Decree of the Government of the Russian Federation of November 5, 1997 N 1387
"On Measures for the Stabilization and Development of Public Health and medical science v Russian Federation"
In order to guarantee the rights of citizens of the Russian Federation to health protection and medical care, to increase the economic stability and efficiency of the activities of healthcare institutions and medical science, the Government of the Russian Federation decides:
1. To approve the Concept for the Development of Health Care and Medical Science in the Russian Federation developed by the Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences (attached).
2. To approve the attached action plan for the implementation of the Concept for the Development of Public Health and Medical Science in the Russian Federation for 1997-1998.
3. To the Ministry of Health of the Russian Federation in agreement with the Ministry of Finance of the Russian Federation, the Ministry of Economy of the Russian Federation and the Federal Compulsory Fund health insurance before January 1, 1998, develop and submit to the Government of the Russian Federation a program of state guarantees to provide citizens of the Russian Federation with free medical care.
4. The Federal Compulsory Medical Insurance Fund, the Ministry of Health of the Russian Federation and the Ministry of Finance of the Russian Federation, by December 1, 1997, determine the procedure for distributing target budget funds of the Federal Fund for Financial Support of the Subjects of the Russian Federation in 1998 to equalize the conditions for financing compulsory medical insurance programs in the constituent entities of the Russian Federation. Federation, based on the funds provided in the federal budget for 1998, and to ensure control over the targeted use of these funds.
5. Interdepartmental Commission of the Russian Federation for cooperation with international financial and economic organizations to continue coordinating activities for the implementation of investment projects as part of the restructuring of the healthcare system in the Russian Federation, financed by loans from international financial and economic organizations.
6. To recommend to the executive authorities of the constituent entities of the Russian Federation to develop action plans for the implementation of the provisions of the Concept for the Development of Healthcare and Medical Science in the Russian Federation.
Concept
development of healthcare and medical science in the Russian Federation
(approved by resolution
I. Introduction
In recent years, there has been a deterioration in the health status of the population. The crisis in the activities of medical institutions is approaching the line, followed by the collapse of the entire health care system.
The amount of healthcare financing from the budgets of all levels and from the funds of compulsory medical insurance does not provide the population with free medical services. At the same time, the available financial and material resources are used inefficiently, and disproportions in the provision of medical care are increasing. Social tension is growing in the industry. The shadow side of payment is becoming more widespread medical services.
In this regard, a well-thought-out strategy for healthcare reform is needed.
II. The main directions of development of the healthcare system
The purpose of the Concept for the Development of Health Care and Medical Science in the Russian Federation (hereinafter referred to as the Concept) is to preserve and improve people's health, as well as reduce direct and indirect losses to society by reducing morbidity and mortality.
The main objectives of the Concept are:
an increase in the volume of measures for the prevention of diseases;
reducing the time for restoring the lost health of the population through the introduction of medical practice modern methods prevention, diagnosis and treatment;
improving the efficiency of resource use in health care.
The implementation of the Concept is based on following principles:
universality, social justice and accessibility of medical care to the population, regardless of the social status of citizens, their level of income and place of residence;
preventive orientation;
economic efficiency of functioning of medical institutions;
unity of medical science and practice;
active participation of the population in solving health issues.
Under the current conditions, the following are of great importance:
shaping public policy in the field of health and medical science and increasing the responsibility of all authorities for its implementation;
ensuring the adequacy of financial resources to state guarantees in the healthcare sector, a gradual increase in the share of funds allocated to finance healthcare, up to 6-7 percent of the gross domestic product;
development of the non-state sector in health care;
improvement of legal regulation of activities in the field of healthcare;
development and implementation into practice of advanced forms and methods of organizing state sanitary and epidemiological supervision, hygienic and epidemiological expertise, monitoring human health and human environment;
conducting investment policy providing high efficiency of investments - maximum medical, social and economic effect per unit cost;
raising the level of qualification of medical workers, improving the system of their training, retraining;
increasing the social protection of medical workers, including wage increases;
involvement of professional medical associations in the implementation of state policy in the field of health and medical science;
perfection state regulation in the field of providing medicines, medical products and medical equipment;
increasing the interest of citizens in maintaining and strengthening their health.
III. Improving the organization of medical care
The main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.
Primary health care is the main link in the provision of medical care to the population.
Special role is given to the development of the institute of general (family) practice. Consultative and diagnostic services should be developed in polyclinics. On their basis, departments of medical and social rehabilitation and therapy, care services, day hospitals, centers for outpatient surgery and medical and social assistance, etc. can be deployed.
The reorganization of inpatient care will ensure a reduction in the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the diagnostic and treatment process as follows:
intensive treatment - up to 20 percent;
rehabilitation treatment - up to 45 percent;
long-term treatment of patients with chronic diseases - up to 20 percent;
medical and social assistance - up to 15 percent.
Wider use of day forms of stay of patients in hospitals.
It is necessary to revive inter-regional and inter-district specialized medical centers.
For high-quality medical care, it is necessary to ensure the continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of the provision of medical care, as well as between different types of medical institutions, becomes important. This implies the creation of a higher level of financing and management of health institutions.
Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.
It is necessary to take effective measures to develop the maternal and child health service, while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating obstetric institutions with the general medical network.
It is necessary to carry out comprehensive measures for the further development of psychiatric and narcological assistance to the population, the fight against tuberculosis and sexually transmitted diseases.
Require government support measures to implement modern technologies in intensive care units, cardiology and cardiac surgery, oncology, diagnostics and treatment of socially significant diseases.
It is necessary to strengthen the ambulance service, make it more mobile and equipped with modern facilities for emergency medical care and emergency hospitalization of patients.
It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.
It is necessary to take measures of state support to improve rehabilitation assistance, the development of sanatorium-resort organizations of the healthcare system, health-improving institutions and organizations.
To improve the quality and accessibility of medical care rural population it is required to form treatment and diagnostic complexes on the basis of central district hospitals, including municipal rural medical institutions, to develop mobile forms of treatment, diagnostic and advisory assistance, and to create inter-district clinical and diagnostic centers.
It is necessary to integrate departmental medical institutions into the general health care system on a single regulatory and legal basis, taking into account their industry specifics and location.
While maintaining the dominant role of state and municipal health care, the emerging private sector will play an important role. Creation of conditions for its development is the most important element of structural reforms in health care.
It is necessary to provide medical organizations, persons engaged in private medical activities, state and municipal organizations with equal rights to work in the system of compulsory medical insurance and participate in the implementation of state and municipal targeted programs. Participation of medical organizations of various forms of ownership in the implementation of state health programs, municipal orders should be carried out on a competitive basis.
State and municipal medical institutions that perform functions that are not related to the framework of a single technology for the provision of medical care should have broad powers in matters of the use of property and remuneration of personnel.
IV. Improving the health financing system
Improving the health care financing system implies a close dependence of the amount of financing of medical institutions on the volume and quality of the services they provide.
The system of financing should ensure an increase in the efficiency of the use of resources and the quality of medical care.
For these purposes it is necessary:
develop legal mechanisms that ensure unconditional compliance with the volumes and conditions of compulsory medical insurance of the population with financial security;
establish the procedure for distributing funds federal budget allocated to equalize the conditions for financing compulsory medical insurance programs in the constituent entities of the Russian Federation;
improve methods of setting tariffs for medical services;
introduce a unified system of payments for the provision of medical care provided under the program of state guarantees to provide citizens of the Russian Federation with free medical care;
to determine the mechanisms of financial coverage of part of the costs of providing medical care to citizens on the basis of the development of voluntary medical insurance;
contribute to the creation competitive environment in the medical services market.
The existing procedure for compulsory medical insurance needs to be improved. There are two possible financing schemes for medical organizations in the system of compulsory health insurance:
financing through insurance medical organizations providing compulsory medical insurance;
financing of medical organizations by branches of territorial funds of compulsory medical insurance.
The use of the second scheme is expedient for rural areas and areas with low population density, where the activities of insurance organizations and their competition with each other are objectively difficult.
To ensure the targeted and effective use of funds allocated by the state for healthcare, it is necessary:
to supplement the current legislation on health care with norms providing for stricter control over their spending, as well as over the financial and economic activities of health care institutions and organizations;
improving the accounting system for funds received by healthcare institutions, including for the provision of paid medical services, as well as their use;
improving the competitive system for the purchase of medicines, medical devices and medical equipment, the widespread use of financial leasing to equip healthcare facilities with medical equipment;
increasing the responsibility of compulsory health insurance funds for the results of their activities;
executive authorities and local self-government bodies, compulsory medical insurance funds, medical insurance organizations, medical institutions to publish mandatory annual reports on the expenditure of compulsory medical insurance funds and budget funds.
In 1998, in order to equalize the conditions for financing compulsory medical insurance programs in the constituent entities of the Russian Federation, it is planned to establish the distribution of insurance premiums in the following ratio: the Federal Compulsory Medical Insurance Fund - 0.5 percent, territorial compulsory medical insurance funds - 3.4 percent or 2 percent of the fund wages, if the income of citizens will be respectively more or less than 60 million rubles a year.
In the future, it is planned to pool funds earmarked for social and compulsory health insurance in order to ensure their more efficient use within the framework of unified system compulsory medical and social insurance.
V. Organization of health care
In order to improve the provision of medical care, it is necessary to adopt federal laws on state, municipal and private health care as a matter of priority. This will ensure the implementation of state health policy at the modern level.
In order to implement a unified state policy in the field of healthcare, it is necessary to modernize the management structure of the industry.
The main tasks of the healthcare organization at the federal level should be considered:
determination of the health development strategy in the country;
development and implementation of federal targeted health care programs;
development of a legislative and regulatory framework for healthcare;
coordination of activities of public authorities to address health issues;
development of mechanisms for the operation of the control and permitting system in the field of circulation of medicines.
At the level of the subject of the Russian Federation, the main tasks of the healthcare organization should be:
development of health care taking into account regional specificities;
development and implementation of territorial targeted health care programs and programs of state guarantees to provide citizens with free medical care in the territory of the constituent entities of the Russian Federation.
The main task of organizing health care at the municipal level should be considered the formation and implementation of municipal health care programs.
The main direction of improving the organization of health care is to ensure its integrity through unified approaches to planning, regulation, standardization, licensing and certification. At the same time, the system of compulsory medical insurance as the basis for financing medical care within the framework of state guarantees should have a positive impact.
The basis for planning will be federal health development programs that implement the goals and objectives of state policy for a certain period and include:
federal targeted programs for the development of health care;
programs of state guarantees to provide citizens of the Russian Federation with free medical care.
These federal programs must be approved simultaneously with the allocation of appropriate financial resources for their implementation.
To ensure a unified (basic) level of state guarantees in healthcare, medical and social standards should be approved at the federal level, including:
the main indicators of the provision of the population with hospitals and outpatient clinics, as well as doctors and paramedical personnel;
norms of per capita financing of health care.
In addition, methods for calculating the standards for providing health care institutions with material, labor and financial resources are being approved at the federal level.
The healthcare programs of the constituent entities of the Russian Federation include programs of state guarantees to provide citizens with free medical care, which should define:
health indicators to be achieved as a result of improving the health system;
the amount of funding from the health budget and compulsory medical insurance, ensuring the implementation of state guarantees;
general principles of financing and performance indicators of health care institutions;
measures to improve the efficiency of health care institutions;
main directions of preventive activity.
In the constituent entities of the Russian Federation, cost standards for outpatient and inpatient treatment should be approved. Based on these standards and morbidity rates, the structure of medical care for the population is determined.
The healthcare programs of the constituent entities of the Russian Federation serve as the basis for the formation of municipal programs that contain indicators of the volume of activities of healthcare institutions and their financing at the municipal levels.
Executive authorities at all levels control the implementation of relevant programs, which will increase the efficiency of healthcare organization.
In order to more rationally use financial and material resources in healthcare, it is necessary to establish that the largest investment projects to which they are directed budget resources are subject to mandatory examination by the Ministry of Health of the Russian Federation.
In conditions of insufficient financing of health care, duplication of work of medical institutions of the public sector, especially departmental health care institutions, should be excluded. It is necessary to attract departmental medical institutions to implement the program of state guarantees, which will make it possible to effectively use financial and material resources, implement the principle of equal treatment of the state to all citizens, regardless of their place of work, and reduce the financial burden on the budgets of departments. Separate departmental health care institutions should be transferred to the ownership of the constituent entities of the Russian Federation or to municipal ownership.
The priorities of international cooperation are the expansion and deepening of cooperation with the CIS member states, support for compatriots abroad (primarily in the provision of medical care) both at the intergovernmental level and through the provision of humanitarian assistance.
To ensure gradual integration into the global community on an equal basis, it is necessary to continue cooperation with international organizations healthcare in the following areas:
protection of national interests in the implementation of international projects in the field of healthcare and health protection;
expanding participation in such international projects;
participation in health care programs for citizens individual countries;
adaptation international criteria classification of diseases and standards of medical care for the Russian Federation;
international expertise of Russian bills in the field of public health protection;
study and application of international experience of legal regulation in the field of healthcare;
expanding the volume of medical care for Russian citizens abroad and foreign citizens in Russia.
Vi. Ensuring sanitary and epidemiological well-being
The development and improvement of the state sanitary and epidemiological service of the Russian Federation (hereinafter referred to as the service) is essential condition improving the health of the population of the country.
Ensuring the effective functioning of the service consists in the development and implementation state program its development, which provides for bringing the organizational structure, management, resource and scientific support of the service, organization of its activities in line with the tasks and functions.
It is required to continue the reorganization of the structure of service institutions in accordance with the previously approved concept of restructuring the centers of state sanitary and epidemiological surveillance through the formation of departments (departments) for studying the influence of environmental factors on health, departments of hygienic education and education of the population.
It is necessary to provide:
a clear delineation of the functions of state sanitary and epidemiological supervision and sanitary and epidemiological activities between service organizations and medical and preventive institutions;
protection of the territory of the Russian Federation from the importation and spread of especially dangerous infectious diseases of people, animals and plants, as well as toxic substances;
introduction of new scientific developments;
strengthening interaction with other control and supervisory bodies;
improvement of the economic mechanism of activity and development of criteria for normative financing of institutions;
improvement of the legislative base in the field of state sanitary and epidemiological supervision, strengthening the organizational and legal status of the service;
reorganization of the system of hygienic upbringing and education of the population, formation of a system of self-healing of the population.
Vii. State guarantees for the provision of free
medical care and protection of the rights of patients
State guarantees for the provision of free medical care should be provided at the expense of the relevant budgets, payments for compulsory medical insurance and other revenues. To do this, it is necessary to adopt a program of state guarantees for the provision of free medical care to citizens of the Russian Federation, which should contain:
a list of relevant types of medical care;
volumes of medical care;
basic compulsory health insurance program constituent part state guarantee programs;
per capita standard of healthcare financing, which ensures the provision of guaranteed volumes of medical care.
In order to ensure the rights of citizens to health care, the adoption of a law on the rights of the patient is required.
VIII. Development of medical science
The main tasks of medical science should be:
formation of a strategy for maintaining and strengthening the health of the population, development of scientific foundations for combating the most common diseases;
receiving based on basic research new and deepening existing knowledge about a healthy and sick human body, its vital activity and adaptation to environmental conditions;
development of new methods of prevention, diagnosis and treatment of diseases, restoration of lost health, increase in the duration of a person's active life;
development of new schemes for the organization of medical care and healthcare management.
The development of medical science will be based on the following principles:
concentration of scientific and technical potential and resources in priority areas of medical science;
increasing the role of program-target planning, improving the quality of scientific research expertise, ethical control over their conduct;
budget financing of fundamental and applied research on a competitive basis;
state support for research teams that make a great contribution to the development of domestic and world medical science, the use of extrabudgetary sources of funding (international projects, funds, etc.);
development of regional scientific and practical divisions, development of programs and research;
expansion of links between science, technology and production;
legislative consolidation legal mechanisms for the development of medical science;
development of scientific and technical entrepreneurship, creation of small innovative enterprises and pilot productions;
protection of intellectual property rights of researchers on the results of scientific activity.
Budget financing of scientific developments should be carried out on the basis of competitive allocation of grants, creating for this purpose interdepartmental competitive commissions. To carry out developments in theoretical and practical areas, it is necessary to use a multi-channel financing system with the involvement of extrabudgetary sources.
Particular attention should be paid to research and development activities, which require state support to fund research that will ensure import substitution and contribute to the development of the domestic medical industry.
The Russian Academy of Medical Sciences will carry out the functions of identifying and developing the most important areas of fundamental and applied research, organizing and coordinating them in the Russian Federation, training highly qualified scientific personnel, and also participating in the development and implementation of scientific sections of federal and other programs.
The Ministry of Health of the Russian Federation should determine priorities in scientific developments of an applied nature and coordinate federal programs in terms of scientific support for the protection of human health and state sanitary and epidemiological surveillance.
The Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences should jointly carry out a comprehensive examination of federal and other scientific programs, present their recommendations on the introduction into practice and the effective use of the achievements of medical science.
The Ministry of Health of the Russian Federation, together with the Ministry of Science and Technology of the Russian Federation and with the participation of the Russian Academy of Medical Sciences, will coordinate the interaction government agencies executive power and local governments with research institutes, institutions and organizations of the medical and biological profile, develop and implement a system of measures to strengthen international relations in order to solve urgent problems of domestic science.
IX. Improving medical education and personnel policy
Personnel policy issues should be addressed taking into account the changes taking place in all areas of health care. It is necessary to develop a program for reforming the system of medical education, providing for a reduction in the training of medical workers in traditional specialties, and a revision of the structure of training specialists. It is necessary to improve the system of planning, forecasting and monitoring the training of healthcare professionals, including in such new areas as a general practitioner, a clinical pharmacologist, a medical psychologist, a nurse with a higher education, a specialist in social work, Health Economist, Healthcare Manager.
It is necessary to improve the system of final state certification of graduates of medical and pharmaceutical educational institutions, as well as the certification of healthcare professionals.
V international relations in the field of training should:
restore professional medical ties with the CIS member states;
develop work on the conclusion of international agreements of the Russian Federation on the mutual recognition of medical diplomas and other documents on professional training, as well as on the training of specialists, training of doctors and nurses abroad on the principle of exchange.
The system of planning and distribution of personnel potential is subject to reorganization, which should change the ratio of a doctor to a middle-level medical worker in the direction of increasing the number of the latter.
The practice of forming targeted orders for the training of specialists by health authorities with the conclusion of relevant agreements with educational institutions and applicants should be spread.
In order to include medical workers in the work of reforming health care, it is necessary to:
improve the system of remuneration of health care workers, taking into account harmful working conditions, the complexity, volume and quality of treatment and prevention work;
install and index wages health care workers in amounts not lower than the subsistence level;
regularly review the rates for medical services on the basis of tariff agreements with professional medical associations;
expand the list of categories of health workers, regardless of the departmental affiliation of the institutions in which they work, who are entitled to a pension for long service, working with a special risk to their health.
In the field of ensuring labor protection of medical workers, it is necessary to:
to develop regulations on labor safety in healthcare institutions;
organize training on labor protection issues for heads of government bodies and healthcare institutions, students of medical educational institutions;
pursue a unified policy to establish compensations and benefits for special working conditions of medical workers.
X. Improvement of drug provision, guarantees in the field of drug assistance to the population
The state policy of providing the population with medicines and medical products is aimed at providing them to consumers in a sufficient quality assortment and volume at affordable prices.
The implementation of this policy should be carried out through the development of the market for pharmaceutical services.
In order to ensure the safe use of medicines and medical devices, it is necessary to improve the existing control and licensing system for examination, standardization and state control both at the federal level and at the level of the constituent entities of the Russian Federation.
The main direction of the implementation of the state policy in the field of drug care to citizens should be drug, including preferential, provision of the population in the provision of medical care within the framework of state guarantee programs.
At the stage of outpatient treatment:
formation, within the framework of state and municipal orders, of lists of medicines and medical devices for preferential provision of citizens;
formation within the framework of state and municipal orders of lists and volumes of medicines and medical devices for the treatment of socially significant diseases.
At the stage of inpatient treatment - free drug provision within the framework of the types, volumes and conditions for the provision of medical care provided for in state guarantee programs.
In order to effectively spend public funds allocated for the preferential provision of citizens with medicines and medical products, it is planned to develop and implement a system for accounting and controlling these funds, creating conditions that ensure the interest of citizens in the rational use of drug benefits.
In the field of wholesale purchases and retail sale of medicines, you should:
carry out these purchases and sales on a competitive basis and ensure transparency in the selection of wholesale suppliers of medicines;
to ensure the safety, efficacy and quality of medicines through the selection, standardization and monitoring of compliance with standards;
ensure the availability of a wide range of medicines in retail sales, in the stationary network - under state guarantee programs.
In order to ensure the availability and adequacy of drug care to the population, it is necessary:
improve the mechanisms of state regulation of drug provision;
provide state support for domestic drug manufacturers;
improve the organization of drug supply and the management of pharmaceutical activities.
XII. Mechanisms and stages of implementation of the Concept
To ensure consistency in the implementation of the provisions of the Concept, work on its implementation will be carried out in 2 stages.
Stage I (1997-2000)
Implementation of the measures set out in the program of the Government of the Russian Federation "Structural adjustment and the economic growth in 1997-2000".
Taking measures to ensure the stable operation of health care institutions to increase the amount of funding for the industry and improve the efficiency of resource use in health care.
To this end, the provision of medical care to the population, starting from 1998, will be carried out within the framework of state guarantee programs for the provision of free medical care. At the same time, the amount of financial resources allocated for the implementation of these programs must comply with the state guarantees provided for in them.
Implementation during 1997-1999 of structural transformations in the industry. Carrying out the restructuring of inpatient care with the simultaneous development of outpatient facilities and the creation of day hospitals and hospitals at home. An important direction of this work will be the introduction of the institute of general medical practice.
Introduction in 1998 of the standardization of medical services, regulation of the provision of hospitals and polyclinics with medicines, medical products and medical equipment.
Completion by 1999 of work on the reorganization and elimination of duplication in the activities of federal health care institutions, including departmental ones.
Development and approval in 1997-1998 of federal targeted programs to combat tuberculosis and sexually transmitted diseases, to develop oncological care for the population, and to prevent and treat cardiovascular diseases.
The implementation of state anti-alcohol measures, the development and subsequent implementation of the federal targeted program to combat smoking will help reduce the incidence and mortality of the population.
Stage II (2001-2005)
Implementation of federal target programs for the development of health care, the implementation of which will create a basis for the introduction of effective methods of prevention, diagnosis and treatment of diseases into healthcare practice and provide the population with affordable qualified and specialized medical care.
Completion of work on the restructuring of the industry. As a result, a private sector should emerge in health care. In the system of primary health care, the main role will be assigned to general practitioners. Inter-district and inter-regional clinical centers of specialized medical care will be greatly developed. Mobile forms of providing medical care to the population in rural areas will be actively introduced.
Formation of a unified information system health monitoring, creation of telecommunication links between clinical centers and general (family) practitioners to consult patients and improve the professional knowledge of medical workers.
Plan
measures to implement the Development Concept
health and medical science
in the Russian Federation for 1997-1998
(approved by Decree of the Government of the Russian Federation of November 5, 1997 N 1387)
Approved by the Decree of the Government of the Rostov Region
1. General Provisions
In order to ensure sustainable socio-economic development of the Rostov region, one of the priorities of the region's policy should be to preserve and strengthen the health of the population through the formation of a healthy lifestyle and increasing the availability and quality of medical care.
The effective functioning of healthcare is determined by the main system-forming factors:
improving the organizational system to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens of the Rostov region (within the framework of state guarantees);
development of infrastructure and resource support for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization;
the presence of a sufficient number of trained medical personnel capable of solving the tasks set for the healthcare of the Rostov region.
These factors are interdependent and mutually determining, and therefore the modernization of health care requires the harmonious development of each of them and the entire system as a whole.
The concept of healthcare development in the Rostov region (hereinafter referred to as the Concept) is an analysis of the state of healthcare in the Rostov region, as well as the main goals, objectives and ways to improve it based on a systematic approach.
The concept was developed in accordance with the Constitution of the Russian Federation, the Concept for the Development of Healthcare in the Russian Federation until 2020, federal legislation and other regulatory legal acts of the Rostov Region.
2. The current state of healthcare in the Rostov region
2.1. Demographic situation in the Rostov region
The implementation of the activities of the Strategy for the socio-economic development of the Rostov region, federal and regional targeted programs, the national project "Health", the regional long-term target program "Modernization of health care in the Rostov region for 2011-2012" has made it possible in recent years to reorganize the comprehensive system of public health and improve the demographic situation in the area in which stabilization trends have been outlined.
The current demographic situation in the Rostov region was formed under the influence of political, socio-economic, as well as demographic processes that took place in the country in previous decades. The population of the Rostov region, taking into account the preliminary results of the All-Russian census of 2010, as of January 1, 2011, amounted to 4,276.4 thousand people, or 3 percent of the population of Russia. Among the subjects of the Russian Federation, the region occupies the 6th place in terms of the number of permanent population, among the subjects of the Southern Federal District - the 2nd - after the Krasnodar Territory. The Rostov region is one of the most densely populated regions of Russia, the population density is 42.4 people per 1 sq. km. km. The most populated are Rostov-on-Don, Taganrog and Gukovo, Aksai and Myasnikovsky districts. In the total population, urban residents make up 67.3 percent, rural residents - 32.7 percent.
The demographic situation in the Rostov region is still unfavorable. The population decline that began in 1992 continues. However, the rate of population decline in recent years has significantly decreased - from 32 thousand people annually in the period 2000-2005 to 14.2 thousand people in 2011.
As of January 1, 2012, the permanent population of the Rostov Region was 4,260.6 thousand people, which is 15.8 thousand people less than on the corresponding date of 2010.
The decrease in the rate of population decline is mainly due to an increase in the birth rate and a decrease in mortality. In 2011, 46.5 thousand children were born, which is 17.3 percent more than in 2005.
The birth rate in 2011, compared to the previous year, slightly decreased and amounted to 10.9 per 1,000 of the population, compared to 11.0 in 2010; 10.8 - in 2009. In 27 territories of the region (out of 55) there was an increase in the number of births against the level of the previous year.
There is a decrease of 4.7 percent in the total mortality of the population, the level of which was 14.2 per 1,000 population in 2011, compared to 14.9 in 2010. A decrease in mortality was noted in 30 territories of the region (54.5 percent). An increase in mortality is observed in 4 cities and 21 districts of the region (45.4 percent).
In comparison with the territories included in the Southern Federal District, the Rostov region in 2010 has the lowest birth rate and the highest mortality and natural population decline.
Subject name | Number of births | The number of deaths | Natural increase (+), decrease (-) |
per 1,000 population |
|||
the Russian Federation | |||
Southern Federal District | |||
Republic of Adygea | |||
Republic of Kalmykia | |||
Krasnodar region | |||
Astrakhan region | |||
Volgograd region | |||
Rostov region | |||
Low birth rate and high mortality determined a significant level of natural decline in the population of the region, which is not compensated by migration gain. In many ways, this situation has developed due to the unfavorable age structure of the population of the region - a high proportion of people of retirement age (23.8 percent) and a low proportion of children and adolescents (16.9 percent). The reasons for the low birth rate of the population, in addition to the transition of families to small families, were material and domestic difficulties, housing problems, low living standards of part of the population, low wages, deterioration in the reproductive health of the population, loss of family values, an increase in the number of divorces, a large number of premature termination of pregnancy and others
In 2011 positive demographic development noted only in 7 out of 55 municipalities: the cities of Bataysk, Rostov-on-Don, Azovsky, Aksaisky, Bagaevsky, Myasnikovsky, Rodionovo-Nesvetaysky districts.
In these territories, by the beginning of 2012, there was an increase in the population.
The regressive type of age structure of the population that has developed under the influence of a long-term decline in the birth rate (the proportion of the population of older ages exceeds the proportion of children and adolescents) does not ensure the numerical growth of the region's population and leads to its "aging". The average age of the region's population is increasing.
In the reproduction of the population in modern conditions, migration acquires a certain significance.
In recent years, migration processes have undergone significant changes. Until the mid-1990s, migration developed at an increasing pace. Moreover, the influx of migrants to the Rostov region significantly exceeded the outflow. In these years, migration growth played a significant role in maintaining the population.
The main causes of death of the region's population are diseases of the circulatory system, neoplasms, accidents, poisoning and injuries, which account for 83.9 percent of the total number of deaths. In 2011, more than 38 thousand people (62.9 percent of the dead) died from diseases of the circulatory system in the Rostov region, 14.6 percent died from neoplasms, and 6.4 percent from external causes.
For a long time, the Rostov region occupied one of the first places in Russia in terms of accidents on the roads, which were often caused by drunk drivers. However, thanks to a set of measures taken in recent years to improve road safety and reduce traffic injuries, the death rate from all types of traffic accidents (mainly road traffic accidents) in 2011 amounted to 8.1 per 100,000 population (in 2010, it was 8.1 per 100,000 people). – 10.3).
2.2. Brief description of indicators
public health in the Rostov region
In the last 15 years, the incidence of the population of the Rostov region has been constantly growing, which is associated, on the one hand, with an increase in the proportion of the elderly population and with more effective detection of diseases using new diagnostic methods, on the other hand, with the ineffectiveness of the disease prevention and prevention system. In 1996, the level of general morbidity of the population (adults, adolescents and children) was 1137.3 cases per 1000 population, in 2001 - 1323.4; in 2006 - 1,544.8; in 2011 - 1,604.2. The increase in incidence over 15 years amounted to 41 percent.
It should be noted that from 1996 to 2011 in the Rostov region, as well as in the Russian Federation as a whole, the number of cases of diseases leading to death has significantly increased. For example, the incidence rate of diseases of the circulatory system almost doubled (from 115.9 per 1,000 population in 1996 to 213.2 in 2011), neoplasms - by 37 percent (from 31.9 per 1,000 population in 1996 up to 43.7 in 2011). The number of diseases of the musculoskeletal system and connective tissue, leading to disability, as well as complications of pregnancy, childbirth and the postpartum period, has also almost doubled. In 2011, as well as 15 years ago, diseases of the respiratory organs (24.8 percent) and diseases of the circulatory system (13.3 percent) prevail in the structure of the general morbidity, while over the past time the proportion of diseases of the respiratory, digestive, urinary systems and injuries in the structure of general morbidity decreased, and the proportion of diseases of the circulatory system and diseases of the nervous system and sensory organs increased.
Since 1998, there has been a sharp increase in the number of children born sick or falling ill during the neonatal period. By 2008, this figure had reached 42.5 percent of the total number of live births. In 2010-2011, the incidence of newborns began to decline.
Disability in the Russian Federation from 1990 to 2006 does not decrease, including among people of working age, whose share in the total number of people recognized as disabled for the first time is at least 40 percent.
Nevertheless, in the Rostov region, in the period from 2001 to 2008, the number of disabled people per 10,000 people aged 18 and over decreased by 3.3 times.
From 2009 to 2011, the disability rate increased by 43 percent.
There are 14 million people with disabilities in the Russian Federation, including 523 thousand children. In the Rostov region, according to data for 2011, there are 328.8 thousand disabled people, including 11,610 children. This indicates an insufficiently high quality of medical care and inadequate social rehabilitation.
In the structure of primary disability of the adult population, cardiovascular diseases and malignant neoplasms predominate. Mental disorders, diseases of the nervous system, congenital anomalies and metabolic disorders are leading among the diseases that have caused the development of disability in children.
In the Rostov region, as well as in Russia as a whole, there are four main risk factors: high blood pressure, high cholesterol, tobacco smoking and excessive alcohol consumption, which contribute 87.5 percent to the structure of total mortality, and in the number of years of life with loss working capacity - 58.5 percent. At the same time, the first place in terms of influence on the number of years of life with disability (16.5 percent) is occupied by alcohol abuse. According to expert estimates, relative indicators little has changed in the last 6 years.
2.3. Implementation of the State Guarantee Program
provision of free medical care to citizens of the Rostov region
The legislation of the Russian Federation establishes the insurance principle of financing medical care. In 1993, in addition to budget system In the 1990s, a system of compulsory medical insurance (OMI) was created in Russia, as a result, a budget-insurance model for financing the state healthcare system has developed in Russia.
In order to ensure a balance between the obligations of the state to provide the population with free medical care and the financial resources allocated for this, to create a unified mechanism for the implementation of the constitutional rights of citizens of the Russian Federation to receive free medical care and to increase the efficiency of the use of healthcare resources, the Government of the Rostov Region annually adopts the Territorial Program of State Guarantees for the provision of citizens Russian Federation of free medical care in the Rostov region.
The implementation of the Territorial Program of State Guarantees is carried out on the basis of the approved standards for the volume of medical care (by type of medical care) and the standards for financial costs per unit of medical care.
The following types of medical care are provided free of charge under the Program:
primary health care;
ambulance, including specialized (sanitary and aviation), medical care;
specialized, including high-tech, medical care.
Primary health care includes: treatment of the most common diseases, injuries, poisonings and other conditions requiring emergency care, medical prevention of diseases, implementation of preventive vaccinations, preventive examinations, dispensary observation of women during pregnancy, healthy children, persons with chronic diseases, prevention of abortion, sanitary and hygienic education of citizens, as well as other activities related to the provision of primary health care to citizens.
