According to this document, the strategic goals of ensuring national security in the field of healthcare and the health of the nation are:

• increasing life expectancy, reducing disability and mortality;
• improvement of prevention and provision of timely qualified primary health care and high-tech medical care;
• improving standards of medical care, as well as quality control, effectiveness and safety of medicines.

Some of the main threats to national security in the field of healthcare and the health of the nation are the emergence of large-scale epidemics and pandemics, the massive spread of HIV infection, tuberculosis, drug addiction and alcoholism, and the increased availability of psychoactive and psychotropic substances.
A direct negative impact on ensuring national security in the field of healthcare and the health of the nation is caused by the low efficiency of the medical insurance system and the quality of training and retraining of healthcare professionals, the insufficient level of social guarantees and remuneration of medical workers and financing for the development of a high-tech medical care system, and the incompleteness of the formation of the regulatory legal framework for healthcare. in order to increase accessibility and guarantee the provision of medical care to the population.
The state policy of the Russian Federation in the field of healthcare and the health of the nation is aimed at preventing and preventing the increase in the level of socially dangerous diseases.
The main directions of ensuring national security in the field of healthcare and the health of the nation are in the Russian Federation medium term determines the strengthening of the preventive focus of healthcare, a focus on preserving human health, and improving the institution of family, maternal, paternal and childhood protection as the basis for the life of society.
Strengthening national security in the field of healthcare and the health of the nation will be facilitated by improving the quality and accessibility of medical care through the use of advanced information and telecommunication technologies, government support for promising developments in the field of pharmaceuticals, biotechnology and nanotechnology, as well as the modernization of economic mechanisms for the functioning of healthcare and the development of material and technical infrastructure. bases of state and municipal health care systems, taking into account regional characteristics.
To counter threats in the field of healthcare and the health of the nation, national security forces, in interaction with civil society institutions, ensure the effectiveness of state legal regulation in the field of standardization, licensing, certification of medical services, accreditation of medical and pharmaceutical institutions, ensuring state guarantees for the provision of medical care and modernization systems of compulsory health insurance, determination of uniform criteria for assessing the work of medical institutions at the level of municipalities and constituent entities of the Russian Federation.
Solving national security problems in the field of healthcare and the health of the nation in the medium and long term is achieved by:
formation of national programs (projects) for the treatment of socially significant diseases (oncological, cardiovascular, diabetological, phthisiological diseases, drug addiction, alcoholism) with the development of unified all-Russian approaches to the diagnosis, treatment and rehabilitation of patients;
development of a system for managing the quality and availability of medical care, training of healthcare professionals;
ensuring a qualitative change in the structure of diseases and eliminating the preconditions for epidemics, including those caused by particularly dangerous infectious pathogens, through the development and implementation of promising technologies and national programs state support disease prevention.

It says that in order to ensure sustainable socio-economic development of the Russian Federation, one of the priorities public policy should be the preservation and strengthening of public health based on the formation healthy image life and improving the availability and quality of medical care.

The effective functioning of the healthcare system is determined by the main system-forming factors:
- improving the organizational system to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens of the 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 institutions based on innovative approaches and the principle of standardization;
- the presence of a sufficient number of trained medical personnel capable of solving the problems set before the healthcare system of the Russian Federation.

These factors are interdependent and mutually determining, and therefore modernization of healthcare requires the harmonious development of each of them and the entire system as a whole.
The concept for the development of healthcare in the Russian Federation until 2020 is an analysis of the state of healthcare in the Russian Federation, as well as the main goals, objectives and ways to improve it based on the application of a systems approach.
The concept was developed in accordance with the Constitution of the Russian Federation, federal laws and other regulations legal acts of the Russian Federation, generally accepted principles and norms of international law in the field of health care and taking into account domestic and foreign experience.

Clause 2.5 Innovative and staffing support for healthcare development reads:
The level of development of medical science determines the prospects for improving the entire healthcare system. The current state of medical science in the Russian Federation is characterized by blurred priorities, low innovative potential, poor communication with government customers, and a weak system for introducing scientific results into practical healthcare. Development of modern scientific research in the field of medicine is possible only if integrated approach, based on the involvement of developments in fundamental biomedical, natural and exact sciences, as well as new technological solutions.
In 2007, the healthcare system employed 616.4 thousand doctors and 1,349.3 thousand paramedical personnel (in 2004 - 607.1 thousand and 1,367.6 thousand; in 2006 - 607.7 thousand . and 1,351.2 thousand, respectively). The provision of doctors per 10 thousand population was 43.3 (2004 - 42.4; 2006 - 43.0), nursing staff - 94.9 (2004 - 95.6; 2006 - 95.0 ). The ratio of doctors and nursing staff is 1: 2.2.
Despite the fact that there are more doctors per capita in the Russian Federation than on average in developed countries, the quality of medical care and health indicators of the population in our country are much worse, which indicates the low efficiency of the domestic medical care system, insufficient qualifications of doctors and their weak motivation for professional improvement.
In addition, the ratio between the number of doctors and paramedical personnel in our country is significantly lower than in most developed countries of the world, which causes an imbalance in the medical care system and limits the possibilities for the development of aftercare, patronage, and rehabilitation services.
In addition, there is a significant disproportion in the distribution of medical personnel: excessive concentration in inpatient facilities and a shortage in outpatient clinics.
Among the problems in the field of medical personnel management, one should note the low wages of medical workers, egalitarian approaches to the remuneration of medical personnel, low social security and prestige of the medical profession, inconsistency of federal state educational standards of higher and secondary vocational education modern healthcare needs and low quality of teaching, lack of a continuous medical education (CME) system, low awareness of medical workers about modern methods diagnosis and treatment of diseases, poor training of management personnel in healthcare and health insurance, low professional level of medical workers.

