Healthcare in Russia. Model of public health care in Russia Model of public health care in Russia
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Concept in the Russian healthcare system
LEARNING OBJECTIVES Students must “KNOW”;
the concept of healthcare system and policy in Russia;
leadership and management of nursing in the Russian Federation;
types of healthcare facilities;
job responsibilities of nursing staff in the clinic, admission and treatment departments of the hospital;
types of medical documentation Health care facility.
QUESTIONS FOR SELF-PREPARATION
The concept of the healthcare system, its goals and objectives.
Characteristics of three areas in healthcare in the Russian Federation.
Changes in social, political and economic life have led to the emergence of the issue of nursing reform in Russia.
The main activities of paramedical personnel in Russia.
Conditions necessary for the implementation of the reform.
State structures dealing with nursing issues in Russia.
Health care facilities, their functions, job descriptions of average medical workers in various types of health care facilities.
8. The concept of medical documentation, its types, sang, requirements for maintaining medical records
THEORETICAL PART
HEALTH CARE SYSTEM is a set of interrelated activities that promote health and are carried out in homes, schools, workplaces, communities, physical and psychosocial environments, and in the health and related sectors (Primary Health Care Journal) "Moscow, 1989)
The purpose of the health system is a continuous, ongoing process of improving the health of the population.
The issue of achieving health for all by the year 2000 was the focus of the International Conference on Primary Health Care, held in September 1978 in Almaty, where a declaration was adopted, which indicated the need for immediate action on the part of all governments, all workers in the field of health and development and the entire world community in order to protect and strengthen the health of all peoples of the world.
However, the decisions of the Alma-Ata Conference have not yet been fully implemented.
The goal of improving the health of the population requires every government to develop a national health policy.
There is now a shift from public to private healthcare across the world. There is much debate as to whether this transition improves the quality of health care services.
In this regard, in Russia there are three areas in the healthcare system:
state medicine
insurance medicine
private (commercial)
Their main difference lies in the financing mechanisms.
State system- financed from the state budget. And our government, taking into account the peculiarities of the development of the country’s economy, strives, with all the diversity of forms of ownership, to preserve the state health care system in healthcare and provide state guarantees in the implementation of the constitutional rights of citizens to free medical care.
The system is also developing medical system howv ania.
The compulsory health insurance system is financed at the expense of the insurer. Its role can be played by enterprises, organizations and individuals. The compulsory health insurance program includes the conditions under which a case is recognized as insurable, a list of medical institutions providing services to insurers, as well as categories of the population to whom services will be provided free of charge.
And a very young industry - private or commercial medicine, the financing of which is based on economic calculation and self-sufficiency. But so far this level of medical care is available only to a small contingent of our country’s population.
Today in the world, and especially in Russia, rapid changes are taking place in social, economic and political life. This:
deterioration in the quality of health care and education services,
increase in the number of poor;
rising unemployment;
Access to health services is becoming increasingly limited;
significant migration across borders for both economic and political reasons, an increase in the number of refugees, -
environmental degradation;
changes in demography and epidemiology: an increase in the number of elderly people, an increase in the number of chronic diseases and illnesses, accidents and suicides, the return of old epidemic diseases (tuberculosis, cholera, diphtheria, plague)
Continuous increase in crime and violence, leading to increased feelings of insecurity and isolation.
These changes have led to a significant deterioration in the health of the population of the entire planet and our country in particular; medical care of the population has moved to a lower level.
In the context of decentralization of the healthcare system, the development of market relations and the transition to budgetary insurance medicine, it has become obvious that the quality and safety of medical care, as well as the effectiveness of services provided to the population, largely depend on the organization and management system of medical care.
Based on the factors listed above, we can conclude that the issue of healthcare reform has long been overdue in Russia.
Based on the experience of many countries, it can be argued that healthcare reform, first of all, begins with nursing reform.
Nurse profession- one of the most widespread in healthcare. In Russia, there are about 1.5 million health workers with specialized secondary education; they make up a third of any healthcare facility and play an important role in the treatment process, to a large extent determining the final result - the patient’s health.
Prior to 1993, there was a trend in nursing toward simplification, downskilling among health care workers, where nursing was viewed as a long list of assembly line activities, and nurses were trained to perform specific tasks that did not require high professional skill. This direction was supported by arguments about the low cost of such training. The doctor has traditionally been considered the leader of the nurse's activities, often without mastering either the basics or subtleties of this profession.
The system, when the doctor was responsible for the activities of the nurse, the nurse was responsible for the activities of the junior medical staff, and when sometimes this work took up most of the main working time, was not only outdated, but also hampered the development of the professionalism of the nurse and the introduction of the latest technologies.
Currently, there are trends in nursing leading to professionalization and specialization. In light of the State Program for the Development of Nursing in the Russian Federation, adopted at the 1st All-Russian Congress of Nursing Professionals in St. Petersburg in November 1998, the main areas of activity of nursing staff in Russia are as follows:
primary health care with an emphasis on preventive activities;
diagnostic and treatment assistance, including provision of intensive inpatient treatment and care;
rehabilitation assistance and medical and social assistance to chronically ill people, the elderly and the disabled;
medical and social assistance to incurably ill and dying people.
For the successful implementation of the planned directions, a system of interaction and cooperation between nursing staff and doctors, other specialists and services must be clearly thought out and ensured.
Modern conditions require the training of nurses with knowledge in the field of management, economics, legislation and law, psychology and pedagogy. They must be able to:
plan your care work and the work of your team,
rational use of material resources,
actively participate in training the patient and his family, nursing staff in carrying out prevention and rehabilitation measures.
The areas of activity of paramedical personnel are determined four levels of nursing activity:
Improving public health.
Prevention of diseases and injuries.
Rehabilitation of lost or impaired body functions.
Relief of suffering.
According to these levels, the nurse works not only with sick people, but also with healthy people.
STATE ORGANIZATIONAL STRUCTURES,
THOSE INVOLVED IN NURSING ISSUES
All issues related to nursing are supervised by the Ministry of Health of the Russian Federation.
Regulatory and legislative acts approved by the Ministry of Health of the Russian Federation are distributed to regional and city health departments. The city and regional health departments have freelance employees (chief nurse of the region and chief nurse of the city) who deal with nursing issues.
The city health department supervises the work of chief doctors and chief nurses of hospitals and clinics. The work of the chief nurses of the hospital is monitored by the chief doctors of hospitals and clinics. The chief nurses of hospitals and the chief nurses of clinics are in charge of the work of all senior nurses and nurses of the departments, to whom the middle and junior medical staff of the department of the hospital or clinic are subordinate.
Now in many cities of Russia, associations of nurses are being created, which are organizations designed to protect the rights of nursing staff and improve the working and living conditions of nurses. The Interregional Association of Nurses, officially registered in 1994, has 19 thousand members, representing 63 territories of Russia. The Russian Nurses Association is an independent, non-governmental professional organization of nurses. The goals and objectives of the Association are as follows:
increasing the role of specialists with secondary education in the healthcare system;
increasing the prestige of the profession;
improving the level and quality of nursing services;
revival of the traditions of nursing and medical ethics;
ensuring the socio-economic and professional interests of nurses, midwives, paramedics;
influence on the formation of the national healthcare concept;
development and implementation of Federal standards of professional activity and a quality control system for the work of nurses;
holding seminars, conferences;
strengthening ties between regional and specialized Associations of Russia.
But these organizations do not have the right to legislatively resolve issues relating to nursing personnel,
TYPES OF HEALTH CARE
Health care facilities are organizations designed to provide medical care to the population. They are different in their tasks, functions, volume and content of work of nursing staff.
HOSPITALS (hospitals) are medical institutions where they provide care for patients in need of constant monitoring, using treatment methods that are difficult to implement at home or in a clinic (dynamic monitoring of the patient’s condition, surgical interventions, emergency medical care).
There are single-profile and multi-profile hospitals. Multidisciplinary hospitals provide care to patients with various diseases (therapy, surgery, gynecology, pediatrics, and so on), while single-profile hospitals are designed to treat patients with a single disease (for example, an oncology hospital).
Hospitals include: reception, treatment, diagnostic departments, laboratory, pharmacy, and so on.
Reception department
The reception department includes:
Waiting hall
nurse's office
examination rooms (for patient examination by doctors)
treatment room
dressing room or small operating room
insulator
sanitary inspection room (bath, changing room)
bathroom
laboratory
x-ray room
Reception department functions:
reception and registration of patients
examination and initial examination of patients with a presumptive diagnosis
provision of emergency and qualified medical care
sanitary and hygienic treatment of admitted patients
transportation of patients to medical departments
Job descriptions of a nurse in the emergency department:
filling out medical documentation
fulfilling doctor's orders
calling specialists for consultation
patient sanitization
emergency medical care
control of the work of junior med. personnel
Medical department
The medical department includes:
patient rooms
treatment room
resident (for doctors)
manager's office department
head nurse's office
room for a guard (ward) nurse
manipulation (enema)
Linen room (for storing clean bed and underwear)
-dining room for meals
pantry for serving food
rank room (toilet, bath, shower) for patients
rooms for treatment and diagnostic services (ECG, FGDS)
Functions of the medical department:
emergency medical care
disease diagnosis
Carrying out treatment that is not possible on an outpatient basis
Job descriptions of a guard (ward) nurse: (depending on the profile of the department)
follow all doctor's orders
maintain medical records
Supervise the work of the junior medical officer. personnel
collect biological material for research (feces, urine, sputum)
monitor compliance with the sanitary epidemiological regime in the department
measure body temperature and record data on a temperature sheet
monitor the condition of patients and report it to the doctor
determine water balance, blood pressure, Ps
Job descriptions of a treatment room nurse:
comply with internal regulations, labor discipline, aseptic and antiseptic rules
maintain necessary medical documentation
carry out injections (intravenous, intramuscular, subcutaneous), as prescribed by a doctor
ensure the serviceability of equipment and tools
receive the necessary medications and dressings on time
supervise the work of junior medical staff
POLYCLINIC is a multidisciplinary health care facility providing specialized care to the population on an outpatient basis and at home.
Polyclinics operate on a local-territorial principle, that is, the local doctor and nurse are assigned a territory with a certain number of population, where they must carry out all therapeutic and preventive measures, as well as conduct sanitary educational work among the population.
The clinic includes specialists' offices (cardiologists, endocrinologists, ophthalmologists, etc.), diagnostic rooms, a treatment room, and a laboratory.
Job descriptions of a clinic nurse:
maintain the necessary medical documentation
carry out doctor’s orders at the patient’s home and in the clinic
instruct patients on preparation for various examination methods
Assist the doctor when seeing patients
OUTPATIENT - a health care facility located in a rural area, where
Medical care is provided to patients on an outpatient basis and at home. The responsibilities of medical staff are the same as those of clinic workers. The difference lies in fewer workers and more limited diagnostic capabilities and scope of medical care.
DISPENSERS are medical institutions designed to provide specialized care to patients with certain diseases (dermatological and venereal diseases, oncology, and so on). The task of the medical staff of dispensaries is to identify, record and register patients among the population, provide specialized care, study the causes and conditions of the occurrence of diseases, preventive measures, as well as health education, work among the population.
MED.-SAN.CHAST - unites a number of health care facilities designed to provide medical care and medical services to workers and employees of large enterprises and organizations.
The medical unit includes: a clinic, a hospital, a dispensary, a dispensary, etc. Their functions and the activities of medical personnel in these institutions were discussed earlier. A special feature of the work of medical personnel is that preventive examinations of workers are systematically carried out here, specific working conditions and occupational conditions are studied. hazards, a set of preventive measures is being developed to improve the working and living conditions of the enterprise’s employees.
