Home Smell from the mouth The state of the health resort industry in the Russian Federation. Sanatorium and resort industry: problems and prospects

Smell from the mouth

The state of the health resort industry in the Russian Federation. Sanatorium and resort industry: problems and prospects

CONDITION AND IMPORTANCE OF THE SANATORIUM AND RESORT COMPLEX ON THE SERVICE MARKET OF RUSSIA AND KHABAROVSK REGION

Avetisyan Alina Edwardovna

5th year student, Department of Economics and Management at Trade Enterprises KhSAEP, Russian Federation, Khabarovsk

E-mail: rozohka@ mail. ru

Zolotova Yana Vladimirovna

scientific supervisor, Ph.D. econ. Sciences, Associate Professor KhSAEP, Russian Federation, Khabarovsk

The prospects for the development of the sanatorium and resort industry in Russia and the Khabarovsk Territory are significant. In order to satisfy medical and health needs, a person visits resorts, sanatoriums and holiday homes, where he receives high-quality treatment, undergoes health improvement and rehabilitation courses. Today, this area is one of the fundamental social institutions, solving the problem improving the quality of public health. Particularly relevant and necessary is the development of a regional sanatorium-resort network, the activities of which are aimed at the treatment and prevention of many diseases, since in some regions of our country an alarming level of general morbidity is recorded, sometimes exceeding 80-90%.

The purpose of the functioning of the sanatorium-resort territory is to comprehensively satisfy the medical and biological (treatment, recovery, prevention), social (recreation and leisure) and economic (reduction of disability, replenishment of local budgets, development of local infrastructure) needs of people and society as a whole. The resort area is a medical, health and recreational environment where a person receives full treatment, a series of health procedures or relaxes, and can also visit cultural and sports institutions.

Today, the market of sanatorium and resort services in Russia includes more than 2.2 thousand health and sanatorium and resort institutions with 371.2 thousand beds. Most of these health resorts are located in the Volga (22%) and Southern (28.8%) federal districts. This distribution is explained by the population density of the country and the favorable natural and climatic conditions of these regions.

Sanatorium-resort institutions differ in their organization and the number of clients served. This can be either a small hospital with 100 beds or a large multidisciplinary complex, which includes several sanatoriums with an annual turnover of hundreds of millions of rubles. Almost 60% of the market for sanatorium and resort services is represented by boarding houses with treatment and sanatoriums. The most popular areas of treatment are cardiology and neurology. To a lesser or greater extent, market participants are not only sanatorium and resort institutions of various types, but also individual complexes, travel companies specializing in organizing health-improving holidays, etc.

The maximum occupancy of sanatoriums and resorts occurs from June to September, with the busiest months being July and August. The market share of sanatorium and resort services in these months accounts for up to a quarter of the annual volume.

According to some data, the Russian market of sanatorium and resort services in 2011 increased by 8% compared to 2010 and amounted to about 65.5 billion rubles. According to experts’ forecasts, in the period from 2011 to 2015 the annual market growth is expected to be within 8%. The growth will be due to the expansion of the proposed treatment programs and, as a result, an increase in the number of consumers.

Recently, in the market of sanatorium and resort services, there has been a tendency towards requests for shorter, compared to standard, terms of sanatorium-resort courses. spa treatment. This, in turn, led to the consolidation of hospitals and an increase in the capacity of services provided. Reducing the average time spent in health resorts prevents more rapid growth market of sanatorium and resort services.

Medical and health services that a person receives within the institutions of a sanatorium-resort complex can improve the quality of health by 2-2.5 times. The use of natural healing factors in the treatment process makes it possible to increase the efficiency of citizens’ health improvement by more than a quarter and reduce the cost of treatment in a hospital by approximately 15%. Enterprises of the sanatorium-resort system form a separate sector of the regional economy, ensuring social stability in the development of depressed and marginal territories by replenishing the local budget and constructing infrastructure facilities.

The sanatorium and resort services industry in Russia employs 212.6 thousand people or 0.15% of the total population of Russia (Figure 1).

Figure 1. Dynamics of changes in the number of service personnel in the Russian sanatorium and resort complex by year

A general decrease in the number of service personnel (doctors, nurses, managers, maids, cooks, etc.) of the sanatorium-resort complex is observed in almost all regions of Russia, which needs to be stabilized through effective regional policies to regulate the development of the resort business. The reasons for the decrease in the number of personnel in sanatorium-resort institutions may be the following: a decrease in demand for resort treatment, the high cost of sanatorium-resort vouchers, which is caused by the high cost of medical care, as well as a decrease in government social support citizens for the allocation of preferential support for sanatorium treatment and rehabilitation.

In the complex of medical and recreational and preventive measures spa treatment occupies an important place. Sanatorium-resort institutions include sanatoriums, sanatoriums, boarding houses with treatment, resort clinics, balneological hospitals, year-round mud baths.

Resort fund Russian Federation- this is the totality of all identified and recorded natural healing resources, medical and recreational areas, as well as resorts and resort regions. Taking into account the vast expanses of Russia, the uniqueness and diversity of natural healing factors, and the development of the resort industry, the following are highlighted: resort regions:

· resorts of the North-West and North of Russia;

· resorts of Central Russia;

· resorts of the Volga region;

· resorts of the Urals;

· resorts of Siberia;

· resorts of the Far East.

Today, the country's health resort industry does not have a unified structure and is dispersed between various ministries, departments, joint stock companies, public organizations. In this regard, the development sanatorium organizations occurs unsystematically, in isolation, the main criterion and guiding vector here are only the interests and capabilities of the owners. However, regardless of departmental affiliation and organizational and legal form, the health resort industry is a single complex that requires organizational and methodological support and management.

In modern economic conditions, several groups can be distinguished in the structure of the country’s sanatorium and resort complex.

The first group includes non-profit treatment and preventive institutions with state and municipal ownership, operating on a “hospital” principle, providing primarily medical services and a limited list of other services. These institutions make up approximately 38% of the total number of enterprises in the industry.

The second category of health resorts (about 5%) consists of structures of departments and financial and industrial groups in the form health centers, most often representing hotel complexes with a developed medical and diagnostic base. In addition, the system of providing related services is highly developed: food, leisure, household, excursion, etc.

The remaining part of the enterprises of the sanatorium and resort industry ¾ are commercial enterprises of various organizational and legal forms, about 57%. Some of the enterprises of this group continue to operate according to the principles medical institutions, attracting funds from enterprises and organizations and personal funds of citizens, as well as funds from the Social Insurance Fund, for sanatorium and resort treatment. Thus, the processes currently taking place in the health resort industry represent a certain transition from free preferential medicine to medicine operating on a commercial basis.

The market for sanatorium and resort services contributes to economic development global, national and regional economies, all interacting industries, including transport, hotel management, catering, entertainment, medical treatment services provided to the population for the prevention and treatment of diseases, as well as the sale of leisure services (Figure 2).

According to Figure 2, the share of sanatorium and resort organizations in the Khabarovsk Territory in 2013 was 19%.

Figure 2. Share of health resort enterprises in the Khabarovsk Territory for 2013

A study of the dynamics of the number of people treated and vacationed in medical and health institutions in the Khabarovsk Territory for the period from 2010 to 2012 showed that this figure is gradually increasing from year to year. Thus, in 2010, the number of people who rested in medical and health institutions of the Khabarovsk Territory amounted to 50.1 thousand people, and in 2012 - ¾ 52.9 thousand people.

The dynamics of the number of citizens who were treated and rested in medical and health institutions of the Khabarovsk Territory is presented in Table 1.

Table 1.

The number of people treated and vacationing in medical and health institutions of the Khabarovsk Territory in 2010-2012, people.

Index
Sanatoriums
Sanatoriums - preventoriums
Total for sanatoriums and health resorts
Year-round health resort camps

Accommodation medical institutions sanatorium-resort type in the Khabarovsk Territory is uneven.

Thus, 9 medical and health institutions, or 36%, are located in the Khabarovsk city zone, 6 ¾ in the Jewish Autonomous Region in the village of Kuldur, 3 ¾ in Komsomolsk-on-Amur, 2 ¾ in the Vaninsky district (the villages of Vanino and Tumnin), also There are sanatoriums in Amursk, the villages of Khor and Solnechny.

As a rule, the location of institutions is determined by natural and climatic factors: the presence of medicinal mud, underground thermal springs, mineral waters, and ecologically clean forest zones.

The main profile of the enterprises is treatment and prevention various kinds diseases.

A number of medical and health-improving enterprises are general therapeutic institutions (health resorts “Dream”, “Rodnik”, “Yelochka”, “Breeze” and others).

Among the specialized institutions, the largest are the sanatoriums “Ussuri”, “Druzhba”, “Kuldur”, “Annensky Mineral Waters”.

The sanatorium-preventorium accepts all age categories, with the exception of specialized children's sanatoriums “Amursky” and “New Source”.

