On modern stage healthcare reform, improving primary health care (PHC), expanding its scope, improving quality and efficiency are considered one of the most important tasks.
The goal of reforming outpatient care, as well as the entire health care system, is to adapt medical care to market conditions, review the relationship between the state, the population and medical institutions, and introduce new principles for the provision of primary care. To achieve this goal, it is necessary to solve the following tasks:
- maximum intensification of the doctor’s activity by giving him freedom to choose the forms of organizing his work.
- exemption from activities that do not require medical competence. (Mendrina G.I., Oleinichenko V.F., 1997)
To develop medical care without compromising its quality, you can either decide on an extensive path of healthcare development, providing for an increase in the number of beds in hospitals, or on transferring the main burden of providing primary medical and social care to the outpatient clinic and creating alternative forms of medical care while optimizing the efficiency of the functioning of a medical institution and improving the quality of medical services. (Mighty O.V., 1997)
The implementation of primary health care reform should significantly improve the quality and efficiency of medical services at the prehospital stage, incl. at home, and emergency medical care provided by clinics, improve the continuity of medical care at all levels, and reduce the need for hospitalization.
For these purposes it is necessary:
- establish legislatively that state (municipal) outpatient clinics retain their non-profit status and must become independent legal entities with all the relevant attributes;
- develop and implement at the prehospital stage a system for monitoring the health status of the population, the need for medical and social care and drug provision;
- increase resource provision outpatient clinics;
- develop and implement algorithms for the provision of medical care at the prehospital stage; (Skvirskaya G.P., 1998).
When discussing ways to improve public health, primary health care is considered a crucial link in this process. The basis for the reorganization of primary health care should be the general practitioner (family doctor) (Pavlov V.V., Galkin R.A., Kuznetsov S.I., 1997).
Consolidating these structural and functional perspectives, the general opinion is that at present it is advisable to shift the structure of total costs between the hospital and the clinic from the ratio of 80 and 20 to the ratio of 60 and 40. Some call the ratio 50 and 50, which is difficult to implement under current conditions, although there is a ratio abroad such examples. When allocating costs for outpatient care in the amount of 40% of total expenses, a general practitioner can take on work equal to 20% of all expenses in payment against 6-8% of a local general practitioner in the past (Shchepin O.P., Ovcharov V. K., Korotkikh R.V., Dmitrieva N.V., Lindenbraten, 1997).
It has already been said that one of the key issues in carrying out health care reform is the reform of primary health care, i.e. a gradual transition to its organization on the principle of a general practitioner and a family doctor.
The main direction of the reform is the structural restructuring of the industry in a market economy and the introduction of health insurance with the mandatory preservation of publicly available medical and medicinal assistance to all citizens. Naturally, this structural restructuring of the industry involves, first of all, the transformation of primary health care and social care.
At the same time, depending on the need, the volume and structure of medical services provided by specialized specialists should change step by step. Their activities should be aimed primarily at providing consultations, providing high-tech medical services, and increasing the volume and quality of preventive care for the population.
Given the current situation, the question clearly arises of the need to develop a program for reforming outpatient care, which should be based on improving the quality of primary health care. At the same time, one of the main conditions for reforming primary care is the maximum preservation of all available material, labor and financial health care resources. It is not planned to destroy existing medical institutions, but to change their functions, working methods, financing systems and relationships. (Zyyatdinov K.Sh., 1997).
Of primary importance is the optimization of the organizational and functional relationship between outpatient and inpatient units. Each of them must provide medical care that most closely matches its purpose. At the same time, the level of technical support, personnel qualifications, the degree of medical specialization, and the features of the services provided are significantly different, and in each specific case, the choice of one of these links for the provision of medical care should be fully appropriate.
It is necessary to overcome the existing imbalance between the activities of outpatient clinics and inpatient facilities, which leads to irrational proportions in the financing of the industry. Provided that the complex of functions performed in outpatient clinics is optimized, it becomes possible to assign predominantly more specific and complex tasks to the hospital, which will entail a reduction in the required volume of beds.
A task arises that must be solved as soon as possible - organizing the optimal distribution of patient flows to the appropriate institutions with a focus on the most complete, highly professional and intensive functioning of the outpatient clinic.
It should be borne in mind that the strategic task of redistributing volumes of care in favor of the outpatient clinic can be solved if there is an economic basis, targeted training of medical and nursing staff. medical personnel.
In fact, modern healthcare is gradually being reformed into a 3-link system: inpatient, semi-inpatient and outpatient clinics.
There is no doubt that the implementation of the entire complex of these measures is possible only in the conditions of a new medical care management system, based on a reasonable combination of centralization and decentralization of this process with the integration of the efforts of all interested legislative and executive government structures, as well as relevant federal and regional departments level on the implementation of equal rights guaranteed by the state to the entire population, in receiving affordable and high-quality medical care. (Svetlichnaya T.G., Krom L.I., Zenishina V.E., Udalova L.S.)
Thus, from the above it follows that the need for reforms in healthcare is obvious. However, they must be justified, and the main criteria for assessing the chosen direction should be the satisfaction of patients and doctors (Komarov Yu.M., 1997).
Based on the law “On health insurance of citizens in the Russian Federation,” the transition to additional financing from insurance funds does not yet solve even the problem of stabilizing the health care system due to insufficient contributions (3.6% of the wage fund) to the compulsory health insurance fund. Therefore there was urgency in the effective and rational use of existing resources, in the creation of more rational forms of medical care in order to maintain the effective operation of the public health system.
At the same time, the mechanism for the functioning of health insurance requires modernization of the health care infrastructure and, above all, primary health care, which must successfully solve not only medical, but also social and hygienic issues. One of the areas that makes it possible to increase the social, economic and medical efficiency of the functioning of the public health system is the reform of primary health care - the main component of the health care reform program. The term "primary health care" (PHC) appeared during the preparation and holding of the International Conference under the auspices of the World Health Organization (Alma-Ata, 1978). At this conference, the basic principles of organizing primary health care were formulated and a powerful impetus was given to the development of international cooperation in this area.
The basic principles of organizing primary health care are defined in WHO documents as follows:
- Primary health care is the main means to realize the main goal - achieving a satisfactory level of health for all.
- Primary health care should be based on practical, evidence-based and socially acceptable methods and technologies that should be accessible to both individuals and families.
- The population must actively participate in health care.
- The costs of organizing primary health care must be justified both for the community and for the country as a whole at each stage of its development.
- Primary health care is an integral part of the national health care system and is its core. This is the first step in the contact of an individual, family, community with the entire national health care system. Primary health care should be as close as possible to a person’s place of residence and work, as it forms a continuous process of protecting public health.
- Primary health care should be as accessible as possible, i.e. Any person should have the opportunity to receive highly qualified medical care in the shortest possible time and in the proper amount.
- The activities of primary health care should be coordinated with the activities of the social and economic sectors at the federal, territorial and local levels.
- Health policies must be able to provide accessible primary health care to all segments of the population.
- All parts of the national health care system should support primary health care through professional training and provision of logistical support.
- Each country must ensure that there is a commitment to primary health care at all levels of government and society. These commitments must become an integral part of the national health system.
- Particular attention must be paid to those segments of the population that are insufficiently provided with medical care.
- The PHC strategy must be constantly reviewed to ensure that health care adapts to new stages in society's development.
