed in healthcare. In the primary health care system, the main role will be assigned to general practitioners. Interdistrict and interregional clinical centers for specialized medical care will be greatly developed. Mobile forms of providing medical care to the population in rural areas will be actively introduced.

Formation of a unified information system for health monitoring, creation of telecommunication links between clinical centers and general (family) doctors to advise patients and improve the professional knowledge of medical workers.

APPROVED
Government resolution
Russian Federation
dated November 5, 1997
N 1387

Approved by decree of the Government of the Rostov region

1. General Provisions

In order to ensure sustainable socio-economic development of the Rostov region, one of the priorities of the region's policy should be to preserve and strengthen the health of the population based on the formation of a healthy lifestyle and increasing the availability and quality of medical care.

The effective functioning of healthcare is determined by the main system-forming factors:

improving the organizational system to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens of the Rostov region (within the framework of state guarantees);

development of infrastructure and resource provision for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization;

the presence of a sufficient number of trained medical personnel capable of solving the problems posed to the healthcare system of the Rostov region.

These factors are interdependent and mutually determining, and therefore modernization of healthcare requires the harmonious development of each of them and the entire system as a whole.

The Concept for the development of healthcare in the Rostov region (hereinafter referred to as the Concept) is an analysis of the state of healthcare in the Rostov region, as well as the main goals, objectives and ways to improve it based on the application of a systematic approach.

The concept was developed in accordance with the Constitution of the Russian Federation, the Concept for the development of healthcare in the Russian Federation until 2020, federal legislation and other regulatory legal acts of the Rostov region.

2. Current state of healthcare in the Rostov region

2.1. Demographic situation in the Rostov region

The implementation of the activities of the Strategy for the socio-economic development of the Rostov region, federal and regional target programs, the national project “Health”, the regional long-term target program “Modernization of healthcare in the Rostov region for 2011–2012” has made it possible in recent years to reorganize the comprehensive system of protecting public health and improve the demographic situation in the area in which stabilization trends have emerged.

The current demographic situation in the Rostov region was formed under the influence of political, socio-economic, as well as demographic processes that took place in the country in previous decades. The population of the Rostov region, taking into account the preliminary results of the 2010 All-Russian Census, as of January 1, 2011 amounted to 4,276.4 thousand people, or 3 percent of the population of Russia. Among the constituent entities of the Russian Federation, the region ranks 6th in terms of permanent population, and among the constituent entities of the Southern Federal District - 2nd - after the Krasnodar Territory. The Rostov region is one of the most densely populated regions of Russia, the population density is 42.4 people per 1 sq. km. The most populated areas are Rostov-on-Don, Taganrog and Gukovo, Aksaisky and Myasnikovsky districts. Of the total population, urban residents make up 67.3 percent, rural residents – 32.7 percent.

The demographic situation in the Rostov region still remains unfavorable. The population decline that began in 1992 continues. However, the rate of population decline in recent years has decreased significantly - from 32 thousand people annually in the period 2000-2005 to 14.2 thousand people in 2011.

As of January 1, 2012, the permanent population of the Rostov region was 4,260.6 thousand people, which is 15.8 thousand people less than on the corresponding date in 2010.

The slowdown in population decline is mainly due to an increase in the birth rate and a decrease in mortality. In 2011, 46.5 thousand children were born, which is 17.3 percent more than in 2005.

The birth rate in 2011 decreased slightly compared to the previous year and amounted to 10.9 per 1,000 population, compared to 11.0 in 2010; 10.8 – in 2009. In 27 territories of the region (out of 55) there was an increase in the number of births compared to last year.

There has been a decrease of 4.7 percent in the overall mortality rate of the population, the level of which was 14.2 per 1,000 population in 2011, compared to 14.9 in 2010. A decrease in mortality was noted in 30 territories of the region (54.5 percent). An increase in mortality is observed in 4 cities and 21 districts of the region (45.4 percent).

Compared to the territories included in the Southern Federal District, the Rostov region in 2010 had the lowest birth rate and the highest mortality rates and natural population decline.

Subject name	Number of births	Number of deaths	Natural increase (+), loss (-)
	per 1,000 population
Russian Federation
Southern Federal District
Republic of Adygea
Republic of Kalmykia
Krasnodar region
Astrakhan region
Volgograd region
Rostov region

Low fertility and high mortality have determined a significant level of natural population decline in the region, which is not compensated by migration growth. This situation has largely arisen due to the unfavorable age structure of the region's population - a high proportion of people of retirement age (23.8 percent) and a low proportion of children and adolescents (16.9 percent). The reasons for the low birth rate of the population, in addition to the transition of families to small children, were material and living difficulties, housing problems, low living standards of part of the population, low wages, deterioration in the reproductive health of the population, loss of family values, an increase in the number of divorces, a large number of premature terminations of pregnancy and etc.

In 2011, positive demographic development was observed only in 7 out of 55 municipalities: the cities of Bataysk, Rostov-on-Don, Azov, Aksai, Bagaevsky, Myasnikovsky, Rodionovo-Nesvetaysky districts.
In these territories, by the beginning of 2012, there was an increase in population.

The regressive type of age structure of the population that has developed under the influence of a long-term decline in the birth rate (the share of the population of older ages exceeds the share of children and adolescents) does not ensure the numerical growth of the region’s population and leads to its “aging”. The average age of the region's population is increasing.

In the reproduction of the population in modern conditions, migration acquires a certain significance.

In recent years, significant changes have occurred in migration processes. Until the mid-90s, migration developed at an increasing pace. Moreover, the influx of migrants to the Rostov region noticeably exceeded the outflow. In these years, migration growth played a significant role in maintaining the population size.

The main causes of death in the region remain diseases of the circulatory system, neoplasms, accidents, poisoning and injuries, which account for 83.9 percent of the total number of deaths. In 2011, more than 38 thousand people died from diseases of the circulatory system in the Rostov region (62.9 percent of deaths), 14.6 percent died from neoplasms, and 6.4 percent died from external causes.

For a long time, the Rostov region occupied one of the first places in Russia in terms of road accidents, which were often caused by drunk drivers. However, thanks to a set of measures taken in recent years to improve road safety and reduce transport injuries, the mortality rate from all types of transport accidents (mainly road traffic accidents) in 2011 amounted to 8.1 per 100 thousand population (in 2010 – 10.3).

2.2. Brief characteristics of indicators

public health in the Rostov region

In the last 15 years, the morbidity rate of the population of the Rostov region has been constantly growing, which is associated, on the one hand, with an increase in the proportion of the elderly population and with more effective detection of diseases using new diagnostic methods, and on the other hand, with the ineffectiveness of the disease prevention and prevention system. In 1996, the level of general morbidity in the population (adults, adolescents and children) was 1137.3 cases per 1000 population, in 2001 – 1323.4; in 2006 – 1,544.8; in 2011 – 1,604.2. The increase in incidence over 15 years was 41 percent.

It should be noted that from 1996 to 2011 in the Rostov region, as well as in the Russian Federation as a whole, the number of cases of diseases leading to death increased significantly. For example, the incidence rate of diseases of the circulatory system increased almost 2 times (from 115.9 per 1000 population in 1996 to 213.2 in 2011), neoplasms - by 37 percent (from 31.9 per 1000 population in 1996 . to 43.7 – in 2011). The number of diseases of the musculoskeletal system and connective tissue leading to disability, as well as complications of pregnancy, childbirth and the postpartum period, has also almost doubled. In 2011, as 15 years ago, the structure of general morbidity was dominated by diseases of the respiratory system (24.8 percent) and diseases of the circulatory system (13.3 percent), while over the past period the share of diseases of the respiratory, digestive, urinary systems and injuries in the structure of general morbidity has decreased, and the share of diseases of the circulatory system and diseases of the nervous system and sensory organs has increased.

Since 1998, the region has seen a sharp increase in the number of children born sick or falling ill during the neonatal period. By 2008, this figure had reached 42.5 percent of the total number of children born alive. In 2010–2011, the incidence of newborns began to decline.

Disability in the Russian Federation has not decreased from 1990 to 2006, including among people of working age, whose share in the total number of persons recognized as disabled for the first time is at least 40 percent.

However, in the Rostov region in the period from 2001 to 2008, the number of disabled people per 10 thousand population aged 18 years and older decreased by 3.3 times.
From 2009 to 2011, the disability rate increased by 43 percent.

There are 14 million people with disabilities in the Russian Federation, including 523 thousand children. In the Rostov region, according to data for 2011, there are 328.8 thousand disabled people, including 11,610 children. This indicates an insufficiently high quality of medical care and inadequate social rehabilitation.

The structure of primary disability in the adult population is dominated by cardiovascular diseases and malignant neoplasms. Among the diseases that cause the development of disability in children, the leading ones are mental disorders, diseases of the nervous system, congenital anomalies and metabolic disorders.

In the Rostov region, as in Russia as a whole, there are four main risk factors: high blood pressure, high cholesterol, smoking and excessive alcohol consumption, the contribution of which to the structure of overall mortality is 87.5 percent, and in the number of years of life lost ability to work – 58.5 percent. At the same time, alcohol abuse ranks first in terms of its impact on the number of years of life with loss of ability to work (16.5 percent). According to expert estimates, relative indicators have changed little over the past 6 years.

2.3. Implementation of the State Guarantees Program

providing citizens of the Rostov region with free medical care

The legislation of the Russian Federation establishes the insurance principle of financing medical care. In 1993, in addition to the budgetary healthcare system, a compulsory health insurance (CHI) system was created, as a result, a budgetary insurance model for financing the state healthcare system emerged in Russia.

In order to ensure a balance between the state's obligations to provide free medical care to the population and the financial resources allocated for this, to create a unified mechanism for the implementation of the constitutional rights of citizens of the Russian Federation to receive free medical care and to increase the efficiency of use of health care resources, the Government of the Rostov Region annually adopts the Territorial Program of State Guarantees for the provision of citizens Russian Federation of free medical care in the Rostov region.

The implementation of the Territorial State Guarantee Program is carried out on the basis of approved standards for the volume of medical care (by type of medical care) and standards for financial costs per unit of volume of medical care.

The following types of medical care are provided free of charge under the Program:

primary health care;

ambulance, including specialized (sanitary and aviation) medical care;

specialized, including high-tech, medical care.

Primary health care includes: treatment of the most common diseases, injuries, poisoning and other conditions requiring emergency care, medical prevention of diseases, implementation of measures for preventive vaccinations, preventive examinations, dispensary observation of women during pregnancy, healthy children, individuals with chronic diseases, abortion prevention, sanitary and hygienic education of citizens, as well as other activities related to the provision of primary health care to citizens.

Primary health care is provided to citizens in medical organizations and their respective structural units by local general practitioners, local pediatricians, general practitioners (family doctors), medical specialists, as well as relevant paramedical personnel.

Ambulance, including specialized (sanitary and aviation) medical care is provided immediately to citizens in conditions requiring urgent medical intervention (accidents, injuries, poisoning, as well as other conditions and diseases), by institutions and emergency medical care units of the state or municipal systems healthcare.

Specialized, including high-tech, medical care is provided to citizens in medical organizations for diseases that require special diagnostic methods, treatment and the use of complex, unique or resource-intensive medical technologies.

In order to rationally use budget funds, in recent years, work has been carried out in the Rostov region to optimize the bed network: the bed capacity in municipal health care institutions that have an excess bed network is being reduced; expensive hospital beds are repurposed into less expensive day hospitals on the basis of outpatient clinics and hospitals; Inefficient beds are being cut.

In addition, a legislative framework for the development of regional healthcare has been formed at the regional level.

The activities of the regional long-term target program “Healthcare Development in the Rostov Region for 2010 – 2014” and the regional long-term target program “Healthcare Development in the Rostov Region for 2015 – 2020”, as well as the regional long-term target program “Modernization” are aimed at achieving the set goals in the Rostov region. health care of the Rostov region for 2011 – 2012”, aimed at strengthening the resource base of health care in the Rostov region, introducing standards of medical care and modern information technologies in health care.

In accordance with the requirements of Art. 69.2 of the Budget Code of the Russian Federation, by Decree of the Government of the Rostov Region dated December 23, 2011 No. 291 “On the procedure for organizing work on the formation and financial support of state assignments for state institutions of the Rostov Region” and in order to create incentives for institutions to focus on the requests of consumers of budget services and improve their quality and the dependence of financing on actual performance results, optimization of the mechanism for managing budgetary resources, since 2010 a transition has been made from financing budgetary institutions according to estimates to financing the services they provide based on the founder’s instructions.

Since January 1, 2012, in accordance with the norms of federal legislation, there has been a division of powers between state authorities of a constituent entity of the Russian Federation and local governments in the field of health care in terms of providing primary health care. Funding for the costs of providing emergency medical care, medical care provided by paramedic and obstetric centers, pathology bureaus, hospices, nursing homes, sanatoriums, HIV-infected people, and medical personnel serving preschool educational institutions is made in the form of a subvention from the regional budget.

Since 2013, in connection with the transition to predominantly single-channel financing of medical care at the expense of compulsory health insurance, it is planned to provide financial support for emergency medical services, first aid stations and medical staff of preschool institutions. In addition, it is planned to expand the list of expenses included in the tariff for payment of medical care.

Measures are being taken step by step to optimize the number of technical, financial, economic and other non-medical personnel in state and municipal healthcare institutions in order to increase the efficiency of human resource management.

The implementation of these regional programs and activities in the field of healthcare will make it possible in the coming years to form an effective innovative model of medical care for the population of the region in the region.

2.4. System of organizing medical care to the population

Currently, medical care to the population of the Rostov region is provided in 216 state and municipal healthcare institutions (5 of them are federal), including 111 hospitals, 9 dispensaries, 47 independent outpatient clinics, 25 independent dental clinics, 1 independent station emergency medical care, 1 blood transfusion station, 8 sanatoriums, 7 children's homes and 5 special institutions.

Primary health care is a set of medical, social, sanitary and hygienic measures that provide health improvement, prevention of non-communicable and infectious diseases, treatment and rehabilitation of the population. Primary health care represents the first stage of the continuous process of protecting public health, which dictates the need for it to be as close as possible to the place where people live and work. The main principle of its organization is territorial and local.

The network of outpatient clinics and the existing system of primary health care fully satisfy the needs of the population.

Imperfections in the work of outpatient health care, in particular, an insufficiently effective system of patronage and monitoring of patients with chronic pathologies have led to the fact that emergency medical care is the most common type of out-of-hospital medical care for the population of the country, taking on some of the functions of outpatient clinics. link

Currently, in the Rostov region, emergency medical care is provided by 1 independent station and 56 departments, staffed by general (360; 24.8 percent of the total number of teams), specialized (150; 10.3 percent), paramedic (940; 64.8 percent) ) teams. During 2011, over 1,479 thousand visits to patients were made, while less than 151 thousand people were hospitalized, that is, only every 10th call ended in hospitalization.

In order to ensure the uninterrupted operation of the emergency medical service in modern conditions, as part of the implementation of the regional long-term target program “Modernization of healthcare in the Rostov region for 2011-2012”, management of emergency medical teams using GLONASS/GPS satellite navigation equipment is provided. For this purpose, in 2012, 495 ambulance vehicles and 57 duty control services of medical institutions will be equipped with GLONASS/GPS navigation system equipment.

It should be noted that the immediate cause of death for people of working age in most cases is an emergency condition. At the same time, about 1.8 million people a year in the country die outside hospitals, and every third hospitalized patient in a life-threatening condition is admitted to hospital with a delay of more than 24 hours.

The following factors hinder the effective use of emergency medical services:

1. The provision of timely medical care in municipal areas occurs not according to the principle of the closest team, but according to the principle of territorial affiliation.

2. There is an insufficient staffing of emergency medical teams with qualified personnel, including specialists who have undergone retraining in a timely manner, due to the imperfection of the training system for emergency medical personnel at both senior and middle levels, as well as a reduction in the number of specialized teams and the outflow of experienced medical personnel.

3. Often there is inappropriate use of emergency medical teams (for transporting planned patients, calls to provide assistance to chronically ill patients).

Thus, the low efficiency of the preventive work of primary health care, the lack of a system of outpatient follow-up care and patronage, as well as the imperfect organization of emergency medical care have led to the fact that hospital care acts as the main level in the public health system. At the same time, inpatient medical care is necessary only for diseases that require an integrated approach to diagnosis and treatment, the use of complex methods of examination and treatment using modern medical equipment, surgical interventions, constant round-the-clock medical supervision and intensive care.

According to the work of hospitals of municipal and regional subordination, the average annual occupancy of a bed in state (municipal) health care institutions in 2011 was 315 days, the average length of stay of a patient in a bed in state (municipal) health care institutions was 12.4 days.

The introduction of hospital-replacing technologies in the activities of hospital institutions and outpatient clinic services made it possible from 2006 to 2011 to increase the number of places in day hospitals by 17.0 percent (from 3,382 places in 2006 to 3,958 in 2011), the provision of places in day hospitals - by 21.0 percent (from 7.6 to 9.2 per 10 thousand population, respectively) and the level of hospitalization in day hospitals - by 21.0 percent (from 1.9 to 2.3 per 100 population, respectively).

However, despite this, the level of hospitalization in state (municipal) health care institutions remains high (19.4 per 100 people in 2011). There is a significant shortage of inpatient beds for certain profiles. The number of beds in state (municipal) healthcare institutions per 10 thousand population in the Rostov region is 78.7.