Clause 2.7 Healthcare informatization reads:

In the Russian Federation, the development and implementation of healthcare informatization programs has been ongoing since 1992. To date, the country has created elements of information and communication infrastructure for the needs of medicine, and has begun the use and dissemination of modern information and communication technologies in the healthcare sector. In the constituent entities of the Russian Federation, medical information and analytical centers, automated information systems of compulsory health insurance funds and insurance medical organizations.
At the same time, the developed information systems, as a rule, are narrowly focused, focused on providing specific functions and tasks. The lack of a unified approach to their development during operation has led to serious problems. As a result, existing information systems represent a complex of disparate automated workstations, rather than a unified information environment.
The level of equipment of the healthcare system with modern information and communication technologies is extremely heterogeneous, and is mainly limited to the use of several computers as autonomous automated workstations.
Another problem in the field of informatization of the healthcare system is the lack of unification of the software and hardware platforms used. Today, there are more than 800 different medical information systems in medical institutions, and a variety of software packages are used for the needs of accounting, human resources and economic departments.
Some institutions, mainly operating and financed from the compulsory health insurance system, are implementing systems that allow them to keep track of the patient population, conduct activity analysis and compile routine reports. In general, a single information space is not being formed in healthcare institutions, therefore electronic exchange data between them is difficult.
The only kind software installed almost everywhere in healthcare institutions, these are developed programs for recording registers of services provided in the compulsory health insurance system, as well as components of information systems for providing preferential benefits medicines.
To date, a unified approach to organizing the development, implementation and use of information and communication technologies in medical institutions and organizations has not been formed. As a result, the ability to integrate existing software solutions is very limited.
Thus, the current level of informatization of the healthcare system does not allow quickly solving issues of planning and management of the industry to achieve existing targets.
Currently, many countries have begun to implement a program to create a unified information space in the areas of health and social development.
For example, in the UK, the NHS Connecting for Health program is being implemented with a total investment until 2014 of about 25 billion US dollars with a population of approximately 60.5 million people. Similar programs are being implemented in all countries of the Organization for Economic Cooperation and Development (30 countries).
In Europe, in addition to national programs, a unified European Union e-health program is being implemented. Priority tasks: standardization, ensuring insurance coverage regardless of location, processing medical information about the patient using information technology (sometimes the term telemedicine is used to describe the latter task, but it does not fully reflect the essence of these processes).
The volume of EU investments within the framework of the pan-European e-health program (excluding similar national programs) has already amounted to about €317 million.
A unified health information system is being created in Canada. Priority areas of work: Electronic health passport, infrastructure, telemedicine, creation of national registers, reference books and classifiers, systems for diagnostic visualization and storage of graphic information. The program budget for the period until 2009 is $1.3 billion with a population of about 39 million people.
A similar comprehensive program is being implemented in the United States. According to this program, it is planned to create a segment information system in the field of healthcare within the framework of Electronic Government. Total eHealth investment needs for the next decade: estimated at $21.6-$43.2 billion. The priority areas of work for the current period are: electronic health passport (EHR), national information infrastructure for health, regional health information centers (RHIOs), electronic health data exchange.
According to expert assessments, full-scale implementation of information technology in medicine in the United States could lead to savings of up to $77 billion. Similar studies in Germany estimate cost savings from switching to eHealth at up to 30% of existing costs. In particular, the introduction of electronic prescription technology saves about €200,000,000 per year, reducing costs associated with choosing the wrong treatment method, unnecessary procedures and medications will save about €500 million annually, identifying and preventing insurance fraud will amount to about €1 billion in year with a population of about 83 million people.

Goals, objectives and main directions of the concept of healthcare development until 2020

In accordance with the results of the analysis of the state of health care in the Russian Federation, as well as to achieve the set goals, it is proposed activities in the following areas:

