Topic number
№ 1 . 2021
Above all

Rating of the effectiveness of healthcare systems in the regions of the Russian Federation, in 2019


The Graduate School of Healthcare Organization and Management (VSHOUZ) has updated healthcare effectiveness ranking in the regions (states) of Russia for 2019 year. This ranking shows how effective is their healthcare policy. The effectiveness is calculated by comparing the level of life expectancy between the regions of the Russian Federation and public healthcare spending on it. Meanwhile it also takes into account the difference in GRP per capita and strong alcoholic beverages consumption per capita in region. It is shown how the position of the region has changed in 2019 compared to 2018.

Actually today

The national system of quality and safety indicators of medical care as a tool to support decision-making in the health care system of the Russian Federation


The quality of medical care is one of the acute problems in today's health care system. Clinical studies have demonstrated widespread defects, inconsistency of medical care with the current level of medical science, and low efficiency of medical care. This problem is urgent for the Russian Federation, since high mortality rates, a significant number of defects and dissatisfaction with medical care are recorded. A literature review was conducted and a model of medical care quality was formulated based on six determinants: effectiveness, efficiency, accessibility, quality of life, safety, and satisfaction.

We analyzed the criteria of accessibility and quality of medical care in 15 regions of the Russian Federation included in the Volga Federal District and the city of Moscow. It was found that the criteria for the quality and accessibility of medical care established under the health insurance program do not evaluate all determinants. Significant qualitative and quantitative variation was recorded between the subjects of the Russian Federation.

Based on the analysis, the development of a national system of quality indicators is justified. This system is necessary for making quality management decisions in the health care system.


Staffing and regulatory provision of medical care for patients with COVID-19 in a hospital care


Aim - аnalysis of regulatory documents governing staffing standards for medical organizations providing medical care to patients with COVID-19 in a hospital setting

Material and methods. Regulatory documents from the legal information and analytical portal "", as well as the collection of the Ministry of Health of Russia "Resources and activities of medical healthcare organizations of the Russian Federation in 2019. Part 1. Medical personnel."

Results. The features of planning the number of human resources for the provision of medical care in a hospital environment, including in emergency situations, pandemic, are shown.

A number of orders of the Ministry of Health of Russia were analyzed, which provide recommendations for the formation of a temporary staffing table of departments for the treatment of patients with COVID-19 and other regulatory documents governing the staffing standards of medical organizations.

The erroneous provisions of the recommendations for the staffing of the hospital stage of treatment of patients with coronavirus infection are highlighted, the transition from the recommendatory method of applying labor standards to the obligatory one, their contradictions with the current regulatory documents are shown, the changes introduced by orders, innovations in labor standards, ineluding differentiation by age are summarized , as well as changes in the number of specialists working in departments, the values of labor standards and others.

Attention is drawn to the expediency of switching to a generally accepted and unambiguously understood and applied normative indicator for labor when organizing round-the-clock work, which is calculated according to a specially developed methodology.

The problems of organizing the provision of medical care to patients with COV-ID-19 in terms of labor standards that need to be addressed have been identified.

Conclusion. The system of labor rationing in health care turned out to be incapable of responding to the challenges of the epidemiological situation in the country, and after almost a year since the appearance of registered cases of coronavirus infection in Russia, no regulatory support has been formed for the treatment of these patients that meets the requirements. presented to documents of this kind. The study revealed systemic shortcomings in labor rationing in health care that have been accumulating over the past decades, which is primarily associated with the absence of a centralized system for managing labor rationing in health care.