- PHC should include at a minimum:
- education on basic health issues and training in disease prevention and control;
- assistance in organizing proper nutrition, providing good-quality water, and carrying out basic sanitary measures;
- maternal and child health, including family planning;
- immunization against major infectious diseases;
- prevention and control of epidemic diseases in the area;
- proper treatment of common diseases and injuries;
- provision of essential medicines.
- The PHC organization system must take into account the needs of particularly vulnerable groups of the population or those at greatest risk - women, children, people working in hazardous conditions, and the poor. It is necessary to ensure systematic identification of people at particular risk, providing them with ongoing care and eliminating factors that contribute to the occurrence of diseases.
- Working in primary care requires special dedication from health workers. Society and authorities must take this circumstance into account and provide them with benefits, the amount of which depends on the relative degree of isolation, the difficulty of living conditions and work of medical workers.
- Most of the above principles of organizing primary health care for the population have not been implemented in our country for various reasons, the main of which are:
- lack of budget funding;
- strict centralized control system;
- the concept of social homogeneity of health;
- the rigid combination of preventive and curative medicine, which led to the prevailing role of the latter (only 5% of the working time of physicians is devoted to prevention);
- an extensive path of development due to the constant increase in the number of doctors, hospital beds, clinics, etc., excessive narrow specialization, which led to low qualifications of primary care medical workers, to disinterest in the final result of work, low level wages, decline in the prestige of a medical worker;
- the disappearance of the organizational and economic basis of the family approach in medicine, the focus on large social groups - the territorial-population (site) or production (collective farm, state farm, factory) principle of medical provision (Shabrov A.V., 1995).
One of the priority areas in organizing medical care is to reduce the level of hospitalization. The relevance of this problem is recognized by almost everyone. Strengthening the role of primary health care is intended to solve a number of medical, social and economic problems, including disease prevention, early diagnosis, reducing society's losses from disability, saving financial resources allocated for healthcare needs, etc. (Kadyrov F.N., 1997).
|
|
Of particular importance in the Concept is the section on guaranteed provision of quality medical care to the population. What is quality health care? As representatives of the Ministry of Health stated, they proceeded from the definitions of quality medical care, which were presented by the WHO:
High-quality medical care is that care that provides the best results based on the modern level of knowledge and technology with the minimum necessary expenses for this care.
In this definition, everything is important: effectiveness, evidence, cost-effectiveness.
The effectiveness of healthcare depends on several interrelated factors:
- organizational system,
- providing resources (financial block, information block, legislative and legal support block).
- the availability of medical personnel in sufficient numbers and properly trained to solve the problems posed to healthcare.
1. Improving the organizational system
The legs of our healthcare system grow from zemstvo medicine. All principles (participation, public access, free for all payers of zemstvo duties, clinical examination) were developed back in the 19th century. Zemstvo doctors were the first to develop and implement individual patient records, which were later recognized as the most advanced form of collecting data on morbidity in outpatient settings.
At first, a traveling system was tested, in which zemstvo doctors sequentially traveled around the settlements included in the zemstvo and provided the necessary assistance at the place of residence of the sick. But at the same time, a lot of time was wasted on the doctor moving from one village to another. Therefore, the traveling system was replaced by medical stations, which continue to exist in Russia to this day.
Our modern system was formed on the foundation of zemstvo healthcare. two-tier system provision of medical care (or the Semashko model, as it is called abroad) - two structures that are poorly integrated with each other: the outpatient stage (clinic, ambulance) and the hospital.
Please note that there are no sanatoriums in this scheme. The Ministry of Health had almost no sanatoriums of its own (in most cases they were subordinate to departments or trade unions; although the Ministry of Health owned about 48 sanatoriums).
We have first contact doctor- This is a local therapist. Having fallen ill, a person goes to the clinic and is treated at home as prescribed by the local therapist or specialist at the clinic. Some patients, referred by clinic doctors or independently through the ambulance service, end up in a hospital, where they spend an average of 2-4 weeks. Then the patients return home, supposedly under the supervision of a local therapist (in fact, under their own supervision).
Abroad, the first contact doctor is a general practitioner (or family doctor). In 2005, Russia set a course for a gradual transition from the principle of serving patients through a polyclinic network to the creation of general medical practices, where generalist specialists would work (Order of the Ministry of Health and Social Development dated January 17, 2005 No. 84 “On the procedure for carrying out the activities of a general practitioner (family doctor) .
But it turned out that it was too early to write off the clinic:
- At the current level of development of medicine, a general practitioner cannot independently maintain a high level of patient care; he needs to constantly learn new techniques. Therefore, a trend has emerged abroad towards organizing services based on collective actions (group practices).
- The clinic has many advantages: rational concentration of material and human resources (due to this concentration the cost of service is reduced), a complex of laboratory and diagnostic services, admission of specialized specialists, availability day hospital, interchangeability of personnel, etc.
Therefore, we came to the conclusion that the general medical practice system is the most convenient form of service for residents of sparsely populated areas. And it is in remote areas and rural areas that the Ministry of Health hopes to develop this system.
The delivery scheme is also organized differently abroad. emergency assistance. In case of development urgent illness or injury, the patient calls a single emergency phone number (911 for the USA or 112 for Europe) and a team of paramedics (delivery service), without any understanding, takes him to the Emergency Department.
The work of a large department for the correction of emergency conditions is well illustrated by the American television series “ Ambulance" Upon admission, the patient is examined to clarify the diagnosis and stabilize the condition. Then, some patients are discharged home with specific recommendations for the family doctor, while others continue treatment in an active nursing home hospital setting.
Some patients (in more complex cases or when it is impossible to quickly correct the condition) are admitted to a hospital bed. There, a course of intensive treatment is carried out over several days (the average length of hospital stay is 4.7 days). After this, some patients are transferred to the rehabilitation department, to hospital treatment at home, others to a hospice or other medical and social beds.
Freeing up a hospital bed in favor of treatment in a “hospital at home” has great advantages. The patient is in his usual home environment, as a rule, he rests better and gets enough sleep. A visiting nurse regularly comes to him (in fact, she is the one who takes care of the patient), and periodically a doctor comes to him, who do all the necessary procedures, injections, dressings, tests, etc. And at the same time, there are no additional costs for food, water and electricity supply, heating, bed linen, repairs, etc. There is no need to maintain nurses, spend money on disinfecting wards, toilets, catering units, fighting hospital-acquired and respiratory infections, etc.
Improving the organization of medical care in our country will be based on three blocks:
- First of all, on ensuring that the patient can get as quickly as possible to an institution that can provide medical care in accordance with Standard. That is, it must be staffed with trained personnel, provided with medicines and equipped with medical products. And all this, of course, in the required quantities.
- The second very important block is the phasing of medical care according to Order. At the same time, ensuring continuity between different stages - important condition providing quality medical care.
- The third important block is the introduction of performance targets that reflect not only the types and volumes of medical care provided, but also its quality. Quality management systems for medical care will be introduced based on the Procedures and Standards for its provision, including the implementation of an independent audit. The use of quality indicators will make it possible to evaluate the effectiveness of medical personnel on a monthly basis, depending on the completeness and correctness of the implementation of the approved procedure and standard of medical care for the corresponding pathological condition. The same information will allow you to rank payments not only based on the type and volume of medical care provided, but also depending on its quality.
In addition, a three-tier healthcare system will be created in Russia:
Level 1. Primary health care
Primary health care, organized on a territorial-precinct principle, has been and remains a priority area of domestic health care due to the huge size of the country and uneven population density.
- Eliminating personnel shortages through intra-industry migration redistribution.