Formation of a healthy lifestyle
Preserving and strengthening the health of the population of the Russian Federation is possible only if health is prioritized in the system of social and spiritual values ​​of Russian society by creating economic and sociocultural motivation for the population to be healthy and providing the state with legal, economic, organizational and infrastructural conditions for leading a healthy lifestyle.
For formation of a healthy lifestyle it is necessary to introduce a system of state and public measures to:
1) improvement of medical and hygienic education and upbringing of the population, especially children, adolescents, youth, through the media and the mandatory introduction of appropriate educational programs in preschool, secondary and higher education. Within the framework of this direction, it is necessary to carry out training in hygienic skills in compliance with occupational hygiene rules, work (including study) and rest, diet and structure, timely seeking medical help and other norms of behavior that support health;
2) creating an effective system of measures to combat bad habits (alcohol abuse, smoking, drug addiction, etc.), including educating and informing the population about the consequences of tobacco use and alcohol abuse, promoting the reduction of tobacco and alcohol consumption, regulating and disclosing the composition of tobacco products and alcoholic products, and providing full information about the composition on the packaging, protecting non-smokers from exposure to tobacco smoke, limiting the consumption of alcohol in public places, regulating the location of places of sale of alcoholic beverages, tobacco and the procedure for their sale, as well as price and tax measures;
3) creating a system for motivating citizens to lead a healthy lifestyle and participate in preventive measures, primarily through the popularization of a way of life and lifestyle that contributes to the preservation and strengthening of the health of citizens of the Russian Federation, the formation of a fashion for health especially among the younger generation, the introduction of a medical care system healthy and practically healthy citizens; conducting awareness-raising work about the importance and necessity of regular prevention and medical examination of citizens;
4) creation of a system for motivating employers to participate in protecting the health of employees by establishing benefits on insurance premiums for compulsory medical and social insurance, stimulating working teams to maintain a healthy lifestyle;
5) prevention of risk factors for non-communicable diseases (blood pressure, poor nutrition, physical inactivity, etc.);
6) creation of a system for motivating heads of school education institutions to participate in health protection and the formation of a healthy lifestyle for schoolchildren.

In order to create a healthy lifestyle, the following tasks will be solved:
· conducting applied scientific and epidemiological research to substantiate the improvement of legislation and methodological framework;
· ensuring interdepartmental cooperation and functioning of the coordination mechanism (including organizing the activities of the federal resource center);
· development modern approaches and providing conditions for training specialists, improving training programs, developing the infrastructure of federal scientific, educational institutions;
· organization and development of medical and preventive care through the introduction of modern medical and preventive technologies;
· organizational and methodological support for the activities of regional preventive organizations (medical prevention centers), as well as primary health care institutions;
· development and implementation of federal information and communication campaigns;
· organization of a vertical interaction between medical prevention centers and prevention rooms in primary care;
· organization of health schools on the main risk factors;
· development of conditions for maintaining a healthy lifestyle, including ensuring monitoring and a modern level of control (supervision) over the compliance of products intended for humans, as well as factors of the human environment, with the requirements current legislation.
Activities aimed at promoting a healthy lifestyle among citizens of the Russian Federation will be carried out in two stages.
At the first stage (2009 - 2015), a health assessment system will be developed, basic indicative indicators will be determined, such as public health potential and a healthy lifestyle index. Their stabilization is also ensured through a gradual increase in the volume of funding for specific activities, including those aimed, taking into account the level of prevalence of bad habits in the country, at reducing the consumption of tobacco and alcohol, and at providing medical and preventive care to the population based on developed methods and standards, taking into account risk groups and stages of implementation of individual medical and preventive technologies (first “pilot” regions, then replication throughout the entire territory of the Russian Federation).
At the second stage (2016 - 2020), it is planned to reach the necessary, in terms of efficiency, volume of activities to gradually increase (in relation to the basic indicators established at the first stage) the public health potential by 10% and the healthy lifestyle index by 25 %. At the same time, the prevalence of tobacco use and the volume of alcohol consumption (in terms of pure alcohol) in the country over the entire period should decrease by 2 times.

At the same time, from 2009 to 2012, the financial support for activities to promote a healthy lifestyle will be the priority national project “Health”, which will provide 3.8 billion rubles. In general, it is planned to allocate budgetary allocations federal budget V total amount at least 13.8 billion rubles for the period 2009-2020. Also, financial support for events should be made from the budgets of the constituent entities of the Russian Federation and local budgets. In addition, the creation of motivation mechanisms and strengthening explanatory work will attract investment from the private sector of the economy in health infrastructure.

The implementation of activities within the framework of the National Preventive Vaccination Calendar will reduce the incidence of hepatitis B to 2.8 cases per 100 thousand population in 2010, to 2.7 cases in 2012, rubella to 10 cases per 100 thousand population in 2010 and up to 8 cases - in 2012, measles up to 1 case per 1 million population in 2010, 0.8 cases in 2012. By 2020, the implementation of these measures will ensure the preservation of the country’s status as a polio-free territory; reduce the incidence of acute viral hepatitis B to 1 case per 100 thousand population, eliminate the incidence of viral hepatitis B in newborns, implement a measles elimination program in the Russian Federation, reduce the incidence of rubella to 1 - 5 cases per 100 thousand population and eliminate it in 40% of the country.
During the period from 2008 to 2020. Every year it is planned to survey at least 22 million people (on average, 15% of the total population of the Russian Federation), this level will remain over the past 10 years.
Considering that over the past 5 years there has been an annual increase in the number of newly diagnosed HIV-infected people in the amount of 35 - 40 thousand, which, according to forecasts, will remain until 2020; the number of people in need of antiretroviral therapy will also increase. Treatment will cover newly diagnosed HIV-infected people, as well as persons undergoing treatment who have stopped receiving treatment previously or who have left dispensary observation and returned again.
In order to fulfill the task of preserving the health of the younger generation and the labor potential of the nation, and also, taking into account the limited financial capabilities of the Project in the field of treatment of patients with viral hepatitis, it is necessary to additionally focus the project’s efforts on the treatment of chronic viral hepatitis in children, adolescents, and young people under 25 years of age. It is planned to provide further treatment against viral hepatitis B and C to persons with HIV infection, as well as to persons in need of treatment and who have good adherence to treatment.

