Oncohematological diseases in the Russian Federation and in developed countries: mortality, incidence, resources and organization of medical assistance in consideration of the COVID-19 pandemic
The purpose of the scientific work is to study the mortality and incidence of oncohematological diseases in the Russian Federation (RF) in comparison with developed countries (Great Britain, Germany, Spain, Italy, Canada, Poland, USA, Turkey, Finland, France, South Korea, Japan), as well as resources and volumes of medical care for patients of this profile. It was revealed that from 2012 to 2020 in the Russian Federation, mortality from all malignant neoplasms of lymphatic and hematopoietic tissue increased by 16%. In 2020, in the Russian Federation, compared with Germany, the primary incidence of non-Hodgkin’s lymphomas was 47% lower, leukemia – 21% lower, multiple myeloma – 36% lower, Hodgkin’s lymphoma – 9% lower. In 2020, in the Russian Federation, compared to Germany, the mortality rate from all of the above cancers was also lower, with the exception of Hodgkin’s lymphoma, the mortality rate from which was 3 times higher than in Germany. In the Russian Federation, compared with Germany, the ratio of mortality to primary morbidity in non-Hodgkin’s lymphomas was 34% higher, leukemia – 25% higher, multiple myeloma – at the same level, Hodgkin’s lymphoma – 2 times higher. In the Russian Federation, the prevalence of oncohematological diseases is growing annually by 6.8 thousand people on average, against this background, from 2019 to 2020, the volume of assistance is reduced by 0.5%.The results of a comparative study indicate that in the Russian Federation there is an insufficient detection of oncohematological diseases, their ineffective treatment, as evidenced by the high ratio of mortality to primary morbidity, as well as insufficient assistance, which does not reflect the growth rate in the number of patients with this pathology. All this can lead to an increase in mortality from cancer of the lymphatic and hematopoietic tissue.
Analysis of morbidity and mortality from diseases of the circulatory system in the subjects of the Volga Federal District in the pre- and pandemic periods (2015–2020)
The leading ranks in the structure of disability and mortality in Russia are firmly occupied by diseases of the circulatory system. The authors analyzed the indicators of morbidity and mortality of diseases of the circulatory system (BSC), availability of primary health care and hospitalization for this group of diseases in the pre- and pandemic periods COVID-19 (2015–2020) in the regions of the Volga Federal District (PFD).
Methods. The work used data from monitoring the health status of the population of the Federal State Statistics Service on the general incidence of BSC, mortality from BSC, statistical data on attendance of medical organizations providing medical care in outpatient settings, dispensary observation for this group of diseases, hospitalization of patients with BSC.
Statistical data processing was performed using methods for assessing the statistical significance of differences in average values, analysis of dynamic series. Data processing was carried out using Microsoft Office Excel (2010) and Statistica 6.0.
Results. Diseases of the circulatory system continue to be the main causes of morbidity and mortality in the period 2015–2020. This is confirmed by the analysis of the overall morbidity of the entire population of BSK, mortality from BSK in the regions of the Volga Federal District and the Russian Federation. A decrease in the primary health care function and the availability of specialized care play an important role in maintaining unfavorable trends.
Health of the economically active population the Russian Federation and the Siberian Federal District. Social and economic aspects
The aim is to analyze the dynamics of indicators characterizing the health status of the economically active population and some socio-economic consequences of the implementation of measures to improve it in the Russian Federation and the Siberian Federal District (SFD).
Material and methods. The statistical data of the Ministry of Health of the Russian Federation, the Federal State Statistics Service (Rosstat), the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being (Rospotrebnadzor), as well as data from the Ministries of Health of the constituent entities of the Russian Federation that are part of the SFD were used. Scientific publications on the problem under consideration have been studied. Statistical, historical and economic methods were used.
Discussion and results. The Russian Federation in its recent history is characterized by negative demographic processes characterized by low birth rate, high mortality of the population, including economically active. This entails not only restraining the economic development of the country, but also significant economic losses and additional costs. There is a high incidence of temporary disability, including professional disability, despite the reduction in the number of jobs with harmful and dangerous conditions for health. Our country has the highest mortality rate in Europe against the background of a low level of occupational injuries. In the period before the COVID-19 pandemic, there was a decrease in mortality among people of working age, but the planned indicators were not achieved, and it remains almost the highest among developed countries.
In the SFD, the health of the economically active population is worse than in the whole of the Russian Federation. This is due to the following reasons: harsh climatic conditions, the presence of a large number of mining and processing enterprises with harmful and dangerous conditions for health, as well as traumatic types of work.
Conclusions. All of the above indicates the insufficiency of the measures taken and implemented to preserve the health of the working population, which ensures economic growth in the country and the social well-being of its citizens.