- Disaggregation of sites: reducing the number of attached adult population from 1700-2500 people to 1.2-1.5 thousand people per site (becomes possible when the personnel shortage is eliminated).
- Creating human conditions for work - increasing the standard time allocated for one adult patient to 20 minutes.
- Reducing the workload by transferring a number of activities to the nursing staff: first aid for acute pathology, dispensary observation of patients with chronic pathology, etc.
- Retrofitting primary care with technologies that replace hospitals - developing systems of “hospitals at home” and active patronage.
- Transition to other performance targets with an emphasis on preventive activities. For example, share healthy people everyone age groups of the total attached population, the percentage of detection of diseases in the early stages among all first-time cases.
Level 2. Inpatient care
- The main point is the intensification of the work of the bed. This will be possible, on the one hand, if hospital-replacing technologies are introduced into primary care, and a network of departments for after-care and rehabilitation is developed. Inpatient medical care should be limited to patients requiring 24-hour monitoring.
- Creation of a routing service in each hospital through which patients will be discharged from the hospital. This service will ensure the organization of stage-by-stage recovery treatment and rehabilitation, continuity in the management of the patient at all stages, the transfer of information about the patient and medical and social recommendations to the local patronage unit at the patient’s place of residence.
- The gradual creation of head regional centers coordinating the entire scope of preventive, diagnostic and therapeutic measures on socially significant medical problems.
- Improving institutional performance targets stationary level, reflecting the quality of medical care (mortality, degree of restoration of impaired functions).
Level 3. Rehabilitation
None of the previous Health Development Concepts, including Soviet period, this stage was not included (remember, the Ministry of Health did not have its own sanatoriums?). Thus, a three-tier (instead of a two-tier) healthcare system is being created in Russia: primary health care, inpatient care and a rehabilitation treatment service.
- Creation and expansion of a network of institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care by repurposing some of the operating hospitals and sanatorium-resort institutions.
- Determination of target performance indicators that reflect the quality of medical care (degree of restoration of impaired functions, indicators of primary disability and severity of disability).
Level 4. Parahospital service
This is just a pilot project that will be launched in those regions that will achieve good development by 2014-2015.
The essence of the project: an organizational structure is created into which the emergency department hospital and ambulance station, plus services for discharge and routing of patients, primary care patronage services and after-care services.
This service will be intended for:
- providing the population with emergency and urgent medical care (first-time cases and persons with exacerbation of a chronic disease);
- determining the need (or lack of need) for hospitalization of the patient in a hospital;
- carrying out a complex of diagnostic and therapeutic measures for pathological conditions that do not require continuous round-the-clock monitoring;
- organizing the optimal stage of follow-up treatment for the patient (“home hospital”, rehabilitation treatment and rehabilitation departments, hospice) and implementing active or passive patronage.
UDC 616.1-082-07 (048.8) Review
problems and WAYS TO IMPROVE THE PROVISION OF MEDICAL CARE TO PATIENTS WITH CIRCULAR DISEASES (REVIEW)
G. Yu. Sazanova - State Budgetary Educational Institution of Higher Professional Education "Saratov State Medical University named after. V.I. Razumovsky" of the Ministry of Health of Russia, Associate Professor of the Department of Healthcare Organization, Public Health and Medical Law, Candidate of Medical Sciences.
THE MAIN ISSUES AND THE WAYS OF IMPROVEMENT OF HEALTH CARE FOR PATIENTS WITH DISEASES OF THE CIRCULATORY SYSTEM (REVIEW)
G. Yu. Sazanova - Saratov State Medical University n.a. V. I. Razumovsky, Department of Public Health Care Organization and Medical Law, Assistant Professor, Candidate of Medical Science.
Date of receipt - 03.12.2013 Date of acceptance for printing - 3.03.2014
Sazanova G.Yu. Problems and ways to improve the provision of medical care to patients with circulatory diseases (review). Saratov Scientific and Medical Journal 2014; 10(1): 27-31.
Studied regulations and publications by domestic scientists on the problems of providing quality medical care to patients with circulatory diseases. Many works address issues of non-compliance with standards of medical care: uneven distribution of diagnostic resources across levels of medical care with their concentration in hospitals of multidisciplinary treatment and preventive medical organizations. Proposed ways to improve the provision of medical care are analyzed.
Keywords: medical care, standards, diseases of the circulatory system.
Sazanova GYu. The main issues and the ways of improvement of health care for patients with diseases of the circulatory system (review). Saratov Journal of Medical Scientific Research 2014; 10(1): 27-31.
Regulations and publications on the provision of quality health care for patients with diseases of the circulatory system of the native scientists have been studied. The majority of the issues concerns the disorganization of health care standards: the uneven distribution of diagnostic resources mostly in the hospitals and preventive health care organizations. The proposed ways to improve the patient care have been analyzed.
Key words: medical care, standards, circulatory disorders.
the federal law RF dated November 21, 2011 No. 323-F3 “On the fundamentals of protecting the health of citizens in the Russian Federation” established the main priorities in the field of protecting public health and ensuring state guarantees associated with these rights, the main ones being: compliance with the rights of citizens in the field of health protection; priority of the patient's interests in the provision of medical care; social protection of citizens in case of loss of health; accessibility and quality of medical care; responsibility of state authorities and local governments, officials of organizations for ensuring the rights of citizens in the field of health protection; priority of prevention in the field of health care. Accessibility and quality of medical care are ensured by the organization of medical care based on the principle of proximity to the place of residence, place of work or training, the presence of the required number of medical workers and their level of qualifications; the ability to choose a medical organization and doctor; application of procedures for the provision of medical care and standards of medical care; provision by a medical organization of a guaranteed volume of medical care in accordance with the program of state guarantees of free provision of medical care to citizens; establishing requirements for the location of medical organizations of the state and municipal healthcare system and other infrastructure facilities in the healthcare sector based on the needs of the population.
The main strategic direction for improving the quality of medical care
Email: [email protected]
is to create all the necessary conditions in order to meet the needs of the population for quality medical care at all its stages - from outpatient care to specialized care. As for the availability of medical care (MC), it is legally considered as one of the basic principles of protecting the health of the population of the Russian Federation.
According to the Concept of Health Care Development in the Russian Federation until 2020, in order to ensure sustainable socio-economic development of the Russian Federation, one of the priorities of state policy is to preserve and strengthen the health of the population based on the formation of a healthy lifestyle and increasing the availability and quality of healthcare. The effective functioning of healthcare is determined by the main system-forming factors:
Improving the organization of medical care aimed at creating a healthy lifestyle and providing high-quality free medical care to citizens of the Russian Federation within the framework of state guarantees;
Development of infrastructure and resource provision for healthcare, including financial, material, technical and technological equipment of medical organizations.
These factors are interdependent and mutually determining at all stages of development of the healthcare system.
Mortality and disability of the population of the Russian Federation are more than 50% caused by diseases of the circulatory system, and therefore one of the leading tasks of modern healthcare is to establish the causes and prevent the occurrence of diseases of the cardiovascular system.
The basis for the continuity of improving the quality of medical care as the main guidelines should be the improvement and strengthening of the stimulating role of the economic mechanism in intensifying the work of health authorities and institutions, establishing the dependence of the wage fund on the final results of the activities of medical personnel. At the same time, in ensuring the continuity of improving the quality of medical care, the main place is given to the use of methodological, regulatory and legal documents, including medical standards.
