Topic number
№ 2 . 2020
Content
Above all

Coronavirus and healthcare

Аннотация

Russian healthcare, healthcare reform, COVID-19 pandemic, financing problems

Аннотация

The COVID-19 pandemic has identified such health problems in the Russian Federation and most developed countries as: shortage of hospital beds, medical staff and personal protective equipment; disintegration of management between the center and the regions; slowness of health care financing systems. But for the healthcare in Russia the situation was incomparably worse, because by the time the epidemic began, it was already in critical condition due to untalented reforms of recent years (the notorious optimization), because of long-term underbudgeting, disempowered position of medical workers. At the same time, the fight against epidemic came upon their shoulders, as well as upon all frontline health care workers. And absolute majority of them have fulfilled and continue to fulfill their duty. This also led to death of 100 of medical workers.

Following all these events, the country's leadership and society are not entitled to continue the policy of previous years. This means that it is necessary to prepare the Healthcare Reform Program, which will allow in the new conditions (protracted nature of the COVID-19 pandemic and decline in real incomes for the majority population of the Russian Federation) preserve its sustainability and correct impossible situation with medical workers, thereby ensuring social stability.

The main proposals to reform the healthcare sector of the Russian Federation for 2020-2022: 1) increase in wages and ensuring occupational safety of medical workers; 2) increasing government funding for healthcare up to 6% of gross domestic product (GDP); 3) transition to payment of medical organizations according to estimate and reorganization of medical care insurance funds in financial departments of state health authorities; 4) creation of a single healthcare management vertical under the leadership of the Ministry of Health of the Russian Federation with subordination to it of the Sanitary and Epidemiological Surveillance service; 5) creation of a global system of medicine provision on an outpatient basis; 6) providing conditions for a system of continuing medical education and improving the quality of student training in medical universities and colleges; 7) an increase in funding for medical science by 3 times (from 0.04 to 0.12% of GDP); 8) ensuring the constant preparedness of the healthcare system for crisis situations.

Effective management

Features of financial support of territorial programs of state guarantees of free medical care for citizens in 2018-2020

Аннотация

About 80% of the funds allocated to health care from state sources are financed under the territorial state guarantee programs approved annually and implemented by all government bodies of the constituent entities of the Russian Federation.

In this article, based on a set and analysis of the approved territorial programs of state guarantees of all constituent entities of the Russian Federation for the last 3 years, the features of their financial support in 2018-2020 are revealed.

Analysis of population health indicators and their determining factors in the Moscow region from 2012 to 2018

Аннотация

This paper presents evaluation of demographic and public health indicators of Moscow region and the factors determining them. The analysis was performed in dynamics from 2012 to 2018 and in compare is on with the Russian Federation and the Central Federal district in average, including that versus each of 18 entities being members of the district. Based on the findings, conclusions and recommendations for the Moscow region in the public health and healthcare have been formulated.

Analysis of population health indicators and their determining factors in the Moscow region from 2012 to 2018. Continuation

Аннотация
This paper presents evaluation of demographic and public health indicators of Moscow region and the factors determining them. The analysis was performed in dynamics from 2012 to 2018 and in compare is on with the Russian Federation and the Central Federal district in average, including that versus each of 18 entities being members of the district. Based on the findings, conclusions and recommendations for the Moscow region in the public health and healthcare have been formulated.
Actually today

Respiratory disasters: technological paradigm of mechanical ventilation as a threat to national security

Аннотация

The coronavirus pandemic has shown the critical vulnerability of national health systems to the risk of sudden mass appearance of patients with respiratory failure and the need for mechanical ventilation (IMV). The author sees the reason for this vulnerability in the historically established technological paradigm of IMV, which provides no alternative to conventional positive pressure ventilation (PPV) and its use for all types of patients (both surgical and therapeutic), including in situations of respiratory disasters. However, PPV proved to be ineffective for ventilating COVID-19 patients and has many medical, economic, mass-acqusition, and ethical disadvantages that make this method ineffective in cases of respiratory disasters. On the contrary, negative pressure ventilation (NPV, Iron Lung), which has been superseded from medical practice, is close to the ideal for respiratory therapy in the case of mass admission of patients with a therapeutic profile with respiratory failure due to infectious, chemical or radiation lesions. At the same time, available data on the use of NPV suggest the possibility of improving the results of COVID-19 treatment. As a solution, the author suggests a new technological paradigm of IMV, in which PPV and NPV are not alternative, but complementary methods of a single technological chain of respiratory therapy. It is concluded that the rejection of the view of NPV as an anachronism and the "catch-up" development of this technology will increase the effectiveness of the fight against the COVID-19 pandemic and/or create reserves for the healthcare system in the event of respiratory disasters in the future.

A shift on the front line

Аннотация

Lessons from CEOs: health care leaders nationwide respond to the Covid-19 crisis

Аннотация

COVID-19, coronavirus infection, caused by SARS-CoV-2

Аннотация
Legal advice

What is the doctor to blame? Problems of identifying cause-effect relationships in criminal cases of doctors

Аннотация

The article considers the problem of the scientific definition of causal relationships in criminal cases on charges of doctors. The investigation of such criminal cases, in addition to basic knowledge in medicine, requires professional practitioners to take a scientific approach to identifying cause-effect relationships. Over the past two millennia, philosophy has been engaged in a methodology for identifying these relationships. The relevance of the article is due to the fact that the doctrine of causality is not sufficiently represented in textbooks for practitioners of justice.

CHIEF EDITOR
CHIEF EDITOR
Guzel E. Ulumbekova
MD, MBA from Harvard University (Boston, USA), Head of the Graduate School of Healthcare Organization and Management (VSHOUZ)
Вскрытие
Medicine today

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