Primary health care is provided to citizens in medical organizations and their respective structural subdivisions by district general practitioners, district pediatricians, general practitioners (family doctors), specialist doctors, as well as by relevant paramedical personnel.
Ambulance, including specialized (sanitary and aviation), medical care is provided immediately to citizens in conditions requiring urgent medical intervention (accidents, injuries, poisoning, as well as other conditions and diseases), institutions and units of emergency medical care of the state or municipal systems health care.
Specialized, including high-tech, medical care is provided to citizens in medical organizations for diseases that require special methods of diagnosis, treatment and the use of complex, unique or resource-intensive medical technologies.
In order to rationalize the use of budgetary funds in recent years, work has been carried out in the Rostov Region to optimize the bed network: the number of beds in municipal health care institutions with an excess bed network is being reduced; the expensive bed fund of hospitals is re-profiled into a less expensive day hospital on the basis of outpatient clinics and hospitals; inefficient beds are being reduced.
In addition, at the regional level, a legislative framework for the development of regional health care has been formed.
The activities of the regional long-term target program "Development of healthcare in the Rostov region for 2010-2014" and the regional long-term target program "Development of healthcare in the Rostov region for 2015-2020", as well as the regional long-term target program "Modernization healthcare of the Rostov region for 2011-2012”, aimed at strengthening the resource base of healthcare in the Rostov region, introducing standards for the provision of medical care and modern information technologies in healthcare.
In accordance with the requirements of Art. 69.2 Budget Code of the Russian Federation, Decree of the Government of the Rostov Region dated December 23, 2011 No. 291 “On the procedure for organizing work on the formation and financial support of the state task for state institutions of the Rostov Region” and in order to create incentives for orienting institutions to the requests of consumers of budgetary services, improving their quality and dependence of financing From real results of work, optimization of the mechanism for managing budgetary resources, since 2010, a transition has been made from financing budgetary institutions according to estimates to financing the services they provide based on the instructions of the founder.
Since January 1, 2012, in accordance with the norms of federal legislation, there has been a delimitation of powers between state authorities of a constituent entity of the Russian Federation and local governments in the field of health protection in terms of providing primary health care. Financing of expenses for the provision of emergency medical care, medical care provided by feldsher-obstetric stations, pathological and anatomical bureaus, hospices, nursing homes, sanatoriums, HIV-infected, medical personnel serving preschool educational institutions is made in the form of a subvention of the regional budget.
Since 2013, in connection with the transition to predominantly single-channel financing of medical care at the expense of compulsory medical insurance, it is planned to provide financial support for emergency medical care, feldsher-obstetric stations and medical staff of preschool institutions. In addition, it is planned to expand the list of expenses included in the tariff for medical care.
Step by step, measures are being taken to optimize the number of technical, financial, economic and other non-medical personnel in state and municipal healthcare institutions in order to improve the efficiency of human resource management.
The implementation of these regional programs and activities in the health sector will allow in the coming years to form an effective innovative model of medical care for the population of the region in the region.
2.4. The system of organization of medical care to the population
Currently, medical assistance to the population of the Rostov region is provided in 216 state and municipal health care institutions (of which 5 are federal subordination), including 111 hospitals, 9 dispensaries, 47 independent outpatient clinics, 25 independent dental clinics, 1 independent station ambulance, 1 blood transfusion station, 8 sanatoriums, 7 orphanages and 5 special type institutions.
Primary health care is a set of medical and social and sanitary and hygienic measures that provide health improvement, prevention of non-communicable and infectious diseases, treatment and rehabilitation of the population. Primary health care is the first stage in the continuous process of protecting the health of the population, which dictates the need for its maximum approximation to the place of residence and work of people. The main principle of its organization is territorial-district.
The network of outpatient clinics, the existing system of primary health care fully meet the needs of the population.
Imperfections in the work of outpatient healthcare, in particular, an insufficiently effective system of patronage and monitoring of patients with chronic pathology, have led to the fact that emergency medical care is the most common type of outpatient medical care for the country's population, taking over some of the functions of an outpatient clinic. link.
Currently, in the Rostov region, emergency medical care is provided by 1 independent station and 56 departments, staffed by general-profile (360; 24.8 percent of the total number of brigades), specialized (150; 10.3 percent), paramedical (940; 64.8 percent ) teams. During 2011, more than 1,479 thousand visits to patients were made, while less than 151 thousand people were hospitalized, that is, only every 10th call ended in hospitalization.
In order to ensure the uninterrupted operation of the ambulance service in modern conditions, within the framework of the implementation of the activities of the regional long-term target program "Modernization of healthcare in the Rostov region for 2011-2012", the management of ambulance teams using GLONASS / GPS satellite navigation equipment is provided. To this end, in 2012, 495 ambulances and 57 emergency dispatch services of medical institutions will be equipped with GLONASS/GPS navigation systems.
It should be noted that the immediate cause of death of people of working age in most cases is an emergency. At the same time, about 1.8 million people a year in the country die outside hospitals, and every third hospitalized patient in a life-threatening condition enters a hospital with a delay of more than 24 hours.
The following factors hinder the effective use of ambulance capabilities:
1. The provision of timely medical care in municipal districts does not take place according to the principle of the closest brigade, but according to the principle of territorial affiliation.
2. There is an insufficient staffing of ambulance teams with qualified personnel, including specialists who have undergone retraining in a timely manner, due to the imperfection of the system for training personnel of the ambulance service, both at the highest and middle levels, as well as a reduction in the number of specialized teams and the outflow of experienced medical personnel.
3. Often there is an inappropriate use of ambulance teams (for the transportation of planned patients, calls for assistance to chronic patients).
Thus, the low efficiency of the preventive work of primary care, the lack of a system of outpatient aftercare and patronage, as well as the imperfect organization of the work of emergency medical care, have led to the fact that inpatient care acts as the main level in the system of public health protection. At the same time, inpatient medical care is necessary only for diseases that require an integrated approach to diagnosis and treatment, the use of complex methods of examination and treatment using modern medical equipment, surgical interventions, constant round-the-clock medical supervision and intensive care.
According to the work of hospitals of municipal and regional subordination, the average annual bed occupancy in state (municipal) healthcare institutions in 2011 was 315 days, the average duration of a patient's stay in a bed in state (municipal) healthcare institutions was 12.4 days.
The introduction of hospital-replacing technologies in the activities of hospitals and outpatient polyclinic services made it possible to increase the number of beds in day hospitals by 17.0 percent from 2006 to 2011 (from 3,382 beds in 2006 to 3,958 in 2011); by 21.0 percent (from 7.6 to 9.2 per 10 thousand population, respectively) and the level of hospitalization in day hospitals - by 21.0 percent (from 1.9 to 2.3 per 100 population, respectively).
However, despite this, the level of hospitalization in state (municipal) healthcare institutions remains high (19.4 per 100 people in 2011). There is a significant shortage of inpatient beds for certain profiles. The number of beds in state (municipal) healthcare institutions per 10,000 people in the Rostov Region is 78.7.
Thus, the amount of beds is sufficient to fully provide the population with inpatient care. However, the current organization of inpatient care is not effective enough, which manifests itself in:
discrepancy between the structure of the bed fund and the structure of hospital morbidity;
the presence of cases of insufficiently justified hospitalization;
To date, the system of rehabilitation treatment and rehabilitation in the region requires structural reorganization.
The current departments (rooms) for restorative treatment and rehabilitation do not fully meet modern requirements for equipping with diagnostic and therapeutic equipment. There is a shortage of specialized personnel in the rehabilitation service (doctors and exercise therapy instructors, physiotherapists, speech therapists, neuropsychologists, medical psychologists, occupational therapists, social workers, etc.).
2.5. Innovative and staffing for healthcare development
The level of development of medical science determines the prospects for improving health care. The current state of medical science is characterized by insufficient innovative potential, a weak system for implementing scientific results in practical healthcare. The development of modern scientific research in the field of medicine is possible only under the condition of an integrated approach based on the involvement of the developments of fundamental biomedical, natural and exact sciences, as well as new technological solutions.
As of January 1, 2012, 14.76 thousand doctors and 35.16 thousand nurses worked in the healthcare system of the Rostov region (in 2010 - 14.75 thousand and 35.15 thousand). The number of doctors (individuals) in state (municipal) health care institutions per 10 thousand people was 28.3 people (2010 - 29.5), the number of nursing staff (individuals) in state (municipal) health care institutions per 10 thousand The population was 78.1 people (2010 - 79.0). The ratio of doctors and nurses is 1: 2.7.
The number of doctors per capita in the Rostov region is less than the average for the Russian Federation (the indicator of provision with doctors is 44.1 per 10,000 population, with paramedical workers - 93.6).
The number of full-time positions of district pediatricians in 2011 compared to 2010 increased by 0.3 percent, and the number of individuals decreased by 1.17 percent, as a result of which the staffing rate individuals decreased by 1.5 percent. The combination coefficient remained at the level of 2010 and amounted to 1.1. Low availability of pediatric staff was found in 25 districts and 2 cities. Especially low staffing of pediatric staff (less than 50 percent) was registered in 11 (including 2 cities) territories of the Rostov region: Veselovsky and Kasharsky (37.5 percent), Zavetinsky (40.0 percent), Matveyevo-Kurgansky (44.8 percent), Dubovsky (47.1 percent), Bokovsky (48.0 percent) districts, in the cities of Novoshakhtinsk (35.0 percent), Kamensk-Shakhtinsky (47.5 percent).
There is still a shortage of personnel in neonatology. Neonatological staffing varies from 47.1 percent in the city of Shakhty, 50.0 percent in the cities of Volgodonsk and Gukovo, 57.1 percent in the cities of Kamensk-Shakhtinsky and Novocherkassk to 100 percent or more in the Sholokhovsky district, the cities of Bataysk, Donetsk , Novoshakhtinsk and in the state budgetary institution Regional Clinical Hospital No. 2 of the Rostov Region. The development of inter-territorial neonatal centers is hampered due to a shortage of personnel.
Nevertheless, the rate of staffing of neonatologists by individuals in the whole region (by subordination) increased from 64.6 percent in 2010 to 70.8 percent in 2011 (by 9.6 percent).
The level of quality of medical care and the health indicators of the population of the Rostov region indicate a lack of efficiency in the functioning of the medical care system, as well as the qualifications of doctors and their weak motivation for professional improvement. There is a disproportion in the distribution of medical personnel: their excessive concentration in stationary institutions and the shortage in outpatient clinics.
In addition, the ratio between the number of doctors and nurses in the Rostov region, as in other regions of Russia, is significantly lower than in most developed countries of the world, which causes an imbalance in the system of medical care, limits the possibilities for developing aftercare, patronage, and rehabilitation services. .
Among the problems in the field of medical personnel management, one should note the low wages of medical workers, egalitarian approaches to remuneration of medical personnel, low social security and prestige of the medical profession, the lack of adaptation of federal state educational standards of higher and secondary vocational education to the modern needs of healthcare, insufficient professional training of medical and management personnel in health care.
2.6. Medical provision of citizens
Rostov region on an outpatient basis
Medicinal assistance to the population of the region includes 4 main areas:
providing medicines to regional beneficiaries;
providing medicines to federal beneficiaries;
provision of medicines to patients upon receipt of inpatient and hospital-replacing care;
retail segment.
Providing beneficiary categories of the population with medicines, medical products and specialized medical nutrition products is an important social task, as it affects the most vulnerable categories of the population.
In the Rostov region, an infrastructure for preferential drug provision for the residents of the Don has been created, which includes:
128 medical organizations;
117 holiday points (including 45 located in rural areas);
5,635 doctors (paramedics) issue prescriptions to privileged categories of citizens.
As part of the implementation of drug benefit programs, a software product has been developed that integrates the provision of drug care by all participants in the process.
Preferential drug provision of citizens is an important component in the provision of effective medical care. In this regard, the Ministry of Health of the Republic of Kazakhstan set tasks to improve the quality of providing preferential drug care to certain categories of citizens, which were as follows:
firstly, in optimizing the use of allocated financial resources;
secondly, in carrying out organizational measures aimed at 100% provision of beneficiaries with medicines (reducing the number of prescriptions under “control” and reducing the period for their provision) and improving the quality and availability of preferential drug care.
To implement the process of providing preferential drug care, regional regulations and orders of the Ministry of Health of the Republic of Kazakhstan have been developed, regulating preferential provision:
Decree of the Administration of the Rostov Region “On the Regional Long-Term Target Program “Development of Healthcare in the Rostov Region for 2010-2014”;
Decree of the Government of the Rostov Region "On Approval of the List of Medicines, Medical Devices and Specialized Medical Food Products";
Order of the Ministry of Health of the Republic of Kazakhstan dated February 28, 2011 No. 195 “On approval of the procedure for interaction between participants in drug provision of regional beneficiaries”;
Order of the Ministry of Health of the Republic of Kazakhstan dated June 15, 2008 No. 6 “On the List of Medical Institutions Providing Prescription Medicines on Doctor’s (Paramedic’s) Prescriptions in the Provision of Outpatient Medical Care in accordance with Federal Law No. 178-FZ dated July 17, 1999 “On State Social Assistance”;
Order of the Ministry of Health of the Republic of Kazakhstan dated 02.03.2010 No. 211 "Procedure for interaction of participants in ONLS";
Order of the Ministry of Health of the Republic of Kazakhstan dated 12.01.2011 No. 14 “On fixing medical institutions”;
Order of the Ministry of Health of the Republic of Kazakhstan dated February 27, 2008 No. 89 “On approval of the procedure for interaction between participants in the drug supply of patients with malignant neoplasms of the lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, multiple sclerosis, as well as after organ transplantation and (or) tissues living on the territory of the Rostov region.
The created structure of drug provision has been successfully functioning for a number of years, this has significantly improved the quality of drug care for the population, and removed certain moments of social tension in society.
Preferential provision of medicines to persons entitled to a set of social services, within the framework of the Federal Law of July 17, 1999 No. 178-FZ “On State Social Assistance”, has been functioning since 2005.
The amount of funding for the constituent entities of the Russian Federation is determined based on the number of citizens who have retained the right to receive a set of social services and the established standard of financial costs per citizen. The standard of financial costs increases annually and in 2011 amounted to 570 rubles. Medicinal provision of preferential categories of citizens has been solved for a number of years at the expense of the regional and federal budgets.
The volume of financial resources directed from the regional
and federal budgets, to provide citizens living
on the territory of the Rostov region, from 2009 to 2011 (million rubles)
The number of citizens who refused a set of social services for 2012 is about 80 percent. The right to preferential drug provision within the framework of the Federal Law of July 17, 1999 No. 178-FZ “On State Social Assistance”, as a rule, is retained by citizens who need to regularly take expensive medicines.
In order to improve the quality of the provision of preferential drug care, the Ministry of Health of the Republic of Kazakhstan created a commission for receiving and considering additional applications for medicines, medical devices and specialized food products for children with disabilities (hereinafter referred to as the commission). If new patients are identified for whom drugs are not declared or treatment regimens are changed, medical institutions send additional applications for consideration by the commission. In 2010-2011, 60 meetings of the commission were held, as a result of which additional purchases of medicines were made.
In order to provide preferential categories of citizens within the framework of the subprogram "Drug provision for privileged categories of citizens" of the regional long-term target program "Development of healthcare in the Rostov region for 2010-2014" and to reduce the period for providing prescriptions for "control" in 2010, 30 redistribution of medicines between municipalities was carried out regions, and in 2011 - 46 redistributions.
The measures taken made it possible to increase the number of prescriptions issued by 48.3 thousand, compared with 2010, and their number amounted to more than 1.3 million prescriptions.
Positive results have been achieved in providing prescriptions under “control” – their indicator in 2011 amounted to 0.004 percent of the prescriptions issued to federal beneficiaries.
Since 2008, expensive drugs for the treatment of patients with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, myeloid leukemia, multiple sclerosis, as well as after organ and tissue transplantation, have been withdrawn from the drug supply system for citizens eligible for state social assistance.
To provide patients with seven high-cost diseases in 2011, 13,773 prescriptions were issued, according to which medicines were dispensed in the amount of 727.2 million rubles. In 2011, it was possible to additionally treat 56 patients with these diseases compared to 2010.
Taking into account the serious condition of this category of patients, the delivery of medicines to the house at the place of residence is organized in the region within 3 days from the date of issuing the prescription. This increases the availability of expensive treatment, especially for patients living in rural areas.
Thanks to the support of the Governor of the Rostov Region, in 2011 a number of federal beneficiaries were provided with medicines that were not included in the approved List. 24.6 million rubles were allocated for these purposes, which made it possible to provide medical assistance to 20 citizens suffering from severe chronic diseases, including 12 disabled children.
Almost 3 percent of Don residents are eligible to receive subsidized drug care at the expense of the regional budget, including children in the first three years of life and people with diabetes.
