Analysis of healthcare financing pooling (consolidation) systems in developed OECD countries and Russia
The relevance of the study is conditioned by the influence of the used pooling scheme on the efficiency of financing medical guarantees. The review, comparison and analysis of pooling schemes in healthcare in developed OECD countries and the Russian Federation are presented. The conclusion is made about excessive fragmentation of pooling as a limitation of the effectiveness of national systems of financing medical guarantees in most developed OECD countries and the Russian Federation. The authors believe that the transition to a «single payer» system, which combines all health care resources into one pool and directly, without insurance and/or regional intermediaries, pays for all types of medical care to all citizens throughout the country, is a systemic solution.
Organizational aspects of the implementation of the national project “Healthcare” in the regions of the Russian Federation
This article provides an overview of the successful implementation of two national projects: “Health” and “Healthcare”. The main achievements of the priority national project “Health” include several items: the training of general practitioners, increasing of medical workers salary, equipping with diagnostic equipment and updating the fleet of ambulances, taking measures to prevent, detect and treat viral diseases, including socially significant viruses. Also 15 federal centers of high medical technologies were created. As a result of the project, in 2015, life expectancy (LE) in Russia systematically increased to 70.8 years.
The second national project “Health” is being implemented from 2019 to 2024. The national project consists of 8 parts that lead to the achievement of the National goal, namely, to reach 78-year life expectancy by 2030. In the course of the second national project, there are several current plans: modernization and re-equipment of the outpatient hospitals, construction/reconstruction/repair of medical facilities, renewal of the vehicles and medical equipment fund. “The Ministry of Health” and “Federal Service for Surveillance in Healthcare” have developed a number of solutions to reduce the period of making changes and decrease the risks of failure to meet the federal projects planned values, indicators and results.
The development of healthcare infrastructure turn up the HR issue, namely, the search, attraction, training in working with new equipment, increasing the motivation and involvement of medical and non-medical staff. At the moment, “The Ministry of Health” is developing and implementing a number of organizational solutions to increase the availability of medical care in the face of a staff shortage (for example, the reparation of responsibilities between junior medical and non-medical employees).
The article provides examples of successful practices for the medical staff development. For example, within the framework of the state program “Integrated Development of Rural Areas in the Republic of Bashkortostan”, a pilot project for the construction of housing provided to medical workers under a housing contract was implemented in the Duvansky District. In the Udmurt Republic 30 medical classes have been created since 2018. In 2022, the interregional forum “Start” was organized to develop and support medical students.
Information and educational support of educational process and development of libraries in medical universities in the Russian Federation and abroad: problems and proposals
In the context of exponential growth of medical information and spread of digital technologies, the system of information and educational support (IES) for medical universities must also change. The aim of this study was to formulate proposals for improving the IES system and developing libraries of medical universities in the Russian Federation by studying the relevant regulatory framework in the Russian Federation, international and Russian experience in information and educational support for medical universities, state and activities of their libraries. The main conclusions of the study: the regulatory framework governing the issues of information and educational support for medical universities requires improvement – inclusion of recommendations on the quality and frequency of updating libraries with printed and electronic resources, as well as updating the standards for their provision. In the Russian Federation, the information and educational support of medical universities per 1 student is insufficient – 2.5 times lower than that of high school seniors. Studying the experience of developed countries has shown that government organizations and associations of medical libraries play an active role in translation of new knowledge to medical students by developing special programs for spread of knowledge, standards and performance indicators of medical libraries, as well as publishing journals. Overview of the activities of the library complex of the I.M. Sechenov First Moscow State Medical University showed that in many respects it is not inferior to the libraries of medical universities in developed countries. In the Russian Federation, it is recommended to implement a special program to accelerate translation of new knowledge at all levels of the healthcare system, the core of which will be the “Association of medical universities libraries”.
On the main problems of healthcare in the Russian Federation and measures to eliminate them
In recent years, quite a lot of problems have accumulated in the health care of the Russian Federation, requiring measures to eliminate them.
Аim is to analyze the factors that have had a significant impact on the activity of the modern health care system of the country and to consider measures to eliminate them and improve the structure and functioning of the industry.
Material and methods. Statistical data of the Ministry of Health of Russia and regional health care management bodies, literature devoted to the problems of health care organization in Russia and abroad were used. The following methods were used: analytical, historical, statistical.
Results and discussion. Many problems existing in public health care of the Russian Federation are caused by a number of factors, the main of which are: provision of the branch with medical personnel and deficit financing remaining for many years. All this leads to the non-fulfillment of the Presidential Decree on increasing the salaries of medical workers in some territories. In the country as a whole for the period from 2000 to 2021, the number of doctors per 10,000 population decreased by 10.4%, and the number of specialists with secondary medical education by 17.4%. From 2005 to 2020, in the age structure, the share of doctors under 30 years of age in public medical organizations (MOs) decreased by 1.5 times, and over 50 years of age increased by more than 1.7 times. The number of medical workers in the public health sector decreased by 6.7% over the period, while in the private sector it increased almost threefold. All of the above did not contribute to the improvement of accessibility and quality of medical care. According to the survey data, citizens’ trust in state and municipal MOs at their place of residence amounted to only 16%, while in Malaysia – 75%, in Australia – 74%. Only 11% of Russians consider the quality of medical services in our country to be very good and good.
To improve the quality and availability of medical care to the population it is necessary to: 1) to bring financing up to the level recommended by WHO, i.e. not less than 5% of GDP at the expense of budget funds; 2) to ensure the implementation of the Presidential Decree on raising salaries of medical workers; 3) to create a system of work with personnel, which would allow the state to use trained specialists taking into account the real need for them. In order to ensure more rational and efficient use of the bed fund, its restructuring should be completed. The measures taken should be scientifically justified and financially secured. The heads of the RF subjects should be responsible for the provision of the regions with medical personnel.