EMERGENCY MEDICAL AID STATIONS are medical institutions and are designed to provide emergency medical care to patients with life-threatening conditions and childbirth around the clock, as well as transport patients to medical institutions. In these institutions, nurses can only perform the duties of dispatchers, receiving calls from patients and transferring them to ambulance teams.
WOMEN'S CONSULTATIONS AND MATERNITY HOMES - institutions for the protection of motherhood and childhood. Maternity clinics are designed to identify and treat patients with gynecological diseases, monitor pregnant women, treat them, provide health education, and work with pregnant women and women in labor.
Maternity hospitals provide assistance to women during childbirth, in the early postpartum period, and care for newborns.
The responsibilities of medical staff are similar to those of hospital and clinic workers.
SANATORIUMS, PREVENTION CENTERS - MTU, whose activities are based on the use of natural factors in the treatment of patients and carrying out preventive measures in their free time.
The work of medical personnel is similar to the work of employees of hospitals, clinics, and dispensaries.
MEDICAL DOCUMENTATION
The responsibilities of nurses working in any department of Leningrad State Technical University include clear, competent completion and maintenance of documentation for this department. Documentation is completed for the purpose of:
Maintaining statistical records on the basis of which planning, forecasting and provision of healthcare are carried out.
Displays the diagnostic and treatment process that the patient goes through in order to be able to observe the dynamics of the process, analyze it, and make adjustments.
Ensuring continuity between nursing staff and doctors.
4. Control over the content and use of material
technical means that are used in the work of health care facilities.
Recording of work performed and working hours of medical staff.
Carrying out scientific and pedagogical work.
All this speaks to the importance of professional record keeping. From the variety of medical documents, three main groups can be distinguished that need to be paid close attention to:
Medical documentation of outpatient clinics.
Medical documentation of the hospital admission department
Medical documentation of the hospital treatment department
You are presented with a list of documents from these three groups (see appendix).
LIST OF SUGGESTED DOCUMENTATION FOR REVIEW
Outpatient clinic service:
Outpatient medical record.
Statistical card for registering final (refined) diagnoses.
Voucher for an appointment with a doctor.
Medical examination record card.
Extract from the medical history of an outpatient.
Sanatorium-resort card.
Sheet and certificate of temporary incapacity for work.
Referral for consultation.
12. Diary of the work of nursing staff of a polyclinic (outpatient clinic), dispensary, consultation.
Hospital admissions department:
Medical record of an inpatient (medical history).
Emergency notification of an infectious disease, food poisoning, acute occupational poisoning, or an unusual reaction to a vaccination.
Hospitalization log.
Hospitalization refusal log.
Statistical map of those leaving the hospital.
Medical department of the hospital - post:
Log of reception and delivery of duties.
Portion maker.
Temperature sheet.
Pharmacy requirement.
Request for medications from the head nurse.
Summary of patient movement.
Notebook or journal of medical prescriptions.
Medical department of the hospital - treatment room:
Logbook for narcotic and potent substances.
Journal of blood transfusions and blood substitutes.
Journal of medical prescriptions.
Logbook for blood collection for biochemical analysis, RW, HIV, group and Rh factor.
HISTORY OF NURSING
Milestones in the history of nursing
Founders of nursing.
Participation of A. Dunant in the creation of the International Organization for Relief to War Victims. Russian Red Cross Society.
Development of nursing in the first years of Soviet power. Creation of a system of secondary specialized medical education.
The main directions and events in the process of reforming nursing in the Russian Federation at the present stage.
LEARNING OBJECTIVES
Students must KNOW:
the history of the creation and tasks of WHO, the Red Cross and Red Crescent organizations;
Florence Nightingale's contributions to nursing;
the history of the creation and tasks of sister communities in Russia;
examples of dedication and heroism of Russian sisters of mercy;
the essence and main directions of nursing reform in Russia;
history of the creation and tasks of the Association of Russian Nurses.
QUESTIONS FOR SELF-PREPARATION
Describe the expression: “Change is the price of progress.” Give examples known to you from the history of nursing.
Your attitude to this definition of the nursing specialty: “a nurse is one who nourishes, nurtures and protects; prepared to care for the weak."
Name the factors that influenced the development of modern nursing in Russia.
THEORETICAL PART
Before the great mind I bow my head,
Before a great heart - knees.
Goethe
The complete history of nursing spans thousands of years. It is no coincidence that nursing is sometimes called the most ancient art and the youngest profession. Throughout the development of civilization, the sick and suffering have always been cared for in one way or another. The document of ancient Egyptian culture “The Seven Commandments of True Charity” reads: “Feed the hungry, give water to the thirsty, clothe the hungry, shelter the sick, bury the dead.”
The development of humanitarian thought was influenced by religions. If Hinduism preached an individual search for one’s destiny, then Buddhism came with a mission of compassion, protection of the weak, and a call for mutual assistance. Christianity has done especially a lot for caring for the sick, because the basis of the Christian idea is attention and justice to the individual, pity for the person. These feelings have always been inherent in man. What has changed over the centuries is the concept of who our neighbors are. At first, neighbors were understood as relatives, neighbors, friends, fellow countrymen, people of the same religion and nationality, but the more civilized the world community becomes, the closer we come to the new principle of kinship put forward by Christianity: everyone is a neighbor who is created in the image and likeness of God.
If Cleopatra, in order to satisfy her curiosity, ordered the killing and dissection of pregnant slaves at various intervals after conception, then the teachings of Christ emphasized the enduring value of each individual person, regardless of his position on the social ladder. Christians believed that salvation in the afterlife would depend on a kind attitude towards each other in this life, hence attention and care for the sick.
One ancient patericon (a collection of sayings of saints and stories about their exploits) tells how a certain novice asked an elder:
Abba, one brother eats nothing for six days and only on the seventh day takes a little food, while the other takes care of the sick. Whose feat is higher?
The elder replied:
If the brother who strictly fasts hangs himself by his nostrils,
still cannot be compared with the one who cares for the sick.
The word “mercy” was recently so rarely used among us that it could well be marked in dictionaries as obsolete. Meanwhile, this word denoted the most important quality of the soul.
Mercy was a distinctive quality of the Russian people. Everyone knew that this word means love coming from a merciful heart.
Historically, while doctors were more often men, it was mainly women who cared for the sick. It is explainable. For most men, as for Onegin, “My God, what boredom it is to sit with a sick person day and night, without leaving a single step!” To amuse the half-dead, to straighten his pillows, to bring medicine to him sadly.”
For women, due to their mental organization, this “boredom” can turn into the only joy and purpose of life.
Byzantine-Tatar influence left its mark on the fate of Russian women: it did not give them the opportunity to devote themselves to any kind of civil activity; “Public interests belonged exclusively to one man.” Most women had to choose: a tower or a monastery.
But still, among female recluses, what constitutes the main feature of femininity - philanthropy and compassion - could not be killed and suppressed. Helping one's neighbor was the outlet that helped to exist in the musty and deadening atmosphere of prison life.
Myarshyae- J women cared for household members: helped at birth, raised children, cared for a sick family member, provided first aid for domestic injuries and wounds, consoled and encouraged the dying. This is how the folklore image of “sister-mother” gradually emerged
Among the women of Moscow Rus', private charity was deeply developed; it constituted “the main, fundamental, unchanging work of her entire life,” sanctified by Domostroy itself, this everyday code of Domostroy Rus', which taught: “Churchmen, and the poor, and the mournful, and the sick, and the wretched call into your house and, to the best of your ability, feed, drink, warm, and help...”
Women religiously fulfilled this teaching, especially the Moscow queens. One of the first mentions of a hospital hospital in Russia dates back to the middle of the 10th century, when Princess Olga founded a hospital where women were entrusted with caring for the sick.
The monasteries did a lot for the sick. Monks were often invited to care for the sick at home, and in severe cases the sick were sent to monastery hospitals. This is how the second folklore image developed: “sister is God’s worker.”
Even before the Tatar invasion, the chronicles mention hospitals in Kyiv, Pereslavl Yuzhny, Smolensk, Vyshgorod, Chernigov, Novgorod, Pskov, Volyn, Galician Rus and others. Hospital buildings were located outside the monastery walls, adjacent to them were washrooms, baths, vegetable gardens, and cemeteries. The work of “sickness workers” was very hard. The rich were obliged to take care of the comfortable existence of hospitals; poor patients, during the days spent in the hospital, worked on arable land, in the fields, and as a carrier. Thus, they rewarded God for healing with “prayer and labor.”
Sister-nuns cared for the sick selflessly, since it was believed that charging for care took away the sacred nature of the work of a sister of mercy. The inscription above the entrance to the monastery hospital ward is very characteristic: “Everything to please you, Lord, nothing to satisfy yourself.” Even the abbess of the monasteries visited the chambers daily in order to “have the happiness of serving the sick.” At the same time, the nuns quite consciously risked their lives, since poverty at that time went side by side with infectious diseases; it was a time of widespread epidemics that claimed hundreds of thousands of lives.
In 1545, at the Council of the Hundred Heads it was said: “Describe all the sick and elderly in all cities and in each city establish almshouses for men and women, where the sick had somewhere to lay their heads - be content with food, clothing and assign healthy sisters and women, cooks to them, how much more beautiful it will be.”
Women's work caring for the sick and wounded in hospitals became especially widespread under Peter I.
It was carried out by the so-called “nurses”, who performed the functions of nurses. At the same time, until the end of the 18th century there were no specially trained nurses to care for the sick. Therefore, we can assume that nursing took shape in Russia in 1803, when the service of “compassionate widows” appeared. In 1814, by order of Empress Maria Feodorovna, women from the St. Petersburg “widow’s house” were invited and sent to hospitals on a voluntary basis for “the direct assignment of walking and looking after the sick.” Compassionate widows, unlike “nursing women,” should have already mastered some medical techniques to provide assistance. In 1818, the Institute of Compassionate Widows was created in Moscow, and special courses for nurses began to be organized at hospitals. From this time on, special training for female medical personnel begins. In 1822, the first manual in Russian on caring for the sick was published - Oppel's textbook.
In 1828, Princess Elena Pavlovna took over the leadership of charitable institutions. She expanded the network of charitable institutions and contributed to the development of sister communities.
The first community of sisters of mercy arose in 1844 in St. Petersburg. It existed with funds from charitable organizations. According to the charter of the community - it later became known as Holy Trinity - girls and widows from 20 to 40 years old were accepted into it. They were required to be on duty at the patient's bedside at home or in the hospital for 24 hours every 4-5 days, and to assist the doctor at the appointment. The first year was probationary, after a year the sisters took the oath and became full members of the community.
How hard the sisters of mercy worked is evidenced by the following fact from the sketch of the sisterhood’s 20-year activities: despite the fact that their number did not exceed 23, they provided care and care to 103,758 patients, often with one sister per person. 70-80 patients.
In order to understand the further development of nursing in Russia, we should make a small digression and say a few words about the influence and views of the English nurse Florence Nightingale (1820-1910).
Florence Nightingale was born in Florence, into an aristocratic English family. She received an excellent education and was versed in philosophy, foreign languages and other liberal arts. Florence traveled a lot, studied the organization of hospitals and the procedures that existed in them. At that time, the nursing profession was disrespected in society. The nurses in the hospitals were representatives of the lower strata of society, poorly educated and often involved in illegal criminal activities. Doctors considered nurses to be girls for cooking and putting things in order (third folklore image: “A nurse is a servant of the doctor and the patient”). While caring for the sick in her family, Florence became increasingly convinced of the need for special education to organize and perform nursing care.
