Analysis of budget costs of the Russian Federation budgetary system in "Healthcare" section for 2022 and for the planning period of 2023–2024
October 12, 2021 the President of the Russian Federation V.V. Putin appealed to the deputies of the State Duma of the Federal Assembly of the Russian Federation with a request to solve the problems with poverty, demography and healthcare, which are reflected in the Presidential Decree No. 474 "On the national development goals of the Russian Federation for the period up to 2030" (21 July 2020). The article analyzes the compliance of the state budget allocated for healthcare with solution of these problems. In 2022, compared to 2021, according to the forecast of the Ministry of Finance of the Russian Federation, public spending on the health sector (the budget of the Federal Compulsory Medical Insurance Fund, the federal budget and the consolidated budgets of the regions), at current prices, will increase by only 3% (127 billion rubles), and in constant prices (adjusted for inflation, 2018 = 100%) they will decline by 1%. Over the same period, the share of government funding for healthcare in the gross domestic product (GDP) will also decline from 4.1% to 3.9%. This trend is expected to continue up to 2024. Such indicators of state financing of healthcare will not allow solving the most pressing problems of the healthcare system of the Russian Federation: the growing health professional shortage, unsatisfactory public drug supply on an outpatient basis, insufficient amounts of free medical aid and its financial support. As a result, against the background of an increase in the number of patients in need for free-of-charge medical treatment, its availability will continue to decline, and accordingly, the population mortality rate of the Russian Federation will increase, which today has already assumed catastrophic proportions (during the first 9 months of 2021, an additional 373 thousand people died, which is +18% over the same period last year). To improve the current situation in the healthcare sector, it is necessary to allocate at least 500 billion rubles a year in 2022 and subsequent years, so that in 2025 state funding of healthcare could reach 5% of GDP. The author concludes that budget costs of the Russian Federation budgetary system on saving the people of our country should be a priority compared to infrastructure projects for which up to 2.5 trillion rubles are allocated from the National Welfare Fund.
The cervical cancer prevention in Russia
The rapid increase in morbidity and mortality from cervical cancer of reproductive age, the Lack of organized cervical screening are relevant at the present time in RF. The development of a system for organized screening of cervical cancer is the task of today. The aim of the article is to analyze the state and prospects of the cervical cancer screening system in Russia and world from the leading Russian professionals: cytologists, molecular biologists, oncologists, gynecologists, public health workers, etc.
Scientific substantiation of the cognitive-behavioral strategy for the prevention of iron deficiency in women of reproductive age
The aim is to develop evidence-based preventive measures to manage the risks of iron deficiency in women of reproductive age.
Material and methods. Social, hygienic and psychological research in women of reproductive age was aimed at developing algorithmic prevention tools for outpatient-polyclinic doctors. The research included two blocks: a survey and training seminars. The questionnaire included questions on lifestyle in google-forms and such tests as "Express diagnostics of iron deficiency conditions" (E.V. Kochneva, M.V. Kralevska, 2017) and "Identification of personal and situational anxiety according to Charles Spielberger" (adapted into Russian by Yu. Khanin).
Training seminars were held in 2021 in Kazan in a group of women (n=54) with laboratory-confirmed iron deficiency in frames of "Steps to Health" Nutritional Support Course (D.R. Kuznetsova, 2021).
The seminar program includes information block with the recent evidence on epidemiology of iron deficiency states, diagnostic and prevention algorithms. Work in a small group was expanded with empathic cognition techniques, which contributes to value-mediated perception of information and effective assimilation of the material.
Considering that the problem of iron deficiency in women is often associated with lifestyle and psychological status, a training module on "Elements of cognitive behavior therapy in the practice of a general practitioner" has been added to the program.
Results. It was found out that 26% of the women surveyed have laboratory confirmed iron deficiency (Hb <120 g/l), 35% of the respondents have a low level of tissue iron stores (serum ferritin <40 ng/ml). Among the latter, 89% of women have serum ferritin values <20 ng/ml. 18.5% of the questionnaires had laboratory data attached that testified to latent iron deficiency (serum ferritin <40 ng/ml with Hb ≥120 g/l).
When asked if the doctor of your polyclinic ever talked to you about the prevention of iron deficiency, 87% ticked the box "no", 92% reported that they rate the interaction with their doctor as "insufficient".
Short "before-after training" questionnaire was used to assess the dynamics of female awareness of the problem of iron deficiency. It showed that the basic Level of women's knowledge averaged to 4.6 points, while after they participated in seminars it equaled to 8.8 points (p<0.05).
Conclusion. During the training, women received algorithmized information about iron deficiency conditions risk factors and self-control tactics for primary prevention. There was a positive feedback on the "Latent iron deficiency: from diagnosis to causes" block (86% of the participants highlighted this part of the program as especially valuable).
Thus, evidence obtained during the pilot study shows that women of reproductive age need to get high-quality reliable information on the prevention of iron deficiency conditions. However, to successfully implement such an approach at the population level, we should take measures to develop preventive thinking in clinicians: to introduce a program in frames of training cycles for general practitioners and "Hygiene" course for students of medical and pediatric departments.
Ways to improve organizational and methodological activities in medical organizations at the present stage of healthcare system reform
In the article a set of measures aimed at improving the efficiency of organizational and methodological activities in medical organizations is represented. The methodological approaches to organization and analysis of financial, economic and medical activities of healthcare organizations are disclosed. The main groups of medical accounts and records used in healthcare organizations of various types are represented. The exceptional importance of developing long-term and current plans for optimizing the network of medical organizations is underscored. The main directions of special-purpose inspections and expert evaluations realization are outlined. Modern approaches of improving the efficiency of work with healthcare personnel are disclosed. The modern forms of organization of on-site medical-diagnostic and consulting assistance, taking into account specificity of health care delivery in rural areas, are given. The scheme of telemedicine consultations organization is represented. Special attention is given to organization of preventive work in medical organizations. The main problems and ways to improve organizational and methodological activities at the present stage of healthcare system development are formulated.