In 2011, more than 700 thousand prescriptions were issued to regional beneficiaries, which is almost 10 percent more than in 2010. The average cost of drug provision for one regional beneficiary for the year amounted to 5,305.0 rubles, which also exceeds this indicator in 2010.
Dispensing points received medicines and medical products for 347 international non-proprietary names and 879 trade names during the year.
In 2011, according to the indicator “the number of prescriptions under “control”, a positive result was achieved, it amounted to 0.0003 percent of prescriptions issued to regional beneficiaries.
This indicator was achieved as a result of 19 meetings of commissions for receiving and considering additional applications from medical institutions and 155 redistributions of medicines. In 2010, 23 meetings of the commission were held and 267 redistributions of medicines between the municipalities of the region were carried out.
For 2012, funds from the regional budget for providing patients with diabetes mellitus were allocated 59.5 million rubles more than in 2011, and for providing other categories of citizens and diseases, the increase amounted to 54.7 million rubles.
An increase in funding for the Fight against Diabetes mellitus event will make it possible to move forward in solving the problem of providing patients with the means of self-monitoring of blood glucose levels.
Additional funds to provide citizens suffering from other diseases will be used to continue the treatment of federal beneficiaries who suffer from serious illnesses and require expensive treatment with drugs that are not included in the approved List, as well as to provide drug care to patients with rare (orphan) diseases.
In 2011, positive results were achieved in increasing the availability of drug care to citizens living in rural areas. Work was carried out to license medical institutions to carry out pharmaceutical activities through their structural units (feldsher-obstetric stations, outpatient clinics) located in remote rural areas. 930 structural subdivisions of medical institutions have been licensed.
The existing system of preferential provision of medicines to citizens on an outpatient basis requires further improvement because:
the system does not allow effective planning and control of the level of costs at the level of the Russian Federation due to the fact that the per capita standard for providing essential medicines is formed based on the established monthly cash payment. Every year, more than half of the beneficiary categories of citizens refuse a set of social services, and those most in need of regular intake of medicines remain in the system, which leads to a difference between the allocated funds and the actually spent financial resources for the purchase of medicines. Therefore, it is necessary to work out an economically justified mechanism for analyzing the needs of privileged categories of citizens in the necessary medicines and medical products in order to effectively plan and control the level of costs;
the model of providing essential medicines using procurement procedures for public needs does not guarantee the availability of the range and quantity of medicines necessary for the uninterrupted servicing of preferential prescriptions;
it is necessary to develop evidence-based mechanisms for comparative analysis of clinical and economic efficiency medicines for inclusion in the List of vital and essential medicines and the list of medicines dispensed by prescription, when providing additional medical care to privileged categories of citizens.
Citizens of the Russian Federation will be provided with free primary health care and specialized medical care at the expense of compulsory medical insurance funds within the framework of the State Guarantees Program; the provision of medicines for citizens on an outpatient basis should be gradually included in the financial support at the expense of compulsory medical insurance.
2.7. Informatization of healthcare
The implementation of measures to modernize healthcare in the Rostov region is possible subject to the large-scale introduction of modern information and telecommunication technologies, which will significantly increase the efficiency of providing medical care to the population of the region.
In total, 12,479 units of computer equipment are operated in 220 healthcare institutions in the Rostov region (on average, 56.7 computers fall on one healthcare institution). There are 174 state and municipal health care institutions operating in the system of compulsory health insurance, in which, as of April 1, 2012, 12,122 units of computer equipment are in use (69.7 computers per health care institution, on average). The share of medical institutions with broadband access to the Internet is 81 percent.
In order to increase the availability of highly qualified advisory assistance in the Rostov region, a system for providing advisory assistance using telemedicine technologies has been introduced and is currently actively functioning and developing. Currently, telemedicine consultations are carried out by medical institutions of all municipalities of the region. The demand for this type of assistance is growing: in 2009, 592 telemedicine consultations were performed, in 2010 - 853, and in 2011 - 971.
The regional budget allocated 8,000 thousand rubles for the exchange of telemedicine data in 2011 and 2,000 thousand rubles in 2012 (to equip 3 medical institutions). In 2011, 15 medical institutions of the region purchased equipment and software necessary for the exchange of telemedicine data.
A serious problem remains the low level of training of specialists in informatization and computer literacy of medical workers in healthcare institutions of the region, as well as the level of training that does not meet modern requirements. technical condition computer park, characterized by significant moral and physical deterioration.
3. Key health issues
Rostov region, strategic goal and ways to achieve it
The key health problems of the Rostov region are:
high level of morbidity, disability and mortality of the population with a relatively low level of provision with both medical institutions and personnel;
insufficient level of material and technical support of healthcare institutions in the Rostov region, in particular, insufficient equipment with modern, high-tech medical and diagnostic equipment;
low level of provision of high-tech medical care;
low level of use of information and communication technologies in medical care;
high differentiation of municipalities in terms of quality and accessibility of health care services;
low level of remuneration of workers in the healthcare system of the Rostov region;
low level of early diagnosis, timely treatment and rehabilitation of patients with tuberculosis, vascular, oncological diseases, diabetes mellitus.
At the same time, the Rostov region has a number of competitive advantages not only for solving the above problems, but also for developing a center of high-tech medical services in the South of Russia, which provides a multiplier effect for both the economy and the social sphere. The development of a cluster of high-tech medical services is possible on the basis of the Rostov State Medical University, the Rostov Cancer Research Institute, the cardiology center based on the Rostov Regional Clinical Hospital and other medical and scientific educational institutions in the region. In addition, the Rostov region has unique medical technologies in the field of cardiology, traumatology, ophthalmology, urology, pediatrics and other areas.
The strategic goal of developing the health care system of the Rostov region is to preserve and improve the health of the population, reduce direct and indirect losses of society by reducing the incidence and mortality of the population and, as a result, stop the decline in the population of the Rostov region by 2020 and bring its population to 4.5 million people. people by 2020, increasing the life expectancy of the population to 75 years.
To solve these problems and achieve the goal, it is necessary to implement the following measures:
to continue the structural reorganization of the network of medical institutions, the end result of which should be the optimization of the industry's bed capacity, bringing the volume of inpatient medical care provided in these institutions in line with the needs of the population of the Rostov region. Emphasis should be placed on the development of a network of inter-territorial medical centers;
to continue the modernization and strengthening of the material and technical equipment of medical and diagnostic institutions, including their overhaul, equipping with modern medical and diagnostic equipment, purchasing modular feldsher-obstetric stations;
to continue the development of outpatient medical care, bringing it closer to the population of remote rural areas, and a significant increase in its quality. An increase in the efficiency of the functioning of this link will be achieved through the early detection of diseases among residents of the Rostov region and their timely treatment;
to continue the development of high-tech types of medical care (cardiac surgery, oncohematology, traumatology and other types), increasing its accessibility for residents of the Rostov region, redistributing the flow of patients who need it from federal healthcare institutions located outside the Rostov region to medical and preventive institutions regional subordination;
to actively use modern information and communication technologies in providing medical care to the population. These measures will increase the efficiency of industry management and will allow to get rid of traditional problems (queues in polyclinics) that affect the satisfaction of the population with the quality of medical care received. It is necessary to actively develop telemedicine technologies that will bring highly qualified medical care closer to remote rural areas;
to continue the development and improvement of preventive areas of medical care, including the functioning of a developed network of health centers, whose activities are aimed at promoting and shaping a healthy lifestyle among the population;
increase the birth rate by improving the quality of medical care provided to pregnant women, women in childbirth and newborns, as well as through social incentives for childbirth;
reduce infant and maternal mortality by reducing reproductive losses to the level of unavoidable through the implementation of measures to develop childhood and obstetric services in the Rostov region;
continue the implementation of the procedures and standards for the provision of medical care by healthcare institutions for the most common and socially significant diseases and pathological conditions, which will optimize the stages of medical care, use the correct algorithm for the interaction of healthcare institutions and social security to ensure continuity in the management of the patient at all stages, which will significantly improve the quality of medical care for the population;
continue to strengthen the personnel potential of medical institutions, stimulate their motivation for quality work. These measures are aimed not only at increasing the provision of specialists in healthcare institutions, but also at increasing the level of remuneration for their work;
to improve preferential drug provision of the population. The implementation of these measures will significantly improve the quality of life of chronically ill patients and increase their life expectancy.
The implementation of a set of measures to improve medical care provided to the population of the Rostov Region will allow, in the long run until 2020, to achieve the following results:
improving the health status of the population of the Rostov region, including the formation of a healthy lifestyle among citizens and a decrease in the prevalence of socially significant and mass diseases (tuberculosis, cancer, diseases of the circulatory system, diabetes mellitus). The social picture of diseases will change, cases of “compensated” pathology will prevail, which does not significantly reduce the quality of life of patients, as opposed to the “disabling” course of a significant part of the diseases that is currently observed;
reduction in mortality rates from the main categories of diseases and causes (diseases of the circulatory system, cancer, external causes, including the consequences of road traffic accidents);
increase in life expectancy of the population of the Rostov region, including smoothing out the differences in the value of this indicator for men and women. It should be noted that a direct consequence of this will be an increase in the proportion of elderly people among the population of the Rostov region (the so-called “aging” of the population), who remain socially active and continue working.
In the short term (until 2012-2013), in connection with the modernization of healthcare, strengthening the material and technical base of medical institutions, including their provision with modern diagnostic equipment, we should expect an increase in the detection of diseases among residents of the Rostov region, which will manifest itself in an increase in the registered total morbidity of the population by the specified period.
4. Tasks of health development
The objectives of healthcare development are:
creation of conditions, opportunities and motivation for the population of the Rostov region to lead a healthy lifestyle;
transition to a modern system of organization of medical care;
standardization of medical care;
implementation of state guarantees for the provision of free medical care to citizens of the Russian Federation;
implementation of a unified personnel policy;
healthcare informatization;
improving the financial support for the provision of free medical care to citizens;
improvement of drug provision of citizens;
providing diabetic patients with medicines, self-control devices and needles in accordance with the standards of medical care;
organization of work to effectively provide residents of the Rostov region with medicines, medical products, as well as specialized medical nutrition products for disabled children and improve the organization of drug provision for certain categories of citizens;
optimization of the process of providing preferential drug care to residents of the Rostov region who are entitled to benefits at the expense of the regional budget;
organization of work on effective drug supply for residents of the Rostov region suffering from orphan diseases, drugs.
4.1. Creating conditions, opportunities and motivation
population of the Rostov region for a healthy lifestyle
To form a healthy lifestyle, it is necessary to introduce a system of state and public measures to:
improvement of medical and hygienic education and upbringing of the population, especially children, adolescents, youth, through the media and the mandatory introduction of appropriate educational programs in institutions of preschool, secondary and higher education.
Within the framework of this direction, it is necessary to provide training in hygienic skills to comply with the rules of occupational hygiene, work (including study) and rest, diet and structure of nutrition, timely seeking medical help and other norms of behavior that support health;
creation effective system measures to combat bad habits (alcohol abuse, tobacco smoking, drug addiction, etc.), including educating and informing the population about the consequences of tobacco use and alcohol abuse, promoting the reduction of tobacco and alcohol consumption, regulating and disclosing the composition of tobacco and alcohol products and providing complete information on the composition on the packaging, protection of non-smokers from exposure to tobacco smoke, restriction of alcohol consumption in public places, regulation of the location of places for the sale of alcoholic beverages, tobacco and the procedure for their sale, as well as price and tax measures;
creating a system of motivating citizens to lead a healthy lifestyle and participate in preventive measures, primarily through the popularization of the way of life and lifestyle that contributes to the preservation and strengthening of the health of citizens of the Rostov region, the formation of a fashion for health, especially among the younger generation, the introduction of a system of medical care for healthy and practically healthy citizens; conducting explanatory work on the importance and necessity of regular prevention and medical examination of citizens;
creation of a system to motivate the participation of employers in protecting the health of workers by establishing benefits on insurance premiums for compulsory medical and social insurance, stimulating working groups to maintain a healthy lifestyle;
prevention of risk factors for non-communicable diseases (blood pressure, malnutrition, physical inactivity, etc.);
the introduction of healthy safe nutrition: support for breastfeeding of young children, the creation of a healthy nutrition system for children in organized groups, including improving the organization of nutrition for students in educational institutions, an information and communication campaign to form a healthy safe diet among citizens;
increasing physical activity, which is the most important condition for maintaining the health of citizens. Among such measures should be: promotion and stimulation of an active lifestyle, development of physical therapy and physical culture aimed at maintaining health.
Activities aimed at promoting a healthy lifestyle among citizens in the Rostov region, as well as throughout the Russian Federation, are carried out in two stages.
At the first stage (2009-2015), specialists from the Ministry of Health of the Russian Federation developed health assessment systems, identified basic indicative indicators, such as public health potential and a healthy lifestyle index. On the territory of the Rostov region in 2009-2011, 14 health centers for adults and 6 health centers for children were created, which were equipped with medical equipment at the expense of the federal and regional budgets, in accordance with the decrees of the Government of the Russian Federation.
At the second stage (2016-2020), it is planned to reach the necessary, in terms of efficiency, the volume of activities for a gradual increase (in relation to the baseline indicators established at the first stage) of the public health potential by 10 percent and the healthy lifestyle index by 25 percent .
4.2. Transition to a modern system
organization of medical care
In order to ensure the quality and accessibility of medical care, it is necessary to ensure the functioning of an organizational system that provides for:
the fastest possible delivery of the patient to a medical institution equipped with medical diagnostic equipment, staffed by trained medical personnel and provided with the necessary medicines and medical products in accordance with relevant standards;
for medical reasons - a phased continuation of treatment in other medical institutions (successive aftercare and rehabilitation, secondary prevention, sanatorium-resort rehabilitation treatment) or at home in accordance with the procedure for providing medical care for a specific disease or condition until the best result is achieved (recovery, functional recovery ).
To create a system of medical care that meets the specified criteria, it is necessary:
development of primary health care, including a decrease in the number of attached adults to 1.2 - 1.5 thousand people, children - up to 600 - 800 children and adolescents per 1 site with a decrease in the load on one district doctor; giving priority to preventive work, strengthening the rehabilitation function, improving and expanding hospital-replacing medical technologies;
improving the work of emergency medical care, including optimization of routes for delivering patients to a hospital, depending on the type of pathology, the severity of the patient's condition; introduction of target indicators for the work of emergency medical care (arrival time for a call, time for transportation to a hospital, pre-hospital mortality); introduction of procedures for the provision of medical care in terms of pre-hospital management of patients with various types of pathology;
optimization of the work of hospital-level institutions in terms of setting targets for the work of institutions that reflect not only the types and volumes of medical care provided, but also its quality, the introduction of stages of medical care and developed routes for transporting patients based on the rational distribution of the functional responsibilities of hospitals (municipal (city and district ) - for the provision of primary care in emergency conditions; subject interdistrict - for the provision of specialized care, including in emergency conditions and conditions requiring restorative treatment and rehabilitation; subject and federal - for the provision of specialized, including high-tech, assistance), development specialized institutions to provide diagnostic and therapeutic care to patients with oncological diseases, the creation of a routing service in each hospital responsible for organizing aftercare and rehabilitation of discharged patients, as well as expansion of volumes and introduction of new types of high-tech assistance, including in emergency conditions;
development of patronage and rehabilitation medical care, including the creation of a network of institutions (departments) of rehabilitation treatment (aftercare), rehabilitation, medical care, including through the re-profiling of existing hospitals, expanding the network of day hospitals. Creation of a system of target indicators for the work of institutions of patronage and rehabilitation level, reflecting the quality of medical care (degree of restoration of impaired functions, indicators of primary disability and severity of disability);
quality control of medical care based on the procedures and standards for its provision;
equipping medical organizations with equipment in accordance with the standards and procedures for the provision of medical care;
expanding the economic independence of healthcare institutions, as well as increasing their responsibility for the economic results of their activities, including with a change in organizational and legal forms based on a unified system of criteria.