Security healthy safe food population of all age groups is an important direction in the formation of a healthy lifestyle among the population of the Russian Federation, providing for the optimization of the diet and nature of nutrition, as well as education and training of various groups of the population on healthy nutrition, including with the participation of scientific and treatment centers dealing with nutrition issues .
Measures to introduce healthy, safe nutrition:
· support for breastfeeding of young children,
· support for domestic production of specialized baby food products that fully meet the needs of healthy young children;
· creating a system of healthy nutrition for children in organized groups, including improving the organization of nutrition for students in general education institutions;
· education and training of various population groups in matters of healthy nutrition, including with the participation of scientific and treatment centers dealing with nutrition issues;
· information and communication campaign to develop a healthy, safe diet among citizens of the Russian Federation;
· monitoring the nutritional status of the population.

Another important area is measures to increase physical activity, which is the most important condition for maintaining the health of citizens. Such measures should include:
· promotion and stimulation of an active lifestyle, education of the population in matters of physical culture;
· restoration of industrial gymnastics and development of specific recommendations on its content and forms of implementation, taking into account working conditions;
· development of physical therapy and physical culture aimed at maintaining health, based on the developments of Russian scientists and world experience available in this area.

Quality medical care is based on the use of modern technologies for organizing and providing diagnostic, therapeutic, rehabilitation and preventive services, the effectiveness and safety of which (for specific diseases or pathological conditions) has been confirmed in accordance with the principles of evidence-based medicine.
Guaranteed security every citizen of the Russian Federation quality medical care should be provided with the following measures:
1. specification of state guarantees for the provision of free medical care;
2. standardization of medical care;
3. organization of medical care;
4. provision of medicines to citizens on an outpatient basis;
5. implementation of a unified personnel policy;
6. innovative development of healthcare;
7. system modernization financial security provision of medical care;
8. healthcare informatization.

Specification of state guarantees for the provision of free medical care

State guarantees for the provision of free medical care to citizens of the Russian Federation must be defined by law, including:
· sources of financial support for state guarantees of providing free medical care to citizens of the Russian Federation;
· the scope of state guarantees for the provision of free medical care to citizens of the Russian Federation in terms of the types, procedure and conditions for the provision of medical care;
· the procedure for assessing the effectiveness of the implementation of state guarantees of free medical care;
· responsibility for failure to comply with state guarantees of free medical care;
· the procedure for developing regulations that specify the scope of state guarantees of free medical care established by the legislation of the Russian Federation.
In accordance with the provisions of the legislation of the Russian Federation, the Government of the Russian Federation must adopt a State Guarantee Program for three years, containing:
· the minimum per capita standard for financial support of state guarantees for the provision of free medical care;
· standards of financial costs per unit volume of medical care;
· per capita standards for the volume of medical care by type;
· minimum values ​​of criteria for assessing the quality and accessibility of medical care.
Based on the SGBP approved by the Government of the Russian Federation, the constituent entities of the Russian Federation adopt territorial programs of state guarantees, depending on financial security, establishing their own financial standards (not lower than those established by the Government of the Russian Federation), and also including, if necessary, additional types of medical care.
Monitoring of the implementation of state guarantees of free medical care should be carried out on an annual basis, while information on the implementation of the SGBP in the corresponding year should be the basis for the formation of indicators of state guarantees of free medical care for subsequent periods.
Financial indicators must be linked to qualitative ones:
· population satisfaction with medical care;
· mortality of the population of a constituent entity of the Russian Federation, including infant and maternal mortality, mortality of the population of working age, mortality of the population from cardiovascular diseases, cancer, external causes, as a result of road accidents;
· primary incidence of major socially significant diseases;
· primary disability;
· balance of the territorial program of state guarantees by types and volumes of medical care in accordance with the standards established by the Program;
· waiting times for citizens to receive medical and rehabilitation care by type and conditions of provision.
At the same time, the State Guarantee Program should set target values ​​for these indicators and, if necessary, additional indicators taking into account healthcare priorities.
As part of the management system for the implementation of the SGBP by constituent entities of the Russian Federation and municipalities, mechanisms for financial incentives for achieving the corresponding indicators should be provided through the provision of additional transfers from the federal budget and the Federal Compulsory Medical Insurance Fund.
At the same time, in case of failure to comply with the established control values, the legislation of the Russian Federation must establish appropriate sanctions and introduce an effective mechanism for applying these sanctions.
Implementation stages:
2009 - 2010 - development and adoption of a law on state guarantees for the provision of free medical care to citizens and a law on compulsory health insurance; creation of a system for monitoring the implementation of the state guarantee program;
2010 - 2015 - specification of state guarantees based on standardization of medical care; transition to planning the SGBP for three years with annual adjustments; certification of medical institutions for the provision of premises and equipment in order to determine the possibility of including investment costs in the compulsory medical insurance system;
2016 - 2020 - inclusion in the per capita SGBP standard of investment-related expenses, as well as expenses for the purchase of expensive equipment.