Thus, the volume of bed capacity is sufficient to fully provide the population with inpatient care. However, the current organization of inpatient care is not effective enough, which is manifested by:

discrepancy between the structure of the bed capacity and the structure of hospital morbidity;

the presence of cases of insufficiently justified hospitalization;

Today, the system of restorative treatment and rehabilitation in the region requires structural reorganization.

The currently existing departments (offices) for restorative treatment and rehabilitation do not fully comply with modern requirements for equipping with diagnostic and therapeutic equipment. There is a shortage of specialized personnel in the rehabilitation service (doctors and exercise therapy instructors, physiotherapists, speech therapists, neuropsychologists, medical psychologists, occupational therapists, social workers, etc.).

2.5. Innovative and staffing support for healthcare development

The level of development of medical science determines the prospects for improving healthcare. The current state of medical science is characterized by insufficient innovative potential and a weak system for introducing scientific results into practical healthcare. The development of modern scientific research in the field of medicine is possible only under the condition of an integrated approach based on the involvement of developments in fundamental biomedical, natural and exact sciences, as well as new technological solutions.

As of January 1, 2012, the healthcare system of the Rostov region employed 14.76 thousand doctors and 35.16 thousand paramedical personnel (in 2010 – 14.75 thousand and 35.15 thousand). The number of doctors (individuals) in state (municipal) health care institutions per 10 thousand population was 28.3 people (2010 - 29.5), the number of paramedical personnel (individuals) in state (municipal) health care institutions per 10 thousand The population amounted to 78.1 people (2010 – 79.0). The ratio of doctors and nursing staff is 1: 2.7.

The number of doctors per capita in the Rostov region is less than the average for the Russian Federation (the provision of doctors is 44.1 per 10 thousand population, paramedics is 93.6).

The number of full-time positions of local pediatricians in 2011 compared to 2010 increased by 0.3 percent, and the number of individuals decreased by 1.17 percent, as a result of which the staffing rate with individuals decreased by 1.5 percent. The part-time ratio remained at the 2010 level and amounted to 1.1. A low supply of pediatric personnel was identified in 25 districts and 2 cities. Particularly low pediatric staffing levels (less than 50 percent) were registered in 11 (including 2 cities) territories of the Rostov region: Veselovsky and Kasharsky (37.5 percent), Zavetinsky (40.0 percent), Matveevo-Kurgansky (44.8 percent). percent), Dubovsky (47.1 percent), Bokovsky (48.0 percent) districts, in the cities of Novoshakhtinsk (35.0 percent), Kamensk-Shakhtinsky (47.5 percent).

There remains a shortage of personnel in neonatology. The staffing level of neonatology personnel varies from 47.1 percent in the city of Shakhty, 50.0 percent in the cities of Volgodonsk and Gukovo, 57.1 percent in the cities of Kamensk-Shakhtinsky and Novocherkassk to 100 percent or more in the Sholokhovsky district, the cities of Bataysk, Donetsk , Novoshakhtinsk and in the state budgetary institution of the Rostov region, regional clinical hospital No. 2. The development of interterritorial neonatal centers is hampered due to a shortage of personnel.

Nevertheless, the rate of staffing of neonatologists in the region as a whole (by subordination) increased from 64.6 percent in 2010 to 70.8 percent in 2011 (by 9.6 percent).

The level of quality of medical care and health indicators of the population of the Rostov region indicate insufficient efficiency of the functioning of the medical care system, as well as the qualifications of doctors and their weak motivation for professional improvement. There is a disproportion in the distribution of medical personnel: excessive concentration in inpatient facilities and a shortage in outpatient clinics.

In addition, the ratio between the number of doctors and paramedical personnel in the Rostov region, as in other regions of Russia, is significantly lower than in most developed countries of the world, which causes an imbalance in the medical care system and limits the possibilities for the development of aftercare, patronage, and rehabilitation services .

Among the problems in the field of medical personnel management, it should be noted the low wages of medical workers, egalitarian approaches to the remuneration of medical personnel, low social security and prestige of the medical profession, the lack of adaptation of federal state educational standards of higher and secondary vocational education to modern healthcare needs, insufficient professional training of medical and management personnel in healthcare.

2.6. Medicine provision for citizens

Rostov region on an outpatient basis

Medical assistance to the population of the region includes 4 main areas:

provision of medicines to regional beneficiaries;

provision of medicines to federal beneficiaries;

provision of medications to patients when receiving inpatient and hospital-replacement care;

retail segment.

Providing benefit categories of the population with medicines, medical products and specialized medical nutrition products is an important social task, as it affects the most vulnerable categories of the population.

In the Rostov region, an infrastructure for preferential drug provision to residents of the Don has been created, which includes:

128 medical organizations;

117 holiday centers (including 45 located in rural areas);

5,635 doctors (paramedics) issue prescriptions to privileged categories of citizens.

As part of the implementation of drug benefit programs, a software product has been developed that integrates the provision of drug care by all participants in the process.

Preferential drug provision for citizens is an important component in the provision of effective medical care. In connection with this, the Ministry of Health of the Rostov Region set goals to improve the quality of provision of preferential drug care to certain categories of citizens, which were as follows:

firstly, in optimizing the use of allocated financial resources;

secondly, in carrying out organizational measures aimed at 100% provision of beneficiaries with medicines (reducing the number of prescriptions under “control” and shortening the period of their provision) and improving the quality and accessibility of preferential drug care.

To implement the process of providing preferential drug care, regional regulations and orders of the Ministry of Health of the Rostov Region have been developed, regulating preferential provision:

Resolution of the Administration of the Rostov Region “On the Regional Long-Term Target Program “Health Development of the Rostov Region for 2010 – 2014”;

Decree of the Government of the Rostov Region “On approval of the list of medicines, medical products and specialized medical nutrition products”;

Order of the Ministry of Health of the Republic of Kazakhstan dated February 28, 2011 No. 195 “On approval of the procedure for interaction between participants in drug provision for regional beneficiaries”;

Order of the Ministry of Health of the Republic of Kazakhstan dated June 15, 2008 No. 6 “On the List of medical institutions that provide prescriptions for medicines from a doctor (paramedic) when providing outpatient medical care in accordance with Federal Law dated July 17, 1999 No. 178-FZ “On State Social Assistance”;

Order of the Ministry of Health of the Republic of Kazakhstan dated March 2, 2010 No. 211 “Procedure for interaction between ONLS participants”;

Order of the Ministry of Health of the Republic of Kazakhstan dated January 12, 2011 No. 14 “On the consolidation of medical and preventive institutions”;

Order of the Ministry of Health of the Republic of Kazakhstan dated February 27, 2008 No. 89 “On approval of the procedure for interaction between participants in drug provision for patients with malignant neoplasms of lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, multiple sclerosis, as well as after organ transplantation and (or) fabrics living in the Rostov region."

The created structure of drug provision has been successfully functioning for a number of years, this has made it possible to significantly improve the quality of drug care to the population and relieve certain moments of social tension in society.

Preferential provision of medicines to persons entitled to a set of social services, within the framework of the Federal Law of July 17, 1999 No. 178-FZ “On State Social Assistance,” has been operating since 2005.

The amount of funding for the constituent entities of the Russian Federation is determined based on the number of citizens who have retained the right to receive a set of social services and the established standard of financial costs per citizen. The financial cost standard increases annually and in 2011 was 570 rubles. The provision of medicines to benefit categories of citizens has been solved for a number of years at the expense of regional and federal budgets.

The volume of financial resources allocated from the regional

and federal budgets, to provide citizens living

on the territory of the Rostov region, from 2009 to 2011 (million rubles)

The number of citizens who refused the set of social services in 2012 is about 80 percent. The right to preferential drug coverage within the framework of the Federal Law of July 17, 1999 No. 178-FZ “On State Social Assistance” is, as a rule, retained by citizens who need to regularly take expensive medications.

In order to improve the quality of provision of preferential drug care, the Ministry of Health of the Rostov Region has created a commission to receive and consider additional applications for medicines, medical products and specialized food products for disabled children (hereinafter referred to as the commission). If new patients are identified for which drugs are not declared or treatment regimens have been changed, treatment and prevention institutions send additional applications for consideration by the commission. In 2010–2011, 60 commission meetings were held, as a result of which additional purchases of medicines were made.

To provide preferential categories of citizens within the framework of the subprogram “Medicinal provision of preferential categories of citizens” of the regional long-term target program “Development of healthcare in the Rostov region for 2010 – 2014” and to reduce the period for providing prescriptions under “control” in 2010, 30 redistributions of medicines were carried out between municipalities region, and in 2011 – 46 redistributions.

The measures taken made it possible to increase the number of prescriptions issued by 48.3 thousand compared to 2010, and their number amounted to more than 1.3 million prescriptions.

Positive results have been achieved in providing prescriptions under “control” – their figure in 2011 was 0.004 percent of prescriptions issued to federal beneficiaries.

Since 2008, expensive drugs for the treatment of patients with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, myeloid leukemia, multiple sclerosis, as well as after organ and tissue transplantation have been removed from the drug supply system for citizens entitled to receive state social assistance.

To provide patients with seven high-cost diseases, in 2011, 13,773 prescriptions were issued, for which medicines worth 727.2 million rubles were dispensed. In 2011, it was possible to treat an additional 56 patients with these diseases compared to 2010.

Considering the serious condition of this category of patients, home delivery of medicines at the place of residence has been organized in the region within 3 days from the date of issuing the prescription. This increases the availability of expensive treatment, especially for patients living in rural areas.

Thanks to the support of the Governor of the Rostov Region, in 2011 a number of federal beneficiaries were provided with medicines not included in the approved List. Financial resources amounting to 24.6 million rubles were allocated for these purposes, which made it possible to provide medical assistance to 20 citizens suffering from severe chronic diseases, including 12 disabled children.

Almost 3 percent of Don residents are entitled to receive preferential drug care at the expense of the regional budget, including children in the first three years of life and citizens suffering from diabetes.

In 2011, more than 700 thousand prescriptions were issued to regional beneficiaries, which is almost 10 percent more than in 2010. The average cost of drug provision for one regional beneficiary for the year was 5,305.0 rubles, which also exceeds this figure in 2010.

During the year, the dispensing points received medicinal products and medical products for 347 international nonproprietary names and 879 trade names.

In 2011, a positive result was achieved in terms of the “number of prescriptions under control” indicator; it amounted to 0.0003 percent of prescriptions issued to regional beneficiaries.

This indicator was achieved as a result of 19 meetings of commissions to receive and consider additional applications from medical institutions and 155 redistribution of medicines. In 2010, 23 meetings of the commission were held and 267 redistributions of medicines were carried out between municipalities of the region.

For 2012, financial resources from the regional budget to provide for patients suffering from diabetes mellitus were allocated by 59.5 million rubles more compared to 2011, and to provide for other categories of citizens and diseases the increase amounted to 54.7 million rubles.

An increase in financial resources allocated to the “Combating Diabetes Mellitus” event will make it possible to make progress in solving the problem of providing patients with means of self-monitoring of blood glucose levels.

Additional funds to provide for citizens suffering from other diseases will be used to continue treatment of federal beneficiaries who suffer from serious illnesses and require expensive treatment with drugs not included in the approved List, as well as to provide drug assistance to patients with rare (orphan) diseases.

In 2011, positive results were achieved in increasing the availability of drug care to citizens living in rural areas. Work was carried out to license medical institutions to carry out pharmaceutical activities through their structural units (medical and midwifery stations, outpatient clinics) located in remote rural areas. 930 structural units of medical institutions are licensed.

The existing system of preferential provision of medicines to citizens on an outpatient basis requires further improvement because:

the system does not allow effective planning and control of the level of costs at the level of the Russian Federation due to the fact that the per capita standard for the provision of necessary medicines is formed on the basis of an established monthly cash payment. Every year, more than half of the benefit categories of citizens refuse a set of social services, and those most in need of regular medications remain in the system, which leads to a difference between the allocated funds and the financial resources actually spent on the purchase of medications. Consequently, it is necessary to develop an economically sound mechanism for analyzing the needs of privileged categories of citizens for the necessary medicines and medical products in order to effectively plan and control the level of costs;

the model of providing necessary medicines using procurement procedures for state needs does not guarantee the availability of the range and quantity of medicines necessary for the uninterrupted servicing of preferential prescriptions;

it is necessary to develop scientifically based mechanisms for comparative analysis of the clinical and economic effectiveness of medicines for inclusion in the List of vital and essential medicines and the list of medicines dispensed by prescription when providing additional medical care to preferential categories of citizens.

Using funds from compulsory health insurance within the framework of the State Guarantees Program, citizens of the Russian Federation will be provided with free primary health care and specialized medical care; Financial support from compulsory health insurance should gradually include drug provision for citizens on an outpatient basis.

2.7. Informatization of healthcare

The implementation of measures to modernize healthcare in the Rostov region is possible subject to the large-scale introduction of modern information and telecommunication technologies, which will significantly increase the efficiency of providing medical care to the population of the region.

In total, in the Rostov region, 220 healthcare institutions operate 12,479 units of computer equipment (on average, there are 56.7 computers per healthcare institution). The compulsory health insurance system includes 174 state and municipal health care institutions, which, as of April 1, 2012, operate 12,122 units of computer equipment (on average, 69.7 computers per health care institution). The share of medical institutions with broadband Internet access is 81 percent.

In order to increase the availability of highly qualified advisory assistance in the Rostov region, a system of providing advisory assistance using telemedicine technologies has been introduced and is currently actively functioning and developing. Currently, telemedicine consultations are carried out by medical institutions in all municipalities of the region. The demand for this type of assistance is growing: in 2009, 592 telemedicine consultations were performed, in 2010 – 853, and in 2011 – 971.

The regional budget allocated 8,000 thousand rubles for the exchange of telemedicine data in 2011 and 2,000 thousand rubles in 2012 (for equipping 3 medical institutions). In 2011, 15 medical institutions in the region purchased equipment and software necessary for the exchange of telemedicine data.

A serious problem remains the low level of training of specialists in informatization and computer literacy of medical workers in healthcare institutions in the region, as well as the technical condition of the computer park that does not meet modern requirements, characterized by significant moral and physical wear and tear.

3. Key health issues

Rostov region, strategic goal and ways to achieve it

The key health problems of the Rostov region are:

high level of morbidity, disability and mortality of the population with a relatively low level of provision of both medical institutions and personnel;

insufficient level of material and technical support of healthcare institutions in the Rostov region, in particular, insufficient provision of modern, high-tech diagnostic and treatment equipment;

low level of provision of high-tech medical care;

low level of use of information and communication technologies in medical care;

high differentiation of municipalities in terms of quality and accessibility of healthcare services;

low level of remuneration for workers in the healthcare system of the Rostov region;

low level of early diagnosis, timely treatment and rehabilitation of patients with tuberculosis, vascular diseases, cancer, and diabetes.

At the same time, the Rostov region has a number of competitive advantages not only for solving the above problems, but also for developing a center of high-tech medical services in the South of Russia, providing a multiplier effect for both the economy and the social sphere. The development of a cluster of high-tech medical services is possible on the basis of the Rostov State Medical University, the Rostov Research Oncology Institute, a cardiocenter based on the Rostov Regional Clinical Hospital and other medical, scientific and educational institutions in the region. In addition, the Rostov region has unique medical technologies in the field of cardiology, traumatology, ophthalmology, urology, pediatrics and other areas.

The strategic goal of the development of the healthcare system of the Rostov region is to preserve and improve the health of the population, reduce direct and indirect losses to society by reducing morbidity and mortality of the population and, as a result, stopping the population decline in the Rostov region by 2020 and bringing its number to 4.5 million. people by 2020, increasing life expectancy to 75 years.

To solve these problems and achieve the set goal, it is necessary to implement the following measures:

continue the structural reorganization of the network of medical institutions, the end result of which should be the optimization of the industry’s bed capacity, bringing the volume of inpatient medical care provided in these institutions in line with the needs of the population of the Rostov region. In this case, emphasis should be placed on the development of a network of interterritorial medical centers;

continue to modernize and strengthen the material and technical equipment of medical and diagnostic institutions, including their overhaul, equipping with modern medical and diagnostic equipment, and the acquisition of modular medical and obstetric stations;

to continue the development of outpatient medical care, bringing it closer to the population of remote rural areas, and significantly increasing its quality. Increasing the efficiency of the functioning of this link will be achieved through early detection of diseases among residents of the Rostov region and their timely treatment;

to continue the development of high-tech types of medical care (cardiac surgery, oncohematology, traumatology and other types), increasing its accessibility for residents of the Rostov region, redistributing the flow of patients in need of it from federal-level healthcare institutions located outside the Rostov region to treatment and preventive institutions regional subordination;

actively use modern information and communication technologies in providing medical care to the population. These measures will increase the efficiency of industry management and will help get rid of traditional problems (queues at clinics) that affect the population’s satisfaction with the quality of medical care received. It is necessary to actively develop telemedicine technologies that will bring highly qualified medical care closer to remote rural areas;

continue the development and improvement of preventive areas of medical care, including the functioning of a developed network of health centers in the region, whose activities are aimed at promoting and developing a healthy lifestyle among the population;

increase the birth rate by improving the quality of medical care provided to pregnant women, women in labor and newborns, as well as through measures of social incentives for the birth of children;

reduce infant and maternal mortality by reducing reproductive losses to the level of unpreventable through the implementation of measures to develop childhood and obstetric services in the Rostov region;

continue to implement procedures and standards for the provision of medical care by health care institutions for the most common and socially significant diseases and pathological conditions, which will optimize the stages of medical care, use the correct algorithm for interaction between health care and social security institutions, and ensure continuity in patient management at all stages, which will significantly increase quality of medical care to the population;

continue to strengthen the personnel potential of medical institutions and stimulate their motivation for quality work. These measures are aimed not only at increasing the supply of specialists to healthcare institutions, but also at increasing the level of remuneration for their labor;

improve the provision of preferential medicines to the population. The implementation of these measures will significantly improve the quality of life of chronically ill patients and increase their life expectancy.