Implementation stages:
2012 - 2014:
creation of a system of operational accounting of medical care, healthcare institutions and medical personnel;
planning the development of a network of medical institutions with their profiling, redeployment of personnel and diagnostic and treatment facilities, the formation of routes for the movement of patients, the creation of a system of phased successive care;
gradual improvement of the system of medical care for patients with vascular diseases;
gradual improvement of the system of assistance to victims of road traffic accidents based on the organization of emergency care in hospitals located along federal highways;
step-by-step improvement of the system of providing medical care to patients with oncological diseases: introduction of screening for oncological diseases in primary outpatient clinics and hospitals; re-equipment and additional staffing of five regional oncological dispensaries;
gradual improvement of the system of providing assistance to women during pregnancy and childbirth, as well as to newborns and children;
gradual improvement of the blood service;
2015 - 2020:
Improving Primary Health Care:
development of the territorial-district principle of providing outpatient care to the population, including in rural areas;
additional staffing of outpatient clinics with qualified medical personnel (doctors and paramedical personnel);
giving priority to preventive work (a system of health-improving measures, medical examinations, screening examinations, vaccinations, in-depth examinations, etc.) based on a planned tariff policy;
providing preventive care to the population of rural areas through the formation of mobile medical teams equipped with the necessary laboratory and instrumental equipment;
development of telemedicine technologies for conducting remote consultative and diagnostic activities;
re-equipment of institutions, improvement and expansion of hospital-replacing diagnostic technologies;
introduction of target indicators for the work of outpatient clinics, reflecting the proportion of healthy individuals among the attached population and the percentage of early stages of diseases among all newly diagnosed;
improvement of the tariff policy of wages, reflecting the priority of the work of the district doctor - a set of preventive measures.
Improving the work of emergency medical care:
optimization of routes for the delivery of patients to the hospital, depending on the type of pathology, the severity of the patient's condition;
introduction of standards for prehospital management of patients with various types of pathology;
provision of ambulance crews with a satellite navigation system;
re-equipment of the ambulance service according to the standard;
additional staffing of the ambulance service with trained personnel;
introduction of target indicators for the work of ambulances (time of arrival to a call, time of transportation to a hospital, pre-hospital mortality).
Optimization of the work of institutions of the stationary level:
rational distribution of functional duties of hospitals;
phased creation of head regional centers coordinating the entire volume of preventive, diagnostic and therapeutic measures for socially significant medical problems;
implementation of protocols for managing patients and standards of medical care, registers of inpatients and a system for managing the quality of medical care in the activities of clinical departments of hospitals;
expansion of volumes and introduction of new types of high-tech care, including in emergency conditions;
additional staffing of hospitals with qualified personnel in accordance with the standards;
re-equipment of hospitals according to standards;
ensuring the operation of round-the-clock telemedicine communication between hospitals of municipal and regional subordination;
introduction of stages of medical care and developed routes for the transportation of patients, the creation in each hospital of a routing service responsible for organizing the aftercare and rehabilitation of discharged patients (referral to a “hospital at home” through communication with the patronage service of an outpatient clinic in accordance with the place of residence of the patient, in specialized hospitals for rehabilitation treatment, rehabilitation, medical care);
intensification of the work of an inpatient bed through the introduction of inpatient-replacing diagnostic technologies at the outpatient level and the organization of a phased rehabilitation treatment (patronage service, aftercare and rehabilitation system);
improving the target indicators of the work of hospital-level institutions, reflecting the quality of medical care (mortality, the degree of recovery of impaired functions);
Improving the system of phased rehabilitation treatment and rehabilitation:
creation of a network of institutions (departments) of rehabilitation treatment (aftercare), rehabilitation, medical care, including through the re-profiling of part of the operating hospitals;
expanding the network of day hospitals for rehabilitation treatment and rehabilitation;
staffing institutions (departments) of rehabilitation treatment (aftercare), rehabilitation, medical care with qualified personnel in accordance with the standards;
equipping institutions (departments) of rehabilitation treatment (aftercare), rehabilitation, medical care in accordance with standards;
introduction of high-tech rehabilitation technologies;
creation of a system of target indicators for the work of institutions at the patronage and rehabilitation level, reflecting the quality of medical care (degree of restoration of impaired functions, indicators of primary disability and severity of disability);
improvement of the tariff policy based on taking into account not only the type and volume of medical care provided, but also its quality.
Expanding the economic independence of health care institutions, as well as increasing their responsibility for the economic results of their activities, including with a change in organizational and legal forms, based on a unified system of criteria.
Creation of legal and economic conditions for the formation of a self-regulating system of providing medical care to the population, ensuring the motivated effective work of medical services at each level, the continuity of their actions at all stages of treatment to achieve the best result.
4.3. Standardization of medical care
One of the main factors in creating a system of high-quality and affordable medical care is the existence of uniform procedures and standards for the provision of medical care for the most common and socially significant diseases and pathological conditions for the entire territory of the Russian Federation, including the entire territory of the Rostov Region.
The standards of medical care are developed in accordance with the indicators of the Program of State Guarantees, and their implementation is guaranteed to citizens throughout the Rostov region.
The creation of medical care standards will make it possible to calculate the real cost of medical services in the region, determine the costs of implementing a territorial program of medical care for the population, calculate the necessary drug supply for the program (a list of vital and essential medicines), justify per capita funding standards and optimize options for restructuring the network of healthcare institutions .
The introduction of procedures for the provision of medical care will optimize its phasing, use the correct algorithm for the interaction of healthcare and social security institutions, ensure continuity in the management of the patient at all stages, which will significantly improve the quality of medical care to the population.
The procedures and standards for the provision of certain types of medical care are the basis of the Program of state guarantees for the provision of free medical care to citizens, corresponding to the current level of development of medicine and mandatory.
One of the main elements of quality assurance should be considered the development by professional communities (associations) of clinical recommendations (guidelines) containing information on the prevention, diagnosis, treatment of specific diseases and syndromes, which will serve as the basis for the development of standards of medical care, indicators of the quality of the treatment and diagnostic process.
This approach to the formation of a patient management algorithm helps attending physicians plan the treatment and diagnostic process, taking into account the real capabilities of a medical organization. Heads of medical organizations can evaluate the quality of medical care according to the criteria for the completeness of the implementation of mandatory medical and diagnostic measures, as well as compare the quality of work of individual doctors and departments and introduce differentiated wages.
Implementation stages:
2012 - 2014:
phased introduction of a medical care quality management system based on the procedures and standards for its provision, registers of inpatients, including indicators of the quality of care provided, as well as improving the tariff policy for remuneration of medical workers, dependent on the quality of care;
establishing a procedure for licensing medical organizations, based not only on the availability of appropriate material and technical equipment and certified specialists, but also on the possibility of complying with the technology of providing medical care (availability of a sufficient number of trained medical personnel with access to the necessary types of assistance and material and technical resources that allow the implementation of a schedule equipment operation in accordance with medical care technologies);
2015 - 2020:
introduction of an economically justified self-regulatory system for managing the quality of medical care in the Rostov region.
4.4. Fulfillment of state guarantees for the provision
citizens of the Russian Federation free medical care
State guarantees for the provision of free medical care to citizens of the Russian Federation are determined by law by Federal Law No. 323-FZ of November 21, 2011 “On the Fundamentals of Protecting the Health of Citizens”, which includes:
sources of financial support for state guarantees for the provision of free medical care to citizens of the Russian Federation;
the volume of state guarantees for the provision of free medical care to citizens of the Russian Federation in terms of the types, procedure and conditions for the provision of medical care;
the procedure for assessing the effectiveness of the implementation of state guarantees of free medical care;
responsibility for non-fulfillment of indicators of state guarantees of free medical care;
the procedure for developing regulations specifying the scope of state guarantees of free medical care established by the legislation of the Russian Federation.
In accordance with the provisions of the legislation of the Russian Federation, the Government of the Russian Federation adopts the Program of State Guarantees containing:
the minimum size of the per capita standard of financial provision of state guarantees for the provision of free medical care;
standards of financial costs per unit of medical care;
per capita standards for the volume of medical care by type;
minimum values of criteria for assessing the quality and accessibility of medical care.
On the basis of the Program of State Guarantees approved by the Government of the Russian Federation, the Government of the Rostov Region adopts the Territorial Program of State Guarantees, depending on financial security, setting its own financial standards (bringing them closer to those established by the Government of the Russian Federation), as well as at the stage of transition to predominantly single-channel financing of health care through the system of compulsory health insurance includes additional types of medical care (since 2013 - all feldsher-obstetric stations, ambulance), additional items (overhead and utility costs) in the tariff of compulsory health insurance, introduces new methods of payment according to the per capita funding standard.
Monitoring of the implementation of state guarantees for the provision of free medical care is carried out on an annual basis, while information on the implementation of the Territorial Program of State Guarantees in the corresponding year should be the basis for the formation of indicators of state guarantees of free medical care for subsequent periods.
Financial performance should be linked to quality:
satisfaction of the population with medical care;
mortality of the population of the Rostov region, including infant and maternal, mortality of the population of working age, mortality of the population from cardiovascular diseases, oncological diseases, external causes, as a result of traffic accidents;
primary incidence of major socially significant diseases;
primary disability;
balance of the Territorial Program of State Guarantees by types and volumes of medical care in accordance with the standards established by the Program;
terms of waiting for citizens of medical and rehabilitation assistance by types and conditions of provision.
At the same time, the Territorial Program of State Guarantees establishes target values for these indicators and, if necessary, additional indicators, taking into account healthcare priorities.
As part of the management system for the implementation of the Territorial Program of State Guarantees of the Ministry of Health of the Russian Federation (hereinafter referred to as the Ministry of Health of Russia) and the Federal Compulsory Medical Insurance Fund, mechanisms are provided for financial incentives to achieve the relevant indicators through the provision of additional transfers from the federal budget and the Federal Compulsory Medical Insurance Fund.
At the same time, in case of non-compliance with the established control values, the legislation of the Russian Federation should establish appropriate sanctions and introduce an effective mechanism for applying these sanctions.
Implementation stages:
2012 - 2014 - specification of state guarantees based on the standardization of medical care; transition to the planning of the Territorial Program of State Guarantees for three years with annual adjustments; certification of medical institutions for the provision of premises and equipment in order to determine the possibility of including investment costs in the system of compulsory medical insurance;
2015 - 2020 - phased inclusion in the per capita standard of the Territorial Program of State Guarantees of Investment Expenses; the transition to predominantly single-channel financing of health care through the system of compulsory medical insurance includes additional types of medical care (since 2013 - all feldsher-obstetric stations, ambulance), additional items (overhead and utility costs) in the tariff of compulsory medical insurance; introduction of new payment methods based on the per capita funding standard.
4.5. Implementation of a unified personnel policy
The current situation in health care involves reforms in the field of personnel management in the industry.
The goal of the personnel policy is to train and retrain specialists with modern knowledge and who are able to ensure the economic and clinical efficiency of the high medical technologies used and new methods of prevention, diagnosis and treatment, to achieve the optimal ratio of the number of doctors and paramedical personnel, as well as to eliminate disproportions in the staffing of all levels of the health care system.
The organization of personnel policy should be consistent with the educational policy in the system of continuous professional education, and also aimed at stimulating the motivation of medical workers to improve their professional skills.
The main criteria for the effectiveness of personnel policy, medical education and the incentive system for medical personnel are the quality of medical care and patient satisfaction.
Long-term personnel planning is possible only if reliable information is available on the number of medical workers (doctors of various profiles and paramedical personnel).
One of the directions in the development of the system of providing medical care to the population and the key to increasing its efficiency is the creation of conditions for motivated work of medical personnel. The mechanism of regulation should be the creation of a system of professional self-government and corporate responsibility in the team of each medical institution.
The introduction of medical self-government will allow "from the inside" to regulate the medical activities of each doctor and each medical team, flexibly using economic and moral levers.
Important components of the development of the system of medical self-government are:
formation of a system of corporate responsibility for the quality of medical care provided;
corporate distribution of funds for medical services rendered (transition to new forms of remuneration);
formation of a system of personal admissions to types of medical activities, depending on the level of their complexity;
increasing the motivation of medical workers for continuous professional education and the acquisition of admissions to new types of medical activity within the framework of the main specialty or related fields of medicine.
To determine the personal contribution of each medical worker to the result of the work of a medical institution, it is necessary to update the classification of all types of medical care, ranked by medical specialties, the level of complexity and manufacturability, and the required qualifications of a medical worker.
The introduction of the principles of medical self-government and corporate responsibility will make it possible to effectively use material and moral incentives to increase the motivation of each member of the medical team for continuous professional improvement, which will lead to a significant improvement in the quality of both his personal work and the entire medical institution.
As part of the implementation of the personnel policy, it is proposed to carry out the following activities.
Health staffing:
bringing the number and structure of medical personnel in line with the volume of personnel activities and long-term tasks. Elimination of duplication of functions, redistribution of functions between various professional groups (doctors and nursing staff, nurses and junior nurses);
raising the professional level of health workers on the basis of further development of the system of continuous education of medical and pharmaceutical workers;
improvement of working conditions and its remuneration. Bringing the wage system in line with the complexity, quantity and quality of medical care. Modernization of workplaces, increasing the technical equipment of the work of medical workers;
improvement of the regulatory legal framework that determines the professional activities of medical and pharmaceutical personnel;
development of a set of measures aimed at raising the status of a doctor and paramedical personnel, at understanding by a medical worker the potential of the profession and its prospects, significance for society;
training of specialists in the field of health management.
Improving the quality of training of medical and pharmaceutical personnel:
development of a set of measures for the training of specialists with higher and secondary medical and pharmaceutical education according to government priorities;
improvement of targeted contract training of personnel, providing for the provision of certain social guarantees to students and young professionals;
creation of educational, scientific and clinical complexes that unite educational institutions (medical university, college), specialized research institutes and clinical bases;
optimization of legal and economic relations between medical educational institutions and medical institutions in the framework of creating a unified clinical base;
development of informatization of education in medical and pharmaceutical educational institutions: formation electronic libraries and reference and information databases, the introduction of information technologies and quality management systems in the educational process;
improvement of the system of continuous medical education;
implementation of state programs of international exchange within the framework of professional development of medical workers;
improving the training of managerial personnel in healthcare and specialists in the personnel services of medical organizations based on modern principles of quality management and standardization, multidisciplinary professional knowledge (legal, economic, psychological, sociological, etc.) and personnel management skills;
introduction of a liability insurance system for medical workers in case of an error and in the presence of a degree of risk of medical intervention, as well as personal insurance in the event that the performance of official duties is associated with a threat to life and health;
introduction of uniform criteria for the formation of a professional community in medical specialties (groups of specialties), development of mechanisms for their participation in the development of standards for the provision of medical care, clinical protocols, in licensing medical activities and certification of specialists;
improvement of the work of the main freelance specialists, heads of specialized scientific organizations, representatives of professional societies and associations, etc.;
enhancing the role of scientific, expert and advisory bodies; development of medical professional societies and associations.
Implementation stages:
2012 - 2014:
training of medical specialists who meet the new requirements for professional medical activity; achieving a ratio of doctors and paramedical personnel of 1 to 3 (5);
introduction of new federal state educational standards for higher and secondary vocational education in the specialties of the Healthcare group and federal state requirements for postgraduate medical education (including internship, residency, etc.);
optimization of the system of continuous medical education;
formation of a system of professional growth;
putting into effect mechanisms for exercising the rights of health care workers to insurance in cases where the performance of duties is associated with a threat to their life and health;
introduction of a system of professional liability insurance in case of error and in the presence of risk in connection with medical intervention;
2015 - 2020:
phased transition to the optimal system of placement of medical personnel; approaching the predicted for the Russian Federation ratio of the number of doctors and nurses (1 to 7) for the patronage service of the region;
monitoring the state of health care staffing and migration of personnel, optimization of personnel policy in accordance with the needs of the health care system;
formation of professional self-government in resolving issues of personnel and innovation policy, developing uniform standards for the provision of medical care and assessing its quality.
4.6. Informatization of healthcare
In order to increase the availability and quality of medical care to citizens and to solve the key tasks of the operational management of healthcare in the Rostov region, a regional segment of the unified state information system in the field of healthcare (hereinafter referred to as the Unified State Health Information System) is being created.
The introduction of modern information systems in healthcare provides for measures for personalized accounting of the provision of medical services, the possibility of maintaining a medical record, making an appointment with a doctor in electronic form, exchanging telemedicine data, and introducing electronic document management systems.
Within the framework of these measures, it is planned to transfer all medical and preventive institutions of the region operating in the system of compulsory medical insurance to a single number of the compulsory medical insurance policy, with the personification of the medical care provided on it. This measure will increase the reliability of the collected medical information and facilitate inter-territorial settlements.
The event for the exchange of telemedicine data will bring the modern level of diagnostic tests closer to patients in rural areas. Improving the socio-economic efficiency of spending when using telemedicine methods is achieved by expanding the volume of primary health care and ensuring that it meets the standards for the provision of medical services by type and nature of diseases, meeting the needs and expectations of the population, as well as optimizing the use of quotas for the treatment of citizens in federal medical centers allocated by the Russian Ministry of Health.
The implementation of the event will allow:
ensure general accessibility and a single high quality standard of medical care in any healthcare institution, regardless of its territorial location and departmental affiliation;
organize consultations in leading medical centers;
observe and advise patients after complex surgical interventions;
bridge the gap between the concentration of the best doctors in leading medical centers and low level availability of highly qualified specialists in municipal medical organizations;
to improve the level of medical care for the population by introducing into the practice of healthcare methods of remote provision of advisory medical care and the exchange of specialized information based on modern science-intensive technologies.