A number of medical and recreational enterprises have a departmental affiliation: the main contingent of their clientele is workers and their families related to certain industries and professions.

Thus, in the Khabarovsk Territory there are two sanatoriums for railway workers: “Zheleznodorozhnik” in the city of Khabarovsk and “Goryachiy Klyuch” in the village of Tumnin.

The Khabarovsk Oil Refinery, the Teploozersky Cement Plant, the Komsomolsk-on-Amur Metallurgical Plant and others have their own departmental sanatoriums.

Despite the focus on the main contingent, in order to reduce unprofitability, all departmental medical and health institutions accept third-party visitors, both adults and children.

Visitors are offered accommodation in single, double, triple and quadruple rooms, junior suites and suites. In all medical and health institutions, the necessary living conditions have been created, three and four meals a day are organized, as well as dietary food. Vouchers are offered for various periods of stay: from 1-3 days (for tourism and recreation) to 14-28 days (treatment and recovery). Certain categories of visitors are offered discounted vouchers. In addition to the basic services related to treatment and recovery, sanatorium and resort institutions in the Khabarovsk Territory offer additional services: various massages, baths, mud therapy, cultural, entertainment and sports events, swimming pools, excursions, trips.

During the study, the most competitive medical and health institutions in the Khabarovsk Territory were identified - these are the sanatoriums "Ussuri", "Military Sanatorium", "Zheleznodorozhnik" and "Kedr".

Health resorts in the Khabarovsk Territory make a significant contribution to the formation of a positive image of the Far East. In order to be in demand by health resort enterprises on the market, as well as to improve the quality of their services, they take part in the largest industry exhibitions - the Pacific International Tourism Exhibition, the international tourism exhibition "Leisure Leisure", the international specialized exhibition for the disabled, the All-Russian forum "Health nation", All-Russian specialized exhibition "Tourism. Sport. Recreation" and "Medicine and Health".

Every year there is a gradual increase in additional cultural and recreational services. Based on the above, we can conclude that current situation The market for sanatorium and resort services in the Khabarovsk Territory is characterized by a growing demand not only for medical and health services, but also for the expansion of the range of additional services for organizing leisure time for the population.

In May 2013, the annual All-Russian forum “Zdravnitsa-2013” took place in Sochi. The organizer of the event, the Ministry of Health of the Russian Federation, gathered the best representatives of the sanatorium and resort sector to discuss current issues and get acquainted with innovations, as well as to consider the topic of preserving and developing the sanatorium and resort complex Russia. The forum included a number of events: an international congress, an exhibition of achievements in the health resort industry, a creative competition, as well as numerous conferences, seminars and round tables. The topics of the exhibition were “Natural healing factors, treatment methods, rehabilitation and health improvement in sanatorium and resort institutions.” The main task of the “Health Resort” forum is to unite the efforts of all regions of the country, all sanatorium and resort organizations, regardless of their departmental affiliation, to preserve and develop the sanatorium and resort complex of Russia. Solving this problem requires the participation of specialists from various fields, the interaction of therapeutic and preventive areas of medicine, including representatives of the sanatorium and resort industry.

The State Program of the Russian Federation “Health Development” was approved (December 24, 2012 No. 2511-r). Program Goal: Accessibility medical care and increasing the efficiency of medical services, the volumes, types and quality of which must correspond to the level of morbidity and the needs of the population, and to the advanced achievements of medical science.

Thus, the sanatorium and resort sector is characterized by specific features and characteristics that qualitatively distinguish it from other spheres and sectors of the national economy. These features are directly related to the business activities of sanatorium and resort organizations, which are based on market principles of management. Russia has unique healing resources. This made it possible to create a system of sanatorium-and-resort treatment of various types in the country. The Khabarovsk Territory is one of the largest regions of the Far East in terms of economic potential due to its geographical location, rich history and unique natural resources, ideal for the sanatorium and resort sector.

Further success in improving the health of the Russian population will depend on the provision of sanatorium-resort treatment and rational use of the resources of the sanatorium-resort complex. It is also obvious that without improving the quality and accessibility of sanatorium-resort treatment, it is impossible to achieve the goals of increasing the birth rate and reducing the mortality rate and disability of Russians.

Bibliography:

1.Annual report of JSC Russian Railways-Health for 2010. M.: 2011 [Electronic resource] ¾ Access mode. - URL: http://www.rzdz.ru (date accessed 03/25/2014).

2.Vetitnev A.M., Zhuravleva L.B. Resort business: textbook. allowance. M.: Knorus, 2006. - 528 p.

3. Perova M.B., Perov E.V. Social statistics: mini-dictionary. M.: Finance and Statistics, 2005. -176 p.

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Chapter 1. Trends in the development of the sanatorium and resort sector in Russia

1.1 History of the development of sanatorium and resort business in Russia

1.2 Market of sanatorium and resort services: features of supply and demand

1.3 The place of sanatorium and resort business in the domestic tourism market

1.4 Chapter 1 Conclusions

Chapter 2. Sanatorium and resort potential of the Moscow region

2.1 Natural medicinal resources of the Moscow region

2.2 Sanatorium and resort network of the Moscow region

2.3 Analysis of the needs of the population of the Moscow region for medical recreation and treatment

2.4 Chapter 2 Conclusions

Chapter 3. Development Concept

3.1 Resort zoning of the territory

3.2 Strategy for the development of resort business in the Moscow region

3.3 Recommended conceptual model of management structure in the field of sanatorium recreation and treatment in Russia

3.4 Chapter 3 Conclusions

List of references and sources

Chapter 1. Trends in the development of the sanatorium and resort sector in Russia

1.1 History of the development of sanatorium and resort business in Russia

The beginning of the development of resorts in Russia dates back to the 18th century, when, on the instructions of Peter I, the Marcial, or Konchezersky (near Petrozavodsk), and Lipetsk waters were opened for treatment. With the annexation of the Caucasus, Crimea and Central Asia, rich in healing areas, the resort business began to develop more intensively. At the same time, domestic literature on balneology developed. At the end of the 18th century, a description of Russian resorts appeared. In the 19th century, literature devoted to the description of resorts and their use in various diseases, Cabbage L.I. has expanded significantly. Marcial Waters. Pages of the history of the first Russian resort. - St. Petersburg: "Dmitry Bulanin", 2006. - 100 p..

The authors of works on the study of Caucasian mineral waters were doctors Tsed (1817), Conradi (1824), Nelyubin (1825) and Savenko (1827). The development of Russian clinical balneotherapy was greatly promoted by the work of major clinicians: S.P. Botkina, A.A. Ostroumova and others, and especially G.A. Zakharyin - the founder of domestic balneology. However, resorts in Russia developed slowly. The tsarist government showed almost complete indifference to the domestic resort business and did not create conditions for its development.

The poor amenities of the resorts and the associated inconveniences for patients led to the fact that the Russian bourgeoisie preferred to be treated at foreign resorts, while the working population did not have the financial opportunity to go to resorts.

For many years, resort factors were applied empirically; there was no scientific approach to the study of both indications and contraindications for treatment at resorts. Doctors who worked at the resorts sought to present their resorts as a panacea for all diseases, and those who worked away from the resorts either trustingly sent even hopeless patients there for treatment, or were skeptical about treatment at the resorts.

Scientific balneology began to be created in Russia at the end of the 19th century. Its development was facilitated by the work of the Russian Balneological Society in the Caucasian Mineral Waters, the Odessa Balneological Society, as well as balneologists A.A. Lozinsky and V.S. Sadikov in Kemeri and others. V.A. has great merits in the development of Soviet balneology. Alexandrov Vetitnev A.M., Kuskov A.S. Medical tourism. - M., 2010. - 592 pp..

Scientific balneology and the establishment of resort business in general in pre-revolutionary Russia cannot be compared with the enormous scope of resort construction and achievements in this area after the Great October Socialist Revolution, which is explained by the exceptional attention to resorts shown Communist Party and the Soviet government.

Our country has a widely developed network of resorts, sanatoriums and holiday homes. The planned socialist construction of resorts began with the signature of V.I. Lenin issued a historic decree on March 20, 1919 on the transfer of all resort business to the jurisdiction of the People's Commissariat of Health. The resort wealth of our country is great and diverse. Before the Great October Socialist Revolution in Russia there was no scientific institution specifically dealing with issues of balneology, but now in our country there are a number of institutes of balneology.

I.P. also dealt with issues of experimental balneology, the most important branch of balneology. Pavlov. Back in 1923-1924. he specially sent his students to the Caucasian mineral waters (in Pyatigorsk) to organize an experimental laboratory and research therapeutic effect mineral waters on the body. An experimental laboratory created at that time, later reorganized into the experimental department named after I.P. Pavlova of the Pyatigorsk Balneological Institute, for many years carried out work, guided by the basic principles and ideas of I.P. Pavlov, whose attention to the work of this laboratory did not weaken until the end of his life.