The implementation of a set of measures to improve the medical care provided to the population of the Rostov region will allow us to achieve the following results by 2020:

improving the health status of the population of the Rostov region, including the formation of a healthy lifestyle among citizens and reducing the prevalence of socially significant and widespread diseases (tuberculosis, cancer, diseases of the circulatory system, diabetes). The social picture of diseases will change, cases of “compensated” pathology will prevail, which will not significantly reduce the quality of life of patients, as opposed to the “disabling” course of a significant part of diseases, which is currently observed;

reducing mortality rates from the main categories of diseases and causes (diseases of the circulatory system, cancer, external causes, including the consequences of road accidents);

increasing the life expectancy of the population of the Rostov region, including smoothing out differences in the value of this indicator between men and women. It should be noted that a direct consequence of this will be an increase in the proportion of elderly people among the population of the Rostov region (the so-called “aging” of the population), who remain socially active and continue to work.

In the short term (until 2012 - 2013), in connection with the modernization of healthcare, strengthening the material and technical base of treatment and preventive institutions, including equipping them with modern diagnostic equipment, we should expect an increase in the detection of diseases among residents of the Rostov region, which will manifest itself in an increase in the registered total morbidity of the population by the specified period.

4. Challenges for healthcare development

The objectives of healthcare development are:

creating conditions, opportunities and motivation for the population of the Rostov region to lead a healthy lifestyle;

transition to a modern system of organizing medical care;

standardization of medical care;

implementation of state guarantees for the provision of free medical care to citizens of the Russian Federation;

implementation of a unified personnel policy;

healthcare informatization;

improving financial support for the provision of free medical care to citizens;

improving the provision of medicines to citizens;

providing patients with diabetes mellitus with medications, self-monitoring equipment and needles in accordance with the standards of medical care;

organizing work to effectively provide residents of the Rostov region with medicines, medical products, as well as specialized medical nutrition products for disabled children and improving the organization of drug provision for certain categories of citizens;

optimization of the process of providing preferential drug care to residents of the Rostov region who are entitled to benefits at the expense of the regional budget;

organizing work on effective drug provision for residents of the Rostov region suffering from orphan diseases with drugs.

4.1. Creating conditions, opportunities and motivation

population of the Rostov region to maintain a healthy lifestyle

To create a healthy lifestyle, it is necessary to introduce a system of state and public measures to:

improving medical and hygienic education and upbringing of the population, especially children, adolescents, and young people, through the media and the mandatory introduction of relevant educational programs in preschool, secondary and higher education institutions.
Within the framework of this direction, it is necessary to carry out training in hygienic skills in compliance with occupational hygiene rules, work (including study) and rest, diet and structure, timely seeking medical help and other norms of behavior that support health;

creating an effective system of measures to combat bad habits (alcohol abuse, smoking, drug addiction, etc.), including educating and informing the population about the consequences of tobacco use and alcohol abuse, promoting the reduction of tobacco and alcohol consumption, regulating and disclosing the composition of tobacco products and alcohol products and providing full information about the composition on the packaging, protecting non-smokers from exposure to tobacco smoke, limiting the consumption of alcohol in public places, regulating the location of places of sale of alcoholic beverages, tobacco and the procedure for their sale, as well as price and tax measures;

creating a system of motivating citizens to lead a healthy lifestyle and participate in preventive measures, primarily through the popularization of a way of life and lifestyle that contributes to the preservation and strengthening of the health of citizens of the Rostov region, the formation of a fashion for health, especially among the younger generation, the introduction of a system of medical care for healthy and practically healthy citizens; conducting explanatory work about the importance and necessity of regular prevention and medical examination of citizens;

creating a system for motivating the participation of employers in protecting the health of employees by establishing benefits on insurance premiums for compulsory health and social insurance, stimulating working teams to lead a healthy lifestyle;

prevention of risk factors for non-communicable diseases (blood pressure, poor diet, physical inactivity, etc.);

introduction of healthy, safe nutrition: support for breastfeeding of young children, creation of a system of healthy nutrition for children in organized groups, including improvement of the organization of nutrition for students in educational institutions, information and communication campaign to develop a healthy, safe diet among citizens;

increasing physical activity, which is the most important condition for maintaining the health of citizens. Such measures should include: promotion and stimulation of an active lifestyle, development of physical therapy and physical education aimed at maintaining health.

Activities aimed at creating a healthy lifestyle among citizens in the Rostov region, as well as throughout the Russian Federation, are carried out in two stages.

At the first stage (2009 – 2015), specialists from the Ministry of Health of the Russian Federation developed health assessment systems and identified basic indicative indicators, such as public health potential and a healthy lifestyle index. In the Rostov region in 2009–2011, 14 health centers for adults and 6 health centers for children were created, which were equipped with medical equipment at the expense of the federal and regional budgets, in accordance with the regulations of the Government of the Russian Federation.

At the second stage (2016 - 2020), it is planned to reach the necessary, in terms of efficiency, volume of activities to gradually increase (in relation to the basic indicators established at the first stage) the public health potential by 10 percent and the healthy lifestyle index by 25 percent. .

4.2. Transition to a modern system

medical care organizations

In order to ensure the quality and accessibility of medical care, it is necessary to ensure the functioning of an organizational system that provides for:

the fastest possible delivery of the patient to a medical institution equipped with diagnostic and treatment equipment, staffed with trained medical personnel and provided with the necessary medications and medical products in accordance with relevant standards;

for medical reasons - gradual continuation of treatment in other medical institutions (continuous aftercare and rehabilitation, secondary prevention, sanatorium-resort rehabilitation treatment) or at home in accordance with the procedure for providing medical care for a specific disease or condition until the best result is achieved (recovery, functional restoration ).

To create a medical care system that meets the specified criteria, it is necessary:

development of primary health care, including reducing the number of attached adult population to 1.2 - 1.5 thousand people, children - up to 600 - 800 children and adolescents per site with a reduction in the workload per local doctor; giving priority to preventive work, strengthening the rehabilitation function, improving and expanding hospital-replacing medical technologies;

improving the work of emergency medical care, including optimizing routes for transporting patients to the hospital depending on the type of pathology and the severity of the patient’s condition; introduction of target indicators for the performance of emergency medical services (time of arrival to a call, time of transportation to the hospital, pre-hospital mortality); introduction of procedures for the provision of medical care in terms of pre-hospital management of patients with various types of pathology;

optimization of the work of hospital-level institutions in terms of setting target indicators for the work of institutions, reflecting not only the types and volumes of medical care provided, but also its quality, introducing phasing of medical care and developed routes for transporting patients based on the rational distribution of functional responsibilities of hospitals (municipal (city and district) ) - for the provision of primary care in emergency conditions; regional interdistrict - for the provision of specialized care, including in emergency conditions and conditions requiring restorative treatment and rehabilitation; regional and federal - for the provision of specialized, including high-tech, assistance), development. specialized institutions to provide diagnostic and therapeutic care to patients with cancer, create a routing service in each hospital, responsible for organizing follow-up care and rehabilitation of discharged patients, as well as expanding the volume and introducing new types of high-tech care, including for emergency conditions;

development of nursing and rehabilitation medical care, including the creation of a network of institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care, including through the repurposing of existing hospitals, expanding the network of day hospitals. Creation of a system of target indicators for the performance of nursing and rehabilitation institutions, reflecting the quality of medical care (the degree of restoration of impaired functions, indicators of primary disability and severity of disability);

quality control of medical care based on procedures and standards for its provision;

equipping medical organizations with equipment in accordance with the standards and procedures for providing medical care;

expanding the economic independence of healthcare institutions, as well as increasing their responsibility for the economic results of their activities, including changing organizational and legal forms based on a unified system of criteria.

Implementation stages:

2012 – 2014:

creation of a system for operational accounting of medical care, health care institutions and medical personnel;

planning the development of a network of treatment and preventive institutions with their profiling, redistribution of personnel and treatment and diagnostic capacities, formation of patient routes, creation of a system of phased successive care;

gradual improvement of the system of providing medical care to patients with vascular diseases;

gradual improvement of the system of providing assistance to victims of road traffic accidents based on the organization of emergency care in hospitals located along federal highways;

step-by-step improvement of the system of providing medical care to patients with cancer: introduction of cancer screening in primary outpatient clinics and hospitals; re-equipping and re-staffing five regional oncology clinics;

gradual improvement of the system of providing care to women during pregnancy and childbirth, as well as newborns and children;

gradual improvement of blood services;

2015 – 2020:

Improving primary health care:

development of the territorial-precinct principle of providing outpatient care to the population, including in rural areas;

additional staffing of outpatient clinics with qualified medical personnel (doctors and paramedical personnel);

giving priority to preventive work (a system of health measures, medical examinations, screening examinations, vaccinations, in-depth examinations, etc.) based on a planned tariff policy;

providing preventive care to the population of rural areas through the formation of mobile medical teams equipped with the necessary laboratory and instrumental equipment;

development of telemedicine technologies for remote consulting and diagnostic activities;

retrofitting institutions, improving and expanding hospital-replacement diagnostic technologies;

introduction of target performance indicators for outpatient clinics, reflecting the proportion of healthy individuals among the assigned population and the percentage of early stages of diseases among all newly diagnosed ones;

improvement of the tariff policy of remuneration, reflecting the priority of the work of the local doctor - a set of preventive measures.

Improving the work of emergency medical services:

optimization of routes for transporting patients to the hospital depending on the type of pathology and the severity of the patient’s condition;

introduction of standards for prehospital management of patients with different types of pathologies;

providing emergency medical teams with a satellite navigation system;

upgrading the emergency medical service according to the standard;

additional staffing of the emergency medical service with trained personnel;

introduction of target indicators for the performance of emergency medical services (time of arrival to a call, time of transportation to the hospital, pre-hospital mortality).

Optimization of the work of inpatient institutions:

rational distribution of functional responsibilities of hospitals;

the gradual creation of head regional centers coordinating the entire scope of preventive, diagnostic and therapeutic measures on socially significant medical problems;

implementation of patient management protocols and medical care standards, inpatient registers and a medical care quality management system into the activities of clinical departments of hospitals;

expansion of volumes and introduction of new types of high-tech care, including for emergency conditions;

additional staffing of hospitals with qualified personnel in accordance with standards;

retrofitting hospitals according to standards;

ensuring the operation of round-the-clock telemedicine communications between hospitals of municipal and regional subordination;

introduction of phasing of medical care and developed routes for transporting patients, creation in each hospital of a routing service responsible for organizing follow-up treatment and rehabilitation of discharged patients (referral to a “hospital at home” through communication with the patronage service of an outpatient clinic in accordance with the patient’s place of residence, to specialized hospitals for rehabilitation treatment, rehabilitation, medical care);

intensification of the work of inpatient beds through the introduction of hospital-replacement diagnostic technologies at the outpatient clinic level and the organization of step-by-step rehabilitation treatment (patronage service, aftercare and rehabilitation system);

improving target performance indicators of inpatient facilities, reflecting the quality of medical care (mortality, degree of restoration of impaired functions);

Improving the system of step-by-step recovery treatment and rehabilitation:

creation of a network of institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care, including through the repurposing of some operating hospitals;

expansion of the network of day hospitals for rehabilitation treatment and rehabilitation;

staffing institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, and medical care with qualified personnel in accordance with standards;

equipping institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care in accordance with standards;

introduction of high-tech rehabilitation technologies;

creation of a system of target indicators for the performance of nursing and rehabilitation institutions, reflecting the quality of medical care (the degree of restoration of impaired functions, indicators of primary disability and severity of disability);

improvement of tariff policy based on taking into account not only the type and volume of medical care provided, but also its quality.

Expanding the economic independence of healthcare institutions, as well as increasing their responsibility for the economic results of their activities, including changes in organizational and legal forms, based on a unified system of criteria.

Creation of legal and economic conditions for the formation of a self-regulatory system for providing medical care to the population, ensuring motivated, effective work of medical services at each level, continuity of their actions at all stages of treatment to achieve the best result.

4.3. Standardization of medical care

One of the main factors in creating a system of high-quality and affordable medical care is the presence of uniform procedures and standards for the provision of medical care for the most common and socially significant diseases and pathological conditions throughout the entire territory of the Russian Federation, including the entire territory of the Rostov region.

Standards of medical care are developed in accordance with the indicators of the State Guarantees Program, and their implementation is guaranteed to citizens throughout the Rostov region.

The creation of medical care standards will make it possible to calculate the real cost of medical services in the region, determine the costs of implementing a territorial program of medical care to the population, calculate the necessary drug supply for the program (a list of vital and essential drugs), justify per capita financing standards and optimize options for restructuring the network of health care institutions .

The introduction of procedures for the provision of medical care will make it possible to optimize its phasing, use the correct algorithm for interaction between healthcare and social security institutions, and ensure continuity in the management of the patient at all stages, which will significantly improve the quality of medical care to the population.

Procedures and standards for the provision of certain types of medical care form the basis of the Program of State Guarantees for the provision of free medical care to citizens, corresponding to the modern level of development of medicine and mandatory for implementation.

One of the main elements of quality assurance should be considered the development by professional communities (associations) of clinical recommendations (guidelines) containing information on the prevention, diagnosis, treatment of specific diseases and syndromes, which will serve as the basis for the development of standards of medical care, indicators of the quality of the diagnostic and treatment process.

This approach to the formation of a patient management algorithm helps attending physicians plan the diagnostic and treatment process taking into account the real capabilities of the medical organization. Heads of medical organizations can evaluate the quality of medical care based on the criteria of completeness of mandatory treatment and diagnostic measures, as well as compare the quality of work of individual doctors and departments and introduce differentiated wages.

Implementation stages:

2012 – 2014:

phased implementation of a quality management system for medical care based on procedures and standards for its provision, registers of inpatient patients, including indicators of the quality of care provided, as well as improving the tariff policy for remuneration of medical workers, dependent on the quality of care;

establishing a procedure for licensing medical organizations, based not only on the availability of appropriate material and technical equipment and certified specialists, but also on the ability to comply with the technology of medical care (availability of a sufficient number of trained medical personnel with access to the necessary types of care and material and technical resources allowing the implementation of a schedule operation of equipment in accordance with medical care technologies);

2015 – 2020:

implementation of an economically sound self-regulatory system for managing the quality of medical care in the Rostov region.

4.4. Implementation of state guarantees of provision

citizens of the Russian Federation free medical care

State guarantees for the provision of free medical care to citizens of the Russian Federation are determined by law by Federal Law No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens,” which includes:

sources of financial support for state guarantees of providing free medical care to citizens of the Russian Federation;

the scope of state guarantees for the provision of free medical care to citizens of the Russian Federation in terms of the types, procedure and conditions for the provision of medical care;

the procedure for assessing the effectiveness of the implementation of state guarantees of free medical care;

liability for failure to comply with state guarantees of free medical care;

the procedure for developing regulations that specify the scope of state guarantees of free medical care established by the legislation of the Russian Federation.

In accordance with the provisions of the legislation of the Russian Federation, the Government of the Russian Federation is adopting a State Guarantee Program containing:

the minimum per capita standard for financial support of state guarantees for the provision of free medical care;

standards of financial costs per unit volume of medical care;

per capita standards for the volume of medical care by type;

minimum values ​​of criteria for assessing the quality and accessibility of medical care.

Based on the Program of State Guarantees approved by the Government of the Russian Federation, the Government of the Rostov Region adopts the Territorial Program of State Guarantees, depending on financial security, establishing its own financial standards (bringing them closer to those established by the Government of the Russian Federation), as well as at the stage of transition to predominantly single-channel financing of healthcare through the system compulsory health insurance includes additional types of medical care (since 2013 - all paramedics and midwives, ambulances), additional items (overhead and utility costs) in the compulsory health insurance tariff, introduces new methods of payment according to the per capita financing standard.

Monitoring of the implementation of state guarantees for the provision of free medical care is carried out on an annual basis, while information on the implementation of the Territorial Program of State Guarantees in the corresponding year should be the basis for the formation of indicators of state guarantees of free medical care for subsequent periods.

Financial indicators must be linked to qualitative ones:

population satisfaction with medical care;

mortality rate of the population of the Rostov region, including infant and maternal mortality, mortality of the population of working age, mortality of the population from cardiovascular diseases, cancer, external causes, as a result of road accidents;

primary incidence of major socially significant diseases;

primary disability;

balance of the Territorial Program of State Guarantees in terms of types and volumes of medical care in accordance with the standards established by the Program;

waiting times for citizens to receive medical and rehabilitation assistance by type and conditions of provision.

At the same time, the Territorial Program of State Guarantees sets target values ​​for these indicators and, if necessary, additional indicators taking into account healthcare priorities.

As part of the management system for the implementation of the Territorial Program of State Guarantees of the Ministry of Health of the Russian Federation (hereinafter referred to as the Ministry of Health of Russia) and the Federal Compulsory Medical Insurance Fund, mechanisms are provided for financial incentives for achieving the corresponding indicators through the provision of additional transfers from the federal budget and the Federal Compulsory Medical Insurance Fund.