Measures for personalized accounting of the provision of medical services, the possibility of maintaining an electronic medical record, by appointment with a doctor in electronic form are planned to be carried out in the regional segment of the Uniform State Health Information System.
The centralized architecture of the regional segment of the Unified State Health Information System will allow it to be scaled within the region within short time. Due to centralization, budget costs for providing medical institutions with a technical base will be minimized, and financial costs for ensuring the protection of confidential information (personal data and medical confidentiality) will be reduced.
Implementation stages:
2012 - 2020:
centralized placement of information systems and resources, ensuring redundancy and continuous availability, the requirements of the Federal Law of the Russian Federation of July 27, 2006 No. 152-FZ “On Personal Data”;
unification of regional health care institutions, medical organizations, the Territorial Compulsory Medical Insurance Fund for the Rostov Region into a single secure and redundant multi-service data transmission network for access to centralized information resources and information exchange;
equipping medical organizations with computers;
creation and modernization of existing local area networks in medical organizations, including the purchase, installation and configuration of network equipment;
registration and accounting of served citizens, recording patients for service, resource management of medical organizations, maintaining electronic medical records of patients, managing pharmacy activities, accounting for medical services provided;
introduction of an electronic document management system in regional healthcare institutions and medical organizations;
introduction of an information system for personnel management of regional healthcare institutions and medical organizations;
integration of information systems with regional and single portal public services, a system of interdepartmental electronic interaction, federal components, a universal electronic card a citizen of Russia, an automated system of the Territorial Fund of Compulsory Medical Insurance in the Rostov Region;
ensuring the security of confidential information and personal data during their processing in personal data information systems (PDIS) in accordance with the requirements of the current legislation.
4.7. Financial support for the provision
citizens free medical care
The provision of free medical care to citizens of the Rostov Region is carried out at the expense of the consolidated budget of the Rostov Region and the funds of compulsory medical insurance.
The approved cost of the Territorial program of state guarantees for the provision of free medical care to citizens of the Russian Federation in the Rostov region for 2012 amounted to 25.7 billion rubles, including consolidated budget funds - 11.3 billion rubles, compulsory medical insurance funds - 14.4 billion rubles (including insurance premiums for compulsory medical insurance of the non-working population in the amount of 7.9 billion rubles).
The per capita financial support standards provided for by the Territorial Program of State Guarantees reflect the amount of budgetary allocations and compulsory medical insurance funds necessary to compensate for the costs of providing free medical care per 1 person per year. In 2012, these expenses amounted to:
at the expense of compulsory medical insurance for 1 insured person per year - 3,576.53 rubles;
at the expense of the consolidated budget of the region per 1 inhabitant - 2,664.12 rubles.
Every year there is an increase in the total cost of the Territorial Program of State Guarantees, as well as territorial standards of financial costs per unit of medical care.
Despite the growth in health care financing, its level remains insufficient. At the same time, the financial resources allocated for the health care of the region allow its residents to receive free medical care in full, provided for by the Territorial Program of State Guarantees.
Considering that the health care financing system should ensure the use of resources as an economic tool for improving the efficiency and quality of medical care, it is necessary:
ensure a balance between the volume of medical care approved by the Territorial Program of State Guarantees and the resources for their implementation by optimizing the volume of free medical care provided for by the Territorial Program of State Guarantees;
to develop and implement modern methods of planning financial resources and payment for medical care, corresponding to the goals and objectives of the implementation of the Territorial Program of State Guarantees, taking into account the quality indicators of medical and preventive activities;
to continue targeted financing of priority areas of activity determined annually on the basis of the program-target method of planning.
complete the transition to predominantly single-channel financing of the healthcare system through the system of compulsory medical insurance.
4.8. Improving the provision of medicines to citizens
One of the essential areas for increasing the availability of medical care is the ability to meet the needs of all patients, including those who are socially unprotected, in high-quality medicines in accordance with the standards of medical care.
Based on the statistical forecast, the number of patients with diabetes mellitus in the Rostov region annually increases by 6-8 percent. In patients with diabetes, the need for medical care increases as their condition worsens and complications occur. In this regard, additional measures are required to ensure primary and secondary prevention, organization of treatment, including drug provision and rehabilitation, for patients with diabetes. This is possible through the use of software methods.
The implementation of the programs provides for the purchase and provision of medicines for patients with diabetes mellitus. The list of medicines is formed in accordance with the list of basic vital and essential medicines, standards for the provision of medical care and provides for the provision of patients with insulin and their analogues, hypoglycemic drugs, i.e. provides for the treatment of both type I diabetes mellitus - insulin-dependent and non-insulin-dependent diabetes mellitus type II, as well as self-control devices and needles.
Satisfying the needs of the residents of the Rostov region, including socially vulnerable groups of the population, in medicines and medical products, as well as specialized medical foods for disabled children in accordance with therapeutic indications and nosology, should be considered as an event of a national scale. To improve the availability and quality of drug care, additional measures are required, which should be aimed at improving the manageability of financial, commodity flows and prescribing drugs, while creating a stricter system for monitoring the completeness of meeting demand and the validity of prescribing drugs for certain categories of citizens.
In accordance with the purpose and objectives of the Concept, measures are provided for organizing the provision of citizens with medicines intended for the treatment of patients with malignant neoplasms of the lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, multiple sclerosis, as well as after organ transplantation and ( or) tissues (providing logistical support for drugs intended for the treatment of patients of this category).
In accordance with Article 44 of the Federal Law of November 21, 2011 No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation”, there are categories of citizens included in the Federal Register of Persons suffering from life-threatening and chronic progressive rare (orphan) diseases that lead to to a reduction in life expectancy of citizens or their disability, and the regional segment of the Federal Register, in the outpatient treatment of which medicines, medical devices, specialized medical foods and dressings are dispensed by prescription free of charge.
The organization of providing citizens with medicines for the treatment of diseases included in the list of life-threatening and chronic progressive rare (orphan) diseases that lead to a reduction in the life expectancy of a citizen or disability is attributed to the powers of the constituent entities of the Russian Federation, which are implemented in 2012 in the Rostov region at the expense of the regional budget. In this regard, it is necessary to organize work on the effective drug supply of residents of the region suffering from orphan diseases, drugs.
Thus, the main directions for the implementation of state policy in the field of drug assistance to citizens should be:
guaranteed affordable drug provision for citizens (including preferential ones) within the framework of the State Guarantee Program, the current and newly introduced systems for providing state social assistance at the expense of the federal budget, social support measures for drug provision of the population at the expense of the regional budget and other sources;
improving the organization of drug care, the management of pharmaceutical activities and the mechanism of state regulation of drug provision, the preservation and development of the existing network of state and municipal pharmacies;
increasing the efficiency of the use of financial resources intended for drug provision of citizens.
5. Milestones and expected results of implementation
Concepts for the development of healthcare in the Rostov region until 2020
The implementation of the Concept for the development of healthcare in the Rostov region until 2020 will take place in stages.
At the first stage (2012-2014) state guarantees will be specified on the basis of standardization of medical care; transition to the planning of the Territorial Program of State Guarantees for three years with annual adjustments; certification of medical institutions for the provision of premises and equipment in order to determine the possibility of including investment costs in the system of compulsory medical insurance; a phased introduction of a system for managing the quality of medical care based on the procedures and standards for its provision, registers of inpatients, including indicators of the quality of care provided, as well as improving the tariff policy for remuneration of medical workers dependent on the quality of care; modernization of the material and technical base of health care institutions; a system of continuous training of personnel based on a unified personnel policy will be implemented, new federal state educational standards for higher and secondary vocational education in the specialties of the Healthcare group and federal state requirements for postgraduate medical education will be introduced.
In addition, at the first stage, the implementation of the Priority National Project "Health" will continue in the following areas:
formation of a healthy lifestyle;
development of primary health care and medical prevention;
improvement of specialized, including high-tech, medical care for socially significant diseases, including cardiovascular, oncological, combined injuries in road traffic accidents;
development of the blood service;
improving medical care for mothers and children.
At the second stage of the implementation of the Concept (2015-2020), a phased transition to a self-regulating system of organizing medical care based on the infrastructure and human resources of healthcare and informatization of the industry is planned, further introduction of new technologies developed taking into account the priorities innovative development health care, the inclusion of high-tech and emergency medical care in the system of compulsory medical insurance, the integration of budgetary investments in tariffs for medical care, the creation of a system of drug provision of citizens on an outpatient basis within the framework of compulsory medical insurance.
By 2020 it is expected:
reducing maternal mortality to 13.8 per 100,000 live births by 2020;
reducing the infant mortality rate to 7.2 per 1,000 live births between 2015 and 2020;
the death rate of the working-age population will be 546.0 people per 100,000 population;
the death rate of the working-age population from diseases of the circulatory system will be 173.0 people per 100,000 population;
the death rate of the working-age population from neoplasms will decrease to 82.0 people per 100,000 population;
the death rate of the working-age population from injuries will be 13.5 people per 100,000 people;
an increase in the staffing of full-time positions of doctors by individuals at the level of 72 percent;
an increase in the staffing of regular positions of paramedical workers by individuals up to 76.2 percent;
an increase in the expenses of the consolidated budget of a constituent entity of the Russian Federation for the implementation of the Territorial program of state guarantees for the provision of free medical care to citizens of the Russian Federation in the Rostov Region per 1 inhabitant up to 3,787 rubles;
reduction in the provision of round-the-clock beds (operating in the system of compulsory medical insurance) in state (municipal) healthcare institutions to 60.2 beds per 10 thousand people of the population;
ensuring the average annual bed occupancy in state (municipal) healthcare institutions at the level of 340 days (including nursing beds organized to meet the population's need for medical and social assistance);
stabilization of the proportion of alcoholics who refrain from drinking alcohol during a course of treatment with long-acting drugs, up to 45 percent.
Survey of the population on the evaluation of the effectiveness of managersI. Introduction
In recent years, there has been a deterioration in the health status of the population. The crisis in the activities of medical institutions is approaching the line, followed by the collapse of the entire health care system.
The amount of healthcare financing from the budgets of all levels and from the funds of compulsory medical insurance does not provide the population with free medical services. At the same time, the available financial and material resources are used inefficiently, and disproportions in the provision of medical care are increasing. Social tension is growing in the industry. The shadow side of payment for medical services is becoming more and more widespread.
In this regard, a well-thought-out strategy for healthcare reform is needed.
II. The main directions of development of the healthcare system
The purpose of the Concept for the Development of Healthcare and Medical Science in the Russian Federation (hereinafter referred to as the Concept) is to preserve and improve people's health, as well as reduce direct and indirect losses to society by reducing morbidity and mortality.
The main objectives of the Concept are:
an increase in the volume of measures for the prevention of diseases;
reducing the time for restoring the lost health of the population by introducing modern methods of prevention, diagnosis and treatment into medical practice;
improving the efficiency of resource use in health care.
The implementation of the Concept is based on the following principles:
universality, social justice and accessibility of medical care to the population, regardless of the social status of citizens, their level of income and place of residence;
preventive orientation;
economic efficiency of functioning of medical institutions;
unity of medical science and practice;
active participation of the population in solving health issues.
Under the current conditions, the following are of great importance:
formation of state policy in the field of healthcare and medical science and increasing the responsibility of all authorities for its implementation;
ensuring the adequacy of financial resources to state guarantees in the healthcare sector, a gradual increase in the share of funds allocated to finance healthcare, up to 6-7 percent of the gross domestic product;
development of the non-state sector in health care;
improvement of legal regulation of activities in the field of healthcare;
development and implementation into practice of advanced forms and methods of organizing state sanitary and epidemiological supervision, hygienic and epidemiological expertise, monitoring human health and human environment;
implementation of an investment policy that ensures high efficiency of investments - the maximum medical, social and economic effect per unit of costs;
raising the level of qualification of medical workers, improving the system of their training, retraining;
increasing the social protection of medical workers, including wage increases;
involvement of professional medical associations in the implementation of state policy in the field of health and medical science;
improvement of state regulation in the field of provision of medicines, medical products and medical equipment;
increasing the interest of citizens in maintaining and strengthening their health.
III. Improving the organization of medical care
The main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.
Primary health care is the main link in the provision of medical care to the population.
A special role is given to the development of the institution of a general (family) practitioner. Consultative and diagnostic services should be developed in polyclinics. On their basis, departments of medical and social rehabilitation and therapy, care services, day hospitals, centers for outpatient surgery and medical and social assistance, etc. can be deployed.
The reorganization of inpatient care will ensure a reduction in the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the diagnostic and treatment process as follows:
intensive treatment - up to 20 percent;
rehabilitation treatment - up to 45 percent;
long-term treatment of patients with chronic diseases - up to 20 percent;
medical and social assistance - up to 15 percent.
Wider use of day forms of stay of patients in hospitals.
It is necessary to revive inter-regional and inter-district specialized medical centers.
For high-quality medical care, it is necessary to ensure the continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of the provision of medical care, as well as between different types of medical institutions, becomes important. This implies the creation of a higher level of financing and management of health institutions.
Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.
It is necessary to take effective measures to develop the maternal and child health service, while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating obstetric institutions with the general medical network.
It is necessary to carry out comprehensive measures for the further development of psychiatric and narcological assistance to the population, the fight against tuberculosis and sexually transmitted diseases.
Measures to introduce modern technologies in intensive care units, cardiology and cardiac surgery, oncology, diagnostics and treatment of socially significant diseases require state support.
It is necessary to strengthen the ambulance service, make it more mobile and equipped with modern facilities for emergency medical care and emergency hospitalization of patients.
It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.
It is necessary to take measures of state support to improve rehabilitation assistance, the development of sanatorium-resort organizations of the healthcare system, health-improving institutions and organizations.
To improve the quality and accessibility of medical care to the rural population, it is necessary to form treatment and diagnostic complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of treatment, diagnostic and advisory assistance, and create inter-district clinical and diagnostic centers.
It is necessary to integrate departmental medical institutions into the general health care system on a single regulatory and legal basis, taking into account their industry specifics and location.
While maintaining the dominant role of state and municipal health care, the emerging private sector will play an important role. Creation of conditions for its development is the most important element of structural reforms in health care.
It is necessary to provide medical organizations, persons engaged in private medical activities, state and municipal organizations with equal rights to work in the system of compulsory medical insurance and participate in the implementation of state and municipal targeted programs. Participation of medical organizations of various forms of ownership in the implementation of state health programs, municipal orders should be carried out on a competitive basis.
State and municipal medical institutions that perform functions that are not related to the framework of a single technology for the provision of medical care should have broad powers in matters of the use of property and remuneration of personnel.
In accordance with the Constitution of the Russian Federation, the protection of people's health is one of the foundations of the constitutional order of Russia. Everyone has the right to health care and medical care Constitution of the Russian Federation / Adopted by popular vote on December 12, 1993, Novosibirsk, 2009.
This right is ensured by providing citizens with free medical care in state and municipal health care institutions, financing federal programs for the protection and promotion of public health, implementing measures to develop state, municipal, private health care systems, encouraging activities that promote the development of physical culture and sports, environmental and sanitary - epidemiological welfare.
There is a concept for the development of health care in the Russian Federation until 2020, which is based on the following fundamental documents regulating the social structure in the Russian Federation, including the organization of health care: The Constitution of the Russian Federation, federal laws "On the general principles of organizing legislative (representative) and executive bodies of the state the authorities of the constituent entities of the Russian Federation” No. 95-FZ of 04.07.2003; "On the general principles of organizing local self-government in the Russian Federation" No. 131-FZ of 06.10.2003.
In order to competently and effectively solve the problems of cardinally improving the health of the population and health care, it is advisable to define and clarify the concepts, without which it is difficult to reasonably talk about the concept and its implementation.
First of all, about the concept of "concept". In dictionaries, reference books, this term is explained as “a certain way of understanding”, “the main point of view on the subject”, “explanation of the leading idea” or as “the process of forming the main idea”, even in short - “the idea”.
The goal of the healthcare development concept is to ensure reasonable access to adequate quality medical care for the population, regardless of the social status of citizens, their income level and place of residence, based on improving the efficiency of healthcare institutions through the rational use of resources and the implementation of measures aimed at optimizing the healthcare system. Expert platform for open discussion of the Concept for the development of healthcare until 2020; Finchenko Evgeny Alexandrovich, expert; 22.04.2008
The focus of health care should be on the adequate needs of each person in medical care and, based on this priority, the health care system is built, and the main mechanisms for involving a person in the health care system become compulsory health insurance (CHI) and voluntary health insurance (VHI)2 Fatullayev, G .G. About Competence municipal authorities health management // Bulletin of the Volga University. V. N. Tatishcheva. Series "Jurisprudence". - Tolyatti: VUiT Publishing House, 2006.- No. 60. .