The results of experimental work carried out in this laboratory to study the influence of mineral waters on the function of the digestive organs provided the basis for their scientific and effective therapeutic use for certain diseases. K.M. has done a lot to substantiate the effect of mineral waters on the body. Bykov and his employees (works of the Pyatigorsk and Zheleznovodsk clinics of the Balneological Institute).

Treatment of patients at resorts is mainly carried out in sanatoriums. In the Soviet Union there are also sanatoriums located outside the resorts. Of the 2,200 currently available sanatoriums, more than half are located outside the resorts of Kapusta L.I. Marcial Waters. Pages of the history of the first Russian resort. - St. Petersburg: "Dmitry Bulanin", 2006. - 100 pp. sanatorium resort medicinal natural

The Soviet government set the task of comprehensive development of sanatorium and resort care within the republic, region or group of regions (North, Central regions of the European part of the RSFSR, the Urals, Siberia, Far East and Central Asian republics). The sanatorium at the resort was a stationary medical and preventive institution that provided comprehensive treatment.

A centralized planning and management system was formed and implemented in the Soviet Union sanatorium-resort complex, however, as in all other areas, which provided the conditions for its stable existence and development.

The distribution system, which ensures the employment of most sanatoriums, did not stimulate work to improve the quality of services provided. By the mid-80s. XX century The economy of the resort complex became completely stagnant, equipment was not updated, and there were not enough funds for the expanded reproduction of health resorts. By the end of the 80s. XX century Centrally, money for many health resorts and sanatoriums ceased to be allocated at all; only departmental sanatoriums or those on the balance sheets of large enterprises remained operational. The rest were left to their own devices.

The level of comfort of many health resorts has long ceased to correspond modern requirements in this domain. The quality of service did not stand up to criticism. Many sanatoriums, especially those not located in the medical zone, began to repurpose themselves into other institutions or even abandoned R.M. Navodnichiy. Management of the development of the sphere of medical and health services in Russia // Abstract of the dissertation for the academic degree of Candidate of Economic Sciences. M.: 2011. - 26 p..

The reforms that began in 1991 destroyed the foundations of the previous system, including the system of functioning of the country's resort complex. But no replacement was created new system, there were no clear goals for the functioning and development of the industry in the near future. Everything was left to chance. All government funding was stopped from trade unions, including the withdrawal of social insurance funds from management, which in connection with this lost the function of distributing sanatorium and health vouchers and compensating vacationers for part of their cost. The created state social insurance funds already had other functions and principles of financing; they stopped allocating any funds to recreational enterprises, especially those belonging to enterprises and departments. Only the payment of the cost of vouchers was left within the competence of the funds. This deprived the health resorts of basic funds for expanded reproduction and reconstruction, not to mention capital expenditures to improve the quality of services (purchase of new equipment, staff training, etc.) and further development. The difficult economic situation of most entire sectors of the national economy has sharply reduced another source of financing for the resort complex - funds from consumption funds industrial enterprises, whose main task was the fight for survival. As a result, enterprises generally refused to finance sanatoriums and health centers. This could not but affect the condition of resort institutions; the statistical indicators of sanatorium and resort services sharply deteriorated.

The collapse of the USSR during this period led to the alienation of many important resorts and health resorts, especially Crimean and Caucasian ones.

In the period from 1990 to 1995, the crisis in the resort industry worsened: the number of resort visitors decreased by more than 3.6 times, the number of places in health resorts - by 34%. Economic reforms had a particularly strong impact on the functioning of tourist centers, which had the least comfortable accommodation conditions and the weakest material resources. The number of places in them has decreased over five years by 2.7 times, and the annual number of tourists - by 7.6 times. Only for the resort institutions of the Federation of Independent Trade Unions in 1993, the annual volume of capital investments decreased to 41.7 million rubles. compared to 185.8 million rubles. in 1990 Vetitnev A.M. Resort business. M.: KNORUS, 2012. - 528 pp..

In 1995, the standard service life of more than 1.5 thousand wooden buildings with 49 thousand beds expired, and 107 health resorts with 33.6 thousand beds needed complete reconstruction. The losses of the sanatorium-resort complex of trade unions amounted to 1 billion 365 million rubles in 1993, and the number of employees decreased by 23%.

Since many resorts were of national importance, they began to depend heavily on the seasonality of resort services, which became increasingly pronounced.

These changes led to the fact that the average annual occupancy of health resorts in Pyatigorsk, Kislovodsk, Anapa, Gelendzhik, and Sochi in these years did not exceed 60%. First of all, this is due to the high cost of air and train tickets, the unstable political situation, the proximity of these resorts to zones of armed conflicts, and the traditionally higher level of prices in resort areas for the main groups of consumer and food products compared to other regions of the country. In 1996, in the resort city of Sochi, with an average monthly occupancy rate of 40%, the third quarter accounted for 63.20% of the annual number of vacationers, 50.43% of the number of bed days and 57.97% of the annual revenue from the sale of vouchers. Every year the average number of “days of stay of vacationers” at the resort decreases. There is a reorientation of the main purposes of trips to all-Russian resorts from treatment to recreation Barchukov I.S. Sanatorium and resort business: textbook. A manual for university students studying in the areas of service and tourism / M.B. Barchukov. - M.: Unity-Dana, 2012. - 303 pp..

With the development of market reforms, the country's resort complex was reformed not only quantitatively, but also qualitatively. Major changes began to occur with changes in Russian legislation, privatization took place. Many “surviving” health resorts began to acquire new organizational and legal forms. Of the country's 2,416 stationary recreational enterprises (institutions), just over a third (35.5%) remained in the public sector; the remaining health resorts acquired the status of joint-stock companies (partnerships) or became resort branches of large enterprises.

Thus, recreational enterprises acquired economic independence and financial independence. Due to the end of the centralized distribution of vouchers and subsidies for them, an independent, unique market for vouchers began to be created. This market has shifted priorities to the supply of accommodation facilities, comfort, and quality of services provided.

Simultaneously with the formation of a new market, a new consumer began to form. The number of vacationers purchasing vouchers (tours) at full price and placing completely different (increased) demands on the level of service and variety of resort services has sharply increased, i.e. demand has changed. Satisfying personalized demand has formed the institution of intermediaries between consumers of sanatorium and resort services and accommodation enterprises, represented by travel agents and tour operators, as well as various resort and health associations.

Changes in legislation, especially tax legislation, also contributed to the emergence of travel agents, tour operators and various associations and business formations. Thus, in the new economic conditions, the formation of a completely new market for sanatorium and resort services is observed.

Moreover, it should be noted the positive dynamics in the indicators of recreational services for 1999 - 2000, which indicates a certain adaptation of resorts to market conditions. This trend is confirmed by the volume of sanatorium and resort services provided, as well as an increase in their share in the overall structure paid services population of the country.

However, the state presented the next “surprise” in 2001, when state funding was sharply reduced sanatorium treatment through social insurance. Since 2002 funding was stopped completely. The situation in the resort and sanatorium sector began to deteriorate again, although the occupancy rates of all-Russian resorts decreased by only 7-10%. On the other hand, this encouraged health resorts to take a more active part in the formation of the market for recreational services, especially those that have finally lost state support. Resort business: a textbook / A.M. Vetitnev, L.B. Zhuravleva. - 2nd ed., erased. - M.: KNORUS, 2012.-528 p..

As a result, with Russia’s entry into market conditions, there was a gradual adaptation of the sanatorium and resort complex. The situation in the newly formed market of recreational services has stabilized, the number of sanatoriums and holiday homes in all-Russian resorts began to grow by 5 - 10% annually. However, the trend towards reducing the length of stay at resorts and the seasonality of their operation still persists. But this situation has begun to change in recent years.

1.2 Market of sanatorium and resort services: features of supply and demand

The health resort market for health services is going through difficult times. Created during the Soviet period, it had a hard time learning the lessons of a market economy. In the early 90s of the last century, during the period of transfer of financing for resorts from trade unions to social insurance, sales volumes of resort services sharply decreased. In 1999 - 2000, health resorts gradually adapted to new conditions and reached a stable operating mode. But since 2002, after the reform of the Social Insurance Fund and the curtailment of state financial support, the sanatorium and resort complex fully experienced the laws of the market. It turned out that many health resorts were not ready to move from a relatively quiet existence to fierce competition for vacationers. Medical tourism as a modern direction spa medicine in Russia / A.N. Razumov [and others] // Issues of balneology, physiotherapy and exercise therapy. - 2009. - No. 3. - P. 46..

According to their purpose and the nature of medical work, sanatoriums at resorts are divided into general therapeutic, specialized non-tuberculosis, for tuberculosis patients and children's.

Specialized sanatoriums are divided into cardiological sanatoriums, for patients with diseases of the digestive and metabolic organs, organs of movement and support, the nervous system, rheumatism, the consequences of polio, diseases of the female genital organs, etc.

Sanatoriums for tuberculosis patients are divided into sanatoriums for treatment:

a) patients with active forms of pulmonary tuberculosis;

b) patients with bone tuberculosis;

c) patients with tuberculosis of the kidneys and urinary tract;

d) convalescents after tuberculous meningitis.