At the same time, in case of failure to comply with the established control values, the legislation of the Russian Federation must establish appropriate sanctions and introduce an effective mechanism for applying these sanctions.

Implementation stages:

2012 – 2014 – specification of state guarantees based on the standardization of medical care; transition to planning the Territorial Program of State Guarantees for three years with annual adjustments; certification of medical institutions for the provision of premises and equipment in order to determine the possibility of including investment costs in the compulsory health insurance system;

2015 – 2020 – gradual inclusion of investment-related expenses into the per capita standard of the Territorial Program of State Guarantees; the transition to predominantly single-channel healthcare financing through the compulsory health insurance system includes additional types of medical care (since 2013 - all paramedics and midwifery stations, ambulances), additional items (overhead and utility costs) in the compulsory health insurance tariff; introduction of new payment methods based on per capita financing standards.

4.5. Implementation of a unified personnel policy

The current situation in healthcare requires reforms in the field of human resource management in the industry.

The goal of the personnel policy is the training and retraining of specialists who have modern knowledge and are able to ensure the economic and clinical effectiveness of the high medical technologies used and new methods of prevention, diagnosis and treatment, achieving an optimal ratio of the number of doctors and nursing staff, as well as eliminating imbalances in the staffing of all levels of the health care system.

The organization of personnel policy must be consistent with educational policy in the system of continuing professional education, and also aimed at stimulating the motivation of medical workers to improve their professional qualifications.

The main criteria for the effectiveness of personnel policy, medical education and the incentive system for medical personnel are the quality of medical care provided and patient satisfaction.

Long-term personnel planning is possible only if reliable information is available on the number of medical workers (doctors of various profiles and paramedical personnel).

One of the directions for the development of the system of providing medical care to the population and the key to increasing its efficiency is the creation of conditions for the motivated work of medical personnel. The regulatory mechanism should be the creation of a system of professional self-government and corporate responsibility in the staff of each medical institution.

The introduction of medical self-government will allow “from the inside” to regulate the medical activities of each doctor and each medical team, flexibly using economic and moral levers.

Important components of the development of the medical self-government system are:

formation of a system of corporate responsibility for the quality of medical care provided;

corporate distribution of financial resources for medical services provided (transition to new forms of remuneration);

formation of a system of personal access to types of medical activities depending on their level of complexity;

increasing the motivation of medical workers for continuous professional education and acquiring access to new types of medical activities within the framework of their main specialty or related fields of medicine.

To determine the personal contribution of each medical worker to the result of the work of a medical institution, it is necessary to update the classification of all types of medical care, ranked by medical specialties, level of complexity and manufacturability, and the required qualifications of the medical worker.

The introduction of the principles of medical self-government and corporate responsibility will make it possible to effectively use material and moral incentives to increase the motivation of each member of the medical team for continuous professional improvement, which will lead to a significant improvement in the quality of both his personal work and the entire medical institution.

As part of the implementation of the personnel policy, it is proposed to carry out the following activities.

Healthcare staffing:

bringing the number and structure of medical personnel in line with the volume of personnel activities and long-term goals. Elimination of duplication of functions, redistribution of functions between various professional groups (doctors and nursing staff, nurses and auxiliary nurses);

improving the professional level of healthcare workers based on the further development of the system of continuous education of medical and pharmaceutical workers;

improvement of working conditions and remuneration. Bringing the remuneration system into line with the complexity, quantity and quality of medical care. Modernization of workplaces, increasing the technical equipment of medical workers;

improvement of the regulatory legal framework defining the professional activities of medical and pharmaceutical personnel;

development of a set of measures aimed at improving the status of doctors and paramedical personnel, at making medical workers aware of the potential of the profession and its prospects, and its significance for society;

training of specialists in the field of healthcare management.

Improving the quality of training of medical and pharmaceutical personnel:

development of a set of measures for training specialists with higher and secondary medical and pharmaceutical education in accordance with state priorities;

improving targeted contract training of personnel, providing for the provision of certain social guarantees to students and young specialists;

creation of educational, scientific and clinical complexes uniting educational institutions (medical university, college), specialized research institutes and clinical bases;

optimization of legal and economic relationships between medical educational institutions and treatment and preventive institutions as part of the creation of a unified clinical base;

development of informatization of education in medical and pharmaceutical educational institutions: formation of electronic libraries and reference and information databases, introduction of information technologies and quality management systems in the educational process;

improving the system of continuous medical education;

implementation of state international exchange programs as part of the professional development of medical workers;

improving the training of management personnel in healthcare and specialists in personnel services of medical organizations, based on modern principles of quality management and standardization, multidisciplinary professional knowledge (legal, economic, psychological, sociological, etc.) and personnel management skills;

introduction of a system of liability insurance for medical workers in the event of an error and in the presence of a degree of risk of medical intervention, as well as personal insurance in cases where the performance of official duties involves a threat to life and health;

introduction of uniform criteria for the formation of a professional community in medical specialties (groups of specialties), development of mechanisms for their participation in the development of standards for the provision of medical care, clinical protocols, in the licensing of medical activities and certification of specialists;

improving the work of chief freelance specialists, heads of specialized scientific organizations, representatives of professional societies and associations, etc.;

increasing the role of scientific, expert and advisory bodies; development of medical professional societies and associations.

Implementation stages:

2012 – 2014:

training of medical specialists who meet new requirements for professional medical practice; achieving a ratio of doctors and nursing staff of 1 to 3 (5);

introduction of new federal state educational standards for higher and secondary vocational education in specialties of the “Healthcare” group and federal state requirements for postgraduate medical education (including internship, residency, etc.);

optimization of the system of continuous medical education;

formation of a system of professional growth;

introduction of mechanisms for exercising the rights of healthcare workers to insurance in cases where the performance of duties is associated with a threat to their life and health;

introduction of a professional liability insurance system in the event of an error and in the presence of a risk in connection with medical intervention;

2015 – 2020:

gradual transition to an optimal system of placement of medical personnel; approaching the ratio of the number of doctors and paramedical personnel (1 to 7) for the patronage service of the region to the forecast for the Russian Federation;

monitoring the state of health care staffing and personnel migration, optimizing personnel policies in accordance with the needs of the health care system;

formation of professional self-government in resolving issues of personnel and innovation policy, developing uniform standards for the provision of medical care and assessing its quality.

4.6. Informatization of healthcare

In order to increase the availability and quality of medical care for citizens and to solve key problems of operational healthcare management in the Rostov region, a regional segment of the unified state information system in the field of healthcare (hereinafter referred to as the Uniform State Health Information System) is being created.

The introduction of modern information systems in healthcare provides for measures for personalized accounting of the provision of medical services, the possibility of maintaining a medical record, making an appointment with a doctor in electronic form, exchanging telemedicine data, and introducing electronic document management systems.

As part of these measures, it is planned to transition all medical and preventive institutions in the region operating in the compulsory health insurance system to a single compulsory health insurance policy number, with the personification of the medical care provided according to it. This measure will increase the reliability of the collected medical information and facilitate inter-territorial payments.

The event for the exchange of telemedicine data will bring the modern level of diagnostic research closer to patients in rural areas. Increasing the socio-economic efficiency of costs when using telemedicine methods is achieved by expanding the volume of primary health care and ensuring its compliance with the standards for the provision of medical services by type and nature of diseases, meeting the needs and expectations of the population, as well as optimizing the use of quotas for the treatment of citizens in federal medical centers allocated by the Russian Ministry of Health.

The implementation of the event will allow:

ensure universal accessibility and a uniform high quality standard of medical care in any health care institution, regardless of its territorial location and departmental affiliation;

organize consultations in leading medical centers;

observe and advise patients after complex surgical interventions;

overcome the gap between the concentration of the best doctors in leading medical centers and the low level of provision of highly qualified specialists in municipal medical organizations;

increase the level of medical care for the population by introducing into healthcare practice methods of remote provision of advisory medical care and the exchange of specialized information based on modern high-tech technologies.

Activities for personalized recording of the provision of medical services, the possibility of maintaining an electronic medical record, and making an appointment with a doctor in electronic form are planned to be carried out in the regional segment of the Uniform State Health Information System.

The centralized architecture of the regional segment of the Uniform State Health Information System will allow it to be scaled within the region in a short time. Due to centralization, budget costs for providing medical institutions with a technical base will be minimized, and financial costs for ensuring the protection of confidential information (personal data and medical confidentiality) will be reduced.

Implementation stages:

2012 – 2020:

centralized placement of information systems and resources, ensuring redundancy and continuous availability, requirements of the Federal Law of the Russian Federation of July 27, 2006 No. 152-FZ “On Personal Data”;

consolidation of regional healthcare institutions, medical organizations, the Territorial Compulsory Medical Insurance Fund for the Rostov Region into a single secure and redundant multi-service data transmission network for access to centralized information resources and information exchange;

equipping medical organizations with computer equipment;

creation and modernization of existing local computer networks in medical organizations, including the purchase, installation and configuration of network equipment;

registration and accounting of served citizens, registering patients for services, managing the resources of medical organizations, maintaining electronic medical records of patients, managing pharmacy activities, recording medical services provided;

implementation of an electronic document management system in regional healthcare institutions and medical organizations;

implementation of an information system for personnel management of regional health care institutions and medical organizations;

integration of information systems with the regional and Unified portal of public services, the system of interdepartmental electronic interaction, federal components, the universal electronic card of a Russian citizen, the automated system of the Territorial Compulsory Medical Insurance Fund for the Rostov Region;

ensuring the security of confidential information and personal data during their processing in personal data information systems (PDIS) in accordance with the requirements of current legislation.

4.7. Financial support for provision

free medical care for citizens

The provision of free medical care to citizens of the Rostov region is carried out at the expense of funds from the consolidated budget of the Rostov region and funds from compulsory health insurance.

The approved cost of the Territorial Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation in the Rostov region for 2012 amounted to 25.7 billion rubles, including funds from the consolidated budget - 11.3 billion rubles, funds from compulsory medical insurance - 14.4 billion . rubles (including insurance premiums for compulsory medical insurance of the non-working population in the amount of 7.9 billion rubles).

The per capita financial support standards provided for by the Territorial State Guarantee Program reflect the amount of budgetary allocations and compulsory health insurance funds necessary to compensate for the costs of providing free medical care per person per year. In 2012, these expenses were:

at the expense of compulsory health insurance per 1 insured person per year - 3,576.53 rubles;

at the expense of the consolidated budget of the region per 1 resident - 2,664.12 rubles.

Every year there is an increase in the total cost of the Territorial State Guarantees Program, as well as territorial standards of financial costs per unit of medical care.

Despite the growth in healthcare financing, its level remains insufficient. At the same time, financial resources allocated for healthcare in the region allow its residents to receive free medical care in full, provided for by the Territorial Program of State Guarantees.

Considering that the healthcare financing system must ensure the use of resources as an economic tool for increasing the efficiency and quality of medical care, it is necessary:

ensure a balance between the volumes of medical care approved by the Territorial Program of State Guarantees and the resources for their implementation by optimizing the volumes of free medical care provided for by the Territorial Program of State Guarantees;

develop and implement modern methods of planning financial resources and payment for medical care that correspond to the goals and objectives of the implementation of the Territorial Program of State Guarantees, taking into account the quality indicators of treatment and preventive activities;

continue targeted financing of priority areas of activity, determined annually on the basis of the program-target planning method.

complete the transition to predominantly single-channel financing of the healthcare system through the compulsory health insurance system.

4.8. Improving drug provision for citizens

One of the significant areas for increasing the accessibility of medical care is the ability to satisfy the needs of all patients, including socially vulnerable ones, for quality medicines in accordance with the standards of medical care.

Based on statistical forecasts, the number of patients with diabetes mellitus in the Rostov region increases annually by 6–8 percent. For patients with diabetes, the need for medical care increases as their condition worsens and complications arise. In this regard, additional measures are required to ensure primary and secondary prevention, organization of treatment, including drug provision and rehabilitation, for patients suffering from diabetes. This is possible using software methods.

The implementation of the programs involves the purchase and provision of medicines to patients with diabetes. The list of medicines is compiled in accordance with the list of basic vital and essential medicines, standards of medical care and provides for the provision of patients with insulins and their analogues, hypoglycemic drugs, i.e. Treatment is provided for both type I diabetes mellitus - insulin-dependent and non-insulin-dependent diabetes mellitus type II, as well as self-monitoring devices and needles.

Satisfying the needs of residents of the Rostov region, including socially vulnerable groups of the population, for medicines and medical products, as well as specialized medical nutrition products for disabled children in accordance with therapeutic indications and nosology, should be considered as a national scale event. To improve the accessibility and quality of drug care, additional measures are required, which should be aimed at increasing the controllability of financial, commodity flows and prescription of drugs, while simultaneously creating a more stringent system of control over the completeness of meeting demand and the validity of prescribing drugs to certain categories of citizens.

In accordance with the purpose and objectives of the Concept, measures are envisaged to organize the provision of citizens with medicines intended for the treatment of patients with malignant neoplasms of lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, multiple sclerosis, as well as after organ transplantation and ( or) tissues (providing logistics support for drugs intended for the treatment of patients in this category).

In accordance with Article 44 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation,” in the Rostov region there are categories of citizens included in the Federal Register of persons suffering from life-threatening and chronic progressive rare (orphan) diseases leading to to a reduction in the life expectancy of citizens or their disability, and a regional segment of the Federal Register, for outpatient treatment of which drugs, medical products, specialized medical nutrition products and dressings are dispensed free of charge according to doctor’s prescriptions.

The organization of providing citizens with medicines for the treatment of diseases included in the list of life-threatening and chronic progressive rare (orphan) diseases leading to a reduction in the life expectancy of a citizen or disability is attributed to the powers of the constituent entities of the Russian Federation, which are being implemented in 2012 in the Rostov region at the expense of the regional budget. In this regard, it is necessary to organize work to effectively provide medicines to residents of the region suffering from orphan diseases.

Thus, the main directions for the implementation of state policy in the field of drug assistance to citizens should be:

guaranteed affordable drug provision for citizens (including preferential ones) within the framework of the State Guarantee Program, existing and newly introduced systems for providing state social assistance at the expense of the federal budget, social support measures for drug provision of the population at the expense of the regional budget and other sources;

improving the organization of drug care, management of pharmaceutical activities and the mechanism of state regulation of drug provision, maintaining and developing the existing network of state and municipal pharmacies;

increasing the efficiency of using financial resources intended for providing medicines to citizens.

5. Main stages and expected results of implementation

Concepts for the development of healthcare in the Rostov region until 2020

The implementation of the Concept for the development of healthcare in the Rostov region until 2020 will occur in stages.

At the first stage (2012–2014), state guarantees will be specified based on the standardization of medical care; transition to planning the Territorial Program of State Guarantees for three years with annual adjustments; certification of medical institutions for the provision of premises and equipment in order to determine the possibility of including investment costs in the compulsory health insurance system; a phased implementation of a medical care quality management system was carried out based on the procedures and standards for its provision, registers of inpatient patients, including indicators of the quality of care provided, as well as the improvement of the tariff policy for remuneration of medical workers, dependent on the quality of care; the material and technical base of healthcare institutions was modernized; a system of continuous training of personnel will begin to be implemented, based on a unified personnel policy, new federal state educational standards for higher and secondary vocational education in specialties of the “Healthcare” group and federal state requirements for postgraduate medical education have been introduced.

In addition, at the first stage, the implementation of the Priority National Project “Health” will be continued in the following areas:

formation of a healthy lifestyle;

development of primary health care and medical prevention;

improvement of specialized, including high-tech, medical care for socially significant diseases, including cardiovascular, oncological, combined injuries in road traffic accidents;

development of blood service;

improving medical care for mothers and children.

At the second stage of implementation of the Concept (2015 - 2020), a gradual transition to a self-regulatory system for organizing medical care is expected based on the established infrastructure and human resource of healthcare and informatization of the industry, further introduction of new technologies developed taking into account the priorities of innovative development of healthcare, inclusion of high-tech and emergency medical assistance into the compulsory health insurance system, integration of budget investments into tariffs for medical care, creation of a system of drug provision for citizens on an outpatient basis within the framework of compulsory health insurance.

By 2020 it is expected:

reducing the maternal mortality rate to 13.8 per 100 thousand children born alive by 2020;

reducing the infant mortality rate to 7.2 per 1000 live births, for the period from 2015 to 2020;

the mortality rate of the working age population will be 546.0 people per 100 thousand population;

the mortality rate of the working age population from diseases of the circulatory system will be 173.0 people per 100 thousand population;

the mortality rate of the working-age population from neoplasms will decrease to 82.0 people per 100 thousand population;

the mortality rate of the working age population from injuries will be 13.5 people per 100 thousand population;

increasing the staffing of regular doctor positions by individuals at the level of 72 percent;

increasing the staffing of regular positions of paramedical workers with individuals to 76.2 percent;

increase in expenses of the consolidated budget of a constituent entity of the Russian Federation for the implementation of the Territorial Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation in the Rostov Region per 1 resident to 3,787 rubles;

reduction in the provision of round-the-clock beds (operating in the compulsory health insurance system) in state (municipal) healthcare institutions to 60.2 beds per 10 thousand people;

ensuring the average annual occupancy of a bed in state (municipal) health care institutions at the level of 340 days (including in nursing care beds organized to meet the population’s needs for medical and social care);

stabilization of the proportion of alcoholic patients who abstain from drinking alcohol during a course of treatment with long-acting drugs to 45 percent.

Public survey on assessing the effectiveness of managers

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

Concept for the development of the healthcare system in the Russian Federation until 2020.