The basis of the concept of healthcare development is the improvement of legal regulation in the field of healthcare:
Legislative approval social standards providing the population with medical care within the framework of the Program of State Guarantees of Free Medical Care - providing the population with primary health care, including emergency medical care; medical care for patients with infectious and mental illnesses;
Development and legislative approval of the procedure and rules for the provision of medical care in medical organizations;
Reorganization of municipal and state medical institutions into autonomous institutions;
Creation of a system of restrictive measures in activities commercial organizations profit-oriented in the provision of medical services;
Legislative restriction of over-the-counter sale of medicines to the public;
Introduction to medical organizations of national protocols (standards) for the provision of medical care;
Determining the responsibility of governing bodies and medical organizations, funding organizations at all levels for achieving the results provided for by strategic and current plans, as well as for the efficient use of resources;
Ensuring the possibility of replacing any managerial position in health care exclusively on a competitive basis.
It is fundamentally important to determine the goals, objectives and rules of medical care for the population in medical organizations of various organizational and legal forms and levels of public service; based on this, determine the indications for a particular type of medical care and develop national protocols for the provision of medical care Fatullaev, G.G. Improving the organizational structure is a special function of municipal health authorities // Modern Law 2006, No. 10.
The competence of the state remains:
Determination of the goals, objectives and rules of medical care for the population (both out-of-hospital and inpatient) in medical organizations of various organizational and legal forms and levels of public service;
Development of national protocols (standards) for the provision of medical care;
Regulation of the system of compulsory medical insurance;
Licensing of medical services and accreditation of medical institutions.
The concept provides for the implementation of a set of measures in the main areas of healthcare development.
The main directions of policy in the field of medical education and science include:
Transfer of medical universities, research institutes of federal subordination, located in the constituent entities of the Russian Federation, to the jurisdiction of the constituent entities of the Russian Federation (with the possibility of financing under the federal order for training and scientific research);
Priority training of general practitioners;
Postgraduate training of doctors and paramedical workers on the basis of regional medical organizations;
Ending the practice of training health managers and heads of medical institutions from among doctors;
Introduction of a system of state orders for the development of new medical technologies (grants). Expert platform for open discussion of the Concept for the development of healthcare until 2020; Samoshkin Alexey Anatolievich secret Medical Associations; 04/22/2008
The main directions of personnel policy include:
Creation of a system of examinations when hiring medical personnel and annual certification of specialists;
Changing the nomenclature of leadership positions in medical institutions: the director, who is a manager, is in charge, and the chief physician deals exclusively with medical issues, in the traditional sense, this is the deputy chief physician for medical issues;
Objectivization of the procedure for testing the level of knowledge and skills of the leading health personnel;
Ending the practice of appointing health managers at all levels without appropriate training and passing through certain administrative steps.
The policy in the field of legal regulation assumes:
Implementation antitrust law in the field of insurance medical services, including compulsory medical insurance;
Ensuring the protection of medical institutions by public health authorities at all levels from any interference in their activities by territorial CHI funds.
The financial policy assumes:
Creation of a single-channel system for financing a medical organization, regardless of the organizational and legal form in terms of the provision of medical services in the CHI system;
Bringing tariffs in the CHI system in line with the actual costs of a medical organization for the provision of medical services;
Separation of utility bills (water, electricity, heat, garbage disposal, etc.), other household expenses of a medical institution and medical tariffs for compulsory medical insurance;
It should be noted that the key areas for the development of public health are: ensuring the safety of the population (physical, sanitary and epidemiological, etc.), ensuring the provision of urgent medical care to the population (life saving) and providing an opportunity for every citizen to take measures to preserve the health potential .
The proposed concept of health care reform is not based on increasing health care funding, but on the rational use of existing funds. At the same time, as an option, in case of a negative development of events, even a possible significant reduction in health care financing is expected. Tkachenko Yu.A. Health care reform project in the Russian Federation www. duma.tomsk.ru
Nevertheless, even with such a development of events, the mandatory consequence of the proposed reform will be to improve the health of the population, including an increase in the duration of active life, the removal or significant reduction of social tension.
The current health care models adopted in most countries of the world are based on the market principle: need - satisfaction of need - profit - stimulation of need - need. Thus, the modern medical, pharmacological industry and other associated sectors of the economy, as economic entities, are directly interested in increasing the need for medical care.
At the same time, the most widespread, including in Russia, was the stimulation of the need for medical services, not as preventive measures, which the great physicians of the past dreamed of - "The future belongs to preventive medicine" - N.I. Pirogov, but conscious or unconscious modeling of the situation : the formation of the disease - pain or other symptom - the patient's visit to a medical institution - diagnosis - therapy. This is an unspoken, but really dominant principle today, willy or unwittingly carried out by almost every doctor using standard methods of therapy. Any other interpretation of the current situation in healthcare is artificial, absurd and manipulative, as it should be based only on logic, on the principles of the market and, most importantly, on real facts.
Further, both the media and the established stereotypes among the population, which formed its views in the days of free and developed Soviet health care, clearly exaggerate the role of medicine itself in maintaining health. Medicine as such is only marginally responsible for the health of the population. The long-known data of the World Health Organization on the degree of importance of various factors in public health are not popularized (lifestyle - 50%, environmental conditions - 20%, genetic factors - 20%, the quality of the health care system - 10%) Tobes Brigitte. The right to health. Theory and practice. Moscow, 2009
The current, rather prosperous, situation with the dynamics of life expectancy in recent decades in the economic developed countries to a small extent associated with the success of medicine as such. This is explained by tough and effective measures taken by state authorities in more important areas (unprecedented in terms of scale and success, the formation by the media of a stereotype about health as an obligatory component of a prestigious life, as a result of which there is a sharp decrease in bad habits and an increase in good habits among the population, an intensive growth of paramedical business based on the idea of physical beauty and, as a result, the promotion of a healthy lifestyle, tough measures to protect the environment, the formation of radical environmental thinking in society). The next global step in this direction in the coming years will be a fundamental change in the medical services market associated with the development of genetic engineering.
The implementation of the concept is carried out in stages:
At the first stage (2009-2015), state guarantees for the provision of free medical care to citizens of the Russian Federation will be specified, a transition will be made to a predominantly single-channel model of financing medical care through the system of compulsory medical insurance, standards and procedures for the provision of medical care will be developed, and an information system of personalized accounting for the medical care provided to citizens.
As part of the first stage of implementation, preparatory measures will also be taken for the subsequent transition to a new system of organizing medical care, including the creation of a quality control system for medical care with its subsequent integration into the quality management system, the modernization of the material and technical base of healthcare institutions has begun, and a system of continuous training based on a unified personnel policy, as well as priorities for the innovative development of healthcare, formed interdepartmental targeted scientific programs for the development and implementation of new highly effective technologies for the prevention, diagnosis and treatment of socially significant diseases and pathological conditions. The concept of healthcare development in the Russian Federation until 2020
In addition, at the first stage, the implementation of the Priority National Project "Health" will continue in the following areas:
formation of a healthy lifestyle;
· Development of primary health care and medical prevention;
· improvement of specialized, including high-tech, medical care for socially significant diseases, including cardiovascular, oncological, combined injuries in road traffic accidents;
development of the blood service;
Improving medical care for mothers and children.
At the second stage of the implementation of the Concept (2016-2020), a phased transition to a self-regulating system of organizing medical care based on the established infrastructure and human resources of healthcare and informatization of the industry, the further introduction of new technologies developed taking into account the priorities of innovative development of healthcare, the inclusion of high-tech and emergency medical care into the system of compulsory health insurance, the integration of budgetary investments into tariffs for medical care, the creation of a system of drug provision of citizens on an outpatient basis within the framework of compulsory health insurance.
The effective functioning of the healthcare system is determined by the main system-forming factors. These factors are interdependent and mutually determining, and therefore, the modernization of health care requires the harmonious development of each of them and the entire system as a whole.
The downward trend in the rate of population decline that has emerged in recent years is ensured by an increase in the birth rate and a decrease in mortality. The Concept of Health Development in the Russian Federation until 2020, which discusses and regulates issues related to a healthy lifestyle, is not only relevant, but extremely important for today.
In general, the implementation of all areas of the Concept will ensure by 2020 the formation of a healthy lifestyle for the population of the Russian Federation, as well as create a healthcare system that allows the provision of affordable and high-quality medical care based on uniform requirements and approaches, taking into account the latest achievements of scientific and technological progress, which will be the key to sustainable socio-economic development of the Russian Federation in the long term.
* clarify the concept of "transition to a modern system of organization of medical care";
* supplement "the creation of an effective (uniform for regions and districts) model for managing the financial resources of the program of state guarantees";
* Supplement the “improvement of drug provision of citizens on an outpatient basis within the framework of the compulsory medical insurance system” by expanding the restrictive list formed on the basis of an analysis of clinical and economic efficiency;
* to modify "improving the qualifications of medical workers and creating a system of continuous medical education with motivation for quality work";
Clause 4.1 "Formation of a healthy lifestyle" should be supplemented and proposed as follows:
To form a healthy lifestyle, it is necessary to introduce a system of state and public measures to:
Subparagraph 1) "Improvement of medical and hygienic education and upbringing of the population, especially children, adolescents, youth, through the media (including through commercials) and the mandatory introduction of appropriate educational programs in institutions of preschool, secondary and higher education."
Subparagraph 4) “creating a system of materially motivated motivation of citizens to lead a healthy lifestyle and participate in preventive measures, form a fashion for health, especially among the younger generation, conduct explanatory work on the importance and necessity of regular prevention and medical examination of citizens at the place of residence; selection and implementation of the system of medical care for healthy and practically healthy citizens in outpatient health facilities” Khalfin R.A. Priority National Healthcare Project: Results and Prospects // Healthcare Economics 2009, No. 11 .
It can be concluded that, in general, the scrupulous implementation of all areas of the Concept should ensure by 2020 the formation of a healthy lifestyle for the population of the Russian Federation. And if we talk about the long-term perspective, then a healthcare system should be created that makes it possible to provide affordable and high-quality medical care based on uniform requirements and approaches, taking into account the advanced achievements of scientific and technological progress, which will be the key to sustainable socio-economic development of the Russian Federation.
health care municipal government
Active Edition from 05.11.1997
| Name document | Decree of the Government of the Russian Federation of 05.11.97 N 1387 "ON MEASURES TO STABILIZE AND DEVELOP HEALTH AND MEDICAL SCIENCE IN THE RUSSIAN FEDERATION" |
| Type of document | resolution, concept |
| Host body | Russian government |
| Document Number | 1387 |
| Date of adoption | 01.01.1970 |
| Date of revision | 05.11.1997 |
| Date of registration with the Ministry of Justice | 01.01.1970 |
| Status | acts |
| Publication |
|
| Navigator | Notes (edit) |
Decree of the Government of the Russian Federation of 05.11.97 N 1387 "ON MEASURES TO STABILIZE AND DEVELOP HEALTH AND MEDICAL SCIENCE IN THE RUSSIAN FEDERATION"
THE CONCEPT OF THE DEVELOPMENT OF HEALTH CARE AND MEDICAL SCIENCE IN THE RUSSIAN FEDERATION
I. Introduction
In recent years, there has been a deterioration in the health status of the population. The crisis in the activities of medical institutions is approaching the line, followed by the collapse of the entire health care system.
The amount of healthcare financing from the budgets of all levels and from the funds of compulsory medical insurance does not provide the population with free medical services. At the same time, the available financial and material resources are used inefficiently, and disproportions in the provision of medical care are increasing. Social tension is growing in the industry. The shadow side of payment for medical services is becoming more and more widespread.
In this regard, a well-thought-out strategy for healthcare reform is needed.
II. The main directions of development of the healthcare systemThe purpose of the Concept for the Development of Health Care and Medical Science in the Russian Federation (hereinafter referred to as the Concept) is to preserve and improve people's health, as well as reduce direct and indirect losses to society by reducing morbidity and mortality.
The main objectives of the Concept are:
an increase in the volume of measures for the prevention of diseases;
reducing the time for restoring the lost health of the population by introducing modern methods of prevention, diagnosis and treatment into medical practice;
improving the efficiency of resource use in health care.
The implementation of the Concept is based on the following principles:
universality, social justice and accessibility of medical care to the population, regardless of the social status of citizens, their level of income and place of residence;
preventive orientation;
economic efficiency of functioning of medical institutions;
unity of medical science and practice;
active participation of the population in solving health issues.
Under the current conditions, the following are of great importance:
formation of state policy in the field of healthcare and medical science and increasing the responsibility of all authorities for its implementation;
ensuring the adequacy of financial resources to state guarantees in the healthcare sector, a gradual increase in the share of funds allocated to finance healthcare, up to 6-7 percent of the gross domestic product;
development of the non-state sector in health care;
improvement of legal regulation of activities in the field of healthcare;
development and implementation into practice of advanced forms and methods of organizing state sanitary and epidemiological supervision, hygienic and epidemiological expertise, monitoring human health and human environment;
implementation of an investment policy that ensures high efficiency of investments - the maximum medical, social and economic effect per unit of costs;
raising the level of qualification of medical workers, improving the system of their training, retraining;
increasing the social protection of medical workers, including wage increases;
involvement of professional medical associations in the implementation of state policy in the field of health and medical science;
improvement of state regulation in the field of provision of medicines, medical products and medical equipment;
increasing the interest of citizens in maintaining and strengthening their health.
III. Improving the organization of medical careThe main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.
Primary health care is the main link in the provision of medical care to the population.
A special role is given to the development of the institution of a general (family) practitioner. Consultative and diagnostic services should be developed in polyclinics. On their basis, departments of medical and social rehabilitation and therapy, care services, day hospitals, centers for outpatient surgery and medical and social assistance, etc. can be deployed.
The reorganization of inpatient care will ensure a reduction in the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the treatment and diagnostic process as follows: intensive treatment - up to 20 percent;
rehabilitation treatment - up to 45 percent;
long-term treatment of patients with chronic diseases - up to 20 percent;
medical and social assistance - up to 15 percent.
Wider use of day forms of stay of patients in hospitals.
It is necessary to revive inter-regional and inter-district specialized medical centers.
For high-quality medical care, it is necessary to ensure the continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of the provision of medical care, as well as between different types of medical institutions, becomes important. This implies the creation of a higher level of financing and management of health institutions.
Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.
It is necessary to take effective measures to develop the maternal and child health service, while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating obstetric institutions with the general medical network.
It is necessary to carry out comprehensive measures for the further development of psychiatric and narcological assistance to the population, the fight against tuberculosis and sexually transmitted diseases.
Measures to introduce modern technologies in intensive care units, cardiology and cardiac surgery, oncology, diagnostics and treatment of socially significant diseases require state support.
It is necessary to strengthen the ambulance service, make it more mobile and equipped with modern facilities for emergency medical care and emergency hospitalization of patients.
It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.
It is necessary to take measures of state support to improve rehabilitation assistance, the development of sanatorium-resort organizations of the healthcare system, health-improving institutions and organizations.
To improve the quality and accessibility of medical care to the rural population, it is necessary to form treatment and diagnostic complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of treatment, diagnostic and advisory assistance, and create inter-district clinical and diagnostic centers.
It is necessary to integrate departmental medical institutions into the general health care system on a single regulatory and legal basis, taking into account their industry specifics and location.
While maintaining the dominant role of state and municipal health care, the emerging private sector will play an important role. Creation of conditions for its development is the most important element of structural reforms in health care.
It is necessary to provide medical organizations, persons engaged in private medical activities, state and municipal organizations with equal rights to work in the system of compulsory medical insurance and participate in the implementation of state and municipal targeted programs. Participation of medical organizations of various forms of ownership in the implementation of state health programs, municipal orders should be carried out on a competitive basis.
State and municipal medical institutions that perform functions that are not related to the framework of a single technology for the provision of medical care should have broad powers in matters of the use of property and remuneration of personnel.
IV. Improving the health financing systemImproving the health care financing system implies a close dependence of the amount of financing of medical institutions on the volume and quality of the services they provide.
The financing system should ensure an increase in the efficiency of the use of resources and the quality of medical care.
For these purposes it is necessary:
develop legal mechanisms that ensure unconditional compliance with the volumes and conditions of compulsory medical insurance of the population with financial security;
establish the procedure for distributing federal budget funds allocated to equalize the conditions for financing compulsory health insurance programs in the constituent entities of the Russian Federation;
improve methods of setting tariffs for medical services;
introduce a unified system of payments for the provision of medical care provided under the program of state guarantees to provide citizens of the Russian Federation with free medical care;
to determine the mechanisms of financial coverage of part of the costs of providing medical care to citizens on the basis of the development of voluntary medical insurance;
promote the creation of a competitive environment in the medical services market.