Conclusion. The analysis of the state of health care in the country shows the problems, the main of which is the shortage of personnel and insufficient financing. It is necessary to take scientifically grounded measures for their elimination.
Analyzing payment methods for medical care: in search of the best
The relevance of the search for new methods of payment for medical care is due to significant shortcomings of the approaches used today - both methods of payment for medical services and methods of financing the activities of medical organizations. The authors propose a new combined method of payment for medical care based on the two-component tariff technology: prospective (prepaid) coverage of fixed costs of medical organizations by line-item budget and retrospective reimbursement of actually incurred clinically justified variable costs, including additional payments for efficiency/quality P4P (Pay-for-Performance). In addition, for public health care organizations, the authors consider it advisable to abandon the idea of market relations between providers and payer in favor of a non-market integrated model of administrative subordination and economic accountability of the provider to the payer (The Payvider model).
Results of using remote monitoring of blood pressure through the patients of working age
The widespread prevalence of arterial hypertension in the Russian Federation, and also throughout the world, forces researchers to seek new approaches to improving medical care aimed at reducing morbidity, disability and mortality from cardiovascular diseases. The number of studies aimed at learning the results of remote monitoring of blood pressure, its medical and organizational effectiveness, has been recently increasing.
Our research was conducted between 2019 and 2022 in outpatient conditions to evaluate the results of remote monitoring of blood pressure. By the middle of the median observation period, 86% of patients had arterial pressure reached the target values (120–129 and 80–84 mm Hg) regardless of gender, age and degree of arterial hypertension.
The obtained data were analyzed using statistical methods, in order to confirm the medical effectiveness within the framework of the proposed organizational approaches and risk assessment, which are successfully applied in practice.
Monitoring of medical care for patients with severe pneumonia using a regional telemedicine system
Background. Despite numerous innovations in the field of medical care for patients with severe community-acquired pneumonia over the past decade, the disease remains one of the most serious.
Aim – to study of the organization of medical care for patients with severe community-acquired pneumonia using monitoring of medical care in the regional telemedicine system.
Material and methods. To monitor patients with severe pneumonia in the Krasnoyarsk Territory, an RTS model was developed and put into operation in the Regional Clinical Hospital in 2016.
Results. The article presents the results of using the developed system for monitoring of medical care for patients with severe pneumonia using a regional telemedicine system. The use in the monitoring system of medical care for patients with severe pneumonia of unified approaches to timely diagnosis, the validity of the appointment of therapy, dynamic monitoring of patients improved the medical effectiveness of treatment and, as a result, led to an increase in the quality of medical care. The addition of the telemedicine system with the possibility of statistical accounting made it possible to promptly analyze the situation as a whole, both in a separate medical institution and on the territory of the entire Krasnoyarsk Territory.
Conclusion. The introduction of monitoring of medical care for patients with severe pneumonia using a regional telemedicine system makes it possible to improve the quality of medical care and improve continuity in the work of district medical institutions and air ambulance.
Review of the results of a survey of users of the “ProRodinki” mobile application used to detect malignant skin tumors on the territory of the Nizhny Novgorod region
In Russia, more than 600,000 new cases of malignant skin tumors (hereinafter referred to as MST) are diagnosed annually. MST is in first place in the structure of oncological diseases of the male and female population in the Russian Federation. Currently, an increase of MST is observed throughout the world.
Nowadays, Russian and foreign researchers continue to develop information systems based on automatic analysis of images of neoplasms aimed at diagnosing malignant neoplasms.
In the Russian Federation, the “ProRodinki” mobile application is used. The application was developed by employees of the Department of Skin and Venereal Diseases of the Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation and specialists in the field of IT technologies of AIMED LLC with the support of the Nizhny Novgorod Regional Clinical Oncological Dispensary.
The purpose of this stage of the study is to present and evaluate the results of the use of the ProRodinki mobile application by users in the detection of malignant skin tumors.
Material and methods. The work used a telephone survey of application users who received a referral to a doctor in the near future. The telephone survey was conducted by volunteer students of the Volga Research Medical University. The survey questionnaire was developed jointly with the Department of General and Clinical Psychology of the Volga Research Medical University.
The mobile application “ProRodinki” is an application that determines the probability of having MNV based on a photograph of nevi (moles) and the data sent, on the basis of which it forms and issues a recommendation to the user about the need to visit a doctor.
Results. On the territory of the Nizhny Novgorod region, 37 022 images were uploaded from 18,544 users of the “ProRodinki” mobile application. 659 people (3.5% of users) received a notification about the need for an urgent visit to a doctor at a specialized center. As a result of a telephone survey of 343 (52%) users who were advised on the need for an urgent visit to a doctor of a specialized center, 178 (52%) people consulted a doctor, in 105 (59%) of them, after consultation, the need for a biopsy was confirmed, which is a marker of the diagnostic value of artificial intelligence, equal to the diagnostic accuracy of an examination by a dermatovenereologist. According to the biopsy results, 73 (78%) patients were confirmed to have a malignant neoplasm of the skin.
Of those who did not see a doctor, 45.4% of the surveyed users did not see a notification to see a doctor. 39% of users who received a notification with a suspected MST did not respond to a telephone survey. The data obtained speak in favor of finding active solutions to inform the patient, who is included in the high-risk group for MST. It is expedient to transfer the function of informing patients with a high risk of MST to a specialized medical organization for the subsequent accelerated routing of the patient to a specialized medical institution.