Content

• 1. General Provisions
• 3.1.1 Specification of state guarantees for the provision of free medical care
• 3.1.2 Organization of medical care
• 3.1.3 Providing the population with medicines on an outpatient basis
• 3.1.4 Implementation of a unified personnel policy
• 3.1.5 Financial support for the provision of free medical care to citizens
• 3.1.6 Healthcare informatization
• 4. Legislative and regulatory support for the implementation of the Concept
• 5. Main stages and expected results of the implementation of the Concept for the development of healthcare in the Russian Federation until 2020

1. General Provisions

In order to ensure sustainable socio-economic development of the Russian Federation, one of the priorities of state policy should be to preserve and strengthen the health of the population based on the formation of a healthy lifestyle and increasing the availability and quality of medical care.

The effective functioning of the healthcare system is determined by the main system-forming factors:

- improving the organizational system to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens of the Russian Federation (within the framework of state guarantees);

- development of infrastructure and resource support for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization;

- the presence of a sufficient number of trained medical personnel capable of solving the problems posed to the healthcare system of the Russian Federation.

These factors are interdependent and mutually determining, and therefore modernization of healthcare requires the harmonious development of each of them and the entire system as a whole.

The concept for the development of healthcare in the Russian Federation until 2020 is an analysis of the state of healthcare in the Russian Federation, as well as the main goals, objectives and ways to improve it based on the application of a systematic approach.

The concept was developed in accordance with the Constitution of the Russian Federation, federal laws and other regulatory legal acts of the Russian Federation, generally accepted principles and norms of international law in the field of healthcare and taking into account domestic and foreign experience.

healthcare concept development russian

2. Current state of healthcare in the Russian Federation

2.1 Demographic situation in the Russian Federation

The demographic situation in the Russian Federation still remains unfavorable. The population decline that began in 1992 continues. However, the rate of population decline has decreased significantly in recent years - from 700 thousand people annually in the period 2000-2005 to 213 thousand people in 2007. For 10 months of 2008, the rate of natural population decline was 2.7 per 1000 population, while for the corresponding period in 2007 it was 3.4.

As of October 1, 2008, the permanent population of the Russian Federation was 141.9 million people, which is 116.6 thousand people less than on the corresponding date in 2007.

The slowdown in population decline is mainly due to an increase in the birth rate and a decrease in mortality. In 2007, 1,602 thousand children were born, which is 8.3% more than in 2006. The increase in the birth rate over 10 months of 2008 amounted to 7.7%. The mortality rate (per 1000 population) decreased in 2007 compared to 2006 by 3.3%. Over the 10 months of 2008, the mortality rate did not increase compared to the corresponding period of the previous year.

The maternal mortality rate per 100,000 live births in 2007 decreased by 7.2% compared to 2006. Infant mortality per 1,000 live births in 2007 decreased by 7.8% compared to 2006. Over 10 months In 2008, compared to the corresponding period in 2007, infant mortality decreased by 8.3% and amounted to 8.8 per 1000 live births.

In 2006, for the first time in the last 7 years, life expectancy of the population of the Russian Federation began to increase. Compared to 2005, this figure increased by 1.3 years - from 65.3 years to 66.6 years. In 2007, life expectancy increased to 67.65 years. However, life expectancy in Russia remains low - 6.5 years less than in the "new" EU countries (European countries that joined the EU after May 2004), and 12.5 years less than in the "old" EU countries. " EU countries (European countries that were part of the EU before May 2004). The difference between the life expectancy of men and women remains very high at 13 years. A key role in the low life expectancy of the population of the Russian Federation is played by the high mortality rate of people of working age, mainly men, which increased by more than 40% compared to 1990.

Life expectancy is the most accurate measure of the mortality rate and serves as a recognized indicator of the quality of life and health of the population.

Its significance largely depends on the volume of government spending allocated for the provision of medical care and healthcare in general, as well as on the effectiveness of the population’s cash income policy, the development of the sanitary and epidemiological welfare system, and the level of preventive activity of the population.

The modern history of the Russian Federation convincingly shows that a decrease in state support for healthcare and a deterioration in the quality of life of the population lead to a significant decrease in average life expectancy.

So in 1991-1994, as a result of a significant decline in the standard of living of the population, life expectancy decreased by 5 years. In the first years after the 1998 financial crisis, which led to a 30% reduction in the share of health care expenditures in GDP (from 3.7% in 1997 to 2.6% in 1999), life expectancy decreased by 1.84 years.

The increase in life expectancy in 2005-2007 is largely due to an increase in spending on medical care from 2.6% of GDP in 2005 to 2.9% of GDP in 2007, and spending on health care in general - from 3.2% GDP in 2005 to 3.5% of GDP in 2007.

Rice. 1 GeneralcoefficiententmortalityVdependenciesfromstateper capitaexpensesonhealthcarePPP$

Overall mortality rate, i.e. the number of deaths from all causes per 1000 people in 2007 was 14.7 (in 2005 - 16.1, in 2006 - 15.2), which reflects a certain positive trend. But, nevertheless, the mortality rate remains 1.3 times higher than in the “new” EU countries, and 1.5 times higher than in the “old” EU countries. The main cause of mortality is diseases of the circulatory system, from which about 1.2 million people died in 2007 (56.6% of deaths). 13.8% died from neoplasms, 11.9% from external causes. Indicators of maternal and infant mortality exceed similar indicators in developed countries by 1.5 - 2.0 times. The leading causes of infant mortality are certain conditions that arose in the perinatal period, congenital anomalies and respiratory diseases.

Rice. 2 CausesmortalityVRussia,2007 G.

In the Russian Federation, mortality rates from circulatory diseases (in 2007 - 829 cases per 100 thousand people, in 2006 - 865, in 2005 - 908) are among the highest in the world. The corresponding figures in other countries were in 2005: in the “old” EU countries - 214, in the “new” EU countries - 493, in the USA - 315. At the same time, the share of mortality from strokes in Russia is almost half (46%) in mortality from diseases of the circulatory system. Analysis of the age structure of mortality from diseases of the circulatory system in the period from 1991 to 2006. shows a significant increase in mortality in working age.

For 10 months of 2008, mortality from cancer was 203.9 per 100 thousand people (2007 - 202.3, 2006 - 200.9; 2005 - 201.2). The mortality rate of the Russian population aged 0-64 years from cancer is 30% higher than in the “old” EU countries and is on the same level as the “new” EU countries. Oncological diseases in Russia are characterized by a high proportion of deaths during the first year after diagnosis: for example, the percentage of deaths from lung cancer is 56, from stomach cancer - 55. This indicates the late detection of these diseases. Men of working age die from cancer almost 2 times more often than women, but the incidence among women is higher.

In Russia, for 10 months of 2008, mortality from external causes was 166.0 cases per 100 thousand people (in 2007 - 174.8, 2006 - 198.5 cases, in 2005 - 220.7) , which is 4.6 times higher than the indicators of the “old” EU countries (36.3 cases per 100 thousand population) and 2.6 times higher than the indicators of the “new” EU countries (65 cases per 100 thousand people; 2005) . In the vast majority of cases, mortality from external causes is associated with excessive consumption of strong alcoholic beverages.

For 10 months of 2008, mortality due to accidental alcohol poisoning was 13.7 per 100 thousand population (in 2007 - 14.6, 2006 - 23.1, in 2005 - 28.6). Moreover, in 2006, the mortality rate of the population of working age was 29.8 (for men - 48.0, for women - 10.8) per 100 thousand people of working age. For the urban population, mortality in working age was 26.2, for the rural population - 40.0 per 100 thousand people. The mortality rate is significantly higher for men of working age living in rural areas, where it is 62.2 per 100 thousand people (for women 15.1), which is two times higher than the national average.

The Russian Federation ranks first in the world in terms of road accidents, which are often caused by drunk drivers. The mortality rate from all types of transport accidents (mainly road traffic accidents) is 27.4 per 100 thousand population (in 2007 - 27.7, 2006 - 26.8, in 2005 - 28.1) , which is almost 3.3 times higher than in the “old” EU countries (8.4) and 2.2 times higher than in the “new” EU countries (12.6). In 2007, there were 23,851 road accidents involving children (in 2005 - 25,489, in 2006 - 24,930), 1,116 children died (in 2005 - 1,341, in 2006 - 1,276). It should be taken into account that the number of cars per capita in Russia is more than two times less than in EU countries.

In Russia, the suicide rate for 10 months of 2008 was 27.8 cases per 100 thousand people (in 2007 - 28.8, 2006 - 30.1, in 2005 - 32.2), which is 2.9 times higher than in the “old” EU countries (9.9), and 1.9 times higher than in the “new” EU countries (15.5), in 2005.

2.2 Health indicators and main risk factors for morbidity and mortality of the population of the Russian Federation

Over the past 16 years, the morbidity rate of the population of the Russian Federation has been constantly growing, which is associated, on the one hand, with the growing proportion of the elderly population and with more effective detection of diseases using new diagnostic methods, and on the other hand, with the ineffectiveness of the disease prevention and prevention system. In 1990, 158.3 million cases of morbidity in the population were identified, in 2006 - 216.2 million cases, that is, the increase in incidence was 36% (and in terms of 100 thousand population, the incidence was 41.8% ).

It should be noted that from 1990 to 2006. The number of cases of diseases leading to death has increased significantly. For example, the number of cases of diseases of the circulatory system has increased by 2 times, cancer - by 60%. The number of diseases of the musculoskeletal system and connective tissue leading to disability, as well as complications of pregnancy, childbirth and the postpartum period, has doubled. The structure of morbidity is dominated by diseases of the respiratory system (23.6%) and diseases of the circulatory system (13.8%).

The most important indicator of the effectiveness of healthcare in any country is the average life expectancy of people suffering from chronic diseases. In Russia it is 12 years, and in EU countries it is 18-20 years.

Since 1990, there has been a sharp increase in the number of children born sick or falling ill during the neonatal period. In 2000-2006 this figure reached 40% of the total number of children born alive.

Disability in the Russian Federation from 1990 to 2006. does not decrease, including among people of working age, whose share in the total number of persons recognized as disabled for the first time is at least 40%.

There are 14 million people with disabilities in the Russian Federation, including 523 thousand children. This indicates the low quality of medical care and inadequate social rehabilitation. The structure of primary disability in the adult population is dominated by cardiovascular diseases and malignant neoplasms. Among the diseases that cause the development of disability in children, the leading ones are mental disorders, diseases of the nervous system, congenital anomalies and metabolic disorders.

In Russia, there are four main risk factors: high blood pressure, high cholesterol, tobacco smoking and excessive alcohol consumption, the contribution of which in the structure of overall mortality is 87.5%, and in the number of years of life with disability - 58.5%. At the same time, alcohol abuse ranks first in terms of its impact on the number of years of life with loss of ability to work (16.5%). According to expert estimates, relative indicators have changed little over the past 6 years.

Higharterialpressure. High blood pressure, or arterial hypertension, is the main cause of mortality and the second, in terms of the number of years of life with disability, cause of morbidity in the population of the Russian Federation. About 34-46% of men and 32-46% of women (depending on the region) suffer from arterial hypertension, while more than 40% of men and 25% of women are not aware that they have high blood pressure.

Highlevelcholesterol. About 60% of Russian adults have cholesterol levels above the recommended level, with 20% of them having levels so high that they require medical intervention.

Abusealcohol- the most important public health problem in the Russian Federation. From 1990 to 2006, alcohol consumption per capita in the Russian Federation increased by at least 2.5 times. This was mainly due to an increase in beer consumption (in the structure of sales of alcoholic beverages, the share of beer increased from 59% in 1990 to 76% in 2006). Every day in Russia, 33% of boys and 20% of girls, about 70% of men and 47% of women drink alcoholic beverages (including low-alcohol drinks).

Rice. 3 Consumptionalcoholonsoulpopulationatpersonsolder15 years (Vrecalculationoncleanalcohol)

In 2002, alcohol consumption in the country was 14.5; 2.4 and 1.1 liters per year in terms of pure alcohol, respectively, for men, women and adolescents, or on average about 11 liters per year per capita of the adult population (according to Rospotrebnadzor, 18 liters per year per capita of the adult population). Consumption of strong alcoholic drinks in absolute figures in the Russian Federation has not decreased since 1990, although their share in the consumption structure has decreased to 15% due to a sharp increase in beer consumption.

Tobacco smoking. In the Russian Federation, cigarette consumption from 1985 to 2006. increased by 87%, mainly due to an increase in smoking among women and adolescents. Currently, more than 40 million people smoke in the country: 63% of men and 30% of women, 40% of boys and 7% of girls. The proportion of men who smoke in Russia is one of the highest in the world and 2 times higher than in the USA and EU countries. Every year the number of smokers in Russia increases at a rate of 1.5-2%, affecting women and teenagers. The growth rate of smokers in Russia is one of the highest in the world, and over the past three years, the number of cigarettes smoked in the country has increased by 2-5% per year.

Smoking causes an increase in diseases of the circulatory system, leads to chronic lung diseases and provokes many cancers.

Rice. 4 Sharedailysmokingpopulationolder15 years

220 thousand people die annually from diseases associated with tobacco smoking, while 40% of deaths among men from diseases of the circulatory system are associated with smoking. It is noted that higher mortality among male smokers leads to a 1.5-fold decrease in their share among men over 55 years of age.

2.3 Implementation of the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation

The legislation of the Russian Federation establishes the insurance principle of financing medical care. In 1993, in addition to the budgetary healthcare system, a compulsory health insurance (CHI) system was created, as a result, a budgetary insurance model for financing the state healthcare system emerged in Russia.

Since 1998, the Government of the Russian Federation has annually adopted a program of state guarantees for the provision of free medical care to citizens of the Russian Federation, provided at the expense of the budgetary system of the Russian Federation.

Since 2005, the Government of the Russian Federation has annually approved standards for the financial provision of medical care per capita (per capita financial standards).

Expenditures on the provision of free medical care from government sources of financing in 2007 amounted to 897.3 billion rubles. and increased at current prices by 3.8 times compared to 2001. The program was provided in the reporting year at the expense of the federal budget, budgets of the constituent entities of the Russian Federation and local budgets (63.4%) and funds from the compulsory medical insurance system (36.6%).

It is necessary to note the constant decline in the share of compulsory medical insurance in the financial support of the state guarantee program, while insurance of the non-working population was carried out in the absence of uniform principles for the formation of insurance payments, and the remaining sources of formation of the compulsory medical insurance system were of a tax rather than insurance nature. This happened due to an increase in budget funding within the framework of a priority national project in the healthcare sector.

In 2007, the cost of the basic compulsory health insurance program was 328.2 billion rubles. These expenses included items for wages with accruals, medicines, soft equipment, food, and consumables. Subjects of the Russian Federation and municipalities directly provided financial support for the activities of budgetary institutions in the amount of 361.9 billion rubles. At the same time, of the indicated 361.9 billion rubles, 187.2 billion rubles are appropriations that are subject to transfer through the compulsory medical insurance system, since they are carried out under the same items that are included in compulsory medical insurance tariffs. In addition, 111.8 billion rubles were allocated by the constituent entities of the Russian Federation and municipalities to pay for utilities and other services, maintain property, and purchase fixed assets.

An analysis of the financial indicators of the implementation of territorial state guarantee programs in 2007 made it possible to establish their deficit in 60 constituent entities of the Russian Federation, which amounted to 65.4 billion rubles.

The most deficient in 2007 were territorial programs in the constituent entities of the Southern Federal District: Ingushetia (56.4%), Dagestan (51.1%), Chechen (36.1%), Kabardino-Balkarian (36.6%) republics and Stavropol region (30%). A significant deficit in financial support for territorial programs was also established in the Republic of Khakassia (34.5%), Primorsky Territory (30.5%), Tambov (28.9%) and Kurgan regions (28.4%).

At the same time, in 2007, the deficit in financial support for territorial compulsory medical insurance programs was established in 58 constituent entities of the Russian Federation and amounted to 29.2 billion rubles. The most deficient in the year were territorial compulsory health insurance programs in the Chechen Republic (47.8%), the Republic of Ingushetia (47.4%), Aginsky Buryat Autonomous Okrug (42.3%), the Republic of Dagestan (35.3%), Sakhalin (32.3%), 9%), Ulyanovsk (32.2%) and Chita (31.3%) regions.

It should also be noted that in addition to the shortage of territorial state guarantee programs, there is also a significant differentiation in their provision among the constituent entities of the Russian Federation, which leads to differences in the availability and quality of medical care provided.

Thus, the actual per capita standards of territorial state guarantee programs range from 1,723 rubles in the Republic of Ingushetia to 26,918 rubles in the Chukotka Autonomous Okrug, with the average standard for the Russian Federation being 5,150 rubles.

Funds from the compulsory medical insurance system are delivered to medical institutions through private insurance organizations (IIOs), which are in no way interested in improving the quality of medical care for the insured and reducing the costs of providing it.

An additional channel for the receipt of funds in treatment and prevention institutions (HCI) are paid medical services and VHI programs. The presence of these sources, on the one hand, allows healthcare facilities (in conditions of underfunding) to receive additional funds for employee salaries and the current maintenance of healthcare facilities, but, on the other hand (in the absence of strict regulation of these services), leads to a decrease in the availability and quality of medical care for the population, served under the state guarantee program.

The main problems of implementing state guarantees of providing free medical care to citizens of the Russian Federation in the Russian Federation are:

1. insufficient financial support for the rights of citizens of the Russian Federation to free medical care, strong differentiation among the constituent entities of the Russian Federation in terms of the implementation of territorial programs of state guarantees of free medical care;

2. fragmentation of sources of financing of medical care, which does not allow the full implementation of the compulsory health insurance system.

