Factors affecting mortality rate due to neoplasms and circulatory diseases during the 2019-2020 in the Russian Federation
In the Russian Federation in 2020, during the COVID-19 pandemic, compared with 2019, there was a significant increase in mortality from all causes (+19%, or 340 thousand people), and only half of these additional deaths were associated with a new coronavirus infection. Mortality from cardiovascular diseases (CVD), the main cause of death in the country, increased significantly (by 12%) (44% in the structure of all deaths in 2020). At the same time, over the specified period, mortality from neoplasms decreased by almost 1% (14% in the structure of total mortality in 2020).
A study of the factors that could affect these differences showed that the decrease in mortality from cancer was due to a noticeable increase in the financing of medical care in the oncology profile in inpatient conditions (+18% at constant prices in 2020) against the background of only a slight decrease in its volume (-4%), as well as due to an increase in the volume of care for this pathology in day hospitals (+13%). All this happened against the background of the allocation of additional funding for the fight against cancer and strict control over the implementation of targets in this area by the federal government bodies (Ministry of Health of the Russia) and the Mandatory Medical Insurance Fund. However, in the profile of "Oncohematology" in the Russian Federation (excluding Moscow), there was a decrease in the volume of medical care (-15.5%), and their financial support (-6.5%), which, most likely, led to an increase in mortality from this pathology (+2%).
Against the background of a decrease in mortality from all neoplasms in 2020 compared to 2019, there was an increase in deaths from oncohematological pathology by 2%, which is due to the absence of an increase in the volume of care in this profile in inpatient conditions (a decrease by 0.5% in constant 2020 prices) and insufficient increase in funding for these volumes (+12.8%) compared to the overall growth in funding for the "Oncology" profile (+18%).
And for the class CVD, and for neoplasms there was a significant decrease in primary morbidity (by 16-17%), which can have an extremely negative effect on the early detection and timely treatment of these diseases in the coming years. The authors conclude that in order to reduce mortality in the Russian Federation, it is necessary to increase both the volume of medical care and the costs of its provision.
Changes in the staffing and regulatory support for oncological care in the Russian Federation
The aim of the study was to analyze the regulatory documents governing the staffing and regulatory support for the provision of oncological care in the Russian Federation within the framework of the approval in 2021 of the orders No. 55n and No. 116n of the Russian Ministry of Health on the Procedures for providing medical care to the population with oncological diseases.
Material and methods. The research materials were regulatory documents from the reference legal system ConsultantPlus.
Results. We analyzed the orders of the Ministry of Health of Russia approved in 2021 on the staffing and regulatory support for the provision of oncological care in the Russian Federation.
The erroneous provisions of the Procedures for rendering assistance to the adult and child population, their contradictions with the current regulatory documents, as well as changes in the number of specialists working in departments, the values of labor standards, and others are highlighted.
For the first time, the staffing of the Outpatient Oncological Care Center was presented, the set of units providing medical care to the adult population with cancer and provided with staffing standards was changed. For the first time, the office of photodynamic therapy was included, the departments of anesthesiology and resuscitation, resuscitation and intensive care, rehabilitation, and palliative care were excluded.
Changes in the values of labor standards introduced by order No. 116n are shown, including the specifics of planning the number of human resources for the provision of medical care in a hospital environment.
Conclusion. Orders No. 55n and No. 116n contain both innovations and changes, as well as typical errors of modern regulatory legal documents on labor: violations of the nomenclature of positions and recommendations for establishing the number of posts, which also determines systemic shortcomings that still exist in rationing labor in health care. The deadlines before the entry into force of these orders allow you to make the necessary changes in part of the labor standards specified in this publication.
Health care system financing in the Russian Federation: dynamics, prognoses, comparison with developed countries
Despite the challenges posed by consequences of the global pandemic, achieving the country's national development objectives remains a strategic direction of public health policy.
For sustainable population growth and an increase in average expectation of life in Russian Federation, which should reach 78 years in 2030, it is imperative to ensure availability and good quality of medical care, which in turn directly depend on the level of government funding for healthcare.
This article analyzes main parameters of healthcare financing in the Russian Federation in the period 2012-2020, and assesses them for the future 2022-2024, in comparison with parameters of developed EU countries. The article presents main conclusions on persistence of low parameters of government funding for healthcare in the Russian Federation, which exclude possibility of solving the acute problems of shortage of health care workers, insufficient free drug provision of population, insufficient volumes of free medical care and become a major setback to implementation of measures aimed at achieving national development goals of the Russian Federation.
Analysis of labor costs for employees of state budgetary healthcare institutions in Moscow
The article presents the results of the analysis of data on the share of labor costs with accruals of employees of state budgetary healthcare institutions in Moscow for the period 2018-2020. The study was conducted on the basis of accounting and statistical reporting data of institutions using methods of comparative analysis, comparison and generalization. All institutions were divided into 8 subgroups depending on their type and type of medical care provided. The results of the study showed how the share of labor costs with accruals differs between groups of institutions in dynamics.
Ensuring the quality and safety of medical care in perinatal centers as a basis for reducing infant mortality in the Russian Federation
Infant mortality is traditionally one of the key indicators characterizing the state of health and standard of living of the population. Despite the steady downward trend in infant mortality, its level in the perinatal period of life remains quite high. The article discusses the main causes of deaths of children of this age group in the perinatal Center (PC) for the period 2016-2020, analyzes possible ways to solve the problem.
Material and methods. A cohort study was conducted in the State Medical Institution of the Nizhny Novgorod Region "Dzerzhinsky Perinatal Center" for the period 2016-2020. The analysis included an assessment of the level and structure of causes of mortality of children in the perinatal period of life, compliance of the documents used with the regulatory framework, as well as data from official statistical reporting of work (information about the medical organization (form N 30 (annual), form code for OKUD 0609362)
Results. In accordance with Federal Law No. 323-FZ of 21.11.2011 "On the Protection of the health of citizens in the Russian Federation" (No. 323-FZ), which defines "the quality of medical care as a set of characteristics reflecting the timeliness of medical care, the correctness of the choice of methods of prevention, diagnosis, treatment and rehabilitation in the provision of medical care, the degree of achievement of the planned result", the results of medical activities were evaluated and the documents implementing each of the listed components in the level 3 perinatal center were reviewed. An assessment of the impact of the execution of these documents on infant mortality rates was carried out.
Methodology of marking medical images with the function of crosscheck and intellectual segmentation
Intelligent algorithms for medical image recognition need to be trained on a collection of annotated or tagged images. Image annotation and labeling underlie the medical interpretation of images for both clinical and research purposes. The article provides a methodology for organizing procedures for marking up medical images, including cross-marking by several specialists at once and attracting an expert's opinion in case of disagreement. The technique also considers the use of an image segmentation algorithm operating with graph cuts.
Methodological approaches for the development of a digital clinical recommendation
This article provides an overview of the use of computer-interpreted clinical guidelines abroad, describes the benefits of using digital clinical guidelines in the healthcare system, and proposes a solution for translating clinical guidelines developed and used in the Russian Federation, into a machine-readable format.