Standardization of medical care

One of the main factors in creating a system of high-quality and affordable medical care is the presence of uniform standards for the entire territory of the Russian Federation. orders of magnitude And standards providing medical care for the most common and socially significant diseases and pathological conditions.
Standards of medical care are developed in accordance with the indicators of the State Guarantees Program, and their implementation is guaranteed to citizens throughout the Russian Federation.
The creation of standards of medical care will make it possible to calculate the real cost of medical services in each subject of the Russian Federation, determine the costs of implementing state and territorial programs of medical care to the population, calculate the necessary drug supply for these programs (list of vital and essential drugs), justify per capita financing standards and optimize options for restructuring the network of healthcare institutions.
The introduction of procedures for the provision of medical care will make it possible to optimize its phasing, use the correct algorithm for interaction between healthcare and social security institutions, and ensure continuity in the management of the patient at all stages, which will significantly improve the quality of medical care to the population.
Procedures and standards of provision individual species medical care are the basis of the program of state guarantees for the provision of free medical care to citizens, corresponding to the modern level of development of medicine and mandatory for implementation.
One of the main elements of quality assurance should be considered the development by professional communities (associations) of clinical recommendations (guidelines) containing information on prevention, diagnosis, treatment of specific diseases and syndromes, which will serve as the basis for the development of standards of medical care, indicators of the quality of the diagnostic and treatment process.
This approach to the formation of a patient management algorithm helps attending physicians plan the diagnostic and treatment process taking into account the real capabilities of the medical organization. Heads of treatment and prevention institutions (MPIs) can evaluate the quality of medical care based on the criteria of completeness of implementation of mandatory treatment and diagnostic measures, as well as compare the quality of work of individual doctors and departments and introduce differentiated wages.
Implementation stages:
2009 - 2010:
· development of clinical recommendations, procedures for providing medical care, standards of medical care, quality indicators - for medically and socially significant diseases and conditions; “pilot” implementation of registers of inpatient patients as part of the implementation of measures to improve medical care for patients with vascular and oncological diseases;
2010 - 2015:
· phased implementation of a quality management system for medical care based on procedures and standards for its provision, registers of inpatient patients, including indicators of the quality of care provided, as well as improving the tariff policy for remuneration of medical workers, dependent on the quality of care;
· establishing a procedure for licensing medical organizations, based not only on the availability of appropriate material and technical equipment and certified specialists, but also on the ability to comply with the technology of medical care (availability of a sufficient number of trained medical personnel with access to the necessary types of care and material and technical resources to implement equipment operation schedule in accordance with medical care technologies);
2016 - 2020:
· implementation of an economically sound self-regulatory system for managing the quality of medical care on the territory of the Russian Federation.

Organization of medical care

In order to ensure the quality and accessibility of medical care, it is necessary to create an organizational system providing:

• the fastest possible delivery of the patient to a medical institution equipped diagnostic and treatment equipment, staffed by trained medical personnel and provided with necessary medicines And medical products in accordance with relevant standards;
• if necessary, a step-by-step continuation of treatment in other medical institutions (continuous aftercare and rehabilitation, secondary prevention, sanatorium-resort rehabilitation treatment) or at home, in accordance with the procedure for providing medical care for a specific disease or condition, until the best result is achieved (recovery, functional recovery).

• creation of legal and economic conditions to form a self-regulatory system for providing medical care to the population, ensuring motivated, effective work of medical services at each level, continuity of their actions at all stages of treatment to achieve the best result;
• development of primary health care, including reducing the number of attached adult population to 1.2 - 1.5 thousand people, children - up to 600-800 children and adolescents per 1 site, reducing the workload on one local doctor, giving priority to preventive work, strengthening the patronage and rehabilitation function, introducing a system of “hospitals at home” provided by mobile specially equipped visiting teams, re-equipping institutions, improving and expanding hospital-replacement medical technologies;
• improving the work of emergency medical care, including optimization of routes for transporting patients to the hospital depending on the type of pathology, the severity of the patient’s condition, introducing target indicators for the work of emergency medical care (arrival time to a call, time of transportation to the hospital, pre-hospital mortality), introducing procedures for the provision of medical care assistance in prehospital management of patients with different types pathologies;
• optimization of the work of hospital-level institutions in terms of setting target indicators for the work of institutions, reflecting not only the types and volumes of medical care provided, but also its quality, introducing phasing of medical care and developed routes for transporting patients based on the rational distribution of functional responsibilities of hospitals ( municipal (city and district)- to provide primary care in emergency situations; subject interdistrict- to provide specialized care, including in emergency conditions and conditions requiring restorative treatment and rehabilitation; subject And federal- to provide specialized, including high-tech, assistance), develop specialized institutions for providing diagnostic and therapeutic care to patients with cancer, create a routing service in each hospital responsible for organizing follow-up treatment and rehabilitation of discharged patients, as well as expanding the volume and implementation of new types of high-tech care, including for emergency conditions;
• development of patronage and rehabilitation medical care, including the creation of a network of institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care, including through the repurposing of existing hospitals and sanatorium-resort institutions, expansion of the network of day hospitals, the creation of a system of target indicators for the work of patronage institutions -rehabilitation level, reflecting the quality of medical care (the degree of restoration of impaired functions, indicators of primary disability and severity of disability), the introduction of high-tech rehabilitation technologies;
• development and implementation of a quality management system for medical care based on procedures and standards for its provision, including the implementation of an audit of medical care based on an audit of the treatment process in accordance with indicators of quality and technological deviations;
• unification of equipping medical organizations with equipment in accordance with the standards and procedures for providing medical care;
• expanding the economic independence of healthcare institutions, as well as increasing their responsibility for the economic results of their activities, including with changes in organizational and legal forms based on unified system criteria.