In accordance with the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation”, the availability and quality of medical care is ensured by:
1) organizing the provision of medical care based on the principle of proximity to the place of residence, place of work or training;
2) the availability of the required number of medical workers and their level of qualifications;
3) the ability to choose a medical organization and doctor;
4) application of procedures for the provision of medical care and standards of medical care;
5) provision by a medical organization of a guaranteed volume of medical care in accordance with the program of state guarantees of free provision to citizens of MP.
IN modern conditions achieving a high level of quality of medical care (QMC) is one of the main goals of the healthcare system and, at the same time, a criterion for its evaluation. The quality control system for medical care was also normatively reflected in the order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 No. 230 “On approval of the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance.” All regulatory documents indicate the need to comply with standards of medical care.
The provision of planned medical care to the adult population for diseases of the circulatory system by federal institutions and institutions of the constituent entities of the Russian Federation is regulated by the Procedure for the provision of medical care to this category of patients, approved by Order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 918n, which regulates the provision cardiac care within primary health care; emergency, specialized, including high-tech, medical care. The listed types of medical care can be provided on an outpatient basis (in conditions that do not provide for round-the-clock medical supervision and treatment); in a day hospital (in conditions that provide medical supervision and treatment during the daytime, but do not require round-the-clock medical supervision and treatment); inpatient (in conditions that provide round-the-clock medical supervision and treatment); outside a medical organization (at the place where the ambulance team is called, including specialized emergency medical care, as well as in vehicle during medical evacuation). According to the Regulations on the organization of activities of the cardiology department, it is recommended to provide a room for
carrying out special therapeutic and diagnostic manipulations and procedures (temporary endocardial electrical stimulation, intra-aortic balloon counterpulsation, etc.), which requires the purchase of special medical equipment, training of appropriate highly qualified medical personnel.
The transition since 2013 to predominantly single-channel financing of medical care within the compulsory medical insurance system has necessitated the implementation at the regional level of a set of organizational measures to prepare and include in the tariff for payment of medical care at the expense of compulsory medical insurance the costs of payment for communication services, transport services, utilities, works and services for property maintenance, expenses for rent for the use of property, payment for software and other services, purchase of equipment. The introduction of a full tariff for payment of medical care at the expense of the compulsory health insurance system should be carried out taking into account the need to comply with the standards of medical care established by the Ministry of Health and Social Development of Russia, as well as on the basis of effective methods of payment for medical care, focused on performance.
The amount of funds allocated for the implementation of standards of medical care in each region depends on the current availability of compulsory health insurance.
It is impossible not to take into account the peculiarities of the system of organizing medical care in the country (the amount of financing of the health care system, methods of payment for medical services to providers, approaches to solving personnel issues and issues of material and technical support of the system, mechanisms for regulating the implementation of the principles of social justice in addressing issues of accessibility of primary and specialized expensive medical care ) . At the same time, the role of standards is important, which allow for a unified approach in providing medical care and registering morbidity cases.
The choice of tactics for managing a particular patient depends on many related reasons: the medical practice accepted in a given country (the method of forming clinical medical thinking, methods of creating and methods of disseminating national guidelines, the adherence of doctors to national recommendations, mechanisms that ensure the phasing of patient management).
Standards of medical care can be effectively used to justify the resource and financial support of individual medical organizations and the system of providing medical care to the population as a whole. This is due to the fact that the technical and economic component of the standard is precisely intended to analyze the need for resources and the cost of providing medical services. Moreover, the advantage of any technique based on a standardized sequence of treatment and diagnostic measures is the close connection of economic recommendations with the clinical content of the diagnostic and treatment process, ensured through the medical and technological part of the standard.
delivery of medical care of a certain volume and quality, violation of licensing requirements in terms of compliance of medical institutions with established standards, which leads to a decrease in not only medical, but also economic efficiency of healthcare.
There is an uneven distribution of diagnostic resources across levels of medical care, with their concentration in hospitals of multidisciplinary treatment and preventive institutions in large cities. There are serious shortcomings in the provision of resources and organization of activities of diagnostic units of primary health care, as a result of which its diagnostic capabilities are significantly limited. Medical workers consider the main reasons for non-compliance with standards to be understaffing, lack of necessary medical equipment, and reagents to perform diagnostic procedures And medicines.
N. P. Ledyaeva, I. N. Lapteva name the following violations in the provision of medical care identified as a result of inspections:
Insufficient material and technical base of institutions to meet the standards of medical care in full;
Insufficient staffing or lack of specialists;
Lack of training among specialists in assessing the quality of medical care;
Lack of approved MP standards;
Failure to comply with standards of medical care (lack of provision for the treatment and diagnostic process, violations of accounting and reporting documentation, including indicating the volume of medical care, etc.).
L. A. Bockeria and co-authors believe that real clinical practice differs from the models of patient management on which the standards were created. The standard does not take into account medical services performed in real clinical practice associated with the presence of concomitant pathology. Some of the medical services specified in the standard represent individual actions of a medical examination that cannot be taken into account in information systems. The lack of a methodology for comparing standards and actual clinical practice, the formation of evaluation criteria based on such a comparison does not allow establishing requirements for the provision of treatment and diagnostic services, or assessing the quality control of the care provided.
V. A. Ushakov, M. A. Demidova and co-authors analyzed the compliance of the structure of prescribing drugs for patients with pathology of the cardiovascular system according to the main groups in accordance with the current standards for the provision of medical care to patients of this group of diseases, which showed that patients received both drugs, included in the standard, as well as those medicines that were not listed in it.
O. N. Smuseva and co-authors believe that it is necessary to conduct pharmacoepidemiological studies that help to approximate the results drug treatment in everyday practice to “ideal”, provided that medical standards are followed.
Assessing the completeness of the treatment and diagnostic process based on medical standards
Alexandrova and co-authors note that in a real clinical situation, it is not the compliance of medical care itself with the standard that is important, but the result of treatment - recovery, improvement, achievement of remission of the disease. And the result can be achieved without fulfilling the requirements of the standard in full, and it can not be achieved by fulfilling all the requirements of the standard of medical care. There are real clinical situations when, in addition to the main disease, the patient has several concomitant diseases, and the application of standards of medical care for each of the existing diseases will lead to the patient being overloaded with diagnostic and therapeutic measures and medications. On the other hand, clinical situations are also real when the specifics of the patient’s health condition and disease require the inclusion in the treatment plan of additional therapeutic and diagnostic measures that are not included in the standards of medical care.
According to the results of studies by E.V. Manukhina, G.B. Artemyeva, Yu.M. Belyaev, E.M. Chernenko, the resource content of medical standards significantly exceeds the cost of a completed case for nosologies. The need for financial resources for the implementation of the Territorial Compulsory Medical Insurance Program, calculated taking into account the costs of treatment according to the standards of medical care, is several times higher than the approved one. In the current financial situation, the cost of the standard of medical care is determined from the standard length of stay in a hospital and the bed-day rate, that is, according to the “completed case of treatment.” The calculation of the cost of the standard of care, calculated through the cost of medical services, is higher than that calculated according to the “completed case” of treatment.
M.R. Andreeva and co-authors, based on an analysis of the results of thematic examinations conducted in St. Petersburg, systematized typical errors in the provision of medical care to different groups of patients and established their causes. The most common causes of system errors include defects in the organization of medical care, insufficient resource support, insufficient formalization of medical documentation at the outpatient stage of care, and insufficient qualifications of doctors. According to the authors, the main reasons hindering further improvement of quality control of medical care provision to the population for compliance with standards are the lack of uniform terminology and agreed upon assessment methods at the federal level and an insufficiently developed regulatory legal framework at the federal level that defines mandatory quality level requirements for all medical service providers regardless of the health care system (state, municipal, private) and sources of financing of medical services.