Healthcare workers “burn-out”: diagnostic, treatment, particularities during epidemy of COVID-19


"Burn-out" by ICD-11 - it is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. Profession of healthcare workers is related to constant physical and moral stress. Due to this factor the risk of "burn-out" for healthcare workers is much higher than for people of other professions. Even before COVID-19 epidemy share of "burnt-out" healthcare workers was in RF up to 70%, in USA up to 50%. "Burn-out" has very negative consequences for professional and personal life of physicians: more professional errors, less patients satisfaction, physicians suffer from depression and anxiety, even suicides become possible. Now, the most effective approach for "burn-out" prophylaxis is creating good working environment: Less extra-hours of work, adequate salary, rational use of digital technologies (which doesn't lead to additional burden), creation of positive and supportive organizational culture, development of non-formal colleagues' communication, flexible working hours and support of autonomy at work.

In the time of COVID-19 epidemy healthcare workers meets additional stress factors, as lack of PPE, concerns about children and relatives, physical stress from work in PPE, need of "rationing" hospital resources. As a result, incidence of "burnout" is dramatically increased. For example, "depersonalization" of health care workers in RF is reached 93%. Unfortunately, proposed in RF measures are very non-specific and prepared by psychologists and psychiatrists (not by specialists in healthcare management). In relation to this situation, it is proposed to refine these recommendations taking into account international experience. These measures are divided into three main groups. First group is obligatory provision of healthcare workers by basic needs: PPE, food, transportation, children care and other needs. The second group of measures: provision of complex psychological support: support of colleagues, 24/7 "hot line" with psychologists, plan of actions in case of death of healthcare workers or his relative, guidance of management actions in case of extreme cases of "burn-out" (diagnostic and treatment). The third group of actions are measures for active, constant and positive communication of leaders with workers as: meeting with management constant feedback from workers, creation of positive communication environment in each department of hospital.

Healthcare financing

Financial support of territorial programs of state guarantees of free provision of medical care to citizens in 2020–2021


In 2019, the main thrust of public health policy was to promote the achievement of national development goals. In this direction, management and financial resources were concentrated at all levels of public authority, a system for monitoring the implementation of relevant measures, including the national projects "Healthcare" and "Demography", was built.

In 2020, in connection with the global pandemic of the new coronavirus infection, the conditions for the implementation of this policy have fundamentally changed. The main tasks for healthcare were to smooth out the peaks in the incidence of new coronavirus infection in order to minimize the risks of overloading its capacities and to maintain, despite all the shock changes in the external environment, the main parameters of the functioning of healthcare, both in terms of the volume of medical care provided to the population and its financial support. This determined the initial conditions for the formation and implementation in 2020 and 2021 of territorial programs of state guarantees of free medical care.

This article analyzes the main indicators of the financial support of territorial programs of state guarantees of the constituent entities of the Russian Federation in 2020 and 2021. The main attention is paid to the continuity of the main indicators of health financing for these programs in 2020 and in 2021 in relation to 2019, preceding the year of the onset of the global pandemic.

This article, in its essence, is a continuation of analytical studies of the features of the financial support of territorial programs of state guarantees for free provision of medical care to citizens, starting with the territorial programs approved for 2018 and the planning period of 2019 and 2020.

Dynamics of volumes of potential sources of financing of private medical organizations from 2012 to 2019


The article analyzes the dynamics of the volume of public and personal (private) healthcare expenditures in the Russian Federation from 2012 to 2019. The structure of these expenditures includes items that are potentially profitable sources of payment for medical services in private medical organizations (MO): compulsory funds medical insurance (CMI) sent to private medical institutions, and paid medical services (PMS). During the same period, the dynamics of revenue of large private medical organizations was analyzed.

It was revealed that in the Russian Federation from 2012 to 2019, the total amount of state funding for health care increased by 7% (from 2283 to 2439 billion rubles) in constant prices (2012 = 100%). At the same time, compulsory medical insurance funds grew by 49% (from 932 to 1391 billion rubles) in constant prices. Of these, the amount of funds channeled to private municipalities increased 4.4 times (from 12 to 53 billion rubles). In 2019, these funds accounted for 3.8% of the total amount of CMI funds (83 from 2190 billion rubles). Private spending on healthcare during this period increased by 28% (from 1008 to 1295 billion rubles) in constant prices, of which PMS - by 39% (from 334 to 465 billion rubles).