The following specialization has been established for children's sanatoriums:

1) for patients with active forms of pulmonary tuberculosis;

2) for patients with fading forms of pulmonary tuberculosis;

3) for patients with bone tuberculosis;

4) for convalescent children after tuberculous meningitis;

5) for patients with rheumatism;

6) for patients with rickets;

7) psychoneurological sanatoriums;

8) for patients who have had polio;

9) general therapeutic.

For outpatient patients, resort clinics and boarding houses Manshina N.V. have been organized at resorts. Spa therapy for everyone. For health, go to the resort. -M.: Veche, 2010. - 592 pp..

Much attention is paid to the selection of patients for treatment at resorts. The selection is made by attending physicians during long-term observation of the patient and after diagnosis. For proper selection, the doctor must know the basics of sanatorium-resort business and the indications and contraindications for referring patients to resorts. For each patient, the attending physician fills out a certificate of need for spa treatment, and after the patient receives a voucher, a sanatorium-resort card, which includes data from clinical laboratory, x-ray and inpatient examinations.

Treatment at the resort is indicated for patients in whom it can be assumed that permanent restoration of working capacity will occur. Indications are differentiated according to the seasons of spa treatment.

Local treatment and preventive institutions should monitor the patient upon his return from the resort and study the long-term results of treatment.

Many enterprises and institutions of the sanatorium and resort complex compete in the industry. All sanatoriums have different volumes of services, different organizational and legal forms, material and technical bases and staffing. There is no clear leader in the market. The market is relatively stable. In the 1990s, the sanatorium and resort complex, created during the Soviet period, experienced a period of sharp decline in sales of services. The main reasons were the removal of trade unions from the management of social insurance funds, the limitation of the fund’s ability to pay for sanatorium and resort treatment for workers and members of their families, a sharp decline subsidies to enterprises for resort treatment and rehabilitation. After the curtailment of state support for the sanatorium-resort complex, competition between enterprises for consumers intensified. Many sanatoriums have “left the race”. The remaining ones differ significantly from each other in the level of service provision, material and technical base and pricing policy. And they count on different target groups of consumers.

Most managers do not deal with this issue at all, believing that they can improve their health by buying vouchers at the expense of wages. Others pay a certain amount as compensation for a trip, both to a resort and a tourist one, at the employee’s choice. Under these conditions, the choice naturally falls either on a large resort with a “promoted” name, or on a trip to the warm sea. Often, when choosing a resort facility, the decisive factor is not the quality of the service provided, but its cost. Individuals prefer holidays abroad or in the southern regions of the country.

Every year, the Social Insurance Fund holds competitions for the improvement of health of persons registered with social protection authorities. The requirements for health resorts are such that either large sanatoriums or those resort institutions where the material resources are very poor can win the competition. high level. The rest are doomed to extinction. Some health resorts are being converted into hotels, losing their main meaning - improving the health of the population Resort business: a textbook / A.M. Vetitnev, L.B. Zhuravleva. - 2nd ed., erased. - M.: KNORUS, 2012.-528 p..

The most popular areas of work are the development of SPA technologies: clients really like different kinds massage, water procedures. Solariums have become less popular, and this is understandable - in the age of oncology, you need to be more careful with this procedure.

The main problems of the industry include insufficient attention to the sanatorium-resort complex from the authorities, the seasonality of the provision of recreational services, the imperfection of the animation and leisure component, the low level of management and material and technical base in a number of sanatoriums and, as a consequence, the low quality of the services provided. We cannot discount competitors from neighboring regions. Thus, in recent years, the health resort industry in Bashkortostan has been developing very intensively, and strong government support plays a big role here, which cannot be said about, for example, the Perm Territory.

Of course, the global financial crisis has had an adverse effect on the industry. Enterprises are cutting back social programs aimed at improving the health of workers. The solvency of the population has decreased, and, as a result, the flow of vacationers to sanatoriums has decreased. The industry requires large and long-term financial investments with low level returns, which adversely affects the possibility of lending, since banks are only interested in short-term financial investments. Promising is the emphasis not on treatment, but on health complexes, the development of specialized health programs, especially related to cosmetology and SPA technologies. The rapid development of medical technologies allows us to provide services at a fundamentally higher level. Those health resorts that, thanks to their competitive advantages, will be able to offer consumers something new will flourish.

Trends in the market of sanatorium and resort services fully correlate with the general ones in the country. Medical tourism as a modern direction of resort medicine in Russia / A.N. Razumov [and others] // Issues of balneology, physiotherapy and exercise therapy. - 2009. - No. 3. - P. 46. Thus, the government has long been trying to reduce costs: there was a project to reduce social security contributions from 5.4% to 3.4%. In 2003, the government submitted to the Duma a draft law that provided for a sharp, 3-fold reduction in funding for children's health care. But since 2010, the budget has been approved by deputies elected not from the people, but from parties. As a result, expenses for children’s health, after-care, and medical examinations were reduced from the social insurance budget. These funds appear in the regional budgets.

But the average resident continues to receive treatment in Russian sanatoriums. At least in recent years there has even been an increase. We can conclude that the development of the resort business is hampered by:

1) withdrawal from the state market;

2) the absence of a middle class in the country. The rich are not interested in this, the poor are unable to bear it.

Currently, weak SCOs are continuing to leave the market, then absorption processes will follow (including by non-core structures), as required by the market, which is increasingly “managing” the sphere of sanatorium and resort services Vetitnev A.M. Resort business. M.: KNORUS, 2012. - 528 pp..

Full development of the sanatorium sector is impossible without government support. Its absence may lead to the fact that sanatorium-resort institutions will increasingly transform into ordinary hotel facilities. In the same case, if the industry begins to be developed more actively, it may become dominant in the country’s economy.

1.3 The place of sanatorium and resort business in the domestic tourism market

In the hotel business, which also deals resort establishments, the main ones are hotels with a developed entertainment infrastructure: bars, discos, saunas, etc. and where the development of resort medicine is not necessary Volkov Yu.F. Introduction to hotel and tourism business: Textbook / Yu.F. Volkov. - Rostov-on-Don: Phoenix, 2013. - 348 p.. Russian resorts do not prioritize the development of the high-class hotel sector, but deservedly place emphasis on their main advantage - developed resort medicine, which allows for optimal use of resort resources for the improvement of people's health. Thus, spa medicine provides for the organization of work on the formation of a sanatorium-resort product, which is based on therapeutic or health-improving technology that improves the quality of life. The social significance of resort medicine lies in creating a significant part of the holistic system of prevention and health care through the formation of the “rest” subsystem (for healthy people) Barchukov I.S. Sanatorium and resort business: textbook. A manual for university students studying in the areas of service and tourism / M.B. Barchukov. - M.: Unity-Dana, 2012. - 303 pp..

In this regard, the functioning of the resort industry requires the development of new structural and organizational forms, developed taking into account historical, regional and national characteristics resort business. In recent years, the very term “balneology” itself has been called into question. It quite fully covers the variety of contents of the subject, including balneology, balneology, hydrothermal medicine, landscape therapy, etc. The term “health resort therapy” reflects the therapeutic side of the spa business. More often in this context, the more formal phrase “sanatorium-resort treatment” is used.

In general, in domestic healthcare, a three-stage rehabilitation system was developed and effectively operated, where sanatorium-resort activities played a significant role Vetitnev A.M. Resort business. M.: KNORUS, 2012. - 528 pp..

Stage 1 - polyclinic involves the provision of primary medical care at the place of residence for both children and adults. For these purposes, a network of children's and adult clinics has been deployed.

In addition, there are student clinics and medical and physical education clinics for those involved in physical education and sports, where high-class athletes are observed and undergo medical examinations before competitions, as well as anti-tuberculosis, dermatological and venereal, cardiological and other clinics. The tasks of the latter include early detection, prevention and treatment of patients, as well as long-term monitoring of them.

Stage 2 - clinical. At the outpatient or dispensary stages, up to 75-90% of all primary patients are treated, and patients with a complicated course, exacerbation of a chronic disease, or in emergency cases are referred for clinical treatment.

In a hospital setting, patients receive a course of medication or complex therapy, and according to indications, they undergo emergency or planned operations. Emergency surgical interventions include removal of a suppurating appendix (appendicitis), gall bladder (cholecystitis), removal of part of the stomach for a peptic ulcer in case of bleeding, etc. Planned operations are carried out after preparing the patient for surgical intervention on the heart (coronary bypass surgery), lungs (section resection for tuberculosis), vessels of the extremities (varicose veins), etc. After surgical interventions It is mandatory to prescribe rehabilitation treatment using physical therapy, massage, and physiotherapy.

The length of stay at the inpatient stage of treatment largely depends on the timely and comprehensive application of rehabilitation measures. On average, the inpatient stage in therapeutic clinics is 14-18 days, in surgical clinics 10-14 days. In cardiology (heart attack) departments, the length of stay reaches 30-45 days, which is due to the severity of the disease and the need for phased rehabilitation.