Vector for personalized medicine: from practice implementation to expected results
Background. An unprecedented convergence of medical knowledge, technology and data science is revolutionising patient care. Personalization in the prevention and treatment of diseases is an inevitable vector of development of the healthcare system, which is already being followed by many developed countries: the USA, Great Britain, Germany, China, Turkey, etc. There is a paradigm shift in the world of a vertical treatment-oriented model of medical care to a matrix network structure aimed at the patient. In this model, the patient is considered as a partner in choosing a personalized treatment plan, the purpose of which is to maintain and increase the duration and quality of life. The concept of personalized medicine provides for the transition from universal solutions "for many" to the provision of medical care "for everyone", taking into account the individual needs of patients.
Material and methods. At the session "Vector for personalized medicine: from implementation into practice to expected results" during the IX International Congress "Orgzdrav-2021. Effective management in healthcare", leading industry experts and international experts discussed the prospects for the introduction of personalized medicine in Russia, and also answered questions whether this is a trend of the future or the present; what changes are needed in our healthcare for the introduction of personalized medicine; is the introduction of such a model economically justified for Russian healthcare?
Results. 4 reports covering the structural blocks of personalized medicine and the application of real world data were presented at the session, also the pharma-coeconomical advantages of genetic profiling in oncology were discussed with examples of world experience. Personalized healthcare is not only about treating and preventing disease for individual patients. Personalized medicine can deliver efficiencies that will keep healthcare systems sustainable in the face of rising costs.
The problems of introducing a new wage system for medical workers in the conditions of the modern regulatory framework for labor
Material and methods. The research materials were regulatory Legal acts on Labor standards in healthcare. The source of legal information is the ConsultantPlus legal reference system. Analytical, study and generalization of experience were used as research methods.
Results. In the study, the analysis of the modern regulatory framework for labor within the health care system of the Russian Federation was carried out by types of labor standards, in connection with which their appropriate systematization was developed and a list of normative legal acts was formed for 6 groups: number norms (in orders on Procedures), number norms (in orders on Rules), number norms (in the order on Rules), time norms (for visits), time norms (for diagnostic studies, procedures, manipulations), load norms.
The problems and shortcomings of regulatory legal acts on labor standards in healthcare have been identified, such as the inconsistency of the content of a number of orders and appendices to orders with their names, contradictory data on the values of labor standards in regulatory legal acts, the lack of standards for the number of auxiliary service medical workers, general hospital staff in the main types of hospital organizations, erroneous recommendations for staffing round-the-clock work, violations of the nomenclature of medical care profiles, positions, specialties, the economic unreasonableness of labor standards and, most importantly, the lack of communication between the individual components of the labor rationing system in healthcare. A number of measures have been identified to eliminate erroneous provisions of regulatory legal acts and improve the regulatory framework for labor in the healthcare system.
Conclusion. The revealed shortcomings and problems of the labor regulatory framework hinder the introduction of a new system of remuneration for medical workers and violate its main conditions: transparency and fairness.
In the conditions of the presented state of the regulatory framework for labor rationing in healthcare, it is difficult to count on the creation of equal tension of labor standards, which is the basis for the introduction of a new system of remuneration for medical workers.
Dynamics of key indicators of work of the hospital sector of the health care system of Russia
COVID-19 caused crisis in the field of public health care as medical institutions were badly prepared for such incidents. In this regard importance of estimates of opportunities and results of work of hospitals for the purpose of development of suggestions for improvement of the organization of their activity increases.
Aim. The analysis of change of separate indicators of resource providing and results of work of the hospital sector of a health care system of Russia in dynamics in six years.
Material and methods. Methods of the statistical analysis, information and analytical materials of the Russian and foreign news agencies, statistical materials of the Russian Ministry of Health and Federal State Budgetary Institution TSNIIOIZ of the Russian Ministry of Health are used.
Results. For the last 25 years in Russia the bed fund of the state medical organizations was reduced by 705.6 thousand or for 40%. For the end of 2020 the bed fund of the state medical organizations in Russia made 1031.5 thousand beds, or 7.0 beds for 1000 of the population. 259.1 thousand beds, or 25.1% of total capacities of bed fund of the round-the-clock hospitals of the country were used for treatment of COVID-19 in 2020 in Russia. Average annual employment of bed fund in general for the Russian Federation for the same period decreased from 317.7±21.3 in 2015 up to 255.1±20.3 days in 2020 that makes only 77% of an optimum indicator (330 days in a year). Especially Low were indicators of Load of the bed fund (including resuscitation) intended for treatment of COVID-19 (a bed turn on average - 10.5, average annual employment of a bed - 109 days). Level of all-hospital lethality in 2020 was on average in the Russian Federation 3.14% that is 1.8 times more, than in 2015, and on average in territorial subjects of the Russian Federation at treatment of COVID-19 - 7.62±0.33%.
Conclusion. The health care system overload at emergence of a new coronavirus pathogen of SARS-CoV-2 was result of administrative collapse and wrong distribution of resources. The hospital health sector was in the period of a pandemic loaded in general on only three quarters, and specialized capacities for treatment of the infected COVID-19 of patients - no more than on a third. The priorities realized within the last years on reduction of number and capacities of the round-the-clock hospitals have to be replaced with priorities on ensuring stability and efficiency of their work, especially in a case deterioration in an epidemiological situation.