The entire subsequent life of this remarkable woman was devoted to the development of nursing.
Florence Nightingale was the creator of a scientific system of caring for the sick and wounded. In her famous “Notes on Care”, Florence summarized and systematized all the knowledge and experience of the sisters of mercy accumulated before her, “all the centuries-old mud has settled to the bottom, and from above we see a transparent mirror of crystal clear water, from which we can draw without any difficulty.” Nursing is a science and at the same time an art that requires special training. The job of a sister of mercy, Miss Nightingale believed, is to save not only physically, but also spiritually. The patient's condition can be improved by influencing his environment. Nurses began to take initiative and try to actively influence the course of the disease,
providing fresh air, healthy nutrition, cleanliness of body, leisure, and widespread education of the population on health and disease.
Florence transcended the boundaries of hospital nursing, believing that nursing was not only about caring for the sick, but also about helping people live a normal life. “We must watch the healthy so that they do not become sick,” wrote Miss Nightingale. But this requires scientific knowledge. For example, before people learned about bacteria and germs, one bed was used for several patients without changing linen; “they will go from a bad ulcer to bandaging a clean one without washing their hands,” Florence Nightingale wrote indignantly. The hospital created as many diseases as it cured. The diseases acquired there were pneumonia, sepsis, and fever... Miss Nightingale identified the reasons for this phenomenon: improper location of premises, overcrowding of patients, lack of ventilation and light. She looked for ways to eliminate them, drew plans, selected hygienic materials for walls and floors. This view also required new nurses - intelligent, educated, thoughtful, responsible.
June 24, 1860 became a significant date in the history of England. On this day, a school of nurses was opened at St. Thomas Hospital under the leadership of Florence Nightingale. Out of thousands of applicants, only 15 girls were accepted. Miss Nightingale developed a detailed training plan for this school, a daily routine for students and rules for their behavior. Following her behests, school graduates went to different parts of the world and became directors of medical schools.
But Miss Nightingale gained worldwide unfading fame during the Crimean campaign (1854-1856). Having become familiar with the sad situation of one and a half thousand sick and wounded soldiers in military hospitals, she and thirty “ladies of high soul” went first to Scutari, then to Balaklava and introduced such excellent procedures in the management of the wounded that the terrifying mortality rate that existed before her was from 50 to percent decreased to 2, due to the introduction of the principles of hygiene and nutrition. It was during the Crimean War that Florence Nightingale became known as “The Lady with the Lamp.” Often in the evenings she walked around the wounded soldiers, taking care of them, and she had a lamp in her hands. Longfellow immortalized the name of Florence in his poem "Saint Philomena." “What a relief,” one soldier wrote home, “even the fact that she just passes by brings. He will talk to someone, nod or smile at someone. But, you see, she might not have done this, because there are hundreds of us lying here. It was enough for us to simply kiss her shadow that fell next to her, and we could lean back on the pillows completely satisfied.”
Grateful compatriots raised a capital of £50,000 in her honor, which Florence Nightingale used to train nurses.
Miss Nightingale's ideas and practical activities helped raise the prestige of nursing and establish nursing as an independent profession. In 1919, the League of the International Red Cross established the Florence Nightingale Medal as the highest sign of nursing distinction, awarded once every two years on her birthday - May 12 (International Nurses Day) - only “for exceptional services in nursing, arousing the admiration of all mankind.” "
Following the example of Florence Nightingale, in Russia, Grand Duchess Elena Pavlovna founded the Holy Cross community of Sisters of Charity in 1854 - the first union of Russian women united to care for the wounded on the battlefields. The leadership of the Holy Cross community was taken over by the great Russian surgeon N.I. Pirogov.
During the disastrous months of the Sevastopol defense, the sisters of the Exaltation of the Cross, in dresses reminiscent of monastic robes, were in the very heat of the war and brought, if not healing, then peace of mind to thousands of wounded soldiers and officers.
L. Tolstoy wrote about this time in “Sevastopol Stories”: “The conversation of various groans, sighs, wheezing, sometimes interrupted by a piercing scream, rushed throughout the room. Sisters with calm faces and with an expression not of that empty female painful-tearful compassion, but of active practical participation, now and then there, walking through the wounded, with medicine, with water, with a bandage, with lint, flashed between bloody overcoats and shirts.” .
N.I. Pirogov echoes him: “The sisters are always in hospitals day and night, helping with operations and dressings, distributing tea and wine to the sick and watching over the attendants and caretakers and even the doctors. The presence of a woman, neatly dressed and helping, enlivens the deplorable vale of suffering and disaster. It is difficult to decide what is more surprising - the composure of these sisters or their selflessness. Great and lofty was their duty: they were entrusted with both the last desires and the last breath of those dying for the fatherland!”
In total, 160 sisters worked at the theater of war, 17 of them died.
In addition to the sisters of mercy of the Holy Cross community, the wives, sisters and daughters of Sevastopol residents provided assistance to the wounded. Among them is the legendary Dasha of Sevastopol. Information about Daria Lavrentievna Mikhailova (real name of Dasha Sevastopolskaya) was preserved in the memoirs of N.I. Pirogov, contemporary doctors, participants in the Crimean campaign. One of his contemporaries writes: “When our troops, having lost the battle on September 8, returned after a long and stubborn battle back to Sevastopol exhausted, physically and mentally exhausted, with many wounded and mutilated, bleeding, Daria, who, having been left an orphan, earned money by washing clothes and together with the laundresses she followed the troops with her cart, turned into a sister of mercy and began to help the sufferers free of charge. Fortunately, in her cart she found both vinegar and some rags, which she used to bandage her wounds... Teams passing by her with the wounded came to her as a dressing station for help. Thus, Daria’s cart was the first dressing station after the enemy arrived in Crimea, and she herself was the first sister of mercy.” Such a humane act of a simple girl the next day spread throughout Sevastopol. Nicholas I awarded Daria a gold medal on the Vladimir ribbon with the inscription “For zeal” and 500 rubles in silver.
After the end of the Crimean campaign, the Holy Cross community
was preserved, and in peacetime the sisters continued their work in hospitals. Following her example, communities of sisters of mercy appeared in Odessa, Kharkov, Tbilisi and many other cities.
The activities of N.I. Pirogov and the sisters of the Exaltation of the Cross community led by him, as well as the example of Florence Nightingale and her squad of English sisters of mercy, made a huge impression on the Swiss, an ordinary merchant, Henri Dunant, who had the idea of organizing international private and voluntary assistance victims of the war, without distinction of their ranks and nationality. In 1859, Dunant traveled to Italy. At that time there was a war going on there: the united Franco-Italian army opposed the Austrians. The traveler witnessed a horrific massacre - 40 thousand wounded, dying in agony in the middle of the battlefield, with almost no medical care. This made such an impression on Dunant that he gave up trading and decided to devote his life to suffering humanity. He shared his impressions of what he saw in the book “Memories of Solferino” (1862). Dunant comes to the conclusion that it is necessary to create an international union for the protection of the wounded and sick in war. This is how an organization arose, for which an identification mark was installed in Dunant’s honor, similar to the flag of his homeland. The national flag of Switzerland is a white cross on a red field. The emblem of the society for helping the wounded was a red cross on a white cloth. And the society itself began to be called the International Red Cross. At the suggestion of the Red Cross, various states concluded the Geneva Convention among themselves, prohibiting the use of weapons against the wounded. In accordance with the terms of the Convention, sick and wounded soldiers must receive care without regard to which camp they belong to, and medical personnel, their equipment and institutions must enjoy the right of immunity. They are designated by a distinctive emblem - a red cross on a white background, and for countries with the Muslim religion - a red crescent on a white background. Subsequent conventions developed the rules of warfare on land and sea.
Russia joined the Geneva Convention in 1867, and at the same time, on the basis of the Holy Cross community, a society for the care of wounded and sick soldiers was created. This society in 1876 was renamed the Russian Red Cross Society (ROSC), the main task of which was charitable activities and the training of nurses. But if during the war the training of sisters of mercy was carried out on the basis of short-term medical courses, then in the peace period the training of sisters of mercy was based on the form of training developed by the Holy Cross community. By 1892, there were already 109 communities of nurses who worked in military hospitals, city hospitals and Red Cross hospitals, they were sent to work in areas affected by epidemics and natural disasters.
In addition to Red Cross communities, training of sisters of mercy was carried out at monasteries and at courses at hospitals.
The profession of nurses was respected in society and required special spiritual qualities, philanthropy and even self-denial. Sisters of mercy worked in hospitals during the Russian-Turkish (1877-1878), Russian-Japanese (1904-1905), and First World War (1914-1918). By 1877, Russia had 300 registered nurses.
The heroine of the Russian-Turkish war was the sister of mercy Yulia Vrevskaya. Baroness, the daughter of a general, she considered “self-sacrifice for the good of others” her duty.
Sologub V.A. wrote: “I have never met such a captivating woman in my entire life. Captivating not only with her appearance, but also with her femininity, grace, endless friendliness and endless kindness... This woman never said anything bad about anyone and never allowed anyone to slander her, but, on the contrary, she always tried to bring it out in everyone the good side". With the beginning of the Russian-Turkish war, Yu. Vrevskaya goes to the front. “For 400 people,” she writes, “there are 5 of us sisters, all the wounds are very serious... I’ve been in the hospital all day.” Yulia Vrevskaya contracted typhus in a hospital barracks and died on January 24, 1878.
I. Turgenev dedicated a prose poem “In Memory of Yu.P. Vrevskaya” to her memory
“On the mud, on stinking damp straw, under the canopy of a dilapidated barn, hastily turned into a military hospital in a devastated Bulgarian village, she died of typhus for more than two weeks.
She was unconscious - and not a single doctor even looked at her; The free soldiers whom she cared for, while she could still stand, rose one by one from their infected lairs to carry a few drops of water in the shard of a broken pot to her parched lips.
She was young, beautiful; high society knew her; Even dignitaries inquired about it. Ladies envied her, men followed her... two or three people secretly and deeply loved her. Life smiled on her; but there are smiles worse than tears.
A tender, meek heart... and such strength, such a thirst for sacrifice! Helping those in need... She knew no other happiness - and she knew it. All other happiness passed by. But she had long ago come to terms with this, and all, burning with the fire of unquenchable faith, she devoted herself to serving her neighbors.
No one ever knew what treasured treasures she buried there, in the depths of her soul, in her very teapot - and now, of course, no one will know.
And why? The sacrifice has been made... the deed is done.
But it’s sad to think that no one said thank you even to her corpse - even though she herself was ashamed and shunned all thanks.
Let her dear shadow not be offended by this late flower, which I dare to lay on her grave!”
Among the brilliant names of Russian nurses, Ekaterina Mikhailovna Bakunina occupies a prominent place. A true aristocrat, deeply religious, Ekaterina Mikhailovna was called to the high post of abbess of the Holy Cross community of sisters. She left the amazing “Memoirs of a sister of mercy of the Holy Cross community, 1854-1860” about this time. “So, my heartfelt wish will come true almost from childhood - I will be a sister of mercy!” - this is how her notes begin.
In 1860, Ekaterina Mikhailovna abandoned her post and went to the family estate in the Tver province, where she set up a hospital for sick peasants, a pharmacy with free distribution of medicines prepared by herself.
During the Russian-Turkish War, Ekaterina Mikhailovna led a detachment of nurses traveling to the Caucasus. As a simple nurse, she looked after everyone in need of care and mercy. At the end of the war, Ekaterina Bakunina was awarded two medals.