The existing procedure for compulsory medical insurance needs to be improved. There are two possible financing schemes for medical organizations in the system of compulsory health insurance:
financing through insurance medical organizations providing compulsory medical insurance;
financing of medical organizations by branches of territorial funds of compulsory medical insurance.
The use of the second scheme is expedient for rural areas and areas with low population density, where the activities of insurance organizations and their competition with each other are objectively difficult.
To ensure the targeted and effective use of funds allocated by the state for healthcare, it is necessary:
to supplement the current legislation on health care with norms providing for stricter control over their spending, as well as over the financial and economic activities of health care institutions and organizations;
improving the accounting system for funds received by healthcare institutions, including for the provision of paid medical services, as well as their use;
improving the competitive system for the purchase of medicines, medical devices and medical equipment, the widespread use of financial leasing to equip healthcare facilities with medical equipment;
increasing the responsibility of compulsory health insurance funds for the results of their activities;
executive authorities and local self-government bodies, compulsory medical insurance funds, medical insurance organizations, medical institutions to publish mandatory annual reports on the expenditure of compulsory medical insurance funds and budget funds.
In 1998, in order to equalize the conditions for financing compulsory medical insurance programs in the constituent entities of the Russian Federation, it is planned to establish the distribution of insurance premiums in the following ratio: the Federal Compulsory Medical Insurance Fund - 0.5 percent, territorial compulsory medical insurance funds - 3.4 percent or 2 percent of the fund wages, if the income of citizens will be respectively more or less than 60 million rubles a year.
In the future, it is envisaged to combine funds earmarked for social and compulsory medical insurance in order to ensure their more efficient use within the framework of a unified system of compulsory medical and social insurance.
V. Organization of health careIn order to improve the provision of medical care, it is necessary to adopt federal laws on state, municipal and private health care as a matter of priority. This will ensure the implementation of state health policy at the modern level.
In order to implement a unified state policy in the field of healthcare, it is necessary to modernize the management structure of the industry.
The main tasks of the healthcare organization at the federal level should be considered:
determination of the health development strategy in the country;
development and implementation of federal targeted health care programs;
development of a legislative and regulatory framework for healthcare;
coordination of activities of public authorities to address health issues;
development of mechanisms for the operation of the control and permitting system in the field of circulation of medicines.
At the level of the subject of the Russian Federation, the main tasks of the healthcare organization should be:
development of health care taking into account regional characteristics;
development and implementation of territorial targeted health care programs and programs of state guarantees to provide citizens with free medical care in the territory of the constituent entities of the Russian Federation.
The main task of organizing health care at the municipal level should be considered the formation and implementation of municipal health care programs.
The main direction of improving the organization of health care is to ensure its integrity through unified approaches to planning, regulation, standardization, licensing and certification. At the same time, the system of compulsory medical insurance as the basis for financing medical care within the framework of state guarantees should have a positive impact.
The basis for planning will be federal health development programs that implement the goals and objectives of state policy for a certain period and include:
federal targeted programs for the development of health care;
programs of state guarantees to provide citizens of the Russian Federation with free medical care.
These federal programs must be approved simultaneously with the allocation of appropriate financial resources for their implementation.
To ensure a unified (basic) level of state guarantees in healthcare, medical and social standards should be approved at the federal level, including:
the main indicators of the provision of the population with hospitals and outpatient clinics, as well as doctors and paramedical personnel;
norms of per capita financing of health care.
In addition, methods for calculating the standards for providing health care institutions with material, labor and financial resources are being approved at the federal level.
The healthcare programs of the constituent entities of the Russian Federation include programs of state guarantees to provide citizens with free medical care, which should define:
health indicators to be achieved as a result of improving the health system;
the amount of funding from the health budget and compulsory medical insurance, ensuring the implementation of state guarantees;
general principles of financing and performance indicators of health care institutions;
measures to improve the efficiency of health care institutions;
main directions of preventive activity.
In the constituent entities of the Russian Federation, cost standards for outpatient and inpatient treatment should be approved. Based on these standards and morbidity rates, the structure of medical care for the population is determined.
The healthcare programs of the constituent entities of the Russian Federation serve as the basis for the formation of municipal programs that contain indicators of the volume of activities of healthcare institutions and their financing at the municipal levels.
Executive authorities at all levels control the implementation of relevant programs, which will increase the efficiency of healthcare organization.
In order to more rationally use financial and material resources in healthcare, it is necessary to establish that the largest investment projects for which budgetary funds are allocated are subject to mandatory examination by the Ministry of Health of the Russian Federation.
In conditions of insufficient financing of health care, duplication of work of medical institutions of the public sector, especially departmental health care institutions, should be excluded. It is necessary to attract departmental medical institutions to implement the program of state guarantees, which will make it possible to effectively use financial and material resources, implement the principle of equal treatment of the state to all citizens, regardless of their place of work, and reduce the financial burden on the budgets of departments. Separate departmental health care institutions should be transferred to the ownership of the constituent entities of the Russian Federation or to municipal ownership.
The priorities of international cooperation are the expansion and deepening of cooperation with the CIS member states, support for compatriots abroad (primarily in the provision of medical care) both at the intergovernmental level and through the provision of humanitarian assistance.
To ensure gradual integration into the world community on an equal footing, it is necessary to continue cooperation with international health organizations in the following areas:
protection of national interests in the implementation of international projects in the field of healthcare and health protection;
expanding participation in such international projects;
participation in medical care programs for citizens of certain countries;
adaptation of international criteria for the classification of diseases and standards of medical care for the Russian Federation;
international expertise of Russian bills in the field of public health protection;
study and application of international experience of legal regulation in the field of healthcare;
expanding the volume of medical care for Russian citizens abroad and foreign citizens in Russia.
Vi. Ensuring sanitary and epidemiological well-beingThe development and improvement of the state sanitary and epidemiological service of the Russian Federation (hereinafter referred to as the service) is the most important condition for improving the health of the country's population.
Ensuring the effective functioning of the service consists in the development and implementation of the state program for its development, which provides for bringing the organizational structure, management, resource and scientific support of the service, organizing its activities in accordance with the tasks and functions.
It is required to continue the reorganization of the structure of service institutions in accordance with the previously approved concept of restructuring the centers of state sanitary and epidemiological surveillance through the formation of departments (departments) for studying the influence of environmental factors on health, departments of hygienic education and education of the population.
It is necessary to provide:
a clear delineation of the functions of state sanitary and epidemiological supervision and sanitary and epidemiological activities between service organizations and medical and preventive institutions;
protection of the territory of the Russian Federation from the importation and spread of especially dangerous infectious diseases of people, animals and plants, as well as toxic substances;
introduction of new scientific developments;
strengthening interaction with other control and supervisory bodies;
improvement of the economic mechanism of activity and development of criteria for normative financing of institutions;
improvement of the legislative base in the field of state sanitary and epidemiological supervision, strengthening the organizational and legal status of the service;
reorganization of the system of hygienic upbringing and education of the population, formation of a system of self-healing of the population.
Vii. State guarantees for the provision of free medical care and protection of patients' rightsState guarantees for the provision of free medical care should be provided at the expense of the relevant budgets, payments for compulsory medical insurance and other revenues. To do this, it is necessary to adopt a program of state guarantees for the provision of free medical care to citizens of the Russian Federation, which should contain:
a list of relevant types of medical care;
volumes of medical care;
the basic program of compulsory medical insurance as an integral part of the program of state guarantees;
per capita standard of healthcare financing, which ensures the provision of guaranteed volumes of medical care.
In order to ensure the rights of citizens to health care, the adoption of a law on the rights of the patient is required.
VIII. Development of medical scienceThe main tasks of medical science should be:
formation of a strategy for maintaining and strengthening the health of the population, development of scientific foundations for combating the most common diseases;
on the basis of fundamental research, obtaining new and deepening existing knowledge about a healthy and sick human body, its vital activity and adaptation to environmental conditions;
development of new methods of prevention, diagnosis and treatment of diseases, restoration of lost health, increase in the duration of a person's active life;
development of new schemes for the organization of medical care and healthcare management.
The development of medical science will be based on the following principles:
concentration of scientific and technical potential and resources in priority areas of medical science;
increasing the role of program-target planning, improving the quality of scientific research expertise, ethical control over their conduct;
budget financing of fundamental and applied research on a competitive basis;
state support for research teams that make a great contribution to the development of domestic and world medical science, the use of extrabudgetary sources of funding (international projects, funds, etc.);
development of regional scientific and practical divisions, development of programs and research;
expansion of links between science, technology and production;
legislative consolidation of legal mechanisms for the development of medical science;
development of scientific and technical entrepreneurship, creation of small innovative enterprises and pilot productions;
protection of intellectual property rights of researchers on the results of scientific activity.
Budget financing of scientific developments should be carried out on the basis of competitive allocation of grants, creating for this purpose interdepartmental competitive commissions. To carry out developments in theoretical and practical areas, it is necessary to use a multi-channel financing system with the involvement of extrabudgetary sources.
Particular attention should be paid to research and development activities, which require state support to fund research that will ensure import substitution and contribute to the development of the domestic medical industry.
The Russian Academy of Medical Sciences will carry out the functions of identifying and developing the most important areas of fundamental and applied research, organizing and coordinating them in the Russian Federation, training highly qualified scientific personnel, and also participating in the development and implementation of scientific sections of federal and other programs.
The Ministry of Health of the Russian Federation should determine priorities in scientific developments of an applied nature and coordinate federal programs in terms of scientific support for the protection of human health and state sanitary and epidemiological surveillance.
The Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences should jointly carry out a comprehensive examination of federal and other scientific programs, present their recommendations on the introduction into practice and the effective use of the achievements of medical science.
The Ministry of Health of the Russian Federation, together with the Ministry of Science and Technology of the Russian Federation and with the participation of the Russian Academy of Medical Sciences, will coordinate the interaction of state executive authorities and local governments with research institutes, institutions and organizations of the medical and biological profile, develop and implement a system of measures to strengthening international relations in order to solve urgent problems of domestic science.
IX. Improving medical education and personnel policyPersonnel policy issues should be addressed taking into account the changes taking place in all areas of health care. It is necessary to develop a program for reforming the system of medical education, providing for a reduction in the training of medical workers in traditional specialties, and a revision of the structure of training specialists. It is necessary to improve the system of planning, forecasting and monitoring the training of health professionals, including in such new areas as a general practitioner, clinical pharmacologist, medical psychologist, nurse with a higher education, social work specialist, health economist, health manager.
It is necessary to improve the system of final state certification of graduates of medical and pharmaceutical educational institutions, as well as the certification of healthcare professionals.
In international relations in the field of personnel training, one should:
restore professional medical ties with the CIS member states;
develop work on the conclusion of international agreements
of the Russian Federation on the mutual recognition of medical diplomas and other documents on professional training, as well as internships for specialists, training of doctors and nurses abroad on the principle of exchange.
The system of planning and distribution of personnel potential is subject to reorganization, which should change the ratio of a doctor to a middle-level medical worker in the direction of increasing the number of the latter.
The practice of forming targeted orders for the training of specialists by health authorities with the conclusion of relevant agreements with educational institutions and applicants should be spread.
In order to include medical workers in the work of reforming health care, it is necessary to:
improve the system of remuneration of health care workers, taking into account harmful working conditions, the complexity, volume and quality of treatment and prevention work;
establish and index the wages of health workers in amounts not lower than the subsistence level;
regularly review the rates for medical services on the basis of tariff agreements with professional medical associations;
expand the list of categories of health workers, regardless of the departmental affiliation of the institutions in which they work, who are entitled to a pension for long service, working with a special risk to their health.
In the field of ensuring labor protection of medical workers, it is necessary to:
develop normative documents on labor safety in healthcare institutions;
organize training on labor protection issues for heads of government bodies and healthcare institutions, students of medical educational institutions;
pursue a unified policy to establish compensations and benefits for special working conditions of medical workers.
X. Improvement of drug provision, guarantees in the field of drug assistance to the populationThe state policy of providing the population with medicines and medical products is aimed at providing them to consumers in a sufficient quality assortment and volume at affordable prices.
The implementation of this policy should be carried out through the development of the market for pharmaceutical services.
In order to ensure the safe use of medicines and medical devices, it is necessary to improve the existing control and licensing system for examination, standardization and state control both at the federal level and at the level of the constituent entities of the Russian Federation.
The main direction of the implementation of the state policy in the field of drug care to citizens should be drug, including preferential, provision of the population in the provision of medical care within the framework of state guarantee programs.
At the stage of outpatient treatment:
formation, within the framework of state and municipal orders, of lists of medicines and medical devices for preferential provision of citizens;
formation within the framework of state and municipal orders of lists and volumes of medicines and medical devices for the treatment of socially significant diseases.
At the stage of inpatient treatment - free drug provision within the framework of the types, volumes and conditions for the provision of medical care provided for in state guarantee programs.
In order to effectively spend public funds allocated for the preferential provision of citizens with medicines and medical products, it is planned to develop and implement a system for accounting and controlling these funds, creating conditions that ensure the interest of citizens in the rational use of drug benefits.
In the field of wholesale purchases and retail sale of medicines, you should:
carry out these purchases and sales on a competitive basis and ensure transparency in the selection of wholesale suppliers of medicines;
to ensure the safety, efficacy and quality of medicines through the selection, standardization and monitoring of compliance with standards;
ensure the availability of a wide range of medicines in retail sales, in the stationary network - under state guarantee programs.
In order to ensure the availability and adequacy of drug care to the population, it is necessary:
improve the mechanisms of state regulation of drug provision;
provide state support for domestic drug manufacturers;
improve the organization of drug supply and the management of pharmaceutical activities.
XI. Expansion of the social base of healthcareIt is necessary to involve non-professional public organizations and professional medical and pharmaceutical associations, as well as individual citizens, in the work on protecting the health of citizens and providing medical and social assistance, which will increase the effectiveness of preventive work, including with socially vulnerable groups of the population, facilitate rehabilitation work with groups of patients, to develop the principle of mutual assistance and the skills of solving medical and social problems by the patients themselves.
Work to expand the social base of healthcare should be carried out in the following areas:
search for effective forms of cooperation with public, charitable and religious organizations;
drawing public attention to health issues, promoting the creation of public associations of patients on medical interests;
creation of a system of medical education and medical information, cooperation with the media in promoting a healthy lifestyle, strengthening control over advertising of medical industry products and medical services;
assistance in the implementation of state and public events aimed at preserving and protecting the moral health of society;
work among the population on family planning in order to form a conscious attitude towards the family, motherhood and fatherhood;
creation of a training system for employees of the Ministry of Internal Affairs of the Russian Federation, the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences natural Disasters and other special services for first aid.
XII. Mechanisms and stages of implementation of the ConceptTo ensure consistency in the implementation of the provisions of the Concept, work on its implementation will be carried out in 2 stages.
Stage I (1997-2000)
Implementation of the measures outlined in the program of the Government of the Russian Federation "Structural adjustment and economic growth in 1997-2000".
Taking measures to ensure the stable operation of health care institutions to increase the amount of funding for the industry and improve the efficiency of resource use in health care.
To this end, the provision of medical care to the population, starting from 1998, will be carried out within the framework of state guarantee programs for the provision of free medical care. At the same time, the amount of financial resources allocated for the implementation of these programs must comply with the state guarantees provided for in them.
Implementation during 1997-1999 of structural transformations in the industry. Carrying out the restructuring of inpatient care with the simultaneous development of outpatient facilities and the creation of day hospitals and hospitals at home. An important direction of this work will be the introduction of the institute of general medical practice.
Introduction in 1998 of the standardization of medical services, regulation of the provision of hospitals and polyclinics with medicines, medical products and medical equipment.
Completion by 1999 of work on the reorganization and elimination of duplication in the activities of federal health care institutions, including departmental ones.
Development and approval in 1997-1998 of federal targeted programs to combat tuberculosis and sexually transmitted diseases, to develop oncological care for the population, and to prevent and treat cardiovascular diseases.
The implementation of state anti-alcohol measures, the development and subsequent implementation of the federal targeted program to combat smoking will help reduce the incidence and mortality of the population.
Stage II (2001-2005)
Implementation of federal target programs for the development of health care, the implementation of which will create a basis for the introduction of effective methods of prevention, diagnosis and treatment of diseases into healthcare practice and provide the population with affordable qualified and specialized medical care.
Completion of work on the restructuring of the industry. As a result, a private sector should emerge in health care. In the system of primary health care, the main role will be assigned to general practitioners. Inter-district and inter-regional clinical centers of specialized medical care will be greatly developed. Mobile forms of providing medical care to the population in rural areas will be actively introduced.
Formation of a unified health monitoring information system, creation of telecommunication links between clinical centers and general (family) practitioners to consult patients and improve the professional knowledge of medical workers.
APPROVED BY
government decree
Russian Federation
November 5, 1997
No. 1387