Scientific substantiation of the conditions for increasing the birth rate in the Russian Federation in the period from 2022 to 2030
President of the Russian Federation V.V. Putin has set a national goal by 2030 – to achieve sustainable growth in the country’s population. This requires an increase in the birth rate and a decrease in the death rate of the population. According to these indicators, an emergency situation has developed in the Russian Federation over the past two years. For 2020 and 2021 The population of the country decreased by 1.2 million people, which is directly related to the supermortality of the population and the reduction in the birth rate. Based on a quantitative assessment of the influence of the main factors on the fertility rate, forecasts were made for the dynamics of this indicator for the medium term (until 2030) under three scenario conditions. It is shown that even under the most favorable conditions, i.e. with an increase in the average per capita income of the population by 4% annually, the fertility rate will decrease to 1.44 by 2026. And only starting from 2027 will there be a moderate increase in this indicator. The results obtained indicate that the national goal of the Russian Federation to increase the fertility rate by 2024 to 1.7 children per woman, with the existing measures to support families and stimulate the birth rate, will not be achieved. This requires additional extraordinary measures. The paper proposes the following additional measures for the Russian Federation, which will increase the number of births by approximately 250–300 thousand children annually: 1) doubling the amount of maternity capital for the birth of second and subsequent children, 2) financial support for families with two or more children under the age of 7 years in the amount of 1/2 of the average wage in the region, regardless of the status of need; 3) implementation of mass programs for the protection of the reproductive health of citizens; 4) creation of favorable and friendly conditions for the development of children (places in preschool institutions, extended groups, free circles, affordable medical and preventive care). All these measures will require an additional at least 1.7 trillion rubles, annually, which, taking into account the funds already spent (1.8 trillion rubles), will amount to 3.3% of GDP. This is close to how much developed countries spend on such measures, which managed to achieve a fertility rate of 1.7–2.
Infectious morbidity of the population and resource provision infectious disease service: relationships, challenges and proposals
Infectious diseases are an urgent problem of world health due to their prevalence, mobility, threat to public health and early mortality. The article analyzes the infectious morbidity, mortality from infectious diseases and resource support of the infectious service of the Russian Federation (RF) (from 1990 to 2017) and a separate subject – the Republic of Tatarstan (RT) from 2005 to 2017. During the study period in the Russian Federation and the Republic of Tatarstan, a decrease in the level of primary and general infectious morbidity against the background of an increase in mortality from infectious diseases was established. Such dynamics of morbidity and mortality was affected by a reduction in the resource support of the infectious diseases service in the Russian Federation and the Republic of Tatarstan, including the material and technical base (infection beds), human resources (infectionists) and financial support. In the current situation, it is necessary to develop measures aimed at strengthening the capacity of the infectious diseases service and increasing the availability and quality of specialized medical care in the field of ”Infectious diseases”.
Organization and financing of cancer care in the Russian Federation in 2018–2024
In the Russian Federation cancer mortality is the second cause of all deaths (14% in 2020). Despite decrease in standardized mortality rate (SMR) from malignant neoplasms among population in the Russian Federation (aged 0 to 64 years) its level remains to stay at the level of “new” countries of the European Union and is 1.5 times higher than in old countries of the European Union. The aim of the study was to evaluate measures to reduce mortality from malignant neoplasms that have been taken and are also planned for implementation in the Russian Federation in 2018–2024.
The article analyzes: resources of cancer service in the Russian Federation from 2012 to 2020; current regulations on the organization of cancer care; main features of the Federal Project “Fighting Cancer” implementation, as well as dynamics of provision and financing of medical care for malignant neoplasms in system of Obligatory Medical Insurance (OMI).
In the Russian Federation, starting from 2019 to 2021, significant steps have been taken to increase the availability of cancer care to patients: in the programme of state guarantees the standards for cancer care provision are separately highlighted and established control over their implementation; from 2019 to 2021 the standards for the volume of care in inpatient settings increased by 16%, in day hospital conditions – by 14%; total financial support in inpatient and day hospital conditions increased by 89 billion rubles; 280 outpatient cancer care centers were put into operation; medical organizations are equipped with 207 units of “heavy equipment”. At the same time, in the programme of state guarantees, normative periods for diagnostic examination waiting and for planned hospitalization waiting were reduced from 14 to 7 working days. Implementation of these measures, combined with a favorable state (compared to other profiles of health services delivery) of cancer service resource provision, made it possible to reduce mortality from malignant neoplasms by 0.7% from 2019 to 2020.
The authors conclude that implementation of targeted, comprehensive and controlled measures to increase the volume of medical assistance and their financial support under the programme of state guarantees, sufficient staff reserves and development of material and technical base of medical organizations are highly effective in reducing mortality from oncological diseases. The approach used in the Federal Project ”Fighting Cancer” needs to be multiplied in “oncology” profile and extended to other groups of diseases.