Stage 3 - restorative (supportive) occurs after discharge from the hospital. This stage of treatment is carried out under outpatient observation or sanatorium-resort treatment.

The greatest healing effect is observed with continuity of treatment and monitoring of patients. Restoring the patient’s physical and psychological activity in a local sanatorium or dispensary, usually located at the patient’s place of residence (in a suburban area), allows significant results to be obtained in 30-45 days.

According to indications and in order to consolidate the results of treatment, patients are referred to sanatorium-resort organizations. The choice of resorts depends on the availability of resort medicinal factors, such as mineral waters, medicinal mud, favorable climate, and other specific medicinal factors (naftalan, kumis treatment, speleotherapy, etc.) Vetitnev A.M. Resort business. M.: KNORUS, 2012. - 528 pp..

Indications for spa treatment and seasonality of stay are determined by the attending physician. In this case, it is necessary to strictly adhere to medical instructions, failure to comply with which leads to a decrease in health-improving effectiveness, and in some cases causes exacerbation of the disease and even death of people, for example, in a post-infarction state, with micro-strokes, etc.

Domestic balneology has developed complex system indications and contraindications for sanatorium-resort treatment and recovery for various diseases Barchukov I.S. Sanatorium and resort business: textbook. A manual for university students studying in the areas of service and tourism / M.B. Barchukov. - M.: Unity-Dana, 2012. - 303 pp..

Over time, rational schemes for comprehensive rehabilitation were introduced, taking into account age, gender and professional characteristics the body of vacationers. However, with Russia’s entry into a market economy, the conditions for the functioning of the resort industry have changed, and the need arose to develop new structural and organizational forms that take into account historical, regional characteristics and recreational and health-improving capabilities of resort factors. In addition, these forms should ensure increased profitability of the health resort industry, and therefore take into account business patterns and provide for the use of service quality management technology.

Regenerative medicine is a system of knowledge and practical activities aimed at restoring a person’s functional reserves, reduced as a result of the adverse effects of environmental factors and activities or as a result of illness (at the stage of recovery or remission), through the use of predominantly non-drug methods.

2) secondary prevention.

The first direction - protection (preservation and restoration) of the health of healthy or practically healthy people, covers persons with reversible functional disorders or premorbid disorders. The object of the restorative effect in this case is the reduced reserve regulatory capabilities of the body, the goal is the restoration of impaired functions and lost health.

As an independent section of the first direction, we can highlight the formation and restoration of emerging health in children and adolescents.

The second direction - secondary prevention - involves medical rehabilitation of sick people and disabled people with somatic diseases and irreversible morphological changes in organs and tissues. Rehabilitation treatment in this case is aimed at increasing functional reserves, compensating for impaired functions, secondary prevention of diseases and their complications, restoring reduced work functions or returning limited capacity against the background of partial health insufficiency.

Protecting and promoting the health of healthy and practically healthy people is one of the priority problems Russian system health care, in accordance with which a fundamentally new direction of activity is being developed - the transition of priorities from a system focused on the treatment of patients and rehabilitation of the disabled to a system based on the formation of a culture of health and aimed at preventing diseases Barchukov I.S. Sanatorium and resort business: textbook. A manual for university students studying in the areas of service and tourism / M.B. Barchukov. - M.: Unity-Dana, 2012. - 303 pp..

The protection of the health of a healthy person is understood as a set of measures of a political, spiritual, economic, legal, social, cultural, scientific, medical, sanitary and epidemiological nature, aimed at optimizing the conditions for the formation, active preservation, restoration and strengthening of health, ensuring a reduction in morbidity and an increase in population healthy and practically healthy people.

The protection and promotion of the health of healthy people is carried out in relation to citizens of the Russian Federation - both absolutely healthy (5-7%) and those with one or two diseases in a state of stable remission (55-70%). Among the latter, the most numerous part of the population is with disadaptation phenomena, a state of chronic fatigue, symptoms of fatigue and overwork, and a decrease in mental and physical performance. The named conditions with continued exposure to physical and social factors with a high probability lead to exacerbation of the underlying disease and the development of concomitant ones.

The need to solve this problem in Russia still remains very relevant due to the fact that, despite some positive trends, population health indicators and the state of national system health care in general are at an unsatisfactory level. This is manifested in extremely high morbidity and mortality rates, low birth rates, health status of mothers and children, quality of nutrition, especially for vulnerable segments of the population, and deepening social differentiation.

It should also be pointed out that in the Russian market the key difference is domestic tourism from the outbound - lack of formed packages. All the same things are offered: hotels, transfers, additional services at resorts, but there is no packaging with transportation Manshina N.V. Spa therapy for everyone. For health, go to the resort. -M.: Veche, 2010. - 592 pp..

This is due to the specifics of our transport services market. Russian Railways is a monopolist, and they have no interest in cooperating with operators. In the aviation market, there is an obvious tendency to redistribute the market by key airlines, which hold the bulk of all domestic traffic in Russia. As a result, they are also not interested in tour operators - selling a block for a regular flight to an operator at a low price, or, moreover, signing an agreement for charter transportation, is essentially creating unnecessary competition with your own hands for their sales of tickets for regular flights. Added to this is the lack of low-cost airlines on the Russian market. As a result - high prices for domestic flights and railway transportation, which significantly hinders the development of domestic tourism in Russia. It gets to the point of absurdity: for residents of a number of regions, the cost of moving to the resort exceeds the cost of a holiday at the resort by 2-3 times.

But, despite this, more than 30 million Russians annually vacation within the country. The reasons are different. Firstly, according to statistics, only about 10% of Russians have foreign passports. Secondly, more than half of tourists are families with children, for them our resorts mean the absence of a language barrier, traditional familiar cuisine, the absence of significant cultural, religious and behavioral differences, psychological feeling security - I'm in my country. Many people vacation in their region due to the high cost of transportation; the vast majority of these regions have their own tourist resources - forests, lakes, rivers, mountains, natural healing factors Tourism, hospitality, service: Dictionary-reference book / G.A. Avanesova, L.P. Voronkova, V.I. Maslov, A.I. Frolov; Ed. L.P. Voronkova. - M.: AspectPress, 2012. - 422 pp..

If we talk about the preferences of tourists, the first place goes to family vacations at the resorts of the Krasnodar Territory and Crimea. These Black Sea resorts are actively developing. In recent years, a sufficient number of modern hotels have appeared, focused on the Turkish format (all inclusive, animation, infrastructure for adults and children, SPA centers). The range of prices for accommodation during the high season in Ukraine is $40-70 per day with 3 meals a day, in Russia $50-150. The resort infrastructure is also developing - water parks, amusement parks, interactive museum areas are being built, and event tourism is developing.

The demand for sanatorium-resort holidays is growing steadily. Firstly, it is now becoming fashionable to be healthy, as a result, the average client of health resorts has become much younger - if recently it was the age category from 45 to 70, now it is from 30 to 50 years. And this is the most active and solvent part of the population Volkov Yu.F. Introduction to hotel and tourism business: Textbook / Yu.F. Volkov. - Rostov-on-Don: Phoenix, 2013. - 348 p. Secondly, the medical resorts themselves have recently begun to pay attention to updating their infrastructure. Private investors come, new sanatoriums are built, or old ones are completely reconstructed. Russia has powerful healing resources. There are only 18 unique resort areas, the healing factors of which have no analogues in the world. The traditions of our sanatorium treatment are more than 200 years old. Treatment methods are constantly being refined and developed thanks to advances modern medicine. Sanatoriums are creating new treatment programs, acquiring modern medical equipment. The quality of service is improving.

In third place in popularity is cultural and educational tourism, primarily tours to St. Petersburg, Moscow, and the Golden Ring. Interest in the countries of the post-Soviet space is being revived.

1.4 Conclusions from Chapter 1

The beginning of the development of resorts in Russia dates back to the 18th century, when, on the instructions of Peter I, the Marcial, or Konchezersky (near Petrozavodsk), and Lipetsk waters were opened for treatment. With the annexation of the Caucasus, Crimea and Central Asia, rich in medicinal areas, to Russia, the resort business began to develop more intensively. At the same time, domestic literature on balneology developed. At the end of the 18th century, a description of Russian resorts appeared. In the 19th century, the literature devoted to the description of spas and their use for various diseases expanded significantly.

The reforms that began in 1991 destroyed the foundations of the previous system, including the system of functioning of the country's resort complex. The collapse of the USSR during this period led to the alienation of many important resorts and health resorts, especially Crimean and Caucasian ones.

During the reforms, recreational enterprises acquired economic independence and financial independence. Due to the end of the centralized distribution of vouchers and subsidies for them, an independent, unique market for vouchers began to be created. This market has shifted priorities to the supply of accommodation facilities, comfort, and quality of services provided. An institute of intermediaries has been formed between consumers of sanatorium and resort services and accommodation enterprises, represented by travel agents and tour operators, as well as various resort and health associations.

