Analysis of expenditures of the Russian Federation’s budgetary system (Federal Compulsory Medical Insurance Fund, federal and regional budgets) under the section "Healthcare Service" for 2023 and for the planned period of 2024 and 2025
The article presents an analysis of expenditures of the Russian Federation’s budgetary system for 2023 and for the planned period of 2024 and 2025. In 2023, compared to 2022, according to the prognosis, public expenditures on primary health care will increase by 8% at current prices and by only 2% at constant prices in 2019.
By 2023, the budget expenditures of the Federal Compulsory Medical Insurance Fund will increase by 14% compared to 2022 in current prices, and only by 7% in constant prices. At the same time, subventions to the constituent territories of the Russian Federation for healthcare delivery will increase by only 5% in constant prices.
In 2023, a slight increase in government spending on health care (+2%) will occur against the background of: rise in population mortality rate of the Russian Federation; reduction in life expectancy (LE) to 70.1 years; increasing the number of people in need of free medical care; unresolved most acute problems of Russian health care, main of which is shortage and low wages for medical staff.
Lack of growth in government spending on health care will not allow resolve the healthcare problems, reducing mortality and increasing life expectancy to 78 years by 2030 in accordance with Presidential Decree No. 474 of July 21, 2020 "On the national development goals of the Russian Federation for the period up to 2030".
The impact of the reduction in primary health care during the COVID-19 pandemic on the morbidity and mortality from malignant neoplasms of the adult population in the subjects of the Volga Federal District
In the structure of mortality and disability in Russia, oncological diseases occupy leading positions. An important link in the diagnosis is primary health care, which contributes to the detection of cancer in the early stages. In 2020, due to the COVID-19 pandemic, visits to primary care were reduced. The authors studied the impact of the changed volumes of medical care on the incidence and mortality rates of the population of the Russian Federation and the Volga Federal District (VFD) from malignant neoplasms (MNT).
Material and methods. The object of the study was the nature of the relationship between the incidence of cancer and death from cancer, as well as their relationship with some indicators of the oncological service, human resources for health care and performance indicators of primary health care.
The subject of the study is the level of primary incidence of malignant neoplasms in the adult population, the mortality rate from malignant neoplasms, the proportion of early detection of malignant neoplasms, one-year mortality and five-year survival rates, the availability of district physicians and oncologists, the number of visits to the outpatient clinic link.
Units of observation: primary incidence rate of malignant neoplasms in the adult population per 100 thousand population, mortality rate from CVD per 100 thousand population, per cent of detection of malignant neoplasms at stages I–II, III–IV of the disease, one-year mortality in per cent, five-year survival rate in per cent, security of the population by district general practitioners, oncologists per 10 thousand population, the number of visits to the outpatient clinic unit per 1 inhabitant in total, including for diseases and for preventive visits.
The work used monitoring data of the above indicators on average for the Russian Federation, the Volga Federal District and in the context of each region of the Volga Federal District from official statistical reporting forms in the pre-pandemic period of 2015–2019 in comparison with the period of the pandemic of a new coronavirus infection COVID-19 in 2020. Statistical data processing was performed using methods for assessing the statistical significance of differences in average values, analysis of time series. Data processing was carried out using Microsoft Office Excel (2010) and Statistica 6.0.
Results. The study revealed that during the COVID-19 pandemic in 2020, the primary incidence of malignant neoplasms in the adult population in the Russian Federation, the Volga Federal District and the regions of the Volga Federal District decreased compared to 2019, and is accompanied by a shift in the detection of tumors from I–II stages to III–IV stages. The mortality rate from malignant neoplasms in the specified period has not changed. During the pandemic, a decrease in the number of visits to primary health care in the Russian Federation by 18% was revealed, including for diseases – by 15%, for preventive visits – by 23%; in general, in the Volga Federal District, the indicators amounted to 17, respectively, 13 and 21%. A similar pattern was revealed in all regions of the Volga Federal District. At the same time, a statistically significant inverse relationship was observed between the number of visits for diseases and the mortality rate from malignant neoplasms (r=-0.38, p<0.05).