At the beginning of this century, the leadership of charitable institutions was headed by Grand Duchess Elizaveta Feodorovna. In 1909, the Marfo-Mariinsky Convent was opened to help Manchurian soldiers. The philosopher Fedorov said about this time: “Moscow is becoming richer in thought and kindness.” By 1911, the Marfo-Mariinskaya Convent became a center of mercy in Moscow: free lunches, clinics, and visits of sisters of mercy to the homes of the sick were organized. In 1914, the monastery was turned into a hospital. The wounded were brought here from the fronts of the First World War.
The activities of the Martha and Mary Convent continued after the 1917 revolution until the arrest of the royal family. The fate of Elizaveta Fedorovna is tragic: in 1918 in Alapaevsk she was thrown into a mine and bombarded with grenades. Elizaveta Fedorovna was canonized by the Russian Orthodox Church.
By 1917, there were 10 thousand sisters of mercy in Russia.
On August 26, 1917, the 1st All-Russian Congress of Sisters of Mercy took place in Moscow, at which the All-Russian Society of Sisters of Mercy was established.
The first nursing schools after the revolution appeared in our country in 1920. The initiator of their creation is N.A. Semashko. Communities of nurses were liquidated, but training programs for midwives, nurses, and orderlies were developed. On June 15, 1927, under the leadership of N.A. Semashko, the Regulations on Nurses were published, which defined the responsibilities of nurses in caring for the sick. Spiritual aspects gradually disappeared from nursing; the nurse became only a physician's assistant.
A bright page in the history of nursing was written in the 30s and 40s. This is explained by the period of preparation for war and military conditions. In 1934-1938, 9 thousand nurses were trained, there were 967 medical and sanitary schools and departments.
During the Great Patriotic War, there were 200 thousand doctors and 500 thousand paramedics in the army alone. For the first time in the world, a female medical instructor was brought to the line of fire in the Red Army, whose duties included carrying out the wounded and providing them with emergency assistance.
The mortality rate among company medical instructors was the highest; sometimes only 30% of the personnel left the battles. 24 medical instructors were awarded the title of Hero of the Soviet Union, 10 of them posthumously. The poet Mikhail Svetlov wrote about them, about the dead: “Russian princesses died on long stretchers under a canopy. The machine gunners stood quietly nearby in state sadness.”
L.F. wrote an excellent book about this time, “My Destiny.” Savchenko, a front-line nurse, one of the first in our country to be awarded the Florence Nightingale Medal.
Lidia Filippovna recalls:
“What does it mean to deploy a medical battalion in a new place? This means cutting down 30-40 trees, which even two people couldn’t handle. And all this was done by girls who, before the war, had not held a saw or an ax in their hands. We need to put up tents, insulate them, equip them, and get water. Open all operating rooms and prepare instruments. We had to receive 400-500 wounded per day. Operating room nurses and doctors, when the division was on the offensive, did not leave the operating room for 5-6 days, ate hastily, and there was no talk of normal sleep. If only you knew how these operations were done! Light into the tent was supplied, at best, from a well-worn engine, but more often it was a bat lantern or a torch. But they performed the most complex operations: wounds in the stomach, chest, amputation of limbs, etc. During the bombing, Liya Bentsianovna asked the nurses to bend lower towards the wounded. For what? Yes, in order to protect his body from random fragments that often flew into the operating room. What kind of willpower you need to have! I would like to quote these words:
White coats,
It is not your fault,
That not all soldiers
We survived that time.
Veterans remember
All the fights, all the wounds,
Hands that could
Save the lives of the soldiers.”
As a result of such heroic selfless work, 80% of the sick and wounded returned to duty.
The work of a nurse was not easy in peacetime, especially in the conditions of post-war devastation, when the number of sick, crippled and homeless people increased sharply. As living standards improved, the training time for nurses was extended, new profiles were introduced, and the network of medical schools was streamlined.
In 1987, the 1st Congress of Russian Nurses took place in Tula.
Since 1991, the training of nursing personnel has begun not only
in medical schools for a 2-3 year program, but also in colleges
according to a 4-year training program. Opened in the same year
faculties of higher nursing education. In medical schools
There are already 17 faculties of higher education in the country.
In August 1993, in the village of Golitsyno near Moscow, a Russian-American seminar on the reform of nursing education and practice was held under the motto “New nurses for a new Russia!”
Priority directions in the implementation of reform: creating a philosophy of nursing in Russia
introduction of modern care technologies into nursing education and practice (nursing process)
creation of the Association of Russian Nurses.
In 1994, the Russian Nurses Association was formed (president Valentina Sarkisova). There are regional nursing associations.
Primary objectives of the Association:
increasing the educational level of nurses;
advocating for nurses in consideration of laws, government programs, and national health policies;
creation of a unified information field on nursing issues;
encouraging research in nursing;
creation of a code of ethics for nurses in Russia;
cooperation with international sister organizations;
collection and storage of documents and materials that have contributed and continue to contribute to the historical and cultural development of nursing;
participation in establishing and maintaining standards for the professional activities of nurses;
promoting the prestige of the profession.
In 1995, for the first time in the history of Russian nursing, G.M. Perfileva defended her doctoral dissertation in the field of nursing.
In 1995, the first issue of the journal “Nursing” was published, providing all nurses in the country with information about what is happening today in domestic nursing.
There are currently 1,695,000 health workers in the country
kov with secondary education, including 827,400 nurses.
Nurses make up approximately a third of all workers in any
medical institutions and play a very important role in
treatment process, influence the final result
Patient's health.
Ensuring the connection of Russian nurses with other international groups is an important condition for the success of nursing reform in our country.
Among the most authoritative international organizations are the World Health Organization, the World Medical Association, the International Hospital Federation, the League of the Red Cross, the International Committee of the Red Cross, UNESCO, the Agency for International Development and others.
The title of the oldest international association and at the same time the largest international organization in the world is claimed by the International Council of Nurses (ICN), officially recognized in 1899. Currently, ICN is a federation of national nursing associations from 39 countries. The governing body is
Council of National Representatives, meeting once every 2 years to develop ICN policy. Current activities are carried out by staff from the headquarters in Geneva (Kul de Vermont 37). Six times a year, headquarters publishes in English the International Review of Nursing, which is recognized as the official organ of the ICN.
Objectives of the International Council of Nurses:
promoting nursing education and nursing practice
improving professional standards
development of national associations
improving the status of the nurse.
WHO - World Health Organization - a specialized agency of the United Nations whose main function is to solve international health problems and protect public health. Through this organization, founded in 1948, health professionals in more than 180 countries share knowledge and experience to enable everyone to achieve a level of health that allows them to lead socially and economically fulfilling lives.
WHO has a European Regional Office for Nursing, and WHO provides assistance in almost all areas of nursing: nurse education, social and economic well-being of nurses, sponsorship and assistance to international nursing programs.
History of nursing development
affairs in Russia
The formation of nursing in Rus' X - XVII centuries.
Every nurse should know the history of the development of nursing. Unlike Europe, nursing care in Russia has secular roots. The organization of sister communities and hospitals for the poor was carried out by women of noble birth and grand duchesses (Olga, Maria). In foreign countries, caregiving was carried out mainly by women of the lower classes of society (“fallen women”). In Russia, the profession of “sister of mercy” was considered respected.
Female nursing has existed at all times and in all countries of the world. Women performed hygienic measures and created comfortable conditions for the sick, often relatives.
In monasteries, sisters cared for the sick selflessly. Women were not involved in large numbers to care for the sick. In Rus', already in the 10th century, Princess Olga organized a hospital where care was entrusted to women. In the 16th century, the “Hundred-Glavy Cathedral” issued a decree on the organization of men’s and women’s almshouses with the employment of women.
IN In the 17th century, during the “Time of Troubles,” the first hospital was created on the territory of the Trinity-Sergius Monastery in 1612. In 1618, the first (in the modern sense) hospital arose at the Trinity Monastery. In 1650, a hospital appeared on the territory of St. Andrew's Monastery. There is no reliable data, but it is possible that women's care was used in these hospitals.
Nursing development VXVIII V.
Around 1707, the first civilian hospital was created in Moscow, and in 1715, by decree of Peter I, educational homes were organized in which women were supposed to serve. Then the involvement of women in hospitals was abolished; the role of nurses was performed by retired soldiers. Perhaps the use of female labor was temporary. In 1735, the General Regulations on Hospitals were issued, in which
The sphere of activity of women is determined (mopping floors, washing clothes). In 1763, the Pavlovsk Hospital was established in Moscow, where there were “women-nurses” from widows and wives of hospital soldiers especially for sick women. There was no special training for nurses.
Nursing care V XIX century
Many authors believe that it was in 1803 that “nursing” arose in Russia. It is difficult to argue with this, but it was from the beginning of the 19th century that special training of female nursing personnel began. In 1818, the “Institute of Compassionate Widows*” was created, and nursing courses for women appeared at hospitals. Other authors believe that sisters of mercy appeared in Russia only in 1841, the first community of sisters of mercy (Holy Trinity) was created. In 1854, the Exaltation of the Cross community of sisters of mercy was created. E.M. became its abbess. Some authors consider Balunin to be the founder of “nursing” in Russia. During the Crimean War, she showed herself to be a very good organizer. After the war, she went to her family estate in the Tver province and organized a hospital there for peasants (considered the founder of rural medicine). Great participation in the development of "nursing" N.I. Pirogov - the great Russian surgeon. When the Holy Cross community was created, Pirogov led it. Pirogov actively involved women in nursing and supported innovations among nursing staff.)
At first In the 20th century, the leadership of charitable institutions was headed by Grand Duchess Elizaveta Feodorovna. In 1909, the Marfo-Maryinskaya Convent was opened, which by 1911 became the “center of mercy” in Moscow. In 1914, the community was turned into a hospital due to the outbreak of the First World War. Nursing training
personnel was carried out in communities. Before 1917, there were 10 thousand sisters of mercy in Russia. On August 26, 1917, the First All-Russian Congress of Sisters of Mercy took place in Moscow, at which the All-Russian Society of Sisters of Mercy was established.
The first medical schools appeared in 1920. Have been developed
training programs for midwives, nurses and orderlies. In 1927, under
leadership of N.A. Semashko, a “Regulation on Nurses” was published, which defines the duties i
and patient care nurses. In 1934-
In 1938, 9 thousand nurses were trained, there were 967 medical and sanitary schools and departments.
At this time, new requirements for the training of nurses appear: “for a conscious attitude towards doctor’s prescriptions, she must be medically literate.” The development of “nursing” in Russia was very difficult and lengthy.
Despite this, in the 19th century the profession of a nurse was very honorable,
History and development of nursing affairs
There is very little historical information about women's medical activities in Rus'. It is known that nursing played a huge role in
Orthodox monasteries, where almshouses for lepers were created (1551). The first hospital in which doctors treated and monks served was built in 1618 at the Trinity Monastery (Sergiev Posad). In connection with the reforms of Peter I, the “Medical College” was created, which in 1728 introduced staff positions for women to care for the sick to work in hospitals. By the mid-18th century, women's nursing began to take place in civilian hospitals. In 1804, the trustee of the Moscow Orphanage was asked to build a new house for widows next to the hospital for the poor, so that some of them would take care of the sick for a reasonable fee. In 1813, at the St. Petersburg widow's home, it was decided to employ a certain number of widows to work in the Mariinsky Hospital for the poor, as well as to care for the sick at home. The widows on duty had to monitor the improvement of the wards, the order in the distribution of food and medicine to the sick, the cleanliness and tidiness of the patients, their beds and linen, and the behavior of the patients and visitors. Doctors and healers had to give widows the necessary instructions on caring for the sick. “Compassionate widows” had to master some medical techniques in order to provide assistance to the sick themselves, if necessary.
