Analysis of the scientific validity of incentive payments to primary health care organizations
The article makes an analysis of the changes made to the “Requirements for the structure and content of the tariff agreement” in the compulsory medical insurance system. The procedure for paying medical organizations providing assistance on an outpatient basis has been adjusted – the budget of these institutions will be reduced from 5 to 10% to form a fund of incentive payments. Funds from this fund will be returned to medical organizations only if performance indicators are achieved. TsNIIOIZ approved this innovation without scientific analysis and mistakenly believes that it will lead to increased availability and quality of medical care. The study of VSHOUZ showed that the proposed indicators are unattainable and, in fact, harmful. In a situation of a shortage of medical personnel in primary care, this will cause additional tension and discontent among medical personnel, thereby further increasing the outflow of personnel, which means it will reduce the availability of medical care in primary care.
Why the MHI system is short of money: a comparison of social health insurance contribution bases and rates in developed OECD countries and in the Russian Federation
The relevance of the study is due to the high share of personal health payments of the population in current health expenditure in the Russian Federation – according to the World Bank, 27.76% in 2020, which is significantly higher than the average for developed OECD countries – 18%. The study compared the base and rates of social health insurance contributions withheld from personal income in the Russian Federation and developed OECD countries.
The results showed that in the compared OECD countries the social health insurance contribution base is much broader: contributions are withheld not only from the wages of employees and income from self-employment and self-employment (as in the Russian Federation), but also from income from capital, rents, and in many countries also from old-age pensions. At the same time, the level of informal employment and the shadow economy in the Russian Federation is about 2 times higher than in developed OECD countries – which further reduces the MHI contribution base in Russia. In turn, the MHI contribution rate in the Russian Federation is much lower than in developed OECD countries, where contributions are often 2–2.5 times higher than in the Russian Federation.
These studies suggest that one of the reasons for the excessive share of personal payments of the population in current health care expenditure in the Russian Federation is the MHI contribution base, which is many times lower than in developed countries and which is not compensated by a proportional increase in the rate of these contributions.
A conventional solution to the problem could be to expand the MHI contribution base by deducting it from capital income and rent, and to increase the contribution rate and/or equalise it for all categories of policyholders. However, given the scale of informal employment and the shadow economy in Russia, the authors consider a more systematic and innovative approach to replace MHI premiums with a universal targeted tax (contribution) on non-cash financial transactions and on cash withdrawals and deposits.
Conflict of interest in medical practice: survey of the doctors
Conflict of interest is referred to a situation in which someone’s private interests are opposed to that person’s responsibilities to other people. It can occurs in healthcare setting when doctors are working for a for-profit medical provider. A code of ethics are meant to prevent a conflict of interest however doctors in Russian Federation are not legally bound by ethical code of conduct.
The aim of the study is to conduct a survey among doctors in Russian Federation to reveal a conflict of interest in their practice.
Material and methods. The sample of respondents was 121 doctors, participants Forum "NEConference-2022" (July 16–17, 2022, St. Petersburg). Research method: sociological survey. Sampling method: random sampling.
Results. The study has revealed that doctors are reporting a conflict of interest in their healthcare practice. Some of the respondents reported that a conflict of interest is due to the doctor’s decision-making process commonly under pressure of the healthcare provider business practice. The authors are providing their recommendations the doctors and healthcare provider owners on how to avoid or alleviate such a conflict in their business practice.
Formation of a tool (matrix) to improve efficiency project work in medical organizations
National projects implemented in the Russian Federation since 2019 are a tool for solving complex socio-economic problems of the state, including in the healthcare industry. For their implementation in the regions, and, accordingly, in medical organizations, it is necessary to update management approaches, including familiarizing managers with the principles and skills of project management.
The authors, on the basis of domestic and foreign publications for the period from 2018 to the present, have studied project management methods in relation to solving the tasks assigned to medical organizations, as well as external and internal factors affecting their activities. As a result, a matrix (table) was formulated, filling in which will allow managers to analyze the management features of the organizations entrusted to them, formalize the goals set for organizations and facilitate the choice of an organizational structure for project management.
Analysis of screenings in medicine (systematic review)
Screening is now considered to be one of the most important prophylactic measures. Nevertheless, mass implementation of screenings must follow their comprehensive assessment according to requirements based on analysis of efficiency (socio-demographic, clinical, economical, expert) and safety. Historical aspects of screening studies, goals and principles and evolution of their approaches, main forms and characteristics, mistakes and disadvantages, risks, benefits and harms of typical screenings and the concept of ideal screening are depicted in this article. In conclusion it is said, that screening is not a means of early diagnostics and screening implementation should take into consideration all the needed demands.
