Scientific justification of the need to increase the remuneration of medical workers in the Russian Federation
On June 18, 2022, Russian President Vladimir Putin emphasized fundamental role of healthcare in solving national goals and set the task of its further development. However, despite the heroic efforts of medical workers during the COVID-19 pandemic, led by the headquarters of the industry, in 2020 and 2021 there was a significant increase in mortality rate of the Russian population compared to 2019 (by 19 and 36%, respectively). The most important reason for increase in mortality is decrease in medical care availability for general population due to a shortage of medical personnel. Adoption of measures to increase the remuneration of medical workers, started in 2013 (according to Presidential Decree No. 597 of 07.05.2012), did not allow raising it to a level that would eliminate their deficit.
The aim of the study was to analyze the security and remuneration of medical workers in the Russian Federation and the subjects of the Russian Federation, as well as the main factors that affect the level of these indicators. As a result of the analysis, it was revealed that from 2013 to 2021, the average salary of doctors increased by only 20% in constant prices (2013 = 100%), and for average medical personnel - by 6%. At the same time, the availability of doctors remained at the same level, while for nurses it decreased by 11%. In 2021, in the Russian Federation, the guaranteed salary (tariff rate for one position) for half of doctors was less than 23 thousand rubles, and for average medical workers - less than 12.6 thousand rubles. Excluding Moscow and St. Petersburg, these indicators are less than 22 thousand rubles for doctors, and less than 12 thousand rubles for average medical staff. In 2021, in the Russian Federation, the ratio of the average annual income of a doctor to GDP per capita (that is, to what the country "earns" per capita per year) was 3 times lower than in Germany and 1.5 times lower than in Poland (1.2, 3.6 and 1.8 respectively). As a result of low wages and overwork in 2020, the provision of doctors in the Russian Federation was 5% lower than in the "old" EU countries (3.8 and 4.0 per 1 thousand population, respectively). A particularly pronounced shortage of personnel has developed in the primary health care sector: there are 1.5 times fewer district service doctors than established by the standards, and 2 times fewer paramedics. The difference in salaries of doctors and average medical staff in federal districts was 2 times, in regions - 5 times or more, which leads to labor migration of specialists. To solve the problem of shortage of personnel in the Russian healthcare system, it is required to increase the remuneration of medical workers to the level of military salaries, according to which the wage fund for doctors and secondary medical workers should grow by 2 times in 4 years, which will require an increase in state financing of healthcare, taking into account junior medical and non-medical personnel, annually by at least 300 billion rubles.
The patient's right to voluntary choose euthanasia and assisted suicide: why palliative care should be equated with obstetric care in terms of funding priority
The relevance of the study is due to the growing number of elderly and hopelessly ill patients, the population's demand for practices that, in the event of a severe incurable health disorder, do not become a hostage to the process of dying, painful for the patient and ruinous for his family, artificially prolonged by the healthcare system, as well as the high price of life-supporting medical technologies: up to 20% of national health spending in developed countries goes to pay for medical services to citizens during the last 3 years of their lives. The authors review the economic and ethical aspects of the practices of continuous deep sedation, euthanasia, and assisted suicide permitted in a number of countries. A conclusion is made about the economic feasibility and ethical acceptability of these practices, provided that the voluntariness and freedom of their choice by the patient is ensured by the availability of guaranteed palliative care. It is proposed to equalize the priority of financing palliative care with obstetric care for ensure such guarantees.
Assessment of the impact of new technologies and changes in patient characteristics on the healthcare system: review of publications and results of doctors surveys
It is important to understand trends in the development of new technologies and changes in the characteristics of patients for the medical education programs actualization, the formation of new approaches of medical care and for the communication with patients.
The aim of this study is to provide a brief overview of trends in the transformation of healthcare systems in response to new medical and information technologies introduction, as well as changes in patient characteristics.