With a large influx of wounded and sick, medical institutions could not cope without auxiliary female labor, and therefore in 1818 a state service of nurses was created, who were trained in hospitals in sanitary and hygienic care for the sick and had full-time positions at hospitals. Until the mid-19th century, the service of “Compassionate Widows” remained the only form of professional participation of women in caring for the sick in Russia.
In the mid-19th century, communities of sisters and brothers of mercy were created in Europe. Later, women's communities took over the care of the sick. The first community in Russia sisters of mercy was opened in March 1844, and only in 1873 received its name “Holy Trinity”. According to the charter, girls and widows aged 20 to 40 were accepted into the community. The first year of work was a probationary year, where the mental and physical qualities required for work were tested, which only strong-willed women could withstand. The doctors taught the sisters the rules of caring for the sick, how to dress wounds, pharmacy, and recipes. A year later, the sisters took the oath and became full members of the community. Over time, they began to be invited to private and public hospitals.
Pirogov Nikolay Ivanovich
From 1845 to 1856, the community was visited by N.I. Pirogov, who performed the most complex operations and autopsies of the bodies of the dead there. While working in the community, he expressed the following thought: “It has already been proven by experience that no one better than women can sympathize with the suffering of the patient and surround him with constant care and, so to speak, unusual for men.”
Demand for activities was growing in Russia sisters of mercy and this contributed to the creation of new communities in other cities, the lack of sisters of mercy during the Crimean War 1853-1856.
Pirogov proposed dividing the nurses into dressing nurses, attendants, pharmacists and housewife sisters, developing special instructions for each of these groups, which significantly increased the quality of the nurses’ work and their responsibility.
In order to encourage and perpetuate the merits of the sisters in the Crimean War, the committee of the Holy Cross community established a gilded cross, which was awarded to 158 sisters. It was during the Crimean War that a Russian woman first emerged from the sphere of domestic life into the field of public service, showing high business and moral qualities.
The experience of the Crimean campaign was developed in the Russian-Turkish war of 1877-1878.
By 1877, there were about 300 certified nurses in Russia. During the Russian-Turkish War 6 nurses were awarded silver medals “For Bravery”, and almost all the sisters received the insignia of the Red Cross.
All participants in the war received medals established in memory of the Russian-Turkish War of 1877-1878.
After the October Revolution of 1917, almost all training centers sisters of mercy subordinated to the Main Directorate of the Russian Red Cross Society. On August 7, 1918, the Council of People's Commissars of the RSFSR issued a decree that granted the Soviet Red Cross the legal rights of a public organization.
In 1920, schools were opened to train nurses. IN In October 1922, at the 1st All-Russian Conference on Secondary Medical Education, the types of secondary medical educational institutions and the main profiles of training nurses were determined: nursing for medical institutions, for the protection of motherhood and infancy, for social assistance. In 1926, the 2nd All-Russian Conference on Secondary Medical Education was held in Moscow, which prepared a reform to unify the training of nursing personnel. All medical colleges, schools, courses were reorganized into medical technical schools, in which all applicants were given a unified general medical training with further specialization. The duration of training for nurses there was 2.5 years. At the 3rd and 4th All-Russian conferences on secondary medical education, the principle of polytechnic education of nurses was consolidated and deepened. To replace the definition "sister of Mercy" another came - “nurse”. In 1927, the Regulations were approved about the nurse which clearly defined the responsibilities of the nurse in caring for the sick. From that time on, the professional status of the nurse was defined.
During the Great Patriotic War of 1941-1945. 500,000 paramedical workers fulfilled their patriotic duty. Thanks to medical care, 70% of wounded and sick soldiers were returned to duty, and nurses played a significant role in this success.
A monument has been erected in several cities around the world nurse
IN In 1965, advanced training courses for nurses were created. In the same year, by order of the USSR Ministry of Health No. 395, the position of chief nurse was approved. In 1977, Appendix No. 45 to the same order introduced the position of senior nurse into the staffing table of medical institutions.
The main purpose of nursing is to provide care to the patient. The work of nursing the sick and suffering, having gone through different stages of development of asceticism, became a profession. Currently, nursing education has entered a new stage of development. New levels of nursing education have been introduced. Since 1991, medical colleges and the first faculties of higher nursing education in medical universities have emerged. Their appearance is associated with the introduction of three levels of nursing education, each of which has professional completion.
The Association was created in 1994 nurses Russia, taking an active part in the work of the International Council of Sisters.
The highest level in nursing education is Academic Nursing Education, which can be obtained at the faculties of higher nursing education of medical academies and universities.
Along with higher education, a nurse receives the qualification of a manager. Special curricula have been developed for the Faculty of Higher Nursing Education, including, along with well-known ones, completely new disciplines in the field of nursing: nursing theory, management and leadership in nursing, marketing of nursing services, management psychology, legislation and health economics, pedagogy and others. Healthcare is accepting new nursing specialists into its ranks, specialists with a higher level of knowledge capable of solving the problems facing medical institutions.
International Nurses Day is celebrated on May 12, the birthday of the Englishwoman. Florence Nightingale . which made an invaluable contribution to the development of nursing.
First definition"nursing" given by the legendary Florence Nightingale in “Notes on Care,” published in 1859. In 1865, this term was adopted by the International Committee of the Red Cross. In the second half of the 19th centuryFlorence Nightingale created the first medicalschools that served as models for the development of nursing educationin other countries of the world.Florence Nightingale monuments were erected in England and France, a ship was named after her in her homeland, and Queen Victoria gave her a diamond brooch with the inscription: “Blessed are merciful." Florence Nightingale (1820-19 Jugg) is the author of manybooks and articles about the meaning, role, activities, training of nurses. The sisters of mercy, finishing school, pronounced a composedFlorence Nightingale a solemn oath in which were the following words: “With all my might I will strive to help the doctor in his work and devote myself to ensuring the health of those who turn to me for help.” The selfless woman became an example of service to people and a prototype of international charity. Florence Nightingale is consideredfounder of the Institute of Sisters of Charity inWestern Europe.
Florence Nightingale Medal
Medal with a picture Florence Nightingale are awarded for the special merits of distinguished nurses. On the reverse side of the medal, the Latin inscription in a circle reads: “Pro Vera Misericordia et cara Humanitate Perennis ducor universalis” (“For true mercy and care for people, arousing the admiration of all mankind”) and in the middle is the engraved surname of the owner. The Florence Nightingale Medal was established in 1912. To date, about 1000 people have been awarded this medal, 46 of them are Russian nurses.
Officially International Day nurse was established in 1971.
Students and followers of Florence Nightingale advocated for nursing education to take its rightful place in colleges and universities. The first university nursing training programs appeared in the United States at the end of the 19th century, but their number increased significantly in higher education institutions in America and Europe after the Second World War. New theories and models of nursing and even scientific schools with their own authorities appeared, such as Virginia Henderson and Dorothea Orem. New terms such as “nursing process”, “nursing diagnosis”, etc. have increasingly appeared in professional nursing communication.
However, such favorable conditions for the development of nursing were not everywhere. Neglect of the nursing profession and misuse of nursing personnel in many countries have hampered the development of not only nursing care, but also health care in general. In the words of the eminent researcher and promoter of nursing in Europe, Dorothy Hall, "Many of the problems facing national health services today could have been avoided if nursing had developed at the same rate as medical science over the past forty years." “The reluctance to admit,” she writes, “that the nurse occupies an equal position in relation to the doctor, has led to the fact that nursing care has not received such development as medical practice, and this has deprived both sick and healthy people of the opportunity to use a variety of , accessible, cost-effective nursing services."
Nevertheless, nursing continues to develop, confidently gaining momentum, and nursing professionals in all countries of the world are increasingly declaring with increasing confidence their desire to make a professional contribution to the creation of a qualitatively new level of medical care for the population. Innovative pedagogical technologies are being developed for teaching students, new training programs and advanced training courses for nurses are being offered. Measures are being introduced to evaluate the services provided by nurses using professional practice standards and quality indicators. The popularity of scientific research in the field of nursing is developing and increasing.
According to the modern concept of nursing development, a nurse must be a highly qualified specialist - a partner between a doctor and a patient, capable of independent work within a single medical team. In addition to knowledge about health standards and the basics of care, a modern nurse must have sufficient knowledge in psychology, pedagogy, management, must know how and where to find information about the latest research related to the field of her practice, and also have sufficient knowledge to be able to apply the results of these research in their professional activities.
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Table: (Part I)
| Model type | Social insurance | Social insurance | Social insurance |
| A country | Germany | Japan | Canada |
| Health is a factor that determines the quality of “human capital”. Medical service is the cost necessary to maintain health. | Medical service is a quasi-public good. Compulsory medical insurance programs reimburse part of the costs of medical care. | Medical service is a public good. The health care system should be controlled by the state. | |
| 8,1% | 6,6% | 8,7% | |
| Sources of financing. | Compulsory medical insurance - 60% Voluntary medical insurance - 10% State. Budget - 15% Personal funds -15%. | Compulsory medical insurance - 60% State. budget -10% Public funds - 10% Personal funds - 20% | Federal funds and funds of provincial budgets - 90% Funds of private insurance companies and voluntary donations - 10%. |
| Control is exercised by private and public insurers. | Control is carried out by insurance companies - private insurers | Control is exercised by the state. | |
| 90% of the population is covered by compulsory medical insurance programs; 10% - voluntary health insurance programs; At the same time, 3% of those insured under compulsory health insurance have voluntary health insurance. | 40% of the population is covered by the national insurance system; 60% - by the professional production insurance system. | 98-99% of the population is covered by compulsory medical insurance programs. | |
| A wide range of services through a combination of compulsory health insurance and voluntary health insurance programs. | Compulsory medical insurance programs provide the necessary range of medical services; the introduction of new techniques is limited. | ||
| Demand for a variety of medical services stimulates the introduction of new technologies. | Difficult to overcome barriers to the introduction of new technologies. | ||
| Prices are expressed in “points”; the price of a “point” is revised as the economic situation changes. | Approved by the Ministry of Health and Social Welfare. | Regulated by the government, reviewed annually, but changed slowly. |
Table: National healthcare models(part II)
| Model type | State | State | Market |
| A country | France | Great Britain | USA |
| The principle underlying the model. | Medical service is a quasi-public good. Compulsory medical insurance programs should reimburse only part of the costs of medical care. | Medical service is a public good. The rich pay for the poor, the healthy for the sick. | Medical service is a private good, i.e. a product that can be bought or sold. |
| Share of health care expenditures in GDP | 8,5% | 6,0% | 14% |
| Sources of financing. | Compulsory medical insurance - 50% VHI - 20% State. budget - 10% Personal funds - 20% | The state budget. | Private insurance - 40% Personal funds - 20% Programs for the elderly and low-income -40% |
| Monitoring the efficiency of spending funds. | Control is exercised by insurers: private insurance companies and the state social insurance organization. | Control is exercised by the state represented by the Ministry of Health. | Control is carried out by insurance companies - private insurers. |
| Availability of medical care | 80% of the population is covered by compulsory medical insurance programs. | Universal accessibility | Limited by patients' ability to pay, programs for the elderly and low-income do not cover all those in need. |
| Range of available medical services. | A wide range of services through a combination of compulsory health insurance and voluntary health insurance programs. | A wide range of preventive measures and a range of treatment services are limited by production capabilities. | A wide variety of curative and preventive medical services. |
| Use of new technologies. | Demand for a variety of medical services stimulates the introduction of new technologies. | There are no incentives and new methods are being introduced slowly. | The largest investments in R&D are made in the healthcare sector. |
| Regulation of prices for medical services. | Regulated by the government and reviewed twice a year. | Financial resources are calculated on the basis of standards taking into account the age and sex composition of the population. | There is virtually no regulation. The price is determined as a result of an agreement between the patient, the insurer and the health care facility. |
Let us consider the effectiveness of each of the models from the point of view of the possibility of application in a transition economy. To do this, let us outline the characteristic features inherent in an economy in transition:
1. State budget deficit.
2. Decline in production.
3. High unemployment rate.
4. Low level of income of the population.
5. High inflation rates.
In conditions of declining production and rising unemployment, which entail a deterioration in the quality of life, the need for medical services increases. Therefore, the functioning of treatment and prevention institutions requires, first of all, uninterrupted financing. Consequently, during the transition period, with its characteristic state budget deficit, one cannot count on the effectiveness of the state model of organizing the healthcare system.