According to P. A. Vorobyov, standards at the territorial level are needed. The protocols contain information about what needs to be done, what is the minimum level of care guaranteed by the state, how to provide care both in the hospital and in the clinic, how to carry out prevention and rehabilitation. Territorial documents must contain information on how to do it. For example, the Protocol on Hypertension states that in some cases patients need
EchoCG, duplex scanning renal arteries. However, not all institutions in the region carry out these procedures, and the standard at the territorial level specifies where this can be done, at what time what documents must be sent in order to enroll a patient in the queue, whether hospitalization is required for this, etc. In addition, the economic component is specified, the tariff for the provision of medical care is formed, because the territorial compulsory medical insurance fund and the budget pay for it. And it is here that it is necessary to balance the solvency of the region and the volume of assistance, to justify, if necessary, subventions from the Federal Compulsory Medical Insurance Fund. The basis for financing medical care is the standard.
Thus, there is now a clearly structured legal framework provision of medical care, including a program of state guarantees, standards and procedures for providing medical care to patients with diseases of the circulatory system, which makes it possible to concentrate healthcare efforts on socially significant problems and guarantee the population a certain level of quality of medical care at different stages of its provision. At the same time, scientists have identified structural and cost imbalances in the provision of medical care to this group of patients, which require a more in-depth analysis to determine the reasons for non-compliance with standards.
References (Literature)
1. Federal Law on the basis of health protection in the Russian Federation. 21.11.2011 No. 323-FZ. http://www.rg.ru/2011/11/23/ zdorovie-dok.html (11/20/2013) (On the basics of protecting the health of citizens in the Russian Federation: Federal Law of November 21, 2011 No. 323-FZ. http http://www.rg.ru/2011/11/23/zdorovie-dok.html)
2. Seregina IF, Lindenbraten AL, Grishina NK. The Russian Federation population opinions of quality and availability of medical care: the results of sociological survey. Problemy Sotsialnoi Gigieny, Zdravookhraneniya, i Istorii Meditsiny 2009; (5): 3-7. Russian (Seregina I.F., Lindenbraten A.L., Grishina N.K. Results sociological research opinions of the population of the Russian Federation on the quality and availability of medical care. Problems of social hygiene, health care and history of medicine 2009; (5): 3-7.)
3. Ob utverzhdenii Gosudarstvennoj programmy Rossijskoj Federacii “Razvitie zdravoohranenija”: rasporjazhenie Pravitel "stva RF ot 12/24/2012 No. 2511 -p. http://www.rosminzdrav.ru/health/zdravo2020/72 (11/20/2013) Russian (About approval of the State Program of the Russian Federation “Health Development”: Order of the Government of the Russian Federation dated December 24, 2012 No. 2511-p. http://www.rosminzdrav.ru/health/zdravo2020/72)
4. Turaev RG, Voit LN, Abbasova ES. Morbidity of the population of Amur region. Kazan Medical Journal 2010; 91 (4): 540-542. Russian (Turaev R. G., Voit L.N., Abbasova E.S. Morbidity in the population of the Amur region. Kazan Medical Journal 2010; 91 (4): 540-542.)
5. Schepin OP, Belov VB. The role of public health in the population health formation. Problemy Sotsialnoi Gigieny, Zdravookhraneniya, i Istorii Meditsiny 2007; (3): 1-5. Russian (Shchepin O.P., Belov V.B. The role of healthcare in the formation of public health. Problems of social hygiene, healthcare and history of medicine 2007; (3): 1-5.)
6. Sazanova GYu. The peculiarities of morbidity, disability and mortality parameters of the population in Saratov region. Kubanskii nauchnyi meditsinskii vestnik 2012; (1): 144-146. Russian (Sazanova G. Yu. Features of morbidity, disability and mortality of the population of the Saratov region. Kuban Scientific Medical Bulletin 2012; (1): 144-146.)
7. Saaklyan JA. The quality of medical care and the standardization in public health of Armenia. Problemy Sotsialnoi Gigieny, Zdravookhraneniya, i Istorii Meditsiny 2008; (5): 48-51. Russian (Sahakyan Zh. A. Quality of medical care and standardization in healthcare in Armenia. Problems of social
nal hygiene, health care and history of medicine 2008; (5): 48-51.)
8. Ob objazatel "nom medicinskom insurance v Rossijskoj
Federacii: Federal"nyj zakon ot 29.11.2010 No. 326-FZ.
http://www.rg.ru/2010/12/03/oms-dok.html (11/20/2013) Russian (On compulsory health insurance in the Russian Federation: Federal Law of November 29, 2010 No. 326-FZ. http://www.rg.ru/2010/12/03/oms-dok.html)
9. Lindenbraten AL, Kovaleva VV. Kontrol" kachestva organizacii medicinskoj pomoshhi: sovremennye podhody. Zdravoohranenie 2011; (6): 50-55. Russian (Lindenbra-ten A. L., Kovaleva V. V. Quality control of the organization of medical care: modern approaches. Healthcare 2011; (6 ): 50-55.)
10. Obviously approval of the Procedure for providing medical care to patients with cardiovascular diseases: order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 918n. www.consultant.ru/LAW_141223/)
11. Efimova NK. Regional healthcare modernization programs: methodology development and implementation of indicators. Voprosy jekonomiki i upravlenija zdravoohraneniem 2011; (6): 19-35. Russian (Efimova N.K. Regional healthcare modernization programs: development methodology and implementation indicators. Issues of economics and healthcare management 2011; (6): 19-35.)
12. Report of T. Golikovoj in Russian forum of medical workers. Voprosy jekonomiki i upravlenija zdravoohraneniem 2011; (6): 2-8. Russian (Report by T. Golikova at the All-Russian Forum of Medical Workers. Issues of Economics and Healthcare Management 2011; (6): 2-8.)
13. Balrova YuB, Samorodskaya IV, Kozyrev OA. Peculiarities of health care standardization in practice. Problemy standartizacii v zdravoohranenii 2010; (5-6): 37-43. Russian (Ba-trova Yu. V., Samorodskaya I. V., Kozyrev O. A. Features of standardization of medical care in practical healthcare. Problems of standardization in healthcare 2010; (5-6): 37-43.)
14. Shibkov NA, Nikilina OYu. The role of standards in infotainment of diagnostic and treatment of patients with arterial hypertension. Problemy standartizacii v zdravoohranenii 2010; (9-10): 19-22. Russian (Shibkov N. A., Nikilina O. Yu. The role of standards in information support of the diagnostic and treatment process when providing medical care to patients with hypertension. Problems of standardization in healthcare 2010; (9-10): 19-22.)
15. Recommendations of the Russian Scientific Society of Clinical Electrophysiology, but the pacing and arrhythmology conducting clinical electrophysiology, catheter ablation and implantation of antiarrhythmic devices. Moscow, Zolotoj abrikos, 2006. Russian (Recommendations of the All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Cardiac Stimulation for Clinical Electrophysiological Studies, Catheter Ablation and Implantation antiarrhythmic devices. M.: Golden Apricot, 2006.)