2.4 System of organizing medical care to the population

From the first half of the twentieth century to the present, Russia has been implementing a two-level principle of building a system of medical care for the population, represented by self-sufficient and poorly integrated structures: outpatient, emergency and inpatient.

Currently, medical care is provided to the population of the Russian Federation in 9,620 healthcare institutions, including 5,285 hospitals, 1,152 dispensaries, 2,350 independent outpatient clinics, and 833 independent dental clinics.

Primaryhealthhelp- a set of medical, social and sanitary-hygienic measures that ensure health improvement, prevention of non-infectious and infectious diseases, treatment and rehabilitation of the population. Primary health care represents the first stage of the continuous process of protecting public health, which dictates the need for it to be as close as possible to the place where people live and work. The main principle of its organization is territorial and local.

Despite the developed network of outpatient clinics, the existing primary health care system is not able to meet the needs of the country's population and modern society.

Services providing primary health care remain functionally overloaded and ineffective. It's connected with:

- an inadequately high number of people attached to 1 outpatient site (nominally in large cities - 1800-2500 people per 1 site, in fact - up to 4000 people), which transforms the functions of a doctor into the functions of an operator for issuing prescriptions for drugs within the framework of the complementary drug program provision;

- expanded scope of medical work for acute pathology. The self-liquidation of pre-medical care offices has aggravated the overload of the functions of the medical position.

Taking into account the long waiting time for an appointment, the inconvenient operating hours of state and municipal outpatient healthcare institutions (mainly on weekdays), the availability of primary outpatient medical care for the working population is low. There is a lack of interaction and continuity in the work of individual units of primary health care, which leads to insufficient efficiency of its work as a whole.

Particular attention is required by the fact that shortcomings in the planning and organization of the work of a local doctor, as well as modern principles of remuneration, do not allow primary care to perform the basic, most important function for protecting public health - disease prevention.

Imperfections in the work of outpatient health care, in particular, the lack of a patronage system and ineffective monitoring of patients with chronic pathology, have led to the fact that ambulancemedicalhelp is the most common type of provision of out-of-hospital medical care to the population of the country, taking on part of the functions of the outpatient clinic.

Currently in the Russian Federation ambulancemedicalhelp(hereinafter - EMS) provide 3,268 stations and departments, staffed by general (12,603, 31.4% of the total number of teams), specialized (2,987; 7.5%), paramedic (22,765; 56.8%) teams and intensive care teams (1,741; 4.3%). During 2007, over 48,822 thousand visits to patients were made, while only 9,199 thousand people were hospitalized, that is, only every 5-6th call ended in hospitalization in a hospital.

It should be noted that the immediate cause of death for people of working age in most cases is an emergency condition. At the same time, about 1.8 million people die outside hospitals every year, and every third hospitalized patient in a life-threatening condition is admitted to the hospital with a delay of more than 24 hours, which is due, among other things, to the desire of emergency medical services to treat acute conditions at home.

The following factors hinder the effective use of NSR capabilities:

1. The provision of timely medical care in municipal areas occurs not according to the principle of the closest team, but according to the principle of territorial affiliation.

2. Significant differences in the financial support of the emergency service lead to the inability to create a unified electronic dispatch service and equip emergency service vehicles with a satellite navigation system, as well as to a weakening of control over the technical condition of the equipment supplied for operation.

3. There is an insufficient staffing of EMS teams with qualified personnel, including specialists who have undergone timely retraining, due to the imperfection of the personnel training system for the EMS service at both senior and middle levels. Particularly noteworthy is the reduction in the number of specialized teams and the outflow of experienced medical personnel.

4. There is often inappropriate use of emergency medical services teams (for transporting planned patients).

Thus, the low efficiency of the preventive work of primary health care, the lack of a system of outpatient follow-up care and patronage, as well as the imperfect organization of emergency medical care have led to the fact that stationaryhelp acts as the main level in the public health system. At the same time, in fact, inpatient medical care is necessary only for diseases that require an integrated approach to diagnosis and treatment, the use of complex methods of examination and treatment using modern medical equipment, surgical interventions, constant round-the-clock medical supervision and intensive care.

According to the work of hospitals of municipal, regional and federal subordination, the average annual bed occupancy in 2007 was 318 days, the average length of stay of a patient in a hospital was 13.2 days.

The introduction of hospital-substituting technologies into the activities of outpatient clinics allowed from 2006 to 2007 to increase the number of places in day hospitals by 9% (from 187.7 thousand in 2006 to 206.2 thousand in 2007. ), the provision of places in day hospitals - by 4.3% (from 13.9 to 14.5 per 10 thousand population, respectively) and the level of hospitalization in day hospitals - by 5.5% (from 3.6 to 3.8 per 100 people of the population, respectively; for comparison: in 2003 - 2.6). However, despite this, the level of hospitalization in 24-hour hospitals remains so high (22.5 per 100 population in 2007) that a significant shortage of inpatient beds is created, although the rate of provision of beds per 1 thousand population in the Russian Federation is 12 ,4, i.e. corresponds to the level of such developed countries as Japan (15.4), Holland (14.3), Norway (11.7), and significantly exceeds the levels of other developed countries.

Thus, the volume of hospital beds is sufficient to fully provide the country's population with inpatient care. However, the current organization of inpatient care is not effective, which is manifested by:

- inadequate expansion of bed capacity;

- high rates of unnecessary and non-core hospitalization;

- inadequate increase in the length of stay of the patient in the hospital;

- frequent hospitalization of patients in medical institutions unprepared to provide specialized medical care;

- high frequency of transfers of patients from one medical institution (unprepared or non-core) to another.

Today there is no coherent system of restorative treatment and rehabilitation in the country. In many cases, the patient is discharged from the hospital “under the supervision of a local doctor,” which in reality means “under his own supervision.” At the outpatient clinic level, the patronage service is poorly developed, the “hospital at home” system has not been developed, continuity in treatment between the hospital and the clinic is often not ensured, and rehabilitation measures are not available to patients.

The currently existing departments (offices) for restorative treatment and rehabilitation do not meet modern requirements for equipping with diagnostic and therapeutic equipment. There is an acute shortage of specialized personnel in the rehabilitation service (doctors and exercise therapy instructors, physiotherapists, speech therapists, neuropsychologists, medical psychologists, occupational therapists, social workers, etc.). The necessary regulatory framework for the process of restorative treatment and rehabilitation is completely absent.

Thus, the existing needs of a significant part of the population of the Russian Federation for restorative treatment and rehabilitation are also not met.

2.5 Innovative and staffing support for healthcare development

The level of development of medical science determines the prospects for improving the entire healthcare system. The current state of medical science in the Russian Federation is characterized by blurred priorities, low innovative potential, poor communication with government customers, and a weak system for introducing scientific results into practical healthcare. The development of modern scientific research in the field of medicine is possible only under the condition of an integrated approach based on the involvement of developments in fundamental biomedical, natural and exact sciences, as well as new technological solutions.

In 2007, the healthcare system employed 616.4 thousand doctors and 1,349.3 thousand paramedical personnel (in 2004 - 607.1 thousand and 1,367.6 thousand; in 2006 - 607.7 thousand . and 1,351.2 thousand, respectively). The provision of doctors per 10 thousand population was 43.3 (2004 - 42.4; 2006 - 43.0), nursing staff - 94.9 (2004 - 95.6; 2006 - 95.0 ). The ratio of doctors and nursing staff is 1: 2.2.

Despite the fact that there are more doctors per capita in the Russian Federation than, on average, in developed countries, the quality of medical care and health indicators of the population in our country are much worse, which indicates the low efficiency of the domestic medical care system, insufficient qualifications of doctors and their weak motivation for professional improvement.

In addition, the ratio between the number of doctors and paramedical personnel in our country is significantly lower than in most developed countries of the world, which causes an imbalance in the medical care system and limits the possibilities for the development of aftercare, patronage, and rehabilitation services.

In addition, there is a significant disproportion in the distribution of medical personnel: excessive concentration in inpatient facilities and a shortage in outpatient clinics.

Among the problems in the field of medical personnel management, one should note the low wages of medical workers, egalitarian approaches to the remuneration of medical personnel, low social security and prestige of the medical profession, the inconsistency of federal state educational standards of higher and secondary vocational education with modern healthcare needs and the low quality of teaching, lack systems of continuous medical education (CME), low awareness of medical workers about modern methods of diagnosis and treatment of diseases, poor training of management personnel in healthcare and health insurance, low professional level of medical workers.

2.6 Medicine provision for citizens on an outpatient basis

Currently in the Russian Federation there are three models for providing citizens with medicines: additional medicine provision for preferential categories of citizens as part of the set of social services provided for by Federal Law No. 178-FZ of July 17, 1999 “On State Social Assistance” and medicine provision for certain groups population free of charge or at a discount on doctor's prescriptions in accordance with Decree of the Government of the Russian Federation of July 30, 1994 No. 890, as well as providing expensive medicines to patients with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, myeloid leukemia, multiple sclerosis, as well as after transplantation organs and tissues.

The system of additional drug provision as part of a set of social services has been operating since 2005. Within the framework of this system, medicines are purchased according to the procedures for purchasing goods, works and services for state (municipal) needs.

From 2005 to 2007, purchases were carried out by the Federal Compulsory Medical Insurance Fund at the expense of funds transferred from the federal budget, in 2008 - by government bodies of the constituent entities of the Russian Federation at the expense of subventions transferred to the territorial compulsory health insurance funds, and in 2009 they will be transferred by subventions from the federal budget to the budgets of the constituent entities of the Russian Federation In 2005, 50.8 billion rubles were planned for additional drug provision, actual expenses amounted to 48.3 billion rubles. At the same time, the limited use of financial resources was caused, firstly, by the preservation of the solidarity principle, and secondly, by the adaptation of doctors and patients to the new system of drug provision.

In 2006, there was a legislative refusal of a significant part of beneficiaries from receiving a set of social services, and only citizens who needed to regularly take medications remained in the system of additional drug provision. In addition, the list of medicines has been significantly expanded. Actual expenses amounted to 74.7 billion rubles against the planned 34 billion rubles.

In addition, in 2005 and 2006 there was no unified automated system for recording the prescription and dispensing of medicines, which resulted in a low level of control.

In 2007, the number of citizens who retained the right to additional drug coverage remained virtually unchanged; funds were planned in the amount of 34.9 billion rubles, but expenses decreased by 30 percent and amounted to 50.7 billion rubles. The reduction in costs is due to the establishment of restrictions on the prescription of drugs, as well as the emergence of a centralized automated system.

In 2008, the planned expenses for the implementation of the rights of citizens of preferential categories to additional drug provision amounted to 30.1 billion rubles. At the same time, expensive drugs for the treatment of patients with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, myeloid leukemia, multiple sclerosis, as well as after organ and tissue transplantation were removed from the system of additional drug provision. Funds in the amount of 33 billion rubles were allocated for the purchase of these drugs.

In addition, in 2008, an additional 10 billion rubles were allocated to the constituent entities of the Russian Federation for the implementation of certain powers in the field of drug provision.

In general, the existing system of preferential provision of medicines to citizens on an outpatient basis is subject to change for the following reasons:

- the system does not allow for effective planning and control of the level of costs - the per capita standard for DLO is not based on an analysis of needs, but is formed on the basis of an established monthly cash payment;

- the DLO model using procurement procedures for government needs does not guarantee uninterrupted service of preferential prescriptions of the appropriate assortment;

- the main limiting mechanism is a restrictive list, but its formation is not based on an analysis of clinical and economic effectiveness;

- there are no participants who are economically motivated to spend budget funds efficiently.

2.7 Healthcare informatization

In the Russian Federation, the development and implementation of healthcare informatization programs has been ongoing since 1992. To date, the country has created elements of information and communication infrastructure for the needs of medicine, and has begun the use and dissemination of modern information and communication technologies in the healthcare sector. Medical information and analytical centers, automated information systems of compulsory health insurance funds and medical insurance organizations have been created in the constituent entities of the Russian Federation.

At the same time, the developed information systems, as a rule, are narrowly focused, focused on providing specific functions and tasks. The lack of a unified approach to their development during operation has led to serious problems. As a result, existing information systems represent a complex of disparate automated workstations, rather than a unified information environment.

The level of equipment of the healthcare system with modern information and communication technologies is extremely heterogeneous, and is mainly limited to the use of several computers as autonomous automated workstations.

Another problem in the field of informatization of the healthcare system is the lack of unification of the software and hardware platforms used. Today, there are more than 800 different medical information systems in medical institutions, and a variety of software packages are used for the needs of accounting, human resources and economic departments.

Some institutions, mainly operating and financed from the compulsory health insurance system, are introducing systems that allow them to keep track of the patient population, conduct analysis of activities and compile routine reports. In general, a single information space is not being formed in healthcare institutions, so electronic data exchange between them is difficult.

The only type of software installed almost everywhere in healthcare institutions is the developed programs for recording registers of services provided in the compulsory health insurance system, as well as components of information systems for providing preferential medicines.

To date, a unified approach to organizing the development, implementation and use of information and communication technologies in medical institutions and organizations has not been formed. As a result, the ability to integrate existing software solutions is very limited.

Thus, the current level of informatization of the healthcare system does not allow quickly solving issues of planning and management of the industry to achieve existing targets.

Currently, many countries have begun to implement a program to create a unified information space in the areas of health and social development.

For example, in the UK, the NHS Connecting for Health program is being implemented with a total investment until 2014 of about $25 billion with a population of approximately 60.5 million people. Similar programs are being implemented in all countries of the Organization for Economic Cooperation and Development (30 countries).

In Europe, in addition to national programs, a unified European Union e-health program is being implemented. Primary tasks: standardization, ensuring insurance coverage regardless of location, processing medical information about the patient using information technology (sometimes the term telemedicine is used to describe the last task, but it does not fully reflect the essence of these processes).

The volume of EU investments within the framework of the pan-European e-health program (excluding similar national programs) has already amounted to about? 317 million.

A unified health information system is being created in Canada. Priority areas of work: Electronic health passport, infrastructure, telemedicine, creation of national registers, reference books and classifiers, systems for diagnostic visualization and storage of graphic information. The program budget for the period until 2009 is $1.3 billion with a population of about 39 million people.

A similar comprehensive program is being implemented in the United States. According to this program, it is planned to create a segment of an information system in the field of healthcare within the framework of Electronic Government. Total eHealth investment needs for the next decade: estimated at $21.6-$43.2 billion. The priority areas of work for the current period are: electronic health passport (EHR), national information infrastructure for health, regional health information centers (RHIOs), electronic health data exchange.

According to expert estimates, the full-scale implementation of information technologies in medicine in the United States could lead to savings of up to $77 billion. Similar studies in Germany estimate cost savings from switching to eHealth of up to 30% of existing costs. In particular, does the introduction of electronic prescription technology provide order savings? 200,000,000 per year, reducing costs associated with choosing the wrong treatment method, unnecessary procedures and medications will save about? 500 million annually, detection and prevention of insurance fraud will amount to about? 1 billion per year with a population of about 83 million people.

3. Goals, objectives and main directions of the concept of healthcare development until 2020

Goals

- stopping the decline in the population of the Russian Federation by 2011 and increasing the population to 145 million people by 2020;

- increase in life expectancy of the population to 75 years;

- reduction in the overall mortality rate to 10 (that is, 1.5 times compared to 2007);

- reducing the infant mortality rate to 7.5 per 1000 live births (by 20% compared to 2007);

- reduction in the maternal mortality rate per 100,000 live births to 18.6 (15.7% compared to 2007);

- promoting a healthy lifestyle of the population, including reducing the prevalence of tobacco use to 25% and reducing alcohol consumption to 9 liters per year per capita;

- improving the quality and accessibility of medical care guaranteed to the population of the Russian Federation.

Tasks health development are:

- creating conditions, opportunities and motivation for the population of the Russian Federation to lead a healthy lifestyle;

- transition to a modern system of organizing medical care;

- specification of state guarantees for the provision of free medical care to citizens;

- creation of an effective model for managing financial resources of the state guarantee program;

- improving the provision of medicines to citizens on an outpatient basis within the framework of the compulsory health insurance system;

- improving the qualifications of medical workers and creating a system of motivating them to perform quality work;

- development of medical science and innovations in healthcare;

- healthcare informatization.

4. In accordance with the results of the analysis of the state of healthcare in the Russian Federation, as well as to achieve the set goals, it is proposed EventsBynextdirections:

3.1 Formation of a healthy lifestyle

Preserving and strengthening the health of the population of the Russian Federation is possible only if the priority of health is formed in the system of social and spiritual values ​​of Russian society by creating economic and sociocultural motivation for the population to be healthy and providing the state with legal, economic, organizational and infrastructural conditions for leading a healthy lifestyle.