Most of the indicated areas (Appendix 1) are not expected to be included in the territorial compulsory health insurance program, according to at least at stage 1.
Implementation stages:
2009 - 2010:
· creation of a system for operational recording of medical care, healthcare institutions and medical personnel;
· effective planning of personnel, financial and other material and non-material resources necessary to provide adequate medical care and develop the medical care system;
· planning the development of a network of treatment and preventive institutions with their profiling, redistribution of personnel and treatment and diagnostic capacities, formation of patient routes, creation of a system of phased successive care;
· gradual improvement of the system of providing medical care to patients with vascular diseases: introduction of automated risk assessment of vascular diseases and primary prevention of stroke and myocardial infarction in primary outpatient clinics; creation in the first 36 constituent entities of the Russian Federation of interdistrict primary vascular departments, providing emergency specialized medical care to patients with acute vascular disorders, as well as regional vascular centers coordinating their activities, providing round-the-clock consultative and diagnostic (including telemedicine) and high-tech care for vascular diseases ;
· gradual improvement of the system of providing assistance to victims of road traffic accidents based on the organization of emergency pre-hospital and hospital care in hospitals located along federal highways;
· gradual improvement of the system of providing medical care to patients with cancer: introduction of total cancer screening in primary outpatient clinics and hospitals; re-equipment and additional staffing of regional oncology clinics in the first 22 constituent entities of the Russian Federation; creation of the first high-tech district oncology clinics;
· gradual improvement of the system of providing assistance to women during pregnancy and childbirth, as well as newborns and children;
· gradual improvement of blood service;
2010 - 2015:
· development in each subject of the Russian Federation of a network of treatment and preventive institutions to increase efficiency and ensure the phasing of medical care - repurposing some of the existing 24-hour hospitals and sanatorium-resort institutions in order to expand the network of institutions for rehabilitation treatment (aftercare), rehabilitation and medical care, and the creation of day hospitals;
· improvement of primary health care:
o development of the territorial-precinct principle of providing outpatient care to the population, including rural areas and hard-to-reach areas;
o additional staffing of outpatient clinics with qualified medical personnel (doctors and paramedical personnel);
o giving priority to preventive work (a system of health measures, medical examinations, screening examinations, vaccinations, in-depth examinations, etc.) based on a planned tariff policy;
o providing preventive care to the population of rural areas and hard-to-reach areas of the country through the formation of mobile medical teams equipped with the necessary laboratory and instrumental equipment;
o development of telemedicine technologies for remote consulting and diagnostic activities;
o improving the active patronage service, including equipping with the necessary tools and equipment;
o retrofitting institutions, improving and expanding hospital-replacement diagnostic technologies;
o introduction of outpatient rehabilitation services;
o introduction of target performance indicators for outpatient clinics, reflecting the proportion of healthy individuals among the assigned population and the percentage of early stages of diseases among all newly diagnosed ones;
o improving the tariff policy of remuneration, reflecting the priority of the work of the local doctor - a set of preventive measures;
· improvement of emergency medical services:
o optimization of routes for transporting patients to the hospital depending on the type of pathology and the severity of the patient’s condition;
o introduction of standards for pre-hospital management of patients with different types of pathology;
o providing emergency medical teams with mobile communications;
o retrofitting the emergency medical service according to the standard;
o additional staffing of the emergency medical service with trained personnel;
o introduction of target indicators for the performance of emergency medical services (time of arrival to a call, time of transportation to the hospital, pre-hospital mortality);
· optimization of the work of inpatient institutions:
o rational distribution of functional responsibilities of hospitals;
o phased creation of head regional centers coordinating the entire scope of preventive, diagnostic and therapeutic measures on socially significant medical problems;
o introduction into the activities of clinical departments of hospitals of patient management protocols and standards of medical care, registers of inpatient patients and a quality management system for medical care;
o expanding the volume and introducing new types of high-tech care, including for emergency conditions;
o additional staffing of hospitals with qualified personnel in accordance with standards;
o retrofitting hospitals according to standards;
o ensuring the operation of round-the-clock telemedicine communications between hospitals of municipal and regional subordination;
o introduction of phasing of medical care and developed routes for transporting patients, creation in each hospital of a routing service responsible for organizing follow-up treatment and rehabilitation of discharged patients (referral to a “hospital at home” through communication with the patronage service of an outpatient clinic in accordance with the patient’s place of residence , in specialized hospitals for rehabilitation treatment, rehabilitation, medical care);
o intensification of the work of inpatient beds through the introduction of hospital-replacement diagnostic technologies at the outpatient clinic level and the organization of step-by-step rehabilitation treatment (patronage service, aftercare and rehabilitation system);
o improving target performance indicators of inpatient facilities, reflecting the quality of medical care (mortality, degree of restoration of impaired functions);