16. Manukhina eV, Artemyeva GB. Role of standards in the increase of healthcare efficiency and medical aid quality. Social"nye aspekty zdorov"ja naselenija 2012; (5): 1-6. Russian (Manukhina E.V., Artemyeva G.B. The role of standards in increasing the efficiency of healthcare and the quality of medical care. Social aspects of public health 2012; (5): 1-6.)
17. Yerugina MV. Medical care provided at hospital cardiological department compared with the approved standards. Problemy standartizacii v zdravoohranenii 2008; (6): 27-30. Russian (Erugina M.V. Assessment of the compliance of the volume of medical care provided in the cardiology department of a hospital with established standards. Problems of standardization in healthcare 2008; (6): 27-30.)
18. Martjushov Si, Luzhbinina TV, Saharova ON. Assessment of compliance with standards in acute coronary syndromes an urban hospital. Cardiovascular Therapy and Prevention 2008; (7, Suppl. 1): 234-235. Russian (Martyushov S.I., Luzhbinina T.V., Sakharova O.N. Assessment of compliance with standards in acute coronary syndrome conditions
city hospital. Cardiovascular Therapy and Prevention 2008; (7, Suppl. 1): 234-235.)
19. Sazanova GYu. Structural disproportions in regional medical standards in treatment of blood circulatory disorders. Saratov Journal of Medical Scientific Research 20l2; 8 (1): 3134. Russian (Sazanova G. Yu. Structural imbalances in meeting the requirements of standards of medical care for patients with circulatory diseases. Saratov Medical Scientific Journal 2012; 8 (1): 31-34.)
20. Shestakov G.S. Modern approaches calculation needs diagnostic resources departments of functional diagnostics. Voprosy ekonomiki i upravlenija dlja rukovoditelej zdravoohranenija 2011; (5): 20-24. Russian (Shestakov G. S. Modern approaches to calculating the need for diagnostic resources of functional diagnostic units. Issues of economics and management for healthcare managers 2011; (5): 20-24.)
21. Sazanova G.Ju, Erugina M.V., Dolgova E.M., et al. Problems of regional and federal standards in the provision of medical care to patients with diseases of the circulatory. Problemy upravlenija zdravoohraneniem 2011; (5): 52-55. Russian (Sazanova G. Yu., Erugina M. V., Dolgova E. M. et al. Problems of applying regional and federal standards in providing medical care to patients with circulatory diseases. Problems of healthcare management 2011; (5): 52-55 .)
22. Ledjaeva NP, Lapteva IN. On the need for regulatory control measures on the quality of care. Vestnik Roszdravnadzora 2010; (5): 28-29. Russian (Ledyaeva N.P., Lapteva I.N. On the need for legal regulation of control measures on issues of quality of medical care. Bulletin of Roszdravnadzor 2010; (5): 28-29.)
23. Bokerija LA, Stupakov IN, Samorodskaja IV, et al. Some problems of mismatch between actual clinical practice approved standards identified by information systems. Problemy standartizacii v zdravoohranenii 2008; (2): 13-18. Russian (Bokeriya L.A., Stupakov I.N., Samorodskaya I.V. et al. Some problems of non-compliance of real clinical practice with approved standards, identified with the help of information systems. Problems of standardization in healthcare 2008; (2): 13 -18.)
24. Demidova MA, Kirilenko NN. Analysis of the compliance structure of cardiovascular drugs of the current standard of medical care to patients with angina (for example, the cardiology department of Tver Regional Clinical Hospital). Kubanskii nauchnyi meditsinskii vestnik 2011; (4): 48-52. Russian (Demidova M.A., Kirilenko N.N. Analysis of the compliance of the structure of prescribing cardiovascular drugs with the current standard of medical care for patients with angina (using the example of the cardiology department of the State Clinical Hospital of Tver). Kuban Medical Bulletin 2011; (4): 48 -52.)
25. Ushakov V.A. Analysis of the drug component of the standard of care for patients with uncomplicated acute myocardial infarction. Bjulleten" VSNC SO RAMN 2007; (1): 241242. Russian (Ushakov V. A. Analysis of the medication component of the standard of care for patients with uncomplicated forms acute heart attack myocardium. Bulletin of the All-Russian Scientific Center SB RAMS 2007; (1): 241-242.)
26. Kirilenko NN. Analysis of the compliance structure prescribing affecting the blood clotting system, the applicable
standard of care to patients with stable angina. Vrach-graduate 2011; 42 (47): 277-281. Russian (Kirilenko N. H. Analysis of the compliance of the structure of prescribing drugs that affect the blood coagulation system with the current standard of care for patients with stable angina (using the example of the cardiology department of the State Healthcare Institution “Regional Clinical Hospital” in Tver). Doctor-graduate student 2011; 42 (47) : 277-281.)
27. Smuseva ON, Shatalova OV, Solovkina YuV. Analysis of drug consumption in angina treatment. Siberian Medical Journal 2012; (4): 79-82. Russian (Smuseva O.N., Shatalova O.V., Solovkina Yu.V. Analysis of drug consumption in the treatment of angina pectoris. Siberian Medical Journal 2012; (4): 79-82.)
28. Aleksandrova OYu, Kuznetsova YuG, Vinokurov YeV. Evaluation of diagnostic and treatment process completeness on the basis of medical standards. Problemy standartizacii v zdravoohranenii 2012; (3-4): 3-8. Russian (Alexandrova O. Yu., Kuznetsova Yu. G., Vinokurov E. V.. Assessment of the completeness of the treatment and diagnostic process based on standards of medical care. Problems of standardization in healthcare 2012; (3-4): 3-8.)
29. Manukhina EV, Artemyeva GB. Standardization as a base for medical care improvement in the Ryazan region. Rossijskij mediko-biologicheskij vestnik imeni akademika I. P. Pavlova 2013; (1): 73-77. Russian (Manukhina E.V., Artemyeva G.B.. Standardization as the basis for improving inpatient medical care in the Ryazan region. Russian Medical and Biological Bulletin named after Academician I.P. Pavlov 2013; (1): 73-77.)
30. Beljaev JuM, Chernenko JeM. Increases in effectiveness and quality of medical services on the basis of the organizational-economic guarantee of observation of the contemporary standards. Vestnik Adygejskogo gosudarstvennogo universiteta. Ser. 5: Jekonomika 2012; (1): 205-212. Russian (Belyaev Yu. M., Chernenko E. M. Increasing the efficiency and quality of medical services based on organizational and economic support for compliance with modern standards. Bulletin of the Adygea State University. Ser. 5: Economics 2012; (1): 205-212.)
31. Andreeva MR, Karachevceva MA, Mahova OA, Shipacheva NV. Main tasks and prospects of development of the quality management system of medical care in St. Petersburg. Vestnik Roszdravnadzora 2010; (5): 22-27. Russian (Andreeva M.R., Karachevtseva M.A., Makhova O.A., Shipacheva N.V. Main tasks and prospects for the development of the quality management system for medical care in St. Petersburg. Bulletin of Roszdravnadzor 2010; (5): 22- 27.)
32. Vorob"ev P. A. Standardization system in health care as a sea of documents. Problemy standartizatsii v zdravookhranenii 2005; (8): 1-8. Russian (Vorobiev P. A. Standardization system in health care as a sea of documents. Problems of standardization in health care 2005;(8):1-8.)
33. Aleksandrova O. Ju. Obligation to comply with health care standards and practices of its provision. Pravovye voprosy v zdravookhranenii 2013; (6): 62-77. Russian (Alexandrova O. Yu. Mandatory compliance with standards of medical care and procedures for its provision. Legal issues in healthcare 2013; (6): 62-77.)