Assessment of the impact of benefits and special tax regimes on the revenues of the chi system
In order to stimulate economic growth, a number of employers in Russia are provided with benefits and special tax regimes for paying contributions for compulsory health insurance of the working population with compensation for lost income of the Federal Compulsory Medical Insurance Fund (FCMIF) through an interbudgetary transfer. As part of the study, an assessment was made of the impact of these benefits on the income of the FCMIF and the sufficiency of the compensating transfer. The data obtained suggest that due to benefits and special tax regimes, even taking into account the interbudgetary transfer, the FCMIF can annually lose up to 0.5 trillion rubles of income. At the same time, the rate of compulsory medical insurance contributions for the working population in Russia is significantly lower than the rate of social health insurance in Eastern European countries with a level of production comparable to Russia. The authors conclude that it is necessary to revise the system of benefits and special tax regimes for the payment of compulsory medical insurance contributions and/or to increase the interbudgetary transfer to an amount sufficient to compensate for the shortfall in income of the FCMIF.
Analysis of the relationship between financial and non-financial performance indicators of medical organizations
The article presents the results of the analysis of data on changes in the values of indicators for the period 2016–2019, characterizing the financial and medical and social activities of medical organizations providing primary health care to the adult population. The relationship between individual indicators, the dynamics of changes in which have an impact on the management process and decision-making on the provision of resources in the health sector, is revealed.
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 2
This article is a continuation of the materials published on the topic in 2022*. The second part of the article presents the results of the analysis of the normative legal documents regulating the formation and economic justification of the territorial programs of state guarantees in terms of medical care provided in outpatient and inpatient conditions. The results showed once again that the planned indicators are characterized by sharp annual fluctuations, caused neither by morbidity indicators, nor by new technologies of treatment and diagnostic process. At the same time the dynamics of the actual supply of beds develops smoothly with preservation of the general tendency in all years of observation, except for the situations connected with the necessity to mobilize resources in case of any catastrophic man-caused, biological or other events. This determines the need for correction in the planning of certain types of medical care and, consequently, the redistribution of human resources for the implementation of the tasks of the territorial programs of state guarantees.
Organization of medical care for infection caused by human immunodeficiency virus
In a scientific work, the authors studied the primary incidence of HIV infection in the Russian Federation and developed countries. So, in 2019 in the Russian Federation this indicator was 14.8 times higher than in Germany, and 7.5 times higher than in France (respectively 54.6; 3.7 and 7.3 cases per 100 thousand people population). This indicates insufficient preventive measures among the population to counteract the spread of this pathology.
An analysis was made of the total costs of combating HIV infection and the number of patients with this disease. From 2010 to 2019 in the Russian Federation, these costs in constant prices (2010=100%) increased by 1.8 times (from 20.3 billion rubles to 36.1 billion rubles), and the number of patients over the specified period increased by 1.7 times (from 503.7 thousand to 853.4 thousand people). At the same time, compared with developed countries, the Russian Federation provides 3 times less funds per patient in comparable money for antiretroviral therapy, which is the main item of expenditure for HIV-infected people. This indicates insufficient spending on this item.
The authors also identified problems in counteracting the spread of HIV infection: insufficient coordination in the work of institutions involved in countering the HIV/AIDS epidemic; one-sided orientation of the strategy to combat HIV to the diagnosis and treatment of HIV infection with the weakness of prevention programs. As a result, there is an urgent need in the Russian Federation to expand the range of measures aimed at preventing the spread of HIV.
The incidence of HIV infection among the regions of the Russian Federation was analyzed. Thus, there is a 19-fold difference in this indicator (from 8.5 to 164.8 cases per 100,000 population). It is necessary to apply differentiated approaches to the formation of a program to reduce the prevalence and mortality from HIV infection.
Administrative and legal forms and methods of combating corruption in the field of public health administration
The presented scientific article deals with issues related to the concept, content and main types of administrative-legal forms and methods used to combat corruption in the field of public health administration. The paper substantiates the need to strengthen the fight against corruption in the healthcare sector using the most effective administrative and legal forms and methods aimed at minimizing corruption in the Russian Federation. As a result of the study and analysis of the identified problematic aspects, the authors came to the conclusion that the consistent use of modern anti-corruption forms and methods makes it possible to more effectively combat corruption and corruption offenses in the field of public health administration. In conclusion, the authors formulated certain conclusions and proposals aimed at improving the mechanism for combating corruption in the field of public health administration.
Review of international and Russian strategies for the diagnosis of iron deficiency
The occurrence of iron deficiency anemia in the world in 35% of women is urgent physicians in terms of recognizing nonspecific manifestations of iron deficiency conditions.
The aim is to determine the most optimal screening strategies for diagnosing latent iron deficiency and iron deficiency anemia based on the study of international experience.
Material and methods. The material of the study was international and domestic scientific articles on modern diagnostic practices of iron deficiency conditions (application in different countries of the approach set out in the European diagnostic algorithm, as well as laboratory diagnostic studies regulated by Russian clinical guidelines). Research methods – theoretical analysis and comparison of data obtained from literary sources.
Commitment of citizens when making an appointment with a doctor in the conditions of health informatization
Making an appointment with a doctor online is deservedly among the most popular remote services in today’s conditions. Monitoring the quality of an appointment with a doctor and identifying problems encountered by medical organizations in this regard is a priority task facing the Ministry of Health of Russia in the context of health informatization. By 2024, the share of doctor’s appointments made remotely should be 63%. The article presents the results of a study on the achieved values of this indicator in Moscow polyclinics, and also analyzes the preferences of citizens when making an appointment with a doctor.