Conclusion. As a result of the study, it was revealed that a decrease in the volume of primary health care leads not only to a decrease in the rates of diagnosis of malignant neoplasms in the early stages, but also contributes to an increase in mortality rates from malignant neoplasms. In order to increase the volume of primary health care for patients with suspected cancer during a pandemic, outpatient oncological care centers can be used, performing the function of interdistrict oncological centers of the second level, where the risk of oncological patients crossing with other groups of patients is minimized, including with suspected coronavirus infection.
The role of a psychologist in the health care system: analysis of doctors’ opinions
The article is devoted to the problem of determining the role of a psychologist in a complex and complex structure of a modern medical institution. The authors have considered the basic aspects and offered some developments in such important directions as: integration of the psychologist into the existing system of the healthcare, prevention of the burnout phenomenon among the doctors and medical workers as well as increasing of the communicative competence as a task of the additional psychological education in medicine. The data of the research of 600 doctors’ opinions about the work of a psychologist in a medical institution, conducted by means of online questionnaires, are also given. The results indicate that doctors more clearly formulate tasks for the psychologist in the work with medical workers themselves (overcoming stress, burnout, practicing communication skills) and less clearly define the role of the psychologist in psychological support of the patient (adaptation to the disease, coping with stress and emotions, conflict resolution). Also doctors in the majority indicate their readiness to participate in interdisciplinary and educational projects aimed at the integration of the psychological aspect in the work of the healthcare system.
Assessment of the quality of dispensary observation of patients suffering from CNCDs, based on the Practical Guidances of Roszdravnadzor
This article presents the results of an external patients’ dispensary observation assessment, carried out in outpatient organizations among patients, suffering from chronic diseases, based on Proposals (Practical Guidances) on organizing internal quality and safety control of medical activities (for outpatient hospitals). The external evaluation was conducted according to the section “Dispensary monitoring of chronic patients” of Proposals (Practical Guidances) of Roszdravnadzor by the experts of the “National Quality Institute” of Roszdravnadzor. The results of the external evaluation revealed a low level of quality and efficiency in the organization and conduct of dispensary observation of patients in the studied outpatient organizations: none of the 14 medical organizations was recognized as meeting the requirements of the Practical Guidances of Roszdravnadzor. The problems identified during the external evaluation may be related to the lack of standardization in the conduct of dispensary observation and the system of regular internal audits in the medical organizations.
Cross-border insurance as a way of forming the flow of medical tourism: an overview of opportunities and practices in the Russian Federation
The article discusses the prospects for commercial insurance products specified for medical tourism options. It summarizes key aspects of such insurance products with respect to national legislation and international laws. The authors assess the possible formats of insurance mechanisms, insurance product design and key limitations of medical tourism in Russia as an insurance product.
COVID-19 pandemic as a reason to rethink policy «optimization» of hospitals
The SARS-CoV2 pandemic has become a challenge to the national health systems of all countries. Statistics for 2020 show the impressive success of Taiwan, Japan and South Korea in confronting COVID-19. Without waiting for mass vaccinations, in 2020 these countries have minimized deaths from coronavirus infection and economic losses.
Aim – to identify the factor of high provision of Japan, South Korea and Taiwan with the resources of inpatient care, which is significantly higher than in most developed countries.
Material and methods. Used a comprehensive, statistical, comparative and retrospective analysis of the available data.
Results. The analysis showed that over the past few decades Japan, South Korea and Taiwan did not reduce, but increased the provision of hospital beds and did not prioritize accelerated discharge of patients from hospitals, which did not prevent their health systems from demonstrating high rates of economic efficiency, and in a pandemic, to ensure hospital care for all those in need.
Conclusion. It is necessary to study the experience of these countries and revise the doctrine prevailing in most developed countries and Russia, which postulates the need to reduce (so-called «optimization») hospital beds by reducing the patient’s stay in the hospital as a prerequisite for the economic efficiency of healthcare.