The main directions for improving inpatient medical care:
a) intensification of the treatment process
b) repurposing hospitals and departments (restructuring) for short- and long-term stays, varying intensity of the treatment and diagnostic process, preserving unloaded departments of city clinical hospitals (taking into account tasks for peacetime emergencies) with the creation of:
1) hospitals, departments, intensive care wards for the correction of emergency conditions and
treating patients for a limited period (no more than 5–6 days)
2) hospitals, departments, wards for follow-up treatment (after completion of the acute period of the disease);
3) medical rehabilitation units at the outpatient, inpatient and sanatorium stages (for the restoration of life limitations resulting from illnesses and injuries in persons with a certain rehabilitation potential).
4) hospitals, departments, wards of medical and social care (mainly to solve social problems, life situations, improve the health of elderly patients)
c) increasing the responsibility and economic independence of hospitals
d) ensure the development of a network of day hospitals in hospitals
e) standardize medical care (by creating diagnostic and treatment protocols, etc.)
The main directions for improving specialized care in the Republic of Belarus:
a) restructuring of the bed stock - ensuring a rational number and ratio of beds according to the level of intensity of the treatment process (rehabilitation beds, beds for long-term stay of chronic patients, beds for medical care).
b) concentration of emergency medical services and high medical technologies through the creation of specialized centers
c) ensuring a clear organizational structure of each specialized service
d) development and revision of basic protocols for the diagnosis and treatment of diseases
e) development of a state program for the development of specialized medical care
82. Protecting the health of women and children. Control. Medical organizations.
Maternal and Child Health (MCC)- a set of socio-economic and therapeutic and preventive measures aimed at optimizing the family’s lifestyle, strengthening the health of women and children and allowing a woman to combine motherhood with participation in the social and industrial life of the country.
Legislative acts regulating OMD:
a) Constitution of the Republic of Belarus - 2 articles: 32 art. - marriage, family, motherhood, fatherhood and childhood are under state protection; 45 Art. - these groups are guaranteed the right to health care
b) law on the rights of the child (1993). Child - a person under 18 years of age inclusive.
c) Law on Health Care (2002), section “Protection of motherhood and childhood”.
d) labor legislation.
Stages of organization and medical institutions of OMD:
I. Providing assistance to women before pregnancy, preparation for motherhood, family planning (antenatal clinic, Marriage and Family consultation, medical and genetic consultations)
II. Activities for antenatal fetal care (antenatal clinics, children's and adult clinics)
III. Intranatal fetal care and rational management of childbirth (maternity hospital)
IV. Newborn health care (maternity hospital, children's clinic, hospital)
V. Health protection of preschool children (children's clinics, hospitals, kindergartens, schools)
VI. Health protection for school-age children
Sections of OMD: obstetric and gynecological care and therapeutic and preventive care for children.
Management of the Maternal and Child Health Service:
1. At the republican level: Ministry of Health → medical care department → department of medical care for mothers and children → 2 full-time specialists: chief obstetrician-gynecologist and chief pediatrician of the republic
2. Regional level: ZO management under the regional executive committee → 2 full-time specialists (chief obstetrician-gynecologist and chief pediatrician of the region)
3. District level: Central district hospital → chief physician.
Depending on the size of the area, specialists: if more than 70 thousand, the position of deputy chief physician of the Central District Hospital for obstetrics and childhood is introduced, and the head of the obstetrics and gynecology department serves as the chief obstetrician-gynecologist and chief pediatrician of the district; if less than 70 thousand there is a full-time position of the chief pediatrician of the district, and the chief obstetrician-gynecologist of the district is the head of the obstetrics and gynecology department.
The new edition expands and specifies the subject of regulation of the Law, namely: legal, organizational and economic fundamentals protection of health rights of humans and citizens, certain groups of the population in the field of health protection, guarantees of their implementation powers of federal bodies executive power, state authorities of the constituent entities of the Russian Federation and local governments in the field of health protection, the rights and obligations of organizations, regardless of their organizational and legal form, and individual entrepreneurs when carrying out activities in the field of health care, the rights and obligations of medical and pharmaceutical workers LAW ON THE PROTECTION OF CITIZENS' HEALTH
HEALTH MEDICAL CARE MEDICAL SERVICE PATIENT MEDICAL ORGANIZATION DIAGNOSTICS TREATMENT DISEASE PREVENTION TREATING DOCTOR MEDICAL WORKER HEALTH PROTECTION MEDICAL EXAMINATION MEDICAL INTERVENTION ME CARE ACTIVITIES LAW ON PROTECTING CITIZENS' HEALTH IN THE NEW EDITION THE LAW INCLUDES A DEFINITION OF 15 CONCEPTS WITH AN UNIQUE INTERPRETATION
CHAPTER II. PRINCIPLES OF PROTECTING THE HEALTH OF CITIZENS In the new Law, the basic principles have undergone the following changes: The inadmissibility of refusal to provide medical care in the event of a threat to human life is emphasized. Medical confidentiality and the prohibition of euthanasia are highlighted in separate articles. In order to ensure the rights and freedoms of citizens guaranteed by the Constitution of the Russian Federation to the basic principles of protecting the health of citizens. included voluntary informed consent to medical intervention and the right to refuse medical intervention, as well as a ban on human cloning. Priority was given to the preventive direction, the priority of protecting children's health, the active formation of a healthy lifestyle was declared. A separate article is devoted to each principle. A regulatory field is defined for ensuring access to medical care.
CHAPTER III. POWERS OF FEDERAL EXECUTIVE BODIES Approval of procedures and standards of medical care mandatory on the territory of the Russian Federation Approval of the procedure for the activities of medical commissions Approval of the range of medical services Establishment of requirements for the structure and staffing of medical organizations Ensuring quality control and safety of medical care in accordance with federal standards Introduction of federal information systems , in particular, registers ensuring the confidentiality of personal data Unified methodology in statistical accounting, reporting and information exchange standards, so-called industry reporting Approval of the procedure medical examinations and medical examinations Approval of the list occupational diseases and other positions The powers of federal executive authorities are supplemented by the following points:
CHAPTER IV. RIGHTS AND OBLIGATIONS OF CITIZENS IN THE FIELD OF HEALTH PROTECTION The right to medical care for foreign citizens and stateless persons living and staying on the territory of the Russian Federation is determined by the legislation of the Russian Federation and relevant international treaties. In the new Law this chapter was logically structured and contains the following changes: The article “Citizens’ right to choose a doctor and medical organization” was added. The article “Responsibilities of citizens in the field of health care” was added. The article “Public associations for the protection of citizens’ rights in the field of health care” was added.