Assessment of the quality of training of medical students during the COVID-19 pandemic for future work in practical health care
The COVID-19 pandemic has led to a global transformation of the education strategy at every level, including for higher education. At the same time, as the two main trends of education during the pandemic, experts single out the violation of the educational process and the forced transition to distance learning. The transition to distance learning for medical university students during the pandemic required adaptation to the new reality of all components of the educational process, including for disciplines that were traditionally considered possible only in a clinic.
Aim – to assess the readiness of medical university students studying at senior courses during the pandemic to practice in medical organizations.
Material and methods. The materials of the study were a survey on the author’s questionnaires of students of a medical university of V–VI courses, who over the past 2 years have been engaged mainly in a distance format. The questionnaire questions provided for a subjective assessment of the level of theoretical and practical preparation of students for independent work in medical organizations, as well as an assessment of the level of basic competencies necessary for a doctor to start independent work in a clinic.
Results. According to the students themselves, online education does not allow graduates to feel fully prepared for independent work as doctors. 57% of respondents consider the level of their general therapeutic training (the ability to assess symptoms and syndromes, read ECGs, X-rays, prescribe drug therapy) insufficient to start practical work, 41% – the level of practical knowledge and skills.
Conclusion. Graduates of medical universities who have been studying for two years mainly by distance learning, consider their level of practical skills to be insufficient for independent work, which, of course, will require the development of professional adaptation programs from employers, including the development of a mentoring institute.
Demographic, social and economic effects of hormonal therapy in endometriosis and abnormal uterine bleeding
Endometriosis and abnormal uterine bleeding (AUB) are diseases with very high prevalence which lead to serious negative outcomes. Prevalence of symptomatic endometriosis is 5% and AUB is 10% in women of 16–54 years old. One on most used method of treatment of both diseases is hormonal therapy. The goal of study is to define potentially preventable social, demographic and financial burden of endometriosis and AUB if hormonal therapy is used. Firstly, we assessed total social, demographic and financial burden from endometriosis (including related infertility) and AUB. The burden we calculated by days of absence from work [what need social payment and decrease the impact to gross domestic product (GDP)] and lower number of birth due to infertility (decrease of GDP). Then, the preventable burden due to hormonal therapy was calculated.
Potentially preventable burden from endometriosis and AUB was 93.2 bln rub. per year: 21.0 from endometriosis (due to days of absenteeism 0.65 thsd days and birth of 2.2 thsd children), and from AUB 72.2 bln rub. per year (due to days of absenteeism 4.7 mln days). However, in Russian Federation, only 24% of women with endometriosis take hormonal therapy and only 19% – with AUB. As a result, only part of burden is really prevented nowadays: 19.1 bln rub per year (5.1 bln rub. from endometriosis, including 0.3 bln rub. from infertility and 14,1 bln rub. from AUB). According to these facts, it is possible to prevent additional burden or get an additional effect of 74.0 bln rub. per year, when hormonal therapy is prescribed to all those in need of it. Return on investment, estimated through additional treatment costs, per 1 rub., it will amount to 1.34 rub. in case of endometriosis, and with AUB – 3.35 rub. The authors conclude that organizational measures should be taken to increase the number of women who are diagnosed and should be prescribed hormonal therapy for endometriosis and AUB. Among these measures: informing women, training doctors, actively identifying patients, timely diagnosis and start of therapy, follow-up on prescriptions, creating registers of women who need therapy. At the same time, it is advisable for these diseases to include hormonal therapy in the system of free provision by State on an outpatient basis, as is done in all developed countries.
The Russian neurosurgery to and during COVID-19 pandemic
The pandemic of a new coronavirus (COVID-19) which captured the whole world undermined all aspects of life of society and health care in incomprehensible scales. Neurosurgeons were rather protected from the sudden overloads which fell upon narrow specialists in the field of emergency medical service, an intensive care, pulmonology, but, nevertheless, practice of neurosurgery also underwent changes. It causes relevance of the analysis of key indicators of work of neurosurgical service during the period to and during a pandemic of a new coronavirus infection.
Aim – the description and the analysis of key performance indicators of neurosurgical service during the period to and during a pandemic for the purpose of support of management decisions on ensuring availability to the population of profile specialized medical care.
Material and methods. Data for 2019–2020 on each of 85 territorial subjects of the Russian Federation which are contained in forms of the state statistical observation “Data on activity of the divisions of the medical organization providing medical care in stationary conditions” and “Data on the medical organization” are analysed. For assessment of the obtained data simple (unweighted) arithmetic-mean sizes, specific indicators, a mean square (standard) deviation of the weight of values from average sizes, coefficient of variation (the relation of a mean square deviation to average size) were used. The set was considered as uniform if coefficient of variation did not exceed 33%.