· improvement of the system of stage-by-stage recovery treatment and rehabilitation:
o creation of a network of institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care, including through the repurposing of some operating hospitals and sanatorium-resort institutions;
o expansion of the network of day hospitals for rehabilitation treatment and rehabilitation;
o staffing institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, and medical care with qualified personnel in accordance with standards;
o equipping institutions (departments) for rehabilitation treatment (aftercare), rehabilitation, medical care in accordance with standards;
o introduction of high-tech rehabilitation technologies;
o creation of a system of target indicators for the performance of nursing and rehabilitation institutions, reflecting the quality of medical care (the degree of restoration of impaired functions, indicators of primary disability and severity of disability);
o improving the tariff policy based on taking into account not only the type and volume of medical care provided, but also its quality;
· expanding the economic independence of healthcare institutions, as well as increasing their responsibility for the economic results of their activities, including changing organizational and legal forms based on a unified system of criteria;
· creation of legal and economic conditions for the formation of a self-regulatory system for providing medical care to the population, ensuring motivated, effective work of medical services at each level, continuity of their actions at all stages of treatment to achieve the best result;
· implementation of a “pilot” project to transition to a self-regulatory system for organizing medical care in several constituent entities of the Russian Federation;
2016 - 2020 - “system-forming” stage- with the successful implementation of a pilot project for the transition to a self-regulatory system for organizing medical care in several constituent entities of the Russian Federation, its widespread implementation will be carried out, taking into account regional characteristics.
Development primary health care (outpatient clinic level) should occur in the direction of priority provision of the population of the attached territory (or institution), primarily healthy people and persons with chronic diseases without exacerbation, with preventive care. The main functions of the primary outpatient clinic level should be:
· promotion of a healthy lifestyle and counseling on maintaining and improving the health of a person (starting from early childhood), family or work team (dietology, occupational health, physical education, psychology, etc.);
· clinical examination of the population, identifying risk groups for the development of socially significant non-communicable diseases and the development of individual prevention programs (lifestyle correction, preventive treatment);
· dispensary observation (and in-depth examinations) of persons belonging to risk groups and chronically ill patients;
· monitoring the health of pregnant women and perinatal screening;
· neonatal screening; medical examination of children and adolescents;
· prevention of infectious diseases, including all types of vaccination;
· treatment of intercurrent and other mild diseases and functional abnormalities (as part of a mild exacerbation of a chronic disease) that do not require regular active patronage.
The target indicators for the work of outpatient clinics will be the proportion of healthy people of all age groups from the total attached population and the percentage of early stages of diseases among all newly diagnosed ones. An emphasis on preventive work will make it possible to move from a multi-component tariff for remuneration of medical workers (by type of service) to a “capita” tariff (by the number of attached population).
System creation will occur through its organizational separation from primary health care and specialized medical care. Formation of the system “out-of-hospital medical care, patronage and rehabilitation” planned for:
· providing the population (first-time cases and persons with exacerbation of a chronic disease) with ambulance and emergency medical care;
· 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”, departments of rehabilitation treatment and rehabilitation, hospice) and the implementation of active or passive patronage.
Will be carried out by a specially created “parahospital” service, consisting of:
· divisions emergency assistance and routing of patients, based at multidisciplinary hospitals, primarily under municipal subordination, and including:
o emergency medical teams;
o department of emergency diagnostic and therapeutic care for emergency conditions (can be created on the basis of hospital admission departments);
o patient routing service (can be created on the basis of hospital admission departments);
o local patronage units created from the patronage services of primary outpatient clinics, staffed by mobile visiting teams equipped with mobile diagnostic equipment (portable express laboratories, portable electrocardiographs, ultrasound scanners), dressings and other materials;
· units of restorative treatment (aftercare), rehabilitation, medical care, including:
o institutions for after-care, including day hospitals;
o rehabilitation institutions;
o hospices.
The inclusion of “parahospital” units in the technological chain of medical care will lead to more progressive competitive relations between all levels of the unified system: identifying facts of inadequate examination and ineffective treatment of patients with “parahospital” complexity by doctors at the primary (outpatient) level, as well as non-core hospitalization and unreasonable delays of patients in expensive inpatient beds.
It is advisable to maintain an active independent functional role“parahospital” service while maintaining close ties both with the hospital and with outpatient clinics, which will ensure continuity in the management of patients, as well as jointly rationally use personnel and diagnostic potential.
The target indicator of the effectiveness of the institutions of the system of “out-of-hospital medical care, patronage and rehabilitation” is the number of patients who have restored full or partial functional independence and ability to work, among all those treated.
Further development inpatient medical care should occur in the direction of providing effective assistance to patients in need of control and correction of vital functions, carrying out diagnostic and therapeutic measures that require round-the-clock monitoring of patients.
It is advisable to organize emergency admission of patients to a hospital through a “parahospital” service (ambulance or emergency medical care, department of diagnostic and therapeutic care for emergency conditions); planned hospitalization - by referral from a doctor at an outpatient clinic. Discharge of a patient from a hospital should be carried out through a specialized routing department of the “parahospital” service, which ensures the organization of stage-by-stage recovery treatment and rehabilitation, continuity in the management of the patient at all stages, transfer of information about the patient and medical and social recommendations to the local patronage unit at the patient’s place of residence.
The target indicators of the effectiveness of inpatient care are in-hospital mortality rates and the number of patients who regained full or partial functional independence and ability to work among all those treated.
The introduction of a self-regulatory system for providing medical care to the population will ensure the implementation of a phased technological principle of the functional distribution of diagnostic, preventive, therapeutic and rehabilitation measures in a logical and rational sequence, which will increase the medical and economic efficiency of the entire system.