For formationhealthyimagelife it is necessary to introduce a system of state and public measures to:

1) improvement of medical and hygienic education and upbringing of the population, especially children, adolescents, and young people, through the media and the mandatory implementation of relevant educational programs in preschool, secondary and higher education institutions. Within the framework of this direction, it is necessary to carry out training in hygienic skills in compliance with occupational hygiene rules, work (including study) and rest, diet and structure, timely seeking medical help and other norms of behavior that support health;

2) creating an effective system of measures to combat bad habits (alcohol abuse, smoking, drug addiction, etc.), including educating and informing the population about the consequences of tobacco use and alcohol abuse, promoting the reduction of tobacco and alcohol consumption, regulating and disclosing the composition of tobacco products and alcohol products, and providing full information about the composition on the packaging, protecting non-smokers from exposure to tobacco smoke, limiting the consumption of alcohol in public places, regulating the location of places of sale of alcoholic beverages, tobacco and the procedure for their sale, as well as price and tax measures;

3) creating a system for motivating citizens to lead a healthy lifestyle and participate in preventive measures, primarily through the popularization of a way of life and lifestyle that contributes to the preservation and strengthening of the health of citizens of the Russian Federation, the formation of a fashion for health especially among the younger generation, the introduction of a medical care system healthy and practically healthy citizens; conducting awareness-raising work about the importance and necessity of regular prevention and medical examination of citizens;

4) creating a system for motivating employers to participate in protecting the health of employees by establishing benefits on insurance premiums for compulsory medical and social insurance, stimulating working teams to lead a healthy lifestyle;

5) prevention of risk factors for non-communicable diseases (blood pressure, unhealthy diet, physical inactivity, etc.);

6) creation of a system for motivating heads of school education institutions to participate in health protection and the formation of a healthy lifestyle for schoolchildren.

In order to create a healthy lifestyle, the following tasks will be solved:

- conducting applied scientific and epidemiological research to substantiate the improvement of legislation and methodological base;

- ensuring interdepartmental cooperation and functioning of the coordination mechanism (including organizing the activities of the federal resource center);

...

Similar documents

The main directions of organizing the provision of medical care. Financial, information and legal support for the concept of healthcare development until 2020. Demographic policy of the Russian Federation. Balance of the state of the level of economic development.

presentation, added 09/11/2013


The role of healthcare in the socio-economic sphere, healthcare forecast indicators and the main forecasting methods for this industry. Analysis of the current state of healthcare in Russia and municipalities using the example of the Vladimir region.

course work, added 02/05/2013


Regulatory and legal regulation of healthcare management in the Nizhny Novgorod region. Consideration of the influence of socio-economic factors on population health indicators. Analysis of the healthcare financing system in the Russian Federation.

course work, added 10/18/2013


The state of public health and the organization of medical care in the Republic of Belarus. Problems and shortcomings of the Belarusian healthcare system. The concept of development and improvement of the regulatory framework of the Republic of Belarus in the field of healthcare.

course work, added 01/31/2012


Private financing of health care: theoretical analysis and foreign practice. Assessment of the level of development of private healthcare financing in the modern Russian Federation. Forecasting the share of private financing of medical care.

thesis, added 06/12/2016


Basic models and trends in the development of healthcare in the world. Analysis of the current state and concepts of healthcare development in Russia. Features of the implementation of the Program of State Guarantees for the provision of free medical care to Russian citizens.

course work, added 01/27/2010


State policy of the Russian Federation on the reorganization of the healthcare system, prospects for its development. Structure and profile of industry enterprises. Field of activity of the Ministry of Health and Social Development of the Russian Federation. Types of treatment and preventive institutions.

abstract, added 07/27/2010


The role of the healthcare sector in the Russian Federation. The regulatory framework governing government influence on the healthcare sector in the Russian Federation. Forms and methods of influence of public finance on healthcare in the Russian Federation. Prospects for the development of nursing in Russia.

course work, added 06/14/2012


Formation and development of a modern healthcare system in the Russian Federation. Regulatory framework and main problems in the field of providing medical care to the population. Current state of health indicators in the Republic of Mordovia.

thesis, added 10/11/2013


Features of the health care system in the United States of America: insurance of the nation. Structure of the health care system. Analysis of state medical programs and their financing system. The main problems of American health care reforms.

I. Introduction

In recent years, the health status of the population has deteriorated. The crisis in the activities of medical institutions is approaching the point followed by the collapse of the entire healthcare system.

The amount of healthcare financing from budgets at all levels and from compulsory health insurance does not provide the population with free medical services. At the same time, available financial and material resources are used ineffectively, and disparities in the provision of medical care are increasing. Social tension is growing in the industry. The shadow side of payment for medical services is becoming increasingly widespread.

In this regard, a well-thought-out strategy for health care reform is needed.

II. Main directions of development of the healthcare system

The goal of the Concept for the Development of Healthcare and Medical Science in the Russian Federation (hereinafter referred to as the Concept) is to preserve and improve people's health, as well as reduce direct and indirect losses to society by reducing morbidity and mortality of the population.

The main objectives of the Concept are:

increasing the scope of disease prevention activities;

reducing the time required to restore lost health of the population by introducing modern methods of prevention, diagnosis and treatment into medical practice;

improving the efficiency of resource use in healthcare.

The implementation of the Concept is based on the following principles:

universality, social justice and accessibility of medical care to the population, regardless of the social status of citizens, their income level and place of residence;

preventive focus;

economic efficiency of the functioning of medical institutions;

unity of medical science and practice;

active participation of the population in solving health issues.

In the current conditions, the following become important:

formation of state policy in the field of healthcare and medical science and increasing the responsibility of all government bodies for its implementation;

ensuring the adequacy of financial resources to state guarantees in the healthcare sector, gradually increasing the share of funds allocated to finance healthcare to 6-7 percent of gross domestic product;

development of the non-state sector in healthcare;

improving the legal regulation of activities in the healthcare sector;

development and implementation into practice of advanced forms and methods of organizing state sanitary and epidemiological supervision, hygienic and epidemiological examination, monitoring of human health and the human environment;

implementation of an investment policy that ensures high efficiency of investments - maximum medical, social and economic effect per unit of cost;

increasing the level of qualifications of medical workers, improving the system of their training and retraining;

increasing the social protection of medical workers, including increasing wages;

involving professional medical associations in the implementation of state policy in the field of healthcare and medical science;

improving state regulation in the field of provision of medicines, medical products and medical equipment;

increasing citizens' interest in maintaining and strengthening their health.

III. Improving the organization of medical care

The main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.

Primary health care is the main link in providing medical care to the population.

A special role is given to the development of the institute of general (family) practice doctor. Consultative and diagnostic services should be developed in clinics. On their basis, departments of medical and social rehabilitation and therapy, nursing services, day hospitals, outpatient surgery and medical and social care centers, etc. can be deployed.

Reorganization of inpatient care will reduce the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the diagnostic and treatment process as follows:

intensive treatment - up to 20 percent;

restorative treatment - up to 45 percent;

long-term treatment of patients with chronic diseases - up to 20 percent;

medical and social assistance - up to 15 percent.

Make wider use of day-time forms of hospital stay for patients.

It is necessary to revive interregional and interdistrict specialized medical centers.

To provide high-quality medical care, it is necessary to ensure continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of medical care, as well as between different types of medical institutions, becomes important. This involves creating a higher level of financing and management of health care institutions.

Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.

It is necessary to take effective measures to develop maternal and child health services while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating maternity institutions with the general medical network.

It is necessary to implement comprehensive measures to further develop psychiatric and drug treatment services for the population, combat tuberculosis and sexually transmitted diseases.

Measures to introduce modern technologies in the departments of intensive care, cardiology and cardiac surgery, oncology, diagnosis and treatment of socially significant diseases require state support.

It is necessary to strengthen the emergency medical service, make it more mobile and equipped with modern means for providing emergency medical care and emergency hospitalization of patients.

It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.

It is necessary to take government support measures to improve rehabilitation care, develop sanatorium and resort organizations of the healthcare system, health institutions and organizations.

To improve the quality and accessibility of medical care for the rural population, it is necessary to create diagnostic and treatment complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of treatment, diagnostic and advisory assistance, and create inter-district clinical and diagnostic centers.

It is necessary to integrate departmental medical institutions into the general healthcare system on a unified regulatory and legal basis, taking into account their sectoral characteristics and location.

While the dominant role of state and municipal healthcare continues, the emerging private sector will play an important role. Creating conditions for its development is an essential element of structural changes in healthcare.

It is necessary to ensure that medical organizations, persons engaged in private medical activities, and state and municipal organizations have equal rights to work in the compulsory health insurance system and participate in the implementation of state and municipal target programs. The participation of medical organizations of various forms of ownership in the implementation of state healthcare programs and municipal orders should be carried out on a competitive basis.

State and municipal medical and preventive institutions that perform functions that are not bound by the framework of a unified technology for providing medical care should have broad powers in matters of the use of property and remuneration of personnel.

Decree of the Government of the Russian Federation of November 5, 1997 N 1387
"On measures to stabilize and develop healthcare and medical science in the Russian Federation"

In order to guarantee the rights of citizens of the Russian Federation to health care and medical care, to increase the economic sustainability and efficiency of health care and medical science institutions, the Government of the Russian Federation decides:

1. Approve the Concept for the development of healthcare and medical science in the Russian Federation developed by the Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences (attached).

2. Approve the attached action plan for the implementation of the Concept for the development of healthcare and medical science in the Russian Federation for 1997-1998.

3. The Ministry of Health of the Russian Federation, in agreement with the Ministry of Finance of the Russian Federation, the Ministry of Economy of the Russian Federation and the Federal Compulsory Medical Insurance Fund, before January 1, 1998, develop and submit to the Government of the Russian Federation a program of state guarantees to provide citizens of the Russian Federation with free medical care.

4. The Federal Fund for Compulsory Medical Insurance, the Ministry of Health of the Russian Federation and the Ministry of Finance of the Russian Federation, before December 1, 1997, determine the procedure for distributing targeted budget funds of the Federal Fund for Financial Support of the Subjects of the Russian Federation in 1998 to equalize the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation Federation, based on the funds provided in the federal budget for 1998, and ensure control over the intended use of these funds.

5. The Interdepartmental Commission of the Russian Federation for Cooperation with International Financial and Economic Organizations will continue to coordinate activities on the implementation of investment projects as part of the structural restructuring of the healthcare system in the Russian Federation, financed by loans from international financial and economic organizations.

6. To recommend that executive authorities of the constituent entities of the Russian Federation develop action plans to implement the provisions of the Concept for the Development of Healthcare and Medical Science in the Russian Federation.

Concept
development of healthcare and medical science in the Russian Federation
(approved by resolution

I. Introduction

In recent years, the health status of the population has deteriorated. The crisis in the activities of medical institutions is approaching the point followed by the collapse of the entire healthcare system.

The amount of healthcare financing from budgets at all levels and from compulsory health insurance does not provide the population with free medical services. At the same time, available financial and material resources are used ineffectively, and disparities in the provision of medical care are increasing. Social tension is growing in the industry. The shadow side of payment for medical services is becoming increasingly widespread.

In this regard, a well-thought-out strategy for health care reform is needed.

II. Main directions of development of the healthcare system

The goal of the Concept for the Development of Healthcare and Medical Science in the Russian Federation (hereinafter referred to as the Concept) is to preserve and improve people's health, as well as reduce direct and indirect losses to society by reducing morbidity and mortality of the population.

The main objectives of the Concept are:

increasing the scope of disease prevention activities;

reducing the time required to restore lost health of the population by introducing modern methods of prevention, diagnosis and treatment into medical practice;

improving the efficiency of resource use in healthcare.

The implementation of the Concept is based on the following principles:

universality, social justice and accessibility of medical care to the population, regardless of the social status of citizens, their income level and place of residence;

preventive focus;

economic efficiency of the functioning of medical institutions;

unity of medical science and practice;

active participation of the population in solving health issues.

In the current conditions, the following become important:

formation of state policy in the field of healthcare and medical science and increasing the responsibility of all government bodies for its implementation;

ensuring the adequacy of financial resources to state guarantees in the healthcare sector, gradually increasing the share of funds allocated to finance healthcare to 6-7 percent of gross domestic product;

development of the non-state sector in healthcare;

improving the legal regulation of activities in the healthcare sector;

development and implementation into practice of advanced forms and methods of organizing state sanitary and epidemiological supervision, hygienic and epidemiological examination, monitoring of human health and the human environment;

implementation of an investment policy that ensures high efficiency of investments - maximum medical, social and economic effect per unit of cost;

increasing the level of qualifications of medical workers, improving the system of their training and retraining;

increasing the social protection of medical workers, including increasing wages;

involving professional medical associations in the implementation of state policy in the field of healthcare and medical science;

improving state regulation in the field of provision of medicines, medical products and medical equipment;

increasing citizens' interest in maintaining and strengthening their health.

III. Improving the organization of medical care

The main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.

Primary health care is the main link in providing medical care to the population.

A special role is given to the development of the institute of general (family) practice doctor. Consultative and diagnostic services should be developed in clinics. On their basis, departments of medical and social rehabilitation and therapy, nursing services, day hospitals, outpatient surgery and medical and social care centers, etc. can be deployed.

Reorganization of inpatient care will ensure a reduction in the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the diagnostic and treatment process as follows:

intensive treatment - up to 20 percent;

restorative treatment - up to 45 percent;

long-term treatment of patients with chronic diseases - up to 20 percent;

medical and social assistance - up to 15 percent.

Make wider use of day-time forms of hospital stay for patients.

It is necessary to revive interregional and interdistrict specialized medical centers.

To provide high-quality medical care, it is necessary to ensure continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of medical care, as well as between different types of medical institutions, becomes important. This involves creating a higher level of financing and management of health care institutions.

Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.

It is necessary to take effective measures to develop maternal and child health services while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating maternity institutions with the general medical network.

It is necessary to implement comprehensive measures to further develop psychiatric and drug treatment services for the population, combat tuberculosis and sexually transmitted diseases.

Measures to introduce modern technologies in the departments of intensive care, cardiology and cardiac surgery, oncology, diagnosis and treatment of socially significant diseases require state support.

It is necessary to strengthen the emergency medical service, make it more mobile and equipped with modern means for providing emergency medical care and emergency hospitalization of patients.

It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.

It is necessary to take government support measures to improve rehabilitation care, develop sanatorium and resort organizations of the healthcare system, health institutions and organizations.

To improve the quality and accessibility of medical care for the rural population, it is necessary to create diagnostic and treatment complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of treatment, diagnostic and advisory assistance, and create inter-district clinical and diagnostic centers.

It is necessary to integrate departmental medical institutions into the general healthcare system on a unified regulatory and legal basis, taking into account their sectoral characteristics and location.

While the dominant role of state and municipal healthcare continues, the emerging private sector will play an important role. Creating conditions for its development is an essential element of structural changes in healthcare.

It is necessary to ensure that medical organizations, persons engaged in private medical activities, and state and municipal organizations have equal rights to work in the compulsory health insurance system and participate in the implementation of state and municipal target programs. The participation of medical organizations of various forms of ownership in the implementation of state healthcare programs and municipal orders should be carried out on a competitive basis.

State and municipal medical and preventive institutions that perform functions that are not bound by the framework of a unified technology for providing medical care should have broad powers in matters of the use of property and remuneration of personnel.

IV. Improving the health care financing system

Improving the healthcare financing system implies a close dependence of the amount of funding for medical institutions on the volume and quality of services they provide.

The financing system should ensure increased efficiency in the use of resources and the quality of medical care.

For these purposes it is necessary:

develop legal mechanisms to ensure unconditional compliance with the volumes and conditions of compulsory health insurance for the population and financial support;

establish a procedure for the distribution of federal budget funds allocated to equalize the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation;

improve methods for setting tariffs for medical services;

introduce a unified system of payments for the provision of medical care provided within the framework of the state guarantee program to provide citizens of the Russian Federation with free medical care;

determine mechanisms for financial coverage of part of the costs of providing medical care to citizens based on the development of voluntary health insurance;

contribute to the creation of a competitive environment in the medical services market.

The existing procedure for compulsory health insurance needs to be improved. There are two possible financing schemes for medical organizations in the compulsory health insurance system:

financing through medical insurance organizations providing compulsory medical insurance;

financing of medical organizations by branches of territorial compulsory health insurance funds.

The use of the second scheme is advisable for rural areas and areas with low population density, where the activities of insurance organizations and their competition with each other are objectively difficult.

To ensure targeted and effective use of funds allocated by the state for healthcare, it is necessary:

supplement the current legislation on health care with norms that ensure stricter control over their expenditure, as well as over the financial and economic activities of health care institutions and organizations;

improving the system for recording funds received by healthcare institutions, including for the provision of paid medical services, as well as their use;

improvement of the competitive procurement system for medicines, medical products and medical equipment, widespread use of financial leasing to equip healthcare institutions with medical equipment;

increasing the responsibility of compulsory health insurance funds for the results of their activities;

executive authorities and local governments, compulsory health insurance funds, medical insurance organizations, medical institutions must publish annual reports on the expenditure of compulsory health insurance funds and budget funds.

In 1998, in order to equalize the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation, it is proposed to establish the distribution of insurance premiums in the following ratio: Federal Compulsory Medical Insurance Fund - 0.5 percent, territorial compulsory medical insurance funds - 3.4 percent or 2 percent of the fund wages if citizens' incomes are respectively more or less than 60 million rubles per year.

In the future, it is planned to combine funds allocated for social and compulsory health insurance to ensure their more efficient use within the framework of a unified system of compulsory medical and social insurance.

V. Healthcare organization

In order to improve the provision of medical care, it is necessary to adopt, as a matter of priority, federal laws on state, municipal and private healthcare. This will ensure the implementation of state health policy at a modern level.

To implement a unified state policy in the field of healthcare, the management structure of the industry should be modernized.

The main tasks of healthcare organization at the federal level should be considered:

determining the strategy for the development of healthcare in the country;

development and implementation of federal targeted health care programs;

development of the legislative, regulatory and methodological framework for healthcare;

coordination of the activities of government authorities to address health issues;

development of mechanisms for the control and licensing system in the field of circulation of medicines.