Results. For the end of 2020 of all in the Russian Federation 10 679 beds of a neurosurgical profile, including 1607 children’s beds were developed in general. In the sum it for 2278 beds (or for 18%) is, less, than in 2019. Differences between territorial subjects of the Russian Federation on the level of security with profile beds reach more than 5 multiple sizes. The total number of cases of hospitalization in 2020 on beds of a neurosurgical profile, all made 330.5 thousand cases (272.2 thousand cases of hospitalization of adult patients and 58.3 thousand children) that on 92.3 thousand cases it is less (or for 12%), than in 2019. In 2019 12.8 hospitalization, in 2020 – 9.6 hospitalization were the share of each case of death from an injury of the head on average. The average duration of treatment on beds of a neurosurgical profile was in 2020 8.82±2.24 days (11.15±3.10 days on beds for adults and 6.45±4.47 on beds for children). Average annual employment of one bed of a neurosurgical profile increased about 257.7±90.8 days in 2019 up to 312.9±130.8 days in 2020. All-hospital lethality of the Russian Federation on beds of a neurosurgical profile in 2020 averaged 1.38% (in 2019 – 1.22%). Total number of operations on a nervous system decreased from 179.1 thousand in 2019 to 155.5 thousand in 2020, or for 13%. In Russia the average annual number of operations within the last 2 years is ~1000 operations on 1 million population. Most often in Russia it is carried out neurosurgical operations at degenerative diseases of a backbone and a craniocereberal trauma. Postoperative lethality at nervous system operations on average in territorial subjects of the Russian Federation increased from 8.19±4.48% in 2019 to 10.12±6.52% in 2020. On one neurosurgeon in 2020 on average in territorial subjects of the Russian Federation 108.2±35.1 cases of hospitalization are the share of beds of a neurosurgical profile and 54.5±24.6 nervous system operations.
Conclusion. In Russia the essential deficiency of volumes of neurosurgical operations takes place. The main part of neurosurgical operations is carried out in Russia at degenerative diseases of a backbone and a craniocereberal trauma while in the developed foreign countries – at the craniocereberal trauma and a cerebral stroke which are around the world the leading causes of death. For accumulation of volumes of profile medical care, expansion of access for the population to the main and acute neurosurgical management in Russia there is enough neurosurgeons. Acceptance of organizational measures for reduction of structure and volume of neurosurgical interventions in compliance with needs of the population is necessary.
Tasks of labor rationing for the implementation of the provision of state-guaranteed medical care to the population of the Russian Federation in 2022. Part 1
In the context of the COVID-19 pandemic, limited human resources, slowdown in economic development, planning the organization of medical care, its guaranteed volume for the population of the country, is an urgent task of the country’s healthcare system, implemented through the annually approved Programs of state guarantees of free medical care for the population of the Russian Federation.
The aim of the study is to analyze the regulatory legal and regulatory acts on the issues of labor regulation in the health care system of the Russian Federation for the implementation of the provision of state-guaranteed medical care to the population in 2022.
The materials of the study were the regulatory legal and regulatory acts of the reference legal system “Consultant Plus”.
The results of the first part of the study showed changes in the guaranteed volumes of certain types of medical care for 2022 compared to the data for 2021. An increase in the standard number of comprehensive visits for preventive examinations and medical examinations was revealed against the background of a decrease in the implementation of their volumes at the beginning of the pandemic, as well as hospitalizations, including for medical rehabilitation, and especially the number of cases of treatment in day hospitals. For the first time, the volumes of medical care for medical rehabilitation on an outpatient basis have been determined.
Multidirectional dynamics is shown in the planned volumes of individual diagnostic studies: in an increase in computed tomography and testing for the detection of a new coronavirus infection and a decrease in the volumes of other types specified in the Program. The time norms in the current regulatory legal acts are largely outdated and do not correspond to modern conditions for the provision of medical care, and the results of previous studies are still not taken into account by the Russian Ministry of Health as part of the amendments to the current regulatory framework on labor rationing.
Conclusion. The analysis of the normative volumes of medical care demonstrated the need to immediately address both the existing problems in labor rationing for the implementation of the planned indicators for the volume of medical care provided for by the SGBP, and the consideration of new tasks for developing time standards for certain types of diagnostic studies. Consideration of new tasks in labor rationing identified in the analysis of the TPSG for 2022 and for the planning period of 2023 and 2024 will be presented in the second part of the publication.
The problems of digital transformation of healthcare in the Russian Federation and its possible solutions
The introduction of computer technologies and electronic health records into healthcare practice has significantly increased the volume of collected digital biomedical data and pushed the development of medical informatics. The implementation of the Resolutions of the Government of the Russian Federation on the ”Strategic direction in the field of digital transformation of healthcare” until 2024 and ”On the Unified State Information System in the field of healthcare”, adopted respectively in December 2021 and February 2022, will significantly accelerate these processes. The article discusses the main provision of these documents and describes the problems with the collection, presentation and analysis of data in the field of healthcare organization, which, in the present moment, do not allow making informed decisions. Recommendations are made for the further development of applied solutions of medical informatics in the Russian Federation.