Simultaneously with the formation of a new market, a new consumer began to form.

Thus, in the new conditions, a completely new market for sanatorium and resort services is being formed, and the sanatorium and resort complex has also gradually adapted.

The health resort market for health services is going through difficult times. Created during the Soviet period, it had a hard time learning the lessons of a market economy. In the early 90s of the last century, during the period of transfer of financing for resorts from trade unions to social insurance, sales volumes of resort services sharply decreased. In 1999 - 2000, health resorts gradually adapted to new conditions and reached a stable operating mode. But since 2002, after the reform of the Social Insurance Fund and the curtailment of state financial support, the sanatorium and resort complex fully experienced the laws of the market. It turned out that many health resorts were not ready to move from a relatively calm existence to fierce competition for vacationers.

The structure of the market for consumers of health resort services has changed. The number of vacationers who bought tours at full price and have completely different requirements for service has increased sharply. At the same time, the number of so-called “guaranteed client flows” decreases every year. There is a trend toward a decrease in the average number of days vacationers stay in sanatoriums, an increase in demand for “shortened” health programs, and the widespread introduction of SPA technologies.

All health resorts in Russia are becoming multidisciplinary, great attention is given to the service. Comfortable living conditions, food, and interesting leisure are the leading factors for the client when choosing a vacation spot.

In the past few years, the government's attention to legislative bodies The problem of developing tourism as a highly profitable sector of the economy was faced. A number of legislative programs were adopted on the development of tourism and tourism activities, the recreational sector, etc. The concept of tourism development adopted in Russia allocates a special place to medical tourism as “traditionally one of the main forms of tourist and recreational activity of the population.” The country's sanatorium and resort potential is considered as a material and technical base. Therefore, the development of medical tourism is promising direction health resort industry.

In accordance with modern concept development of healthcare and medical science in the Russian Federation, a new preventive direction, called “restorative medicine,” is increasingly developing in Russia.

Structurally, restorative medicine, as a branch of medicine, combines two main areas:

1) protecting the health of healthy and practically healthy people;

2) secondary prevention.

Protecting and promoting the health of healthy and practically healthy people is one of the priority problems of the Russian healthcare system, in accordance with which a fundamentally new direction of activity is being developed - the transition of priorities from a system focused on the treatment of the sick and rehabilitation of the disabled to a system based on the formation of a culture of health and aimed at preventing diseases.

The demand for sanatorium-resort holidays is growing steadily. Firstly, it is now becoming fashionable to be healthy, as a result, the average client of health resorts has become much younger - if recently it was the age category from 45 to 70, now it is from 30 to 50 years. And this is the most active and solvent part of the population. Secondly, the health resorts themselves have recently begun to pay attention to updating their infrastructure. Private investors come, new sanatoriums are built, or old ones are completely reconstructed. Russia has powerful healing resources. There are only 18 unique resort areas, the healing factors of which have no analogues in the world. The traditions of our sanatorium treatment are more than 200 years old. Treatment methods are constantly being refined and developed thanks to the achievements of modern medicine. Sanatoriums are creating new treatment programs and purchasing modern medical equipment. The quality of service is improving.

Chapter 2. Sanatorium and resort potential of the Moscow region

2.1 Natural medicinal resources of the Moscow region

The Federal Law of February 23, 1995 N 26-FZ (as amended by the latest amendments and additions dated June 25, 2012) “On Natural Healing Resources, Health Resorts and Resorts” defines natural healing resources, according to which they include mineral waters, therapeutic mud, brine of estuaries and lakes, healing climate, other natural objects and conditions used for the treatment and prevention of diseases and recreation http://base.garant.ru/10108541/1/#block_100.

A therapeutic and recreational area is a territory that has natural healing resources and is suitable for organizing the treatment and prevention of diseases, as well as for recreation of the population.

Based on these definitions, we will conduct a study of the natural medicinal resources of the Moscow region. Because, no matter how attractive sea resorts may look, it is preferable for a person living in central Russia to engage in health prevention in their area. Now the sanatoriums of the Moscow region have modern medical equipment, excellent recreation facilities, and the medical staff is fluent in modern treatment methods. Current state and prospects for developing the resort potential of the Moscow region / N.K. Dzhabarova [and others] // Issues of balneology, physiotherapy and exercise therapy. - 2007. - No. b. - pp. 46-47..

Sanatoriums in the Moscow region use the rich natural factors of Central Russia for treatment - the microclimate of forests, waters of mineral springs, therapeutic peat and sapropel mud, beaches of lakes, rivers and man-made reservoirs.

The Moscow region is located in the central part of the East European Plain, between the Volga and Oka rivers, in a zone of mixed forests. The terrain is mostly flat. In the east of the Moscow region there is the swampy Meshcherskaya lowland, and in the north and west there is the Smolensk-Moscow upland, the most high part, which reaches 285 m above sea level.

Forests occupy 50% of the territory of the Moscow region; The main species are spruce, pine, birch; in the south of the region there are oak and linden groves. The water axis of the Moscow region is the Oka and Moscow rivers (with tributaries Ruza, Istra, Yauza, Pakhra, etc.); lakes - Trostenskoye, Nerskoye, Chernok, etc. Within the Moscow region there is a network of reservoirs (Klyazmenskoye, Mozhaiskoye, Uchinskoye, Istrinskoye, Ikshinskoye) Mironenko N.S., Tverdokhlebov I.T. Recreational geography. - M.: MSU, 2011. - 208 p..

The basis of the natural resort resources of sanatoriums in the Moscow region are mineral waters. The Moscow groundwater basin, located in the center of the East European Plain, is one of the largest, forming a kind of underground sea.

The Moscow groundwater basin, located in the center of the East European Plain, is one of the largest, forming a kind of underground sea. In the middle of the 20th century, you could taste the “Moscow Mineral” from the pump room in the very center of Moscow, in the drinking gallery of the Research Institute of Balneology V.S. Nazarenko, O.V. Nazarenko, V.V. Nazarenko. Mineral healing waters and dirt. - Rostov-on-Don, 2008. - 162 p..

The waters of the “Moscow Sea” flow into pump rooms and fill the swimming pools of sanatoriums near Moscow.

Low-mineralized waters (M 2.3 5.5 g/l) of the Upper Devonian horizons, lying at a depth of 335 to 520 m, the composition is predominantly sulfate and sulfate-chloride sodium (calcium-magnesium-sodium), known as "Moscow mineral water" . The mineral waters of the springs located near the cities of Dorokhovo, Ramenskoye and Monino are similar in composition to “Moskovskaya Mineral”.

In the deepest parts (from 1000 m) of the Moscow artesian basin there are brines of high concentration - from 50 to 270 g/l, the composition of the water is sodium chloride, often with a high bromine content.

Drinking and brine waters within Moscow were discovered by wells in the area of New Arbat (Russian Scientific Center for Restorative Medicine and Balneology), on the banks of the Setun River (KB No. 1 "Volynskaya" UDP of the Russian Federation), in the Losiny Ostrov Nature Reserve (Svetlana Sanatorium). Since the 1930s, there have been wells of brine water on Talalikhina Street, which fill the bowl of the Atlant swimming pool and are used in the Specialized Clinical Hospital for Rehabilitation Treatment, located in this area of Moscow.

Many sanatoriums in the Moscow region have swimming pools with sea water - brine waters of the Moscow underground sea diluted with fresh water Nazarenko V.S., Nazarenko O.V., Nazarenko V.V. Mineral healing waters and mud. - Rostov-on-Don, 2008. - 162 p..

Sanatoriums in the Moscow region widely use balneotherapy, magnetotherapy, mud therapy, laser therapy, therapeutic massage, speleotherapy, physiotherapy, physical therapy, reflexology, herbal medicine and a huge range of other types of treatment and wellness procedures.

On the territory of the Moscow region there are several deposits of medicinal peat and sapropel mud. About 65 sanatoriums use peat and sapropel mud from deposits in the Moscow region. Currently, many sanatoriums use imported mud; in the Dorokhovo sanatorium, peat mud from the Yukhnovskoye deposits is used for mud treatment; in the Tishkovo sanatorium, high-silt sapropels of Lake Dolgoe and blue clay are used for mud treatment. Sapropels of Lake Biserova in the Balashikha region and peats of the Tatishchevskoye deposit in the Dmitrov region with therapeutic purpose not currently used.

Internal intake of mineral water is the main method in the treatment of diseases of the digestive system. Mineral water is prescribed to patients with gastric ulcers and 12 duodenum in the remission phase and in the unstable remission phase in the absence of pain; chronic gastritis with reduced and preserved secretion; chronic pancreatitis in the phase of stable remission; with diseases of the liver and biliary tract (gallbladder dyskinesia, chronic cholecystitis and hepatitis); diseases of the small and large intestines (irritable bowel syndrome; intestinal dyskinesia, etc.). Internal intake of mineral water also has a healing effect for diseases of the urinary system; for metabolic disorders (diabetes, obesity).