The analysis is made by reviewing international publications and the results of surveys of foreign and Russian healthcare professionals. The introduction of new medical technologies (based on the achievements of molecular and regenerative medicine, medical engineering, etc.) will allow to select treatment more precisely, restore organs and tissues, and help patients with limited mobility using exoskeletons. Information technologies (big data management, the use of artificial intelligence, mobile applications) will allow remote monitoring of patients, transfer in-patient treatment to home, predict the development of diseases before they appear and make doctors' decisions more accurate. In the next decade, the characteristics of the patients will also change: chronic non-communicable diseases will be more common, and patiens will be more knowledgeable. As a consequence, patients may question the doctor's opinion. According to surveys' results, about 40% of foreign and Russian doctors agree with it. The majority of Russian doctors (60%) believe that the widespread introduction of clinical decision support systems may lead to the decline of their ability of clinical reasoning. It is noteworthy that 20% of doctors at this stage do not believe that the EHR is able to facilitate their work, which indicate the inconvenience of the user properties of the EHR. Taking into account these trends, programs of medical and pharmaceutical education should include training courses in new medical technologies, bioinformatics and communication skills. The leaders of medical organizations should also know the basics of bioinformatics in order to properly introduce digital innovations.
Public-private partnership: guarantees, benefits, risks
This article touches upon a number of issues on the created and unresolved Legal mechanisms and the conditions for their implementation when attracting investments in the economy of the Russian Federation, within the framework of a public-private partnership (РРР), which contribute to improving the quality of goods, works, services provided to consumers in the medical services market.
The implementation of concession agreements directly affects the achievement of national development goals defined by the May and June decrees of the President of Russia, the goals of the national Healthcare project and its constituent federal projects.
The authors have created the preconditions for a possible partnership between the public and private health sectors in the field of health care in the implementation and use of the most effective ways of the unique resources of the private sector to strengthen the capacity and sustainability of the health care system.
Potential risks hindering mutually beneficial relations between public and private PPP partners: lack of return on investment and a long payback period for the project's investments, scanty volumes of medical care for compulsory health insurance brought to a medical organization, an increase in operating costs at the stages of project implementation, bankruptcy of a private partner, an increase in the cost of services , the lack of control over the facility being created or reconstructed, or the non-recoupment of the compulsory medical insurance tariff to cover the costs incurred.
Taking into account the formed legal environment, the solution of these issues should be accompanied by the prompt introduction of the necessary changes to the legislation.
New staff-regulatory support for the provision of medical care for mental and behavioral disorders
One of the key directions in the provision of medical care in any profile is the staffing of the activities of the relevant medical organizations.
Aim - analysis of the new regulatory framework governing labor standards in the provision of medical care for mental and behavioral disorders; analysis of the ratio of the standard number of positions and the actual provision with them; formation of proposals for improving the state policy on the system of labor rationing.
Material and methods. As research materials, normative legal acts from the legal reference system "Consultant Plus", data from statistical collections, publications on the topic were used. Analytical, statistical, economic methods are applied.
Results. The study revealed a significant gap between the normative and actual number of positions, inconsistency in the names of a number of medical organizations, department profiles with the current nomenclature. The introduction of Order of the Ministry of Health of Russia dated 14.10.2022 No. 668n "On approval The procedure for providing medical care for mental disorders and behavioral disorders" into healthcare practice will require significant changes in the scope of training of district psychiatrists and psychotherapists. The possibility of implementing such a decision raises great doubts, due to the fact that other orders on the Orders also recommend an increase in the standard number of posts, in some cases even more significant than in the order No. 688n under consideration.
Organizational risk-oriented approach technology for identifying the characteristics of the internal quality control system subjects
The search for unified mechanisms of vertical and horizontal integration of participants in the medical industry quality and safety control system is an urgent and demanded scientific task, the solution of which will contribute to the development of the national quality and safety management system in medical activities.