Evaluation of the effectiveness of models for organizing ambulance services in the constituent entities of the Russian Federation during the COVID-19 pandemic
In recent years, as part of the development of a three-level system of medical care, intermunicipal centers of specialized medical care and regional centers of specialized care have been formed for patients with acute coronary syndrome, acute cerebrovascular accident, combined injuries, bypassing intermediate hospitalization in the nearest medical organizations.
However, in the part concerning the treatment of patients with other emergency diseases, the issue of medical evacuation of such patients immediately to intermunicipal centers of specialized medical care or to regional centers of specialized medical care remains unresolved, bypassing intermediate hospitalization to the nearest central district hospitals, ensuring that they receive timely specialized medical care in an emergency form in full in the first day. In addition, during the COVID-19 pandemic, such tasks appeared in the organization of emergency and emergency medical care.
Approaches to territorial planning of medical care on the example of the surgical service of the Moscow Region
Within the framework of the program of state guarantees in the field of health care and the basic program of compulsory health insurance, when forming a territorial program, the average Russian standard for the volume of medical care per 1 resident or per 1 insured person (under the CHI program) is taken as a basis. For the provision of modern medical care in various regions of Russia, in a number of different factors that take into account the regional features of the provision of medical care, the density of residence, the climatic and geographical features of the region and transport accessibility are essential. All these factors are listed in the program of state guarantees, but currently, at the federal level, there are no methodological approaches to take into account these regional factors, and each region is forced to make its own decisions when forming territorial standards that take into account these features.
Thus, the development, justification and practical use of criteria that allow an objective assessment of the effectiveness of functioning is an urgent task, first of all, of territorial planning of medical care for the population of the regions of Russia.
The article discusses the criteria developed in the Moscow Region for assessing the effectiveness of the surgical service, allowing to take into account the potential of inpatient departments of multidisciplinary hospitals, to provide high-quality medical care, both at the place of residence and within the framework of regional routing of patients, in accordance with the stages (levels) of its implementation. These criteria make it possible to optimize the planning process within the framework of the territorial program of compulsory medical insurance and determine the rational placement of the planned volumes of inpatient care in medical organizations, with its subsequent financing at the expense of compulsory health insurance.
The application of uniform criteria for all surgical hospitals increases the objectivity of planning and financing and ultimately leads not only to an increase in the economic efficiency of the service, but also affects the clinical and social aspects of medical care.
Opportunities of the regional center for CT diagnostics of COVID-associated pneumonia
Coronavirus infection (COVID-19) today occupies one of the leading places among diseases, the prevalence of which is characterized by a particularly rapid and steady increase in the population. The practical value of computed tomography (CT) of the chest organs for the diagnosis of patients with suspected COVID-associated pneumonia has been repeatedly described in the literature. On the part of the radiodiagnosis service, it is assumed that they will be ready for high-intensity work, under conditions of increasing workload, against the background of losses among medical personnel. This is carried out by a set of organizational and anti-epidemic measures, including zoning of departments, redistribution of human resources and patient flows, ensuring infection control, and restructuring production processes. Telemedicine and other digital technologies play a significant role in this. It is assumed that a change in the functionality of the Department of Radiation Diagnostics and Patient Routing may affect the duration of the formation of a protocol for describing CT examinations.
Aim was to formulate the principles of SMART routing, which will ensure the widest, most timely and prompt coverage of the population of Nizhny Novgorod and districts of the Nizhny Novgorod Region with CT diagnostics of COVID-associated pneumonia.
Material and methods. On the basis of the “Clinical Diagnostic Center”(CDC), a pilot project “Organization of a center for CT diagnostics of COVID-associated pneumonia” is being implemented. The objective of the project is to ensure high throughput (mass examination) and quality of CT diagnostics of patients, rapid receipt and sending of examination results to the referring medical organization. Chest CT was performed according to standard scanning protocols. The formation of protocols of medical reports was carried out in the Unified Radiological Information Service as part of the Unified Medical Information and Analytical System of the Nizhny Novgorod Region.