...

Bibliography

1. Vetitnev A.M.. Service-oriented concept of management of sanatorium and resort organizations in market conditions: dissertation... Doctor of Economic Sciences: 08.00.05. - Moscow, 2005.
2. Lobova S.V., Pyatkova O.N. Development of the sphere of tourist services in the Altai Territory // Regional economics: theory and practice. - 2010. - No. 2 (137).
3. Vetitnev A.M. Resort business: a textbook. - M.: KNORUS, 2007.

2016-09-16

At the end of 2015, there were 1,878 institutions in the sanatorium and resort industry of the Russian Federation, total places in these institutions amounted to 447,000. Over the past four years, the number of institutions has had an unstable dynamics caused by negative events in the country’s economy.

A sharp decrease in the number of sanatorium and resort institutions in 2013 was caused by the difficult economic situation in the country. Many institutions were unable to cope with the consequences of the crisis of 2008–2009 and 2013. and were forced to close.

Figure - Dynamics of the number of sanatorium and health institutions in Russia, units

It should be noted that, despite the decrease in the number of sanatorium and resort institutions, the number of rooms had a positive trend and increased by 6.4% during the analyzed period.

At the end of the first quarter of 2016, the total number of sanatorium and resort organizations in Russia amounted to 1,537 units with a total capacity of 353 thousand beds.

The total number of people treated and resting in sanatorium-resort institutions at the end of 2015 amounted to 6,476 thousand people, of which 375 thousand people received outpatient treatment.

Figure - Number of people treated and vacationing in sanatorium and resort institutions in Russia in 2012 -2015.

Compared to 2014, the number of people who vacationed in Russian health resorts decreased by 2.5%, but compared to 2012, an increase of 4.9% was noted. The reason for the reduction in the number of persons served in sanatorium-resort institutions was the increase in prices for sanatorium-resort services.

It should be noted that the maximum rate of attendance at health resorts in Russia was noted in 2014, which was associated with the volatility of foreign exchange market indicators and the rise in prices of vouchers to foreign resorts. Thus, due to the rise in the exchange rate of the dollar and euro and, accordingly, the increase in the cost of holidays abroad, the majority of Russians gave preference to the domestic resort.

Despite the fact that the number of people served in sanatorium-resort institutions in Russia decreased in 2015, there is a positive trend in the number of overnight stays in sanatoriums. At the end of 2015, this indicator showed an increase of 1%. Over the past 4 years, this figure has increased by 2.7%.

Figure - Number of overnight stays in sanatorium and resort organizations of the Russian Federation in 2012-2015.

In the first quarter of 2016, 1,123 thousand people rested in sanatorium and resort institutions in Russia, of which 97.2% were citizens of the Russian Federation and 2.8% were foreign citizens.

It should be noted that in the structure of the total number of people accommodated in sanatorium and health institutions of the country, 88.9% (997 thousand people) were accommodated on health vouchers.

Due to a decrease in attendance at health resorts in Russia in 2015, a decrease in the growth rate of market volumes was noted. At the end of 2015, the income of sanatorium and resort institutions amounted to 128.6 billion rubles. Compared to the same period last year, the growth rate was 113% (a decrease in the growth rate by 1 percentage point).

Figure - Market volume of sanatorium and resort services in Russia in 2012 -2015. in value terms

According to forecasts of market players, in 2016 the growth rate of the market for sanatorium and resort services is expected to decrease to 109.2% compared to 2015. Starting from 2017, the market situation will begin to stabilize, which will primarily be associated with the growth of domestic tourism and the active development of the industry by the state. In 2017-2019 The growth rate of the market for sanatorium and resort services will not exceed 10% per year.

Today, the active growth of the market for sanatorium and resort services in the country is hampered by a number of factors, which include:

Lack of a unified strategy for the development of the health resort industry and insufficiency of regulatory and legal regulation.
Lack of qualified personnel.
The outdated material and technical base often does not meet modern world standards.
Transport accessibility.
Low level of service.
High price level.
Insufficient awareness of the country's citizens, tour operators, and travel agencies about existing health resorts and the services they offer to their clients.
Decrease in income of the population due to crisis phenomena in the economy.

For questions regarding the valuation of businesses/enterprises in Krasnodar, Novorossiysk, Sochi and other cities Krasnodar region please contact .

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Speaking about the most important role of the resort industry in the prevention of diseases, treatment and rehabilitation of patients, it should be noted the low financial support of the state’s obligations for sanatorium treatment of citizens, the exclusion of sanatorium treatment from types of insurance coverage, the weak solvency of the population, the insufficient demand by the state for the services of sanatorium and resort organizations of all forms of ownership . And, as a consequence, the lack of phasing in the provision of medical care and the persisting high morbidity and disability of the population.

There is no need to convince of the importance of the therapeutic and preventive role of the sanatorium and resort industry, which has always been one of the most effective and widespread parts of domestic healthcare.

Based on this, the Ministry of Health proposed the concept of a program for the development of sanatorium and resort treatment, which not only highlights the problems of the sanatorium and resort industry, but also outlines the main ways to solve them.

The task is to constructively refine the concept, taking into account more effective use of the potential of health resorts for improving the health of the population.

It should be noted that at present there is no reliable accounting of either the number of sanatorium-resort institutions or the number of people who received treatment.

Thus, according to some data from Rosstat, in 2011 there were 2461 sanatorium-resort organization for 499 thousand beds, providing treatment to 5 million 382 thousand patients, according to others - 1958 organizations for 345.6 thousand beds, treating 4 million 951 thousand people, and, according to the Ministry of Health, there are now 1944 sanatoriums and resorts in Russia institutions of various forms of ownership, which treated 6 million 297 thousand patients in 2010 (Rosstat data).

Although the main directions of modernization of the sanatorium-resort treatment system provide for the maintenance of the State Register of the Resort Fund of the Russian Federation, in our opinion, this should be the primary task of the federal executive body in accordance with Article 4.1 No. 23-FZ.

Sanatorium and resort organizations included in the State Register will provide treatment to patients through state orders without any competitions. Repurposing a sanatorium for the morbidity of the population must be carried out taking into account the presence of natural healing factors. And the coverage of sanatorium and resort treatment from 6% in 2012 to 45% can be increased not by 2020, but in the next 2-3 years.

To do this, it is necessary to use the following reserves:

The bed should work not 215-253 days, but 320-350 days a year. In addition, all health resorts included in the State Register must be involved, regardless of their form of ownership. Institutions not included in the State Register will accommodate clients coming for short periods of time, receiving fitness, wellness, SPA, other health services, as well as course treatment at the resort.

If there is no reliable accounting of the resort fund, it is impossible to give an objective assessment of its condition, determine the number of people treated on vouchers and in a shortened period of time, the medical profile of health resorts and the sources of financing for stay in sanatoriums. Not to mention the social, professional and age structures of those treated and the demand for treatment profiles at resorts.

In addition, natural medicinal resources, specially protected areas must be taken into account, their intended use, exploration, and study must be carried out. Reserving them for future resort construction. Today, without determining the real state of the resort industry, it is impossible to build a program for its development. For your information: the area of all lands of medical and recreational areas and resorts is only 0.09% of the area of lands of specially protected areas and facilities.

The effectiveness and demand for sanatorium treatment is evidenced by the fact that in 2011, 431 thousand patients, including 99 thousand children, were treated at resorts using kursovka. And this despite the fact that in 2012, 136 million rubles were allocated from the federal budget for the promotion of Russian tourism products, and 0 for the promotion of resort products.

Outbound tourism increased by 11.8% and amounted to 14 million people in 2011, who took more than 30 billion US dollars out of the country.

Due to the fact that the “creeping” privatization of resort lands has been going on in Russia for a long time, it is necessary to temporarily introduce a moratorium on the sale of lands for medical and recreational purposes, register them, understand for what purposes they are used and by whom, whether planned restoration of natural healing resources, especially whether the lands are reserved for future resort construction or are already being illegally built up today with facilities that have nothing to do with the medical and recreational business. We need to eliminate violations. This is the most important, urgent task.

In recent years, the budget of the Social Insurance Fund of the Russian Federation has not provided funds to pay for sanatorium vouchers for workers and members of their families. Sanatorium assistance programs for citizens belonging to preferential categories are being reduced.

Funds from the federal and regional budgets for sanatorium and resort treatment of citizens preferential category decreasing from year to year. In addition, the competitive cost of a bed-day stay in a sanatorium is set significantly lower than the actual one.

It is known that the costs of sanatoriums are determined by maintaining the required level of material and technical base, room capacity, medical facilities, the maintenance of qualified medical and service personnel, the cost of tax deductions (in particular, property tax and land tax) and occupy a significant share in the cost of the voucher.