Low income levels and high inflation rates will significantly limit the effective demand for medical services from private individuals. A decline in production and a focus on survival will not allow firms to provide voluntary insurance for their workers. Therefore, the use of a market model in a transition period will lead to the fact that a significant part of the population will not be able to receive the necessary medical care. This is especially true for such socially vulnerable segments of the population as the elderly, disabled people, and children, since these are groups with the lowest incomes, but with the greatest needs for medical care. Such negative consequences during the period of economic and political reforms are fraught with a social explosion.
As already noted, during the transition period, people's needs for medical care increase. To ensure the minimum required amount of financing for medical institutions, it is necessary to consolidate all possible sources of raising funds. In conditions of a state budget deficit and low incomes of the population, only a social insurance model with a multi-channel financing system (from the profits of insurance organizations, deductions from salaries, the state budget) is capable of solving this problem.
Social insurance began with its simplest types - life and accident insurance, which were dealt with by small private insurance companies. As industry strengthened and developed, large enterprises and factories appeared, wider sections of the population were involved in the insurance process, and health and ability to work became the main object of insurance. In an effort to provide for themselves and their families in the event of loss of ability to work due to illness or disability, workers created mutual aid societies, “brotherhoods,” and other associations to which they themselves made insurance contributions. In this form, social protection of workers in European countries existed during the 18th-19th centuries. For example, in Germany such a structure has been preserved to this day in the form of occupational insurance funds (Die Innungskrankenkassen). Small funds in each city merged into larger and more stable ones.
In France there were more than 5,000 mutual aid societies in case of job loss, illness or retirement. Some of them operated health centers, hired doctors, but more often reimbursed the patient after a visit from an independent doctor. Insurance partnerships were created in a similar way in Great Britain, Austria, Belgium, Switzerland, Russia, Scandinavian countries and many others.
However, such voluntary structures constantly experienced a shortage of financial resources, and the number of insured people was limited, not to mention dependents, the elderly, children and other categories of needy people.
By the beginning of this century, many European countries had adopted laws on insurance of workers in case of illness, disability, old age, and unemployment. According to these laws, in addition to the workers themselves, entrepreneurs and owners of factories and manufactories began to participate in the formation of insurance premiums, paying from 25 to 40% of insurance premiums. In a later period, insurance funds began to receive subsidies and grants from the state.
The more the state contributed funds (subsidies) to the compulsory health insurance system, the more it controlled this process. The desire to create regulated health insurance has become one of the main prerequisites for the formation of public (budgetary) healthcare in countries such as Great Britain, Sweden, Denmark, Ireland and others (the “Beveridge” model). In Germany, Austria, Belgium, the Netherlands, Switzerland and other countries of Central and Eastern Europe, the so-called “Bismarck” model became widespread, in which the financial participation of entrepreneurs paying mandatory contributions to statutory insurance funds played a significant role.
A case in point is the reform of national insurance in the UK.
The National Insurance Act was adopted in Great Britain on January 15, 1911 and initially, like similar laws in other countries, did not provide for insurance premiums to be paid entirely by the state, which is the most socially fair form of insurance. The 1911 Act established non-contributory insurance for one group of insured (workers in the lowest paid category, earning 1.5 shillings a day, who contributed nothing to the society's coffers, were entitled to all benefits). Their benefits were formed from contributions from entrepreneurs, other higher-paid workers, and state subsidies. For other categories of insured, the Act preserved the principle of mutual assistance, softening it only by requiring the allocation of subsidies and subsidies from the state budget. Thus, the Act of 1911 for the first time in Great Britain enshrined in law the principle of social solidarity, when the rich pay for the poor, the healthy for the sick.
Insurance premiums in the UK (as well as in continental European countries) were collected through the postal departments by purchasing special stamps, then these funds went to the insurance commissioners in the insurance commissions. The latter distributed the received amounts (actually taxes) among all mutual aid societies, depending on the number of insured minus funds intended for replenishing the reserve fund and maintaining the central insurance authorities.
Less than 2 years later (in 1913), national insurance reform was carried out in Great Britain, as a result of which the state began to cover the costs associated with insurance for illness and disability from the budget.
In order for the state to be able to bear such expenses, a relatively broad definition of its competence was needed, bringing the English system of insurance for illness and disability to the ideal of insurance - “insurance without contributions”, which later became the main prerequisite for the reform in Great Britain in 1948 and the creation of a budget-funded National Health Service.
In France, the question of organizing health insurance, paying old-age and disability pensions was first raised by the Convention, which created the register - the “Book of National Charity”, and the Law “22 floreals of the second year”, which determined which categories of the population are subject to entry into this register. But as soon as this Law was published, the Convention, for financial reasons, refused to implement it. And only 100 years later, the French government began to implement the principles proclaimed by the Great French Revolution.
In July 1913, France adopted “a law according to which workers were insured against accidents and occupational diseases. According to this law, the entrepreneur was obliged to pay cash benefits within a calendar year from the date of dismissal of the employee; this issue was decided by a commission, which included deputies, employees of insurance institutions, workers and entrepreneurs.The law was very important in the development of the health insurance system.
In Sweden, a draft law on social insurance for workers was submitted to the Riksdag in 1883. This law was not adopted. In 1907, the Swedish government established a special commission chaired by Professor V. Lindsted, as a result of which, on May 21, 1913, the Riksdag adopted the “Law on Compulsory Insurance in Case of Sickness, Disability, and Old Age.” Under this law, all Swedish citizens aged 16 to 66 were required to be insured. Insurance was carried out with the sole purpose of providing everyone upon reaching old age (67 years), as well as in the event of loss of ability to work (temporary and permanent), with monetary benefits from funds received through contributions from the insured and subsidies from communities and the state. Around the same period, reforms of social insurance laws took place in Austria, Belgium, Switzerland, Norway, Portugal and other countries, where the legislative branch to one degree or another regulated socio-economic relations in the state.
Germany is rightfully considered the ancestor of sickness funds, where they were formed 30 years before the appearance of the first sickness funds in Russia, and the German das Krankenversicherungsgesetz became the model for the preparation of the Law on Social Insurance of Workers in Case of Sickness, adopted by the Third State Duma on June 23, 1912 in Russia .
Back in 1883, immediately after the adoption of das Krankenversicherungsgesetz, health insurance funds began to be formed throughout Germany: factory, construction, community, local, etc. The experience of their activities showed that large health insurance funds are incomparably better at providing all types of assistance to their members than small ones. Therefore, since 1885, the process of unification and centralization of health insurance funds began, their reorganization into local (city) health insurance funds. The largest of them were Leipzig, Dresden, Munich, Stuttgart.
For example, in Leipzig, 18 local cash registers and one community fund were formed, with 22,800 members. Thus, the local health insurance fund for Leipzig and the surrounding area (Ortskrankenkasse fur Leipzig und Umgegend) arose - the largest health insurance fund in Germany. To provide medical care (in the period 1910-1913), the cash office entered into contractual relations with 429 doctors, including 13 clinics, 143 narrow specialists and 28 dentists.
The cash desk maintained its own sanatoriums and the Zander Institute, where there was an X-ray room, electrotherapy and light therapy. It had contractual relations with 59 pharmacies, 29 optical stores and other institutions. Patients had the right to freely choose a doctor from a list of doctors published by the cash register who worked with it under a contract.
- the responsibilities of sickness funds according to the law included:
Providing free treatment;
Payment of cash benefits during illness;
Financial assistance and benefits for pregnant women and women in labor;
Funeral benefit.
Family members of the insured were provided only with free treatment, as well as medical care for pregnant women and women in labor. But most funds did not limit themselves to this and expanded their assistance through preventive measures (sanatoriums, rest homes, boarding houses, etc.), and also allocated special emergency funds to help the disabled, thus creating a replacement for the missing old-age and disability insurance. The funds from the health insurance funds were: 2/3 - contributions from the workers themselves and 1/3 - contributions from entrepreneurs. Thus, several types of organization of medical care for the insured have historically been formed: a system of free choice of doctor; system of "listed doctors"; a system of doctors permanently working in health insurance funds under contracts.
A striking example of evolutionary development is shown by Norway with the introduction of public health insurance:
1909 - the beginning of the development of the first necessary legislative acts;
1911 - the beginning of practical implementation;
formation of the system - by 1956. But only in the last 4 years (by 1999) did health insurance begin to cover the entire population of the country.
Each of the systems had its own advantages and disadvantages and was used depending on the established traditions, socio-economic and geographical characteristics of the given territory.
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FEDERAL EDUCATION AGENCY OF THE RUSSIAN FEDERATION
State educational institution of higher professional education
"Tyumen State Oil and Gas University"
Humanitarian Institute
Department of Social Work
ABSTRACT
by discipline "Social medicine"
on the topic « Healthcare system in Russia »
Performed: student SRb-08 Alekseeva
Tatyana Ivanovna
Checked: teacher Petrova
Yuliana Alekseevna
Tyumen 2009
Introduction
1. Powers of the highest bodies of state power in the field of protecting the health of citizens
2. Levels of healthcare organization in Russia:
· federal level
· regional level
· local level
3. Healthcare systems in Russia:
· public health care system
· municipal health care system
· private healthcare system
4.Federal and territorial compulsory medical insurance funds
5. Insurance companies
6. Financing the health of citizens
Conclusion
Bibliography
Introduction
Today in Russia there are three levels of government: federal (central) government, regional government (power of the constituent entities of the Russian Federation: 21 republics, 6 territories, 49 regions, 10 autonomous districts, autonomous region, cities of federal significance - Moscow and St. Petersburg) and local authorities (local governments of districts, cities, towns, hamlets).
After the collapse of the USSR, simultaneously with the decentralization of power in the country, the decentralization of the healthcare system also occurred. The healthcare system has the same structure as the government: there are federal (central), regional (subjects of the Russian Federation) and local healthcare.
In accordance with the Constitution of the Russian Federation, the jurisdiction of the federal government includes: regulation and protection of human and civil rights and freedoms and coordination of health care issues (together with the authorities of the constituent entities of the Russian Federation). In addition to the Constitution, the main governing document is the law “Fundamentals of Legislation of the Russian Federation on the Protection of Citizens’ Health,” adopted in 1993.
In November 1991, the USSR Ministry of Health was abolished and was replaced by the Ministry of Health and Medical Industry of the Russian Federation. In fact, it simply merged two former ministries - the Ministry of Health of the USSR and the RSFSR. There were certain disagreements regarding the division of responsibilities between the ministries, but in general their merger went quite smoothly, since they had a similar structure.