The main trends in the incidence of the child population, Nizhny Novgorod region in 2017–2021
One of the most important areas of Russian state policy is to overcome the demographic crisis. The successful solution of this issue is determined by the state of health of the child population. However, many indicators of the health of the child population aged 0–14 remain extremely alarming. In the Russian Federation, it is in this age group that about 40 million cases of newly diagnosed diseases are registered annually. Many studies show a change in the incidence pattern in this age group, expressed in an increase in the number of chronic and combined forms of diseases. The quality and accessibility of medical care depend primarily on the provision of healthcare facilities with medical workers, their qualifications and professional level. An effective personnel policy is an important component of the successful functioning of the healthcare industry, and given the global personnel crisis in healthcare, the issue of staffing has recently become of particular importance. In the Nizhny Novgorod region, a number of programs are being implemented that provide for measures to improve the personnel situation in the health care of the region, in particular, the creation of conditions for securing medical workers in the children’s health care industry and the formation of a personnel reserve. At the same time, it is extremely important to assess the impact of these measures on the levels of morbidity in children.
Aim of the study – to assess the impact of the provision of the population with pediatricians on the levels and dynamics of the incidence of children aged 0 to 14 years in the Nizhny Novgorod region over a five-year period (2017–2021).
Material and methods. The analysis of official statistical data for a five-year period (2017–2021) was carried out. For this, information was copied from the statistical materials of Rosstat and the State Budgetary Institution of Healthcare of the Nizhny Novgorod region “Medical Information and Analytical Center” (MIAC). Statistical data processing was carried out using the SPSS Statistics 26 program. A comparative analysis of regional indicators with indicators for the Russian Federation was carried out. To determine the nature of the distribution, the Kolmogorov–Smirnov criterion was used. The levels of general and primary childhood morbidity, staffing in the study region and the Russian Federation were analyzed, for which time series of these indicators were compiled and the calculation of visibility indicators was performed. Correlation analysis was carried out using Spearman’s nonparametric correlation coefficient, the strength of the connection was estimated using the Chaddock scale.
Results. The correlation analysis of a continuous sample of these indicators of general childhood morbidity and staffing of cities and districts of the Nizhny Novgorod region from 2017 to 2021 showed a weak relationship between these values. The correlation index for the five-year period as a whole was 0.26, ranging from 0.15 in the analysis of the relationship of indicators in 2019 to 0.38 in 2020. Similarly, low correlation values were revealed in the analysis of the relationship between the indicators of primary morbidity in children aged 0 to 14 years and the provision of the pediatric population with pediatricians in the Nizhny Novgorod region. The correlation indicator for the period from 2017 to 2021 was 0.24, demonstrating a weak relationship between the criterion (dependent) variable and predictor variables.
Analysis of infant mortality in the regions of the Ural Federal District by the results of 2022
Background. Further reduction in the level of infant mortality in the country remains a priority task in the work of the perinatal and pediatric services, despite the annual positive dynamics in recent years.
The aim of the study was to analyze infant mortality in the regions of the Ural Federal District by the results of 2022.
Material and methods. During the analysis, the relevant indicators of the Rosstat of the Russian Federation and the information provided by the health departments of the Ural Federal District were used.
Results. The article presents an analysis of statistical indicators of infant mortality and its components. The analysis of neonatal mortality as the main component of infant mortality was carried out taking into account the body weight of newborns, the causes of death, as well as taking into account the group of medical institutions.
Conclusion. At the end of 2022, in the regions of the Urals Federal District, in the context of a continuing decline in the birth rate, multidirectional dynamics of infant mortality rates was recorded. A certain proportion of births and deaths of extremely premature newborns in obstetric institutions of the 1st and 2nd level remains. This requires further improvement of the observation of high-risk pregnant women and their timely routing to obstetric facilities of the 3rd group. Infant mortality is determined by neonatal, primarily early neonatal mortality of premature newborns, of which the group of extremely premature infants mainly prevails.
Design: а retrospective statistical study was conducted.
Internal audit of medical institutions in the context of digitalization
The implementation of the National project “Healthcare service” – “Upgrade of the Service of Primary Medical Care Delivery” in the Russian healthcare system has been contemplated. A survey of the two parts of this project has been conducted – priority projects are “Creation of the integrated digital profile in the healthcare service on the basis of the Uniform State Health Information System” and “Creation of the new model of a healthcare organization which provides primary medical care”. In order to evaluate the readiness of outpatient clinics to switch to a new system of medical service and process digitalization it is suggested to apply methods of internal audit of a healthcare center, i.e. testing of the performance of outpatient clinics in accordance with the specially developed checklists to increase healthcare delivery level and healthcare center efficiency. Test procedure has been provided. Expectation effect of the methodology implication has been estimated.