Material and methods. Using the methods of organizational and legal analysis, analytical method and method of logical generalization, using the example of assessment of medical organizations of the Chelyabinsk region (n=123), an organizational technology for determining the characteristics of subjects of internal quality control using a risk-oriented approach was proposed.
Results. When analyzing the requirements of the legislation, it was established that the possibility of a certain variability in the construction of the internal control organizational system. At the same time, in medical organizations of
the Chelyabinsk region, there is a shift in responsibility for internal control from the head of the medical organization and deputies in charge of medical work to specially allocated deputies for internal control and other deputies with the medical organization risk category increase (p=0.001). At the same time, a significant number of medical organizations that have appointed a person responsible for internal control from the list of specialists who do not meet the requirements of the current legislation draw attention to themselves.
Discussion. In accordance with the principles of a risk-oriented mechanism for vertical integration of the medical activities quality and safety control system in the regional health care system, a differentiated approach to building an internal control system based on the risk category of a medical organization is proposed.
Conclusion. The use of a unified technology for organizing internal control using a risk-oriented approach allows a differentiated approach to organizing internal control in each medical organization, taking into account the individual specifics of the medical organization and using the optimal amount of resources, and also expands the degree of vertical integration of participants in the system of quality control and safety of medical activities.
Analysis of the opinions of students and graduates on the implementation of specialist programs in medical universities
The article discusses the satisfaction of graduates and students with the implementation of educational programs of a specialist and formats for the implementation of individual components in medical universities. The assessment was carried out by anonymous questionnaires, 660 people took part in the study. Respondents spoke about the high importance of industrial practice in the training of a doctor and the need to increase its volume in general, and especially in a hospital. In most cases, respondents generally preferred a larger volume of practical training, noting that practical training should take 50-74% of the entire educational program. The change in attitude to lectures draws attention. The remote format of lectures is preferred mainly by students (54% of student respondents), while the opinion of graduates of 2011-2022 divided between remote format (39%) and face-to-face in the classroom (39%). In general, the graduates of 1980-2000 rated an average of 6.88 points, graduates of 2001-2010 -5.96 points, 2011-2022 - 5.35 points. It is noteworthy that in the last group, graduates of 2011-2017 gave an average score of 5.29 points, while 2018-2022 - 5.9 points. The data obtained indicate the need for effective interaction between educational organizations, representatives of practical healthcare and students, the correct balance between the various components of educational programs and the use of new training formats are necessary to ensure the training of qualified specialists.
Development of the doctor's scientific thinking in the course of professional training
The article is devoted to the study of the scientific thinking of a doctor and is due to the need to prevent mistakes made during the COVID-19 coronavirus pandemic. It emphasizes the important social role of the doctor, and his worldview position, influencing the views, beliefs and behavior of patients in difficult conditions for making vital decisions. The level of scientific thinking of a doctor was assessed using a test developed by the All-Union Center for the Study of Public Opinion (VTsIOM). The results obtained indicate a high level of development of the doctor's scientific thinking, which is many times higher than the general indicators of the population. At the same time, the mastery of the scientific method is still at an insufficient level, which made it possible to draw conclusions and formulate some recommendations on the use of various methods in the educational process aimed at solving this problem. Given the requirements of the new Federal State Educational Standards, both in higher and additional professional education, it is advisable to introduce new disciplines, starting with the basics of studying the methodology of science, project methods, etc.
Philosopher, doctor and eternal wanderer
The article describes the main stages in the formation of personality, scientific views and methods of the medieval scientist Ibn Sina under the influence of the works of the great predecessors - Aristotle, Hippocrates, Galen.
Physician, scientist, philosopher and poet Abu Ali al-Hussein ibn Abdallah ibn al-Hassan ibn Ali ibn Sina (Latinized name - Avicenna), being a man of extraordinary abilities, creatively rethought, reworked, systematized and increased knowledge about medicine in his unique work "The Canon of Medical Science". He is one of the first popularizers of science, as he used the poetic style to spread knowledge among the population in the poem about medicine "Urdjuza".