Below, all components of the Russian healthcare structure will be considered in turn.
1. Powers of the highest bodies of state power and administration of the Russian Federation in the field of protecting the health of citizens
Healthcare is a set of political, economic, social, legal, scientific, medical, sanitary and hygienic, anti-epidemic and cultural measures aimed at preserving and strengthening the physical and mental health of each person, maintaining his long active life, providing him with medical care in case of deterioration health.
The Supreme Council of the Russian Federation determines the main directions of federal state policy in the field of protecting the health of citizens, adopts laws and approves federal programs on issues of protecting the health of citizens; approves the republican budget of the Russian Federation, including in terms of healthcare costs, and controls its implementation.
The President of the Russian Federation manages the implementation of federal state policy in the field of protecting the health of citizens, and at least once a year submits a report to the Supreme Council of the Russian Federation on state policy in the field of protecting the health of citizens and the state of health of the population of the Russian Federation.
The Government of the Russian Federation implements federal state policy in the field of protecting the health of citizens, develops, approves and finances federal programs for the development of healthcare; within the limits provided for by law, coordinates the activities of government bodies, as well as enterprises, institutions and organizations, in the field of protecting the health of citizens, regardless of their form of ownership.
2. Levels of healthcare organization in Russia
Federal level
The Ministry of Health is the highest health management body. It is headed by a minister appointed by the Prime Minister after approval of the candidacy in the State Duma.
The Ministry sets healthcare policy in Russia and has officially retained the right to monitor regional healthcare and the implementation of healthcare decisions by constituent entities of the Russian Federation. However, the expansion of the powers of local authorities, and above all their right to form their own budget, means that the ministry can no longer count on the implementation of its instructions.
The structure of the Ministry of Health of the Russian Federation often changes: new departments are merged and created, their functions are redistributed.
The budget for the Ministry of Health is established by the Ministry of Finance. From its budget, the Ministry of Health finances research institutes, clinical activities of the Russian Academy of Medical Sciences, scientific centers and medical educational institutions. Federal medical institutions contain about 4% of the country's bed capacity.
The Ministry of Health and its agencies currently receive only a small portion of government funds allocated to health care, approximately 5%.
Regional level
Governing bodies at this level manage healthcare in the constituent entities of the Russian Federation. Before the introduction of compulsory health insurance (CHI) (see below) in 1993, the authorities of the constituent entities of the Russian Federation had full control over the financing of their healthcare. Later, it partly became the responsibility of established territorial compulsory medical insurance funds. However, health insurance has not been fully introduced, and so far the authorities of the constituent entities of the Russian Federation and local authorities provide healthcare for about two-thirds, and therefore still play an important role in healthcare management. Subjects of the Russian Federation are obliged to ensure the implementation of federal target programs, primarily aimed at monitoring the sanitary and epidemiological situation and combating socially significant infectious diseases, but are not required to report to the Ministry of Health. After the decentralization of power in the first half and mid-1990s. regional authorities have become quite independent. In some constituent entities of the Russian Federation, health departments are actively involved in the development of reforms, monitoring the quality of medical care and other endeavors, while in others they are not particularly active.
Regional health care is typically provided by a general hospital with approximately 1,000 beds and a children's hospital with 400 beds, both of which have an outpatient department. Any resident of a constituent entity of the Russian Federation can be treated in such a hospital. There are also regional specialized medical institutions - infectious diseases, tuberculosis, psychiatric and others. About a quarter of primary health care institutions and over 70% of diagnostic centers are regional.
Local level
Local authorities in many large cities are actively involved in health care reforms, but rural authorities often perform responsibilities more similar to those of the management of a central district hospital. According to the law “On the General Principles of the Organization of Local Self-Government in the Russian Federation” adopted in 1995, local authorities are not responsible to the regional leadership, but must comply with decrees of the Ministry of Health. In such a situation, it is difficult to manage healthcare in the country: programs and reforms that come from regional authorities are not mandatory for local authorities. The latter are only obliged to provide the local population with medical care to the extent specified in the laws. In fact, very often, by mutual agreement, local healthcare comes under the leadership of the regional Ministry of Health.
In cities, as a rule, there is a city multidisciplinary hospital for adults with 250 beds and a children's city hospital with 200 beds. In addition, there is a city emergency hospital, infectious diseases and tuberculosis hospitals with 700 beds, maternity hospitals, psychiatric and neurological hospitals (some are under regional control) and other specialized hospitals. Most primary health care institutions, clinics and some diagnostic centers are also municipal institutions.
Health care facilities in rural areas usually include a central hospital with approximately 250 beds, which often doubles as a clinic. In some areas, hospitals are smaller, with about 100 beds. There are also clinics, outpatient clinics and paramedic stations.
3. Healthcare systems in Russia
Public health system
The state healthcare system includes the Ministry of Health of the Russian Federation, the ministries of health of the republics within the Russian Federation, the health authorities of the autonomous region, autonomous okrugs, territories, regions, the cities of Moscow and St. Petersburg, the Russian Academy of Medical Sciences, the State Committee for Sanitary and Epidemiological Surveillance of the Russian Federations that, within their competence, plan and implement measures to implement the state policy of the Russian Federation, implement programs in the field of health care and the development of medical science. The state health care system also includes state-owned and subordinated to the management bodies of the state health care system, treatment and preventive and scientific research institutions, educational institutions, pharmaceutical enterprises and organizations, pharmacy institutions, sanitary and preventive institutions, forensic medical examination institutions, financial services - technical support, enterprises producing medicines and medical equipment and other enterprises, institutions and organizations.
The state health care system includes treatment and preventive institutions, pharmaceutical enterprises and organizations, pharmacy institutions created by ministries, departments, state enterprises, institutions and organizations of the Russian Federation in addition to the Ministry of Health of the Russian Federation, ministries of health of the republics within the Russian Federation.
Enterprises, institutions and organizations of the state healthcare system, regardless of their departmental subordination, are legal entities and carry out their activities in accordance with these Fundamentals, other acts of legislation of the Russian Federation, republics within the Russian Federation, legal acts of the autonomous region, autonomous districts, territories, regions, the cities of Moscow and St. Petersburg, regulations of the Ministry of Health of the Russian Federation, ministries of health of the republics within the Russian Federation, health authorities of the autonomous region, autonomous districts, territories, regions, cities of Moscow and St. Petersburg.
Municipal healthcare system
The municipal health care system includes municipal health authorities and municipally owned treatment, preventive and scientific research institutions, pharmaceutical enterprises and organizations, pharmacy institutions, forensic medical examination institutions, educational institutions that are legal entities and operate in accordance with with legislative acts of the Russian Federation, republics within the Russian Federation, legal acts of the autonomous region, autonomous okrugs, territories, regions, cities of Moscow and St. Petersburg, regulations of the Ministry of Health of the Russian Federation, ministries of health of the republics within the Russian Federation and local governments.
Municipal health authorities are responsible for the sanitary and hygienic education of the population, ensuring the availability of a guaranteed volume of medical and social assistance to the population, the development of the municipal healthcare system in the territory under their jurisdiction, and monitor the quality of the provision of medical, social and medicinal assistance by enterprises, institutions and organizations of state, municipal , private healthcare systems, as well as individuals engaged in private medical practice.
Financing of the activities of enterprises, institutions and organizations of the municipal healthcare system is carried out from budgets of all levels, trust funds intended to protect the health of citizens, and other sources not prohibited by the legislation of the Russian Federation.
Private healthcare system
The private health care system includes medical and preventive care and pharmacy institutions, the property of which is privately owned, as well as persons engaged in private medical practice and private pharmaceutical activities.
The private healthcare system includes treatment and prevention, pharmacies, research institutions, educational institutions created and financed by private enterprises, institutions and organizations, public associations, as well as individuals.
The activities of institutions of the private healthcare system are carried out in accordance with these Fundamentals, other acts of legislation of the Russian Federation, republics within the Russian Federation, legal acts of the autonomous region, autonomous districts, territories, regions, cities of Moscow and St. Petersburg, regulations of the Ministry of Health of the Russian Federation, ministries of health of the republics within the Russian Federation and local governments.
4. Federal and territorial compulsory medical insurance funds
The 1991 law adopted as part of the health care reform, amended in 1993, introduced compulsory health insurance (CHI) in the country; it was supposed to improve the extremely meager financing of health care and responded to the desire of society to move to a market economy as quickly as possible. In order for market forces to promote cost-effectiveness, quality, and equity in health care, the producers and purchasers of health care had to be separated, which is what the health insurance system did. In the new financing scheme, the key figures were compulsory medical insurance funds - the Federal Compulsory Medical Insurance Fund and territorial compulsory medical insurance funds (one in each constituent entity of the Russian Federation).
Territorial compulsory medical insurance funds collect insurance premiums and distribute them. Two categories of insurance contributions have been defined: for working citizens, payments in the amount of 3.6% of the wage fund are made by employers, for non-working citizens (children, pensioners, the unemployed, and so on) - by local authorities. Territorial compulsory medical insurance funds transfer the received funds to insurance companies (they are also called medical insurance organizations, they will be discussed below) or branches of territorial compulsory medical insurance funds, which, on behalf of the insured, enter into contracts for medical care with medical institutions.
The employer's contribution to compulsory medical insurance, amounting to 3.6% of accrued wages, is distributed as follows: 3.4% - to the territorial compulsory medical insurance fund, 0.2% - to the Federal compulsory medical insurance fund. Funds allocated to the Federal Compulsory Medical Insurance Fund are used to equalize the resources of territorial funds. Federal and territorial compulsory medical insurance funds are state non-profit organizations. The Federal Compulsory Medical Insurance Fund is a legally independent organization and is not subordinate to the Ministry of Health, but it monitors its activities through its representatives on the board.
The Federal Compulsory Medical Insurance Fund monitors the activities of 89 territorial compulsory medical insurance funds, the position of which in the compulsory medical insurance system corresponds to the position of regional health care authorities. The Federal Compulsory Medical Insurance Fund is primarily obliged to manage the entire compulsory medical insurance system and monitor the equality of financial conditions in which compulsory medical insurance is carried out in the regions.
Territorial compulsory medical insurance funds are responsible for collecting insurance premiums and providing the population with a contractual set of medical services.
5. Insurance companies
The next key element established by the law on health insurance is independent organizations that pay for medical services on behalf of the insured. There are two types of such organizations: independent insurance companies and branches of territorial compulsory medical insurance funds, which take on the role of insurance companies in their absence in a given area. Insurance companies (and branches of territorial compulsory medical insurance funds) enter into contracts with territorial compulsory medical insurance funds, receive funds from them for each insured person and select medical institutions with which they enter into an agreement for the provision of medical services. Insurance companies must select medical institutions carefully to promote competition between them, encourage them to reduce costs and improve the quality of medical services. Insurance companies monitor the volume and quality of medical services and, in accordance with them, issue funds to the medical institution. They should help strengthen the role of primary health care and prevention. In addition, insurance companies have the right to provide voluntary health insurance.
Insurance companies, according to the role assigned to them in the law, can organize their activities in a variety of ways (create medical associations that provide paid medical services to a certain group of the population at pre-agreed rates, or general practice institutions with capitation funding, etc.). The Law on Health Insurance does not directly mention these forms of activity, but speaks of the further development of insurance companies; therefore, the emergence of various types of health insurance associations depends only on the desire of insurance companies.