Along with a significant increase in prices for utilities, prices for food and household expenses are rising sharply, and bank loans are becoming more expensive. In general, the costs of health resorts are increasing sharply. Due to the increase in costs, the cost of travel also increases.

As for seasonal health resorts, they receive income for 2-4 months a year, and incur costs all year round, with a profitability of no higher than 3-7%.

Until 2006, there were benefits on property tax and land tax for the country's sanatorium and resort complex. After their abolition, the increase in the tax burden fell on the cost and price of vouchers. In particular, according to SanPiN 2.4.4.1204-03, the area of land for sanatoriums is 150 sq.m. when located in resorts, and 200 sq.m. outside resorts. for one bed. The sanatorium does not have to pay for this land, because... The word “resort” literally means “healing area.” The intended use of this land is protected and regulated by current legislation.

Years	Number of sanatorium and resort organizations and recreation organizations, total	They have beds	Including sanatoriums and boarding houses with treatment	They have beds	Including children's sanatoriums	They have beds
1990	7431	129847	1176	296653	619	81069
2000	4876	754461	1192	287518	528	81510
2002	4709	754025	1279	326169	553	106618
2004	4579	796475	1319	340696	579	112052
2006	4490	761841	1321	354316	580	123021
2008	4484	753331	1361	359460	569	117978

	Number of accommodated persons, total
	2000	2005	2008
Total:	25073,4	28410,9	35454,8
Including:
Hotels and similar accommodation facilities	165559,3	18546,8	24757,6
Sanatorium-resort organizations and recreation organizations, total:	8514,1	9864,1	10697,3
Of them:
Sanatorium and resort organizations	4583,7	5941,2	6356,5
Recreation organizations	3345,8	3411,0	3798,9
Tourist bases	584,6	313,6	364,8

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Chapter 1. Trends in the development of the sanatorium and resort sector in Russia

1.1 History of the development of sanatorium and resort business in Russia

1.2 Market of sanatorium and resort services: features of supply and demand

1.3 The place of sanatorium and resort business in the domestic tourism market

1.4 Chapter 1 Conclusions

Chapter 2. Sanatorium and resort potential of the Moscow region

2.1 Natural medicinal resources of the Moscow region

2.2 Sanatorium and resort network of the Moscow region

2.3 Analysis of the needs of the population of the Moscow region for medical recreation and treatment

2.4 Chapter 2 Conclusions

Chapter 3. Development Concept

3.1 Resort zoning of the territory

3.2 Strategy for the development of resort business in the Moscow region

3.3 Recommended conceptual model of management structure in the field of sanatorium recreation and treatment in Russia

3.4 Chapter 3 Conclusions

Chapter 1. Trends in the development of the sanatorium and resort sector in Russia

1.1 History of the development of sanatorium and resort business in Russia

The poor amenities of the resorts and the associated inconveniences for patients led to the fact that the Russian bourgeoisie preferred to be treated at foreign resorts, while the working population did not have the financial opportunity to go to resorts.

A centralized planning and management system was formed and implemented in the Soviet Union sanatorium-resort complex, however, as in all other areas, which provided the conditions for its stable existence and development.

The collapse of the USSR during this period led to the alienation of many important resorts and health resorts, especially Crimean and Caucasian ones.

Since many resorts were of national importance, they began to depend heavily on the seasonality of resort services, which became increasingly pronounced.

Changes in legislation, especially tax legislation, also contributed to the emergence of travel agents, tour operators and various associations and business formations. Thus, in the new economic conditions, the formation of a completely new market for sanatorium and resort services is observed.

1.2 Market of sanatorium and resort services: features of supply and demand

According to their purpose and the nature of medical work, sanatoriums at resorts are divided into general therapeutic, specialized non-tuberculosis, for tuberculosis patients and children's.

Specialized sanatoriums are divided into cardiological sanatoriums, for patients with diseases of the digestive and metabolic organs, organs of movement and support, the nervous system, rheumatism, the consequences of polio, diseases of the female genital organs, etc.

Sanatoriums for tuberculosis patients are divided into sanatoriums for treatment:

a) patients with active forms of pulmonary tuberculosis;

b) patients with bone tuberculosis;

c) patients with tuberculosis of the kidneys and urinary tract;

d) convalescents after tuberculous meningitis.

The following specialization has been established for children's sanatoriums:

1) for patients with active forms of pulmonary tuberculosis;

2) for patients with fading forms of pulmonary tuberculosis;

3) for patients with bone tuberculosis;

4) for convalescent children after tuberculous meningitis;

5) for patients with rheumatism;

6) for patients with rickets;

7) psychoneurological sanatoriums;

8) for patients who have had polio;

9) general therapeutic.

For outpatient patients, resort clinics and boarding houses Manshina N.V. have been organized at resorts. Spa therapy for everyone. For health, go to the resort. -M.: Veche, 2010. - 592 pp..

Treatment at the resort is indicated for patients in whom it can be assumed that permanent restoration of working capacity will occur. Indications are differentiated according to the seasons of spa treatment.

Local treatment and preventive institutions should monitor the patient upon his return from the resort and study the long-term results of treatment.

The most popular areas of work are the development of SPA technologies: clients really like different kinds massage, water procedures. Solariums have become less popular, and this is understandable - in the age of oncology, you need to be more careful with this procedure.

But the average resident continues to receive treatment in Russian sanatoriums. At least in recent years there has even been an increase. We can conclude that the development of the resort business is hampered by:

1) withdrawal from the state market;

2) the absence of a middle class in the country. The rich are not interested in this, the poor are unable to bear it.

Currently, weak SCOs are continuing to leave the market, then absorption processes will follow (including by non-core structures), as required by the market, which is increasingly “managing” the sphere of sanatorium and resort services Vetitnev A.M. Resort business. M.: KNORUS, 2012. - 528 pp..

1.3 The place of sanatorium and resort business in the domestic tourism market

In general, in domestic healthcare, a three-stage rehabilitation system was developed and effectively operated, where sanatorium-resort activities played a significant role Vetitnev A.M. Resort business. M.: KNORUS, 2012. - 528 pp..

Stage 1 - polyclinic involves the provision of primary medical care at the place of residence for both children and adults. For these purposes, a network of children's and adult clinics has been deployed.

Stage 2 - clinical. At the outpatient or dispensary stages, up to 75-90% of all primary patients are treated, and patients with a complicated course, exacerbation of a chronic disease, or in emergency cases are referred for clinical treatment.

Stage 3 - restorative (supportive) occurs after discharge from the hospital. This stage of treatment is carried out under outpatient observation or sanatorium-resort treatment.

2) secondary prevention.

As an independent section of the first direction, we can highlight the formation and restoration of emerging health in children and adolescents.

In third place in popularity is cultural and educational tourism, primarily tours to St. Petersburg, Moscow, and the Golden Ring. Interest in the countries of the post-Soviet space is being revived.

1.4 Conclusions from Chapter 1

Simultaneously with the formation of a new market, a new consumer began to form.

Thus, in the new conditions, a completely new market for sanatorium and resort services is being formed, and the sanatorium and resort complex has also gradually adapted.

All health resorts in Russia are becoming multidisciplinary, great attention is given to the service. Comfortable living conditions, food, and interesting leisure are the leading factors for the client when choosing a vacation spot.

In accordance with modern concept development of healthcare and medical science in the Russian Federation, a new preventive direction, called “restorative medicine,” is increasingly developing in Russia.

Structurally, restorative medicine, as a branch of medicine, combines two main areas:

1) protecting the health of healthy and practically healthy people;

2) secondary prevention.

Chapter 2. Sanatorium and resort potential of the Moscow region

2.1 Natural medicinal resources of the Moscow region

A therapeutic and recreational area is a territory that has natural healing resources and is suitable for organizing the treatment and prevention of diseases, as well as for recreation of the population.

Sanatoriums in the Moscow region use the rich natural factors of Central Russia for treatment - the microclimate of forests, waters of mineral springs, therapeutic peat and sapropel mud, beaches of lakes, rivers and man-made reservoirs.

The basis of the natural resort resources of sanatoriums in the Moscow region are mineral waters. The Moscow groundwater basin, located in the center of the East European Plain, is one of the largest, forming a kind of underground sea.

The waters of the “Moscow Sea” flow into pump rooms and fill the swimming pools of sanatoriums near Moscow.

In the deepest parts (from 1000 m) of the Moscow artesian basin there are brines of high concentration - from 50 to 270 g/l, the composition of the water is sodium chloride, often with a high bromine content.

Many sanatoriums in the Moscow region have swimming pools with sea water - brine waters of the Moscow underground sea diluted with fresh water Nazarenko V.S., Nazarenko O.V., Nazarenko V.V. Mineral healing waters and mud. - Rostov-on-Don, 2008. - 162 p..

Sanatoriums in the Moscow region widely use balneotherapy, magnetotherapy, mud therapy, laser therapy, therapeutic massage, speleotherapy, physiotherapy, physical therapy, reflexology, herbal medicine and a huge range of other types of treatment and wellness procedures.

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