At the level of the constituent entity of the Russian Federation, the main objectives of the healthcare organization should be:

development of healthcare taking into account regional characteristics;

development and implementation of territorial target health care programs and state guarantee programs to provide citizens with free medical care on the territory of the constituent entities of the Russian Federation.

The main task of organizing healthcare at the municipal level should be considered the formation and implementation of municipal healthcare programs.

The main direction of improving the healthcare organization is to ensure its integrity through unified approaches to planning, regulation, standardization, licensing and certification. At the same time, the system of compulsory health insurance as the basis for financing medical care within the framework of state guarantees should have a positive impact.

The basis for planning will be federal health care development programs that implement the goals and objectives of state policy for a certain period and include:

federal target programs for healthcare development;

state guarantee programs to provide citizens of the Russian Federation with free medical care.

These federal programs must be approved simultaneously with the allocation of appropriate financial resources for their implementation.

To ensure a unified (basic) level of state guarantees in healthcare, medical and social standards must be approved at the federal level, including:

main indicators of the provision of the population with hospital and outpatient clinics, as well as doctors and paramedical personnel;

standards for per capita financing of health care.

In addition, methods for calculating standards for providing healthcare institutions with material, labor and financial resources are approved at the federal level.

Health care programs of the constituent entities of the Russian Federation include programs of state guarantees to provide citizens with free medical care, which must define:

health indicators that should be achieved as a result of improving the health care system;

volumes of financing from the health care budget and compulsory health insurance, ensuring the implementation of state guarantees;

general principles of financing and performance indicators of health care institutions;

measures to improve the efficiency of health care institutions;

main directions of preventive activities.

In the constituent entities of the Russian Federation, cost standards for outpatient and inpatient treatment must be approved. Based on these standards and morbidity indicators, the structure of medical care to the population is determined.

Health care programs of the constituent entities of the Russian Federation serve as the basis for the formation of municipal programs containing indicators of the volume of activities of health care institutions and their financing at the municipal level.

Executive authorities at all levels monitor the implementation of relevant programs, which will increase the efficiency of the healthcare organization.

In order to more rationally use financial and material resources in healthcare, it is necessary to establish that the largest investment projects for which budget funds are allocated are subject to mandatory examination by the Ministry of Health of the Russian Federation.

In conditions of insufficient healthcare funding, duplication of work of public sector medical institutions, especially departmental healthcare institutions, should be eliminated. It is necessary to attract departmental medical institutions to implement the state guarantee program, which will allow for the effective use of financial and material resources, implement the principle of equal treatment of the state towards all citizens, regardless of their place of work, and reduce the financial burden on departmental budgets. Individual departmental healthcare institutions should be transferred to the ownership of the constituent entities of the Russian Federation or to municipal ownership.

The priorities of international cooperation are the expansion and deepening of cooperation with the CIS member states, support of compatriots abroad (primarily on issues of providing medical care) both at the intergovernmental level and through the provision of humanitarian assistance.

To ensure gradual integration into the world community on an equal basis, it is necessary to continue cooperation with international health organizations in the following areas:

protection of national interests in the implementation of international projects in the field of healthcare and health protection;

expanding participation in such international projects;

participation in medical assistance programs for citizens of individual countries;

adaptation of international criteria for the classification of diseases and standards of medical care for the Russian Federation;

international examination of Russian bills in the field of protecting the health of citizens;

study and application of international experience in legal regulation in the field of healthcare;

expanding the scope of medical care to Russian citizens abroad and foreign citizens in Russia.

VI. Ensuring sanitary and epidemiological well-being

The development and improvement of the state sanitary and epidemiological service of the Russian Federation (hereinafter referred to as the service) is the most important condition for improving the health of the country's population.

Ensuring the effective functioning of the service consists of developing and implementing a state program for its development, which provides for bringing the organizational structure, management, resource and scientific support of the service, and the organization of its activities in accordance with the tasks and functions.

It is necessary to continue the reorganization of the structure of service institutions in accordance with the previously approved concept of restructuring the centers of state sanitary and epidemiological surveillance by creating departments (departments) for studying the influence of environmental factors on health, departments of hygienic education and education of the population.

It is necessary to provide:

a clear delineation of the functions of state sanitary and epidemiological supervision and sanitary and epidemiological activities between service organizations and medical institutions;

protection of the territory of the Russian Federation from the importation and spread of especially dangerous infectious diseases of people, animals and plants, as well as toxic substances;

introduction of new scientific developments;

strengthening interaction with other control and supervisory authorities;

improving the economic mechanism of activity and developing criteria for regulatory financing of institutions;

improving the legislative framework in the field of state sanitary and epidemiological surveillance, strengthening the organizational and legal status of the service;

reorganization of the system of hygienic education and training of the population, formation of a system of self-healing of the population.

VII. State guarantees for the provision of free
medical care and protection of patients' rights

State guarantees for the provision of free medical care must be provided from the corresponding budgets, payments for compulsory health insurance and other revenues. To do this, it is necessary to adopt a program of state guarantees to provide citizens of the Russian Federation with free medical care, which should contain:

a list of appropriate types of medical care;

volumes of medical care;

a basic compulsory health insurance program as an integral part of the state guarantee program;

per capita standard for healthcare financing, ensuring the provision of guaranteed volumes of medical care.

In order to ensure the rights of citizens to health care, the adoption of a law on the rights of patients is required.

VIII. Development of medical science

The main objectives of medical science should be:

formation of a strategy for preserving and strengthening the health of the population, development of the scientific basis for combating the most common diseases;

obtaining, on the basis of fundamental research, new and deepening existing knowledge about the healthy and sick human body, its vital functions and adaptation to environmental conditions;

development of new methods for the prevention, diagnosis and treatment of diseases, restoration of lost health, increasing the duration of a person’s active life;

development of new schemes for organizing medical care and healthcare management.

The development of medical science will be carried out on the basis of the following principles:

concentration of scientific and technical potential and resources in priority areas of medical science;

increasing the role of program-target planning, improving the quality of examination of scientific research, ethical control over its conduct;

budgetary funding of fundamental and applied research on a competitive basis;

state support for scientific teams making a great contribution to the development of domestic and world medical science, the use of extra-budgetary sources of funding (international projects, foundations, etc.);

development of regional scientific and practical units, development of programs and research;

expanding links between science, technology and production;

legislative consolidation of legal mechanisms for the development of medical science;

development of scientific and technical entrepreneurship, creation of small innovative enterprises and pilot production;

protection of intellectual property rights of researchers on the results of scientific activities.

Budgetary financing of scientific developments should be carried out on the basis of competitive allocation of grants, creating interdepartmental competition commissions for this purpose. To carry out theoretical and practical developments, it is necessary to use a multi-channel financing system with the involvement of extra-budgetary sources.

Particular attention must be paid to research and development work, which requires government support aimed at financing research that will ensure import substitution and will contribute to the development of the domestic medical industry.

The Russian Academy of Medical Sciences will carry out the functions of identifying and developing the most important areas of fundamental and applied research, their organization and coordination in the Russian Federation, training highly qualified scientific personnel, and also participate in the development and implementation of scientific sections of federal and other programs.

The Ministry of Health of the Russian Federation must determine priorities in applied scientific developments and coordinate federal programs in terms of scientific support for human health protection and state sanitary and epidemiological surveillance.

The Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences must jointly carry out a comprehensive examination of federal and other scientific programs, present their recommendations for the implementation of the achievements of medical science in practice and effective use.

The Ministry of Health of the Russian Federation, together with the Ministry of Science and Technology of the Russian Federation and with the participation of the Russian Academy of Medical Sciences, will coordinate the interaction of state executive authorities and local governments with research institutes, institutions and organizations of the medical and biological profile, develop and implement a system of measures to strengthening international relations in order to solve pressing problems of domestic science.

IX. Improving medical education and personnel policy

Personnel policy issues must be resolved taking into account the changes occurring in all areas of healthcare. It is necessary to develop a program for reforming the medical education system, which provides for a reduction in the training of medical workers in traditional specialties and a revision of the structure of specialist training. It is necessary to improve the system of planning, forecasting and monitoring the training of healthcare professionals, including in such new areas as general practitioner, clinical pharmacologist, medical psychologist, nurse with higher education, social work specialist, healthcare economist, healthcare manager.

It is necessary to improve the system of final state certification of graduates of medical and pharmaceutical educational institutions, as well as the certification of healthcare professionals.

In international relations in the field of personnel training one should:

restore professional medical ties with the CIS member states;

develop work on the conclusion of international agreements of the Russian Federation on the mutual recognition of medical diplomas and other documents on professional training, as well as the internship of specialists, the training of doctors and nurses abroad on the principle of exchange.

The system of planning and distribution of human resources is subject to reorganization, which should change the ratio of doctor to mid-level medical worker in the direction of increasing the number of the latter.

The practice of forming targeted orders for the training of specialists by health authorities should be extended, with them concluding relevant agreements with educational institutions and applicants.

In order to include medical workers in health care reform efforts, it is necessary to:

improve the system of remuneration for healthcare workers, taking into account harmful working conditions, complexity, volume and quality of medical and preventive work;

establish and index the wages of healthcare workers at levels not lower than the subsistence level;

regularly review tariffs for medical services on the basis of tariff agreements with professional medical associations;

expand the list of categories of health care workers, regardless of the departmental affiliation of the institutions in which they work, who have the right to a pension for long service, working with a special risk to their health.

In the field of ensuring labor protection for medical workers, it is necessary:

develop regulatory documents on occupational safety in healthcare institutions;

organize training on labor protection issues for managers of government bodies and healthcare institutions, students of medical educational institutions;

pursue a unified policy on establishing compensation and benefits for special working conditions of medical workers.

X. Improving drug supply, guarantees in the field of drug assistance to the population

The state policy of providing the population with medicines and medical products is aimed at providing them to consumers in a sufficient quality range and volume at affordable prices.

This policy should be implemented through the development of the pharmaceutical services market.

In order to ensure the safe use of medicines and medical products, it is necessary to improve the existing control and licensing system of examination, standardization and state control both at the federal level and at the level of constituent entities of the Russian Federation.

The main direction of implementation of state policy in the field of drug assistance to citizens should be the provision of drugs, including preferential ones, to the population when providing medical care within the framework of state guarantee programs.

At the outpatient treatment stage:

formation, within the framework of state and municipal orders, of lists of medicines and medical products for preferential provision of citizens;

formation, within the framework of state and municipal orders, of lists and volumes of medicines and medical products for the treatment of socially significant diseases.

At the stage of inpatient treatment - free drug provision within the types, volumes and conditions of medical care provided for in state guarantee programs.

In order to effectively spend public funds allocated for preferential provision of citizens with medicines and medical products, it is planned to develop and implement a system for accounting and control of these funds, creating conditions that ensure the interest of citizens in the rational use of drug benefits.

In the field of wholesale purchases and retail sales of medicines, you should:

carry out these purchases and sales on a competitive basis and ensure transparency in the selection of wholesale suppliers of medicines;

ensure the safety, effectiveness and quality of medicines through selection, standardization and monitoring of compliance with standards;

ensure the availability of a wide range of medicines in retail sales, in the stationary network - under state guarantee programs.

In order to ensure accessibility and adequacy of drug care, the population needs to:

improve the mechanisms of state regulation of drug provision;

provide state support for domestic drug manufacturers;

improve the organization of drug supply and management of pharmaceutical activities.

XII. Mechanisms and stages of implementation of the Concept

To ensure consistency in the implementation of the provisions of the Concept, work on its implementation will be carried out in 2 stages.

Stage I (1997-2000)

Implementation of the activities outlined in the program of the Government of the Russian Federation "Structural adjustment and economic growth in 1997-2000".

Taking measures to ensure the stable operation of healthcare institutions, increasing the amount of funding for the industry and increasing the efficiency of use of resources in healthcare.

For these purposes, the provision of medical care to the population, starting from 1998, will be carried out within the framework of state guarantee programs to provide free medical care. At the same time, the amount of financial resources allocated for the implementation of these programs must correspond to the state guarantees provided for in them.

Implementation of structural reforms in the industry during 1997-1999. Carrying out the restructuring of inpatient care with the simultaneous development of outpatient clinics and the creation of day hospitals and hospitals at home. An important area of ​​this work will be the introduction of the institute of general medical practice.

The introduction in 1998 of standardization of medical services, regulation of the provision of hospitals and clinics with medicines, medical products and medical equipment.

Completion by 1999 of work to reorganize and eliminate duplication in the activities of federal health care institutions, including departmental ones.

Development and approval in 1997-1998 of federal target programs to combat tuberculosis and sexually transmitted diseases, to develop cancer care for the population, and to prevent and treat cardiovascular diseases.

The implementation of state anti-alcohol measures, the development and subsequent implementation of a federal targeted program to combat smoking will help reduce morbidity and mortality in the population.

Stage II (2001-2005)

Implementation of federal target programs for the development of healthcare, the implementation of which will create the basis for the introduction into healthcare practice of effective methods of prevention, diagnosis and treatment of diseases and provide the population with accessible qualified and specialized medical care.

Completion of work on structural restructuring of the industry. As a result, a private sector should be formed in healthcare. In the primary health care system, the main role will be assigned to general practitioners. Interdistrict and interregional clinical centers for specialized medical care will be greatly developed. Mobile forms of providing medical care to the population in rural areas will be actively introduced.

Formation of a unified information system for health monitoring, creation of telecommunication links between clinical centers and general (family) doctors to advise patients and improve the professional knowledge of medical workers.

Plan
activities to implement the Development Concept
health and medical science
in the Russian Federation for 1997-1998
(approved by Decree of the Government of the Russian Federation of November 5, 1997 N 1387)

Ensuring the draft federal January 1998 Ministry of Health of the state law "On the rights of Russia guarantees for the patient" Ministry of Labor of Russia health protection Ministry of Finance of Russia of citizens and the Federal Medical Fund assistance with the mandatory determination of medical types, volumes and insurance conditions of its Ministry of Justice of Russia receiving a draft resolution January 1998 Ministry of Health of the Government of Russia of the Russian Federation Ministry of Economy "On the approval of the Russian federal Ministry of Finance of Russia of the program of the Ministry of Labor of Russia of state Federal guarantees for the fund for providing citizens of the Russian Federation with compulsory medical insurance with free medical care Ministry of Justice of Russia and the procedure for its implementation" Measures to support the draft resolution February Ministry of Health of the Federal Government 1998 Russian institutions of the Russian Federation Ministry of Science of Health and "On the development of Russian medical federal Russian scientific centers of medical scientific-academy of medical research Qing sciences institutions" Ministry of Economy of Russia Ministry of Finance of Russia draft resolution December Ministry of Economy of the Government of Russia Russian Federation Ministry of Finance of Russia "On the use of the Ministry of Health of international Russia loans, credits, Ministry of Foreign Economic Relations of Russia debt obligations of foreign states for the purchase of medicines and medical equipment within the framework of state needs" Measures to strengthen projects to combat socially significant diseases of the Russian Federation of the Government of the Russian Federation on the approval of December Ministry of Health federal target programs for 1997 of Russia: Ministry of Economy "Urgent measures for Russia to combat tuberculosis Ministry of Finance of Russia" Russian Academy of Medical Sciences Ministry of Internal Affairs of Russia Ministry of Agriculture and Food of Russia "On measures to develop March 1998 Ministry of Health of Oncology of Russia assistance to the population Ministry of Economy of the Russian Federation of the Russian Federation" Ministry of Finance of Russia Russian Academy of Medical Sciences "About measures for June 1998, the Ministry of Health of Russia to prevent further Ministry of Internal Affairs of Russia of the spread of the Ministry of Economics of Russia of sexually transmitted diseases Ministry of Finance of Russia by "Russian Academy of Medical Sciences" Prevention and November 1998 Ministry of Health treatment of arterial hypertension Russia" Ministry of Economy of Russia Ministry of Finance of Russia Russian Academy of Medicine Qing sciences Measures on normative January 1998 Ministry of Health structural methodological acts on the restructuring of organizations in Russia, Ministry of Labor of Russia in the field of equipment, Federal use of the hospital fund for compulsory intensive medical treatment, insurance for rehabilitation treatment of chronic patients, organization of medical and social units Measures to improve normative and legal economic acts on: efficiency of standardization May Ministry of Health of the medical services industry 1998 Russia Gosstandart of Russia Federal Compulsory Medical Insurance Fund for material and technical support of the Ministry of Health 1998 of Russia, including the Ministry of Economy, including provision of Russia with equipment and medical equipment Federal Medical and Prophylactic Institutions compulsory, regardless of departmental medical insurance, affiliation of procurement organizations December Ministry of Health expensive 1997 Russian medical Ministry of Economics equipment and Russia vital Ministry of Finance of Russia medicines Division of the agreement on the division of powers in the years of Russia in the years of Russia in the sphere Ministry of Justice of Russia Healthcare Ministry of Finance of Russia between bodies between the Government Federal administration of the Russian Federation health care fund and subjects of the Russian compulsory various levels of the Russian Federation of Medical Insurance Streamlining the draft resolution May Ministry of Health of the Government of Russia in 1998 of departmental Russian Ministry of Economy institutions of the Federation "On Russian health care and the participation of the Ministry of Finance of Russia of institutions departmental Federal Ministry of Health of Russia institutions health care fund in compulsory programs medical insurance, medical insurance Ministry of Justice of Russia" other interested federal executive authorities