By the end of the 1990s. The compulsory medical insurance system included: the Federal Compulsory Medical Insurance Fund, 89 territorial compulsory medical insurance funds and 1,170 of their branches, 415 insurance companies. Today there are 300 insurance companies, and their number continues to decline - some go bankrupt, others merge. The emergence of so many independent insurance companies in the health care system is largely due to the fact that health insurance has attracted many of the existing private insurance companies (the creation of private insurance companies has been allowed since the late 1980s).
The implementation of the health insurance law has faced many obstacles. In reality, the law is only partially implemented, and each constituent entity of the Russian Federation has adopted new financing schemes in its own way. It should be noted that in approximately 50% of the regions there are no medical insurance companies (i.e., the services of medical institutions under compulsory medical insurance are paid for by territorial compulsory medical insurance funds or branches of the territorial compulsory medical insurance fund). In the rest, that is, in approximately half of the constituent entities of the Russian Federation, insurance companies act only in the capacity of intermediary buyers of medical services provided for by law. In a broad sense, health care financing has become dual, creating great challenges for health care providers. With very few exceptions, it has not been possible to introduce competition and market relations into medical care. Achievements in improving the financing and cost-effectiveness of health care have also fallen short of expectations.
Today there is a lot of talk about the future of insurance companies. Increasingly, they are considered useless and bureaucratic organizations that are likely to hinder the effectiveness of new methods of financing, and some regions of the Russian Federation have gotten rid of them altogether.
6. Financing the health of citizens
As in most countries, in Russia the Ministry of Finance plays an important role in healthcare, since healthcare financing depends on it. However, state budget funds (as opposed to taxes collected by local authorities) make up only a small part of the overall health care budget. The Treasury Department still sets the federal budget and tells local governments how much they must spend on health care.
Sources of financing for the protection of public health are:
· Funds from budgets of all levels;
· Funds allocated for compulsory and voluntary medical insurance in accordance with the Law of the Russian Federation “On medical insurance of citizens in the Russian Federation”;
· Funds from trust funds intended to protect the health of citizens;
· Funds of state and municipal enterprises, organizations and other economic entities, public associations;
· Income from securities;
· Loans from banks and other lenders;
· Free and (or) charitable contributions and donations;
· Other sources not prohibited by the legislation of the Russian Federation.
Conclusion
Having studied the structure of healthcare in Russia, we can conclude that protecting the health of citizens in Russia is a set of measures of a political, economic, legal, social, cultural, scientific, medical, sanitary and hygienic and anti-epidemic nature, aimed at preserving and strengthening the physical and mental health of each person, maintaining his long active life, providing him with medical care in case of loss of health.
The healthcare system has a specific structure, where each level has its own goals and objectives. So the main tasks of healthcare organization at the federal level should be considered:
· determination of the strategy for the development of healthcare in the country;
· development and implementation of federal targeted health care programs;
· development of the legislative and regulatory framework for healthcare;
· coordination of the activities of government bodies 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 healthcare 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 healthcare 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.
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.
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.
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The model used in Russia (as well as in countries of Eastern Europe with economies in transition, including some CIS countries) is financing that combines elements of state and insurance medicine; gradual introduction of the institution of provision of paid medical services.
The history of health insurance in pre-revolutionary Russia dates back to 1861, when the first law was adopted that introduced elements of compulsory health insurance. The law prescribed the creation of partnerships and auxiliary funds at state-owned mining plants to issue temporary disability benefits in the amount of 1/6 to 3/4 of earnings. Auxiliary funds were formed from contributions from workers, amounting to 2-3% of wages, as well as annual additional payments from the employer.
In 1866 A law was passed obliging factory owners to provide workers with medical care and build hospitals at the rate of 1 bed per 100 workers with free treatment.
With the development of railway transport in Russia, a medical care system was created for railway workers and employees. Cash registers were formed from monthly contributions in the amount of 6% of earnings received. From this amount sickness maintenance, pensions or lump-sum benefits for disability and in the event of the death of the breadwinner were paid.
In the second half of the 19th century, a public insurance system for artisans and hired workers began to develop. Health insurance funds are becoming the main insurance institutions.
In 1903 The law “On remuneration of citizens who suffered as a result of an accident, workers and employees, as well as members of their families in enterprises of the factory, mining and mining industries” was adopted. According to the law, the benefit was half the salary and was paid from the day of the accident until the day of restoration of working capacity. This law forced entrepreneurs to unite into insurance partnerships, to which funds were systematically transferred.
Legislative consolidation of the system of payments through special insurance organizations occurred in 1912, when the III State Duma adopted the following laws: “On the establishment of presences for workers’ insurance”, “On the establishment of the Council for Workers’ Insurance”, “On providing workers in case of illness”, “On insurance of workers against accidents.” From now on, a social insurance system is being formed in Russia. The health insurance fund, established at each enterprise with at least 200 employees, became the insurance agency. The health insurance funds consisted of contributions from workers and entrepreneurs, and the contributions of workers were 1.5 times higher than the contributions of entrepreneurs. The main function of the health insurance fund was to issue benefits in the event of illness, injury, childbirth, or death.
After the October Revolution of 1917 The health and social insurance system has changed radically. A strict centralization of funds allocated for social security was carried out. The Council of People's Commissars issued the following decrees: “On the free transfer of all medical institutions to health insurance funds”, “On health insurance”, “On unemployment insurance”. Based on these decrees, full social insurance was introduced in Russia. It was based on the following principles: the extension of insurance to all hired workers, insurance coverage of all types of disability. All medical factories and all their property were transferred to health insurance funds. Workers' contributions were abolished, and entrepreneurs' contributions were increased.
With the adoption of the Decree of 1918 “On the social security of workers,” the process of centralization of insurance medicine intensified, medical insurance itself was replaced by purely social insurance, and then the concept of “insurance” was replaced by the concept of “security.”
After the adoption of the resolution of the Council of People's Commissars in 1919. “On the transfer of the entire medical part of the former sickness funds to the People's Commissariat of Health”, insurance medicine as such was actually abolished. There was an attempt to partially revive it during the NEP period. Resolutions of the Council of People's Commissars in 1921-1923. For employers of various forms of ownership, insurance premiums were determined, through which expenses for temporary incapacity, disability, and unemployment were reimbursed. In 1922 the amount of the insurance premium ranged from 21 to 28.5% of the wage fund. The target contribution for health insurance based on working conditions was in the range of 5.5-7% of the wage fund. For government institutions, the general social contribution was set at 12% of the wage fund, including 3% for health insurance. Of these, 10% of the collected contributions were sent to the People's Commissariat of Health, and 90% to provincial and local health authorities. However, compulsory health insurance served only as a supplement to government funding for health care.
The system of free healthcare financed directly from the budget that existed during the Soviet period was not effective enough.
In Russia, there is a transition from a completely state system of financing healthcare to a budgetary insurance model, in which medical insurance is combined with budgetary and paid healthcare, but the concept of healthcare reform provides for a transition to a purely insurance model with the expansion of voluntary (private) medical insurance. This decision is very controversial, since the private model is the most costly and does not allow for the efficient use of healthcare resources. In the USA, a country with a private healthcare model, due to the presence of a number of shortcomings, as a result of ongoing reforms, the role of the state in financing the industry is being strengthened through the redistribution of tax revenues.
In a fairly short period, a transition has been made from centralized planning and budget financing to planning for health care development at the regional level, from the system of financing specific health care facilities to the principles provided for by the compulsory medical insurance system. The budgetary method of financing that existed in our country was focused on the budget's capabilities, and not on the real costs arising in this area.
Currently, Russia has both a state system and private health insurance. The state pays the costs of medical institutions through intermediaries - insurance companies. In essence, this is a distribution system with elements of insurance. Private health insurance in our country is sold only by insurance companies and in a variety of forms.
Until now, the state healthcare system has been aimed at providing medical services by state (federal and municipal) medical institutions to all categories of Russian citizens - Article 41 of the Russian Constitution. The list of free medical services is limited. Services are financed through compulsory insurance of medical care costs for a narrow list of services. Expenses for compulsory health insurance are included in the total expenses for social security of citizens.
The population can pay for additional medical services on their own, as well as cover expenses through voluntary health insurance policies. Paid services are allowed to be provided by both private and public medical institutions.
Thus, in Russia there are currently 3 financial models of healthcare:
1. Public health care (in the form of formations of federal and regional compulsory health insurance funds).
2.Voluntary health insurance system.
3.Payment by the population of paid medical services.
This reform was carried out due to the impossibility of quality medical care, relying only on allocations from the state budget. The transformation of the healthcare system in the Russian Federation was an expression of the desire to increase funding for public healthcare by expanding the sources of funds and changing the structure of financial flows.
The replacement of socialist ideology with a market one determined the orientation of health care reforms towards borrowing models of health care organization used in countries with developed market economies.
It should be noted that these models were just beginning to be used in countries at a fundamentally different level of economic development and democracy, and were called upon to solve qualitatively different problems in different institutional conditions: in a developed market economy, with established mechanisms of its state regulation and in that state of civil society. a society that is able to effectively protect the interests of the population.
Improving the efficiency of healthcare and introducing mechanisms for the rational use of limited financial resources of the industry will be facilitated by:
Development of a plan for the privatization of part of medical institutions;
Formation of a unified payment system for medical services, which will help achieve social goals and increase the efficiency of use of available resources, which ensure the economic viability of medical institutions;
Improving the system of contracts between territorial compulsory health insurance funds and medical insurance organizations, medical insurance organizations and medical institutions;
What is apparently required is a return to a certain centralization of financing of medical institutions. Currently, more than half of the total budget funding comes from local budgets;
Creation of a system for collecting and disseminating information to facilitate patients’ free choice of medical institutions;
Taking measures to create conditions that impede the development of the informal market for medical services.
In this regard, the experience of countries with both a mixed financing system and countries with predominantly private medicine is of significant interest. To date, many countries have tried to introduce systems based on the models of Western Europe and North America. These countries typically faced a lack of experienced administrative apparatus capable of making these systems function effectively. In addition, such health care systems have proven to be poorly adapted to the flexible, informal labor market that is now widespread.
It should be pointed out that a simplified interpretation of healthcare models based only on their classical description is inadmissible. The problem of classification cannot be considered as a classification according to one single, albeit most important, attribute. Any set is characterized not only by diversity in any characteristic, but also by the diversity of the characteristics themselves. This fully applies to healthcare models.
The variety of possible healthcare models makes the problem of choosing a specific type quite complex.
There is no ideal healthcare model, and in reality it cannot exist. Any healthcare system must be considered in direct connection with the characteristics of the development and functioning of a particular country. The advantages and disadvantages of each specific model are determined by a combination of various factors. Depending on the specific conditions, each of the models has its own advantages over others in certain indicators.
In essence, choosing a healthcare model is not a once-solved problem. In modern healthcare systems around the world, reform processes are constantly underway, consisting of a multivariate combination of the various healthcare models described above.
Ideally, a system built on the principle of universalism would provide everyone with basic forms of social protection. This means that a certain level of health care benefits must be provided free of charge by the government. A characteristic feature of economic policy in countries with transition economies was the minimization of the role of the state. It is now clear that in the conditions of the transition period, which is protracted and complex in nature, the responsibility of the state should increase rather than decrease. State intervention must be active in those important areas where market forces cannot ensure the efficient allocation of resources or where access to the basic, most important goods and living conditions of people is inequitable.
Thus, the experience of countries with economies in transition demonstrates the importance of maintaining state capacity, which has been weakened during the reform process. In market relations, the state plays a central role in maintaining economic stability, regulating the market, and providing necessary social services.