The total volume of potential sources of financing for private medical organizations from 2012 to 2019 increased by 50% (from 346 to 519 billion rubles) in constant prices (2012 = 100%). In 2019, the total volume of these sources amounted to 806 billion rubles, of which 90% is the share of PMS, 10% falls on the compulsory medical insurance. Over the same period, the average annual growth rate of revenue of large private medical organizations (with a revenue of more than 900 million rubles per year) ranged from 4 to 29% in constant prices.

The authors draw the following conclusions. For the period from 2012 to 2019, the higher growth rate of CMI funds allocated to private MOs compared to the growth rate of all CMI expenses indicates that private MOs are gradually increasing their share in this market sector at the expense of state MOs. The higher growth rate of PMS volumes in the market as a whole, than the growth rate of revenue of large private medical organizations, indicates that the public sector is more actively increasing its share in this market. In order to simultaneously increase the availability of medical care (i.e., its volume) and at the same time balance the interests of private and public health care providers, it is necessary to gradually increase public funding for health care and direct additional funds to those health care organizations, regardless of the form of ownership, which will provide medical care required profile and quality. For the phased elimination of PMS from state-owned MOs, additional funding will also be required to compensate them for lost income.

Public health

World Patient Safety Day: raising awareness of citizens about the quality and safety of medical activity


The article is dedicated to the organization of World Patient Safety Day in the Russian Federation. The main purpose of the World Safety Day events is to raise public awareness of the problem of patient safety around the world, to increase public participation in improving the quality and safety of medical care. The World Health Organization considers the safety of health workers and patients in 2020 in a comprehensive manner Within the framework of an international company, events dedicated to patient safety are being held in the Russian Federation for the second year at federal and regional levels with the support of the Ministry of Health of the Russian Federation and the Federal Service for Surveillance in Healthcare.

Our patients

Development of extended motor regime in patients with spinal cord injury based on the tolerance parameter to physical load in categories of the International classification of functioning


Background. To organize an extended motor regime for children with spinal cord injury (SCI) is an actual task because of the lack of clear criteria justifying the choice of volume, intensity and regime of motor loading when developing a comprehensive program for rehabilitation at Stage I.

Aim - to study the response of functional systems to passive work and to define assessment criteria for extended physical activity which are applicable in clinical practice. To use the defined tolerance criteria in ICF categories for extending the motor regime in children with SCI at an early rehabilitation stage.

Material and methods. 61 children, aged 8-18, with isolated SCI below level C5 who were admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) in 2018-2020 had a course of early rehabilitation. All patients were taken into a 25-day motor rehabilitation program. Before enrolling into the study, all children were tested for physical tolerance with the ergospirometry technique. A total physical tolerance (b4550 by ICF) was assessed with a four-step test having an increasing physical load; aerobic reserve (b4551) was defined by cardiorespiratory testing with O2 peak consumption (peak VO2); anaerobic threshold, fatigue (b4552) were assessed at a repeated test with the respiratory equivalent (RQ) at rest and at dynamics based on VO2 peak value.

Results and discussion. All children were divided into three groups depending on the results of their testing with stepped physical load increase. At the initial testing, only 24 (39.3%) children passed a four-step test. Given these findings and individual patient's potential, a personalized motor rehabilitation program was developed for each patient. At the repeated testing, 54 (94%) children passed the same test with a four-step load increase. Aerobic reserve at the end of rehabilitation course showed an increase of VO2 peak by 51%. It clearly indicates an improved tolerance to physical loading due to a properly developed program of motor rehabilitation.

Conclusion. A properly developed program for motor rehabilitation which takes into account indexes of physical tolerance, aerobic reserve and fatigue can improve physical tolerance and can promote the developed of a proper program for motor regime in patients with SCI.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

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

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