Results. On the basis of the department of X-ray diagnostics, CT and MRI, round-the-clock daily admission of patients with suspected pneumonia caused by a new coronavirus infection COVID-19, both PCR-confirmed and without test results in combination with a pronounced clinical picture of the disease, is organized. The staffing table has been changed, additional training for employees to work with a CT scanner has been carried out. To facilitate work and optimize processes in the face of an increasing volume of work, a cloud solution based on Artificial Intelligence (AI) was used.
To optimize the process, a standard operating procedure (SOP) for conducting CT examinations of patients was developed and approved, including work with personal protective equipment (PPE), the stages of interaction between medical and nursing staff tomography with patients suspicious (confirmed) for a new CVI.
The continuity of the workflow is ensured by remote work with images at night. The obtained CT images at any time of the day are sent electronically to the local data storage (LAS) for description to radiologists. Upon completion of the work, the medical opinion is transmitted via secure ViPNet communication channels to the medical organization that referred the patient, which significantly accelerated the receipt of the result by the attending physician. Support of the medical image archive system is carried out by technical specialists of the information and computing department in 24/7 mode.
During the 13 months of operation of the CT Center of the CDC, 31 704 CT-COVID examinations were performed, which accounted for 27% of all cases of COVID-19 in the Nizhny Novgorod Region.
Speech recognition technology: results of a survey of radiologists at the Moscow reference center for diagnostic radiology
The development of medical digital technologies, such as computer vision and speech recognition, makes it possible to automate and simplify some of the radiologist’s routine tasks. Voice recognition systems reduce the time it takes to fill out medical records, improve workplace ergonomics, and make protocol texts more standardized. Despite this, voice recognition technology is only gaining popularity among specialists in the Russian medical community.
Material and methods. A sociological research method in the form of a questionnaire was used to study the opinion of radiologists about the use of a voice recognition system. The survey was conducted in March 2021 among the specialists of the Moscow Reference Center of Radiology. The questionnaire consisted of 28 questions.
Results. A total of 84 radiologists completed the survey. Slightly more than half of the radiologists (52.2%) prefer using voice recognition system when preparing study reports. Most respondents (62.8%) reported that the voice recognition system improves their efficiency, but 37.2% took a neutral stance or responded that the technology does not affect their efficiency. Most radiologists (72.1%) reported psychological discomfort when filling out protocols by voice in the presence of colleagues. The majority (81.4%) of respondents rated the quality of radiology vocabulary recognition as good and excellent: 58.1 and 23.3%, respectively.
Conclusion. The results of the survey showed the formation of positive attitudes among radiologists toward voice recognition technology. Among Russian-speaking radiologists there remains a wariness about the accuracy of Russian language recognition. As the technology develops and the quality of recognition improves, so does the physician’s attitude to voice completion of medical documents.
Assessing the readiness of a doctor in a multidisciplinary hospital to the application of digital technologies in practice
Background. The fulfillment of the tasks of the federal project “Digital Health Outline” in the practice of each specific medical organization, is largely determined by the readiness of ordinary personnel. In this regard, the purpose of our study was to assess the readiness of medical staff to use digital technologies in their daily practical work.
Material and methods. The study was conducted on the basis of the City Hospital No. 5 of Nizhny Novgorod when creating a strategic plan for the digitalization of the hospital through a questionnaire survey of 73 doctors using author’s questionnaires. It was supposed to study the readiness of doctors for the everyday use of public and professional digital technologies, as well as the attitude of respondents to the introduction of the Internet environment into the doctor–patient relationship system.
Results. Most doctors (88%) already use digital technologies when communicating with patients, the preference is given to e-mail (72%), Viber, WhatsApp, etc. platforms (70%). The vast majority of doctors support the development of telemedicine technologies.
Despite the high degree of availability of Internet sources, 86% of respondents noted that patients trust a real doctor more.
Conclusion. The results of our study indicate that the majority of doctors (74%) positively assess the spread of digital technologies on the prospects for the development of the industry and are ready to introduce the telemedicine format in the provision of medical services.