CHAPTER V. ORGANIZATION OF THE SPHERE OF HEALTH PROTECTION OF CITIZENS IN THE RUSSIAN FEDERATION Prevention of diseases and formation of a healthy lifestyle First aid Medical aid: primary health care specialized care (including high-tech) ambulance, including specialized emergency medical care Medical rehabilitation and sanatorium-resort care treatment Palliative care Medical care in emergency situations Medical care for the population of certain territories and workers Procedures for the provision of medical care and standards of medical care
The new edition expands the definition of concepts related to medical care, in particular adding a classification by types, conditions and forms of its provision. Medical care is provided by medical organizations, as well as by doctors engaged in private medical practice, in accordance with: procedures for providing medical care standards of medical care Types of medical care 1. Primary health care, includes primary pre-medical, medical and specialized health care MEDICAL CARE 2 Specialized, including high-tech, medical care 3. Ambulance, including specialized emergency medical care Conditions of provision 1. Outside the medical organization (at the place where the ambulance team is called, including specialized emergency medical care, as well as in a vehicle during medical evacuation) 2. Outpatient (in conditions that do not provide round-the-clock medical observation and treatment) 3. Inpatient (in conditions that provide round-the-clock medical observation and treatment
MEDICAL CARE Form of provision Planned medical care medical care provided for diseases and conditions that are not accompanied by a threat to the patient’s life, do not require emergency and urgent medical care, the delay of which for a certain time will not entail a deterioration in the patient’s condition, a threat to his life and health Urgent medical assistance medical assistance provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care Emergency medical care medical care provided in case of sudden, life-threatening conditions, acute diseases, exacerbation of chronic diseases, to eliminate the patient’s life-threatening conditions
Includes activities: Prevention PRIMARY HEALTH CARE Diagnostics Treatment Medical rehabilitation Monitoring the course of pregnancy Formation of a healthy lifestyle Sanitary and hygienic education of the population In the new edition, primary health care is closer to the place of residence or work of citizens, is the basis for the provision of medical care and represents the first level contact of citizens with the healthcare system, provided on an outpatient basis and in a day hospital
PRIMARY HEALTH CARE Types of primary health care Primary pre-medical health care Primary medical health care Primary specialized health care Paramedics, obstetricians, other paramedical workers General practitioners, local physicians, pediatricians , local pediatricians, general practitioners (family doctors) Medical specialists of various profiles Form of provision Planned Emergency In federal medical institutions it is provided in the manner determined by the Government of the Russian Federation
Specialized, including high-tech, medical care includes the treatment of diseases that require special diagnostic methods, treatment and the use of complex medical technologies, as well as medical rehabilitation High-tech medical care is provided using: Innovative and high-cost medical treatment methods SPECIALIZED, INCLUDING HIGH-TECH MEDICAL CARE Resource-intensive equipment High-cost consumables and medical products, including those implanted into the human body New highly effective innovative medicines Conditions of provision Inpatient and in a day hospital setting The new edition defines the criteria for high-tech medical care
AMBULANCE, INCLUDING SPECIALIZED MEDICAL CARE Medical evacuation is a set of measures for transporting persons undergoing treatment in medical organizations where there is no possibility of providing the necessary type of medical care in full for life-threatening conditions, women during pregnancy, childbirth, the postpartum period and newborns, as well as persons injured as a result of emergencies and natural disasters, and in other cases in order to save the lives of citizens by providing them with necessary medical care in a timely manner and in full. Medical evacuation includes: Sanitary aviation evacuation carried out by air transport, including including with the use of special medical equipment Sanitary evacuation carried out by land and water transport, including with the use of special medical equipment Medical evacuation carried out by federal government agencies is organized in the manner and under the conditions established by the authorized federal executive body Decision on medical evacuation during emergency situations and natural disasters is accepted by the head of the All-Russian Service for Disaster Medicine. The new edition introduces the concept of “Medical evacuation”:
Medical rehabilitation is a set of medical and psychological measures aimed at restoring the body’s functional reserves, improving the quality of life, maintaining the patient’s working capacity and his integration into society. Includes complex application natural factors, medicinal, non-drug therapy and other methods. MEDICAL REHABILITATION AND SANATORIUM TREATMENT is carried out in medical organizations by specialists with higher and secondary medical education who have appropriate professional training Spa treatment carried out for preventive, therapeutic and rehabilitation purposes based on the use of natural healing resources Conditions Stay at a resort Stay in a health-improving area Stay at sanatorium-resort organizations Introduced for the first time in a new edition
A set of medical measures provided to citizens suffering from incurable, life-limiting progressive diseases in order to improve the quality of life of patients and members of their families PALLIATIVE CARE is carried out by specialists with higher and secondary medical education who have appropriate professional training Palliative care in medical organizations is provided free of charge in the amount and on the terms established by the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation, as well as on a paid basis from other sources not prohibited by the legislation of the Russian Federation. Conditions Outpatient Inpatient Institutional social protection of the population The procedure for providing palliative care is approved by the authorized federal executive body Introduced for the first time in a new edition
The procedure for providing medical care may include: Stages of providing medical care ORDERS FOR PROVIDING MEDICAL CARE Regulations on the organization of activities of a medical organization (its structural unit, a doctor of this medical organization) in terms of providing medical care Standard for equipping a medical organization, its structural units for providing medical care Recommended staffing standards of a medical organization, its structural divisions for the provision of medical care Other provisions, based on the characteristics of the provision of medical care The procedure for the provision of medical care is a set of organizational measures aimed at timely ensuring the provision of medical care to citizens of appropriate quality and in full. Procedures for the provision of medical care and standards of medical care are mandatory for implementation on the territory of the Russian Federation by all medical organizations. Introduced for the first time in a new edition
STANDARDS OF MEDICAL CARE A standard of medical care is a unified set of medical services, medications, medical devices and other components used in providing medical care to a citizen for a specific disease (condition). The standard of medical care is developed taking into account the range of medical services approved by the authorized federal executive body. The standard of medical care may include: A list of diagnostic medical services, indicating the quantity and frequency of their provision; A list of medical products; A list of therapeutic medical services, indicating the quantity and frequency of their provision; A list of drugs used; drugs included in the list of vital and essential drugs, indicating daily and course doses List of types of dietary and therapeutic nutrition, indicating the quantity and frequency of their provision List of blood components and blood products, indicating the quantity and frequency of their provision Procedures for the provision of medical care and standards medical care are mandatory for all medical organizations on the territory of the Russian Federation. Introduced for the first time in a new edition
Medical products - any instruments, apparatus, instruments, materials and other products used individually or in combination with each other, as well as together with other accessories, including special software necessary for the use of these products for their intended purpose MEDICAL DEVICES (INTRODUCED FOR THE FIRST TIME) Intended for: Prevention Diagnostics Circulation of medical devices includes standardization, development, design, production, examination, state registration, sales, transportation, import into the territory of the Russian Federation, export from the territory of the Russian Federation, installation, commissioning, operation, including Maintenance and repair, advertising, application, disposal and state control Treatment of diseases Rehabilitation Monitoring of body functions Research Restoration, replacement, change anatomical structure or physiological functions of the body Prevention or termination of pregnancy The state register of medical devices includes: name of the medical device date of state registration of the medical device and its registration number, validity period of the registration certificate purpose of the medical device, type of medical device established by the manufacturer class of potential risk of using the medical device OKC code of the medical device name and legal address of the organization - manufacturer of the medical device; address of the place of production of the medical device; name and legal address of the organization - applicant of the medical device
THERAPEUTIC NUTRITION (THE ARTICLE IS INTRODUCED FOR THE FIRST TIME) Therapeutic nutrition is a set of measures for organizing nutrition that ensures the satisfaction of the physiological needs of the human body for nutrients and energy, taking into account the pathogenetic features of the disease, the characteristics of the course of the main and concomitant diseases, performing preventive and therapeutic tasks, is an integral component therapeutic process and preventive measures, included in the standards of medical care Medical nutrition Food rations Specialized medical nutrition products (food products with a given chemical composition, certain energy value and physical properties, proven therapeutic effect, which have a specific effect on the restoration of body functions impaired or lost as a result of diseases