Providing the population with medicines on an outpatient basis

One of the significant areas for increasing the accessibility of medical care is the ability to satisfy the needs of all patients (including socially vulnerable) for high-quality medicines in accordance with therapeutic indications. The availability of medicines is determined by the availability of medicines on the pharmaceutical market and the economic accessibility of medicines, that is, price regulation and compensation of the population’s costs for medicines through the compulsory health insurance system.
The insufficient level of provision of high-quality medical care and medicines against the backdrop of the uncontrolled dispensing of prescription drugs and the low culture of drug consumption by the population of the country intensifies the so-called self-medication of citizens, leading to an increase in the duration of temporary disability, a decrease in labor productivity, and a reduction in life expectancy of the population.
Overcoming these trends is possible through the introduction of a program of universal compulsory drug insurance, aimed at an optimal balance between the effectiveness and cost of treatment with rational use of resources.
The introduction of drug insurance is advisable at the stage of treatment in outpatient clinics for all citizens, with the exception of patients in need of expensive drug therapy.
Drug insurance is primarily focused on preserving the health of the population that has not partially lost

The key areas for improving healthcare are informatization and innovation.
Everyone who was “lucky enough” to get into the emergency department of almost any domestic hospital had to observe an amazing picture: there are computers at the reception desk, a nurse diligently enters information about the patient into the database, and records his insurance policy number. Next, the person seeking medical help is sent to an examination room for an initial examination by a specialized specialist. It would seem that everything is quite logical and civilized for honey. 21st century institutions. However, then a doctor comes into the examination room and begins to carry out incomprehensible and even strange actions. The fact that you can wait more than an hour for a doctor when you arrive by ambulance is special moment, which is not included in the context of the issue under study. These are already questions of the level of staffing, motivation, professionalism and ethical competence of medical workers. As part of the analysis of informatization and innovation, the patient is faced with problems (or, more correctly, outright nonsense) of a different nature. The doctor begins the survey by collecting initial data: full name, address... again the policy number, i.e., everything that the person has already provided at the registry. But besides this, the doctor writes everything down on a paper card. Next, a survey and examination begins regarding the essence of the disease. All this is entered by the doctor into the same paper card. During the further treatment process, all facts of changes in well-being and the treatment methods used are also entered into a paper card. The statement is also drawn up on the basis of a paper card, and the statement itself is made in paper form. All this negates the presence of computer equipment and information technology in a medical institution. The most paradoxical thing happens when a person is admitted to the hospital again: the whole procedure is repeated again. - from the beginning to the end.
Thus, healthcare institutions in general are provided with information technology and equipment, but its use is completely ineffective.
There is an obvious need to improve information and innovative support for the work of medical institutions.

Informatization of healthcare

Modern medical information technologies can have a significant impact on improving the quality and accessibility of medical services to the population in combination with increasing the efficiency of planning and resource management of the healthcare system of the Russian Federation based on monitoring and analysis of quality indicators of medical care.
The goal of informatization of the healthcare system is to increase the availability and quality of medical care to the population based on the automation of the process of information interaction between institutions and organizations of the healthcare system, healthcare authorities of the constituent entities of the Russian Federation, as well as federal authorities executive power, ensuring the implementation of state policy in the field of health care.
In order to information support operational management and planning of resources of the healthcare system, as well as increasing the availability and quality of medical care for citizens of the Russian Federation, a state information system for personalized accounting of medical care provision (System) should be created, which will provide operational accounting of medical care, healthcare institutions and medical personnel and create a reliable basis to solve key industry management problems.
In order to achieve this goal, it is planned to solve the following main tasks:
· creation of an information and analytical system for maintaining federal registers and registries, as well as regulatory and reference support in the field of healthcare;
· creation of an information system for personalized recording of medical care;
· information support for the process of providing primary medical care, as well as the treatment and diagnostic process, including by ensuring access of medical workers to the regulatory and reference information necessary for professional activity;
· information support for the provision of high-tech medical care services;
· creation and implementation automated system conducting medical card patient in electronic form;
· creating conditions for the implementation of a self-regulatory system for organizing medical care using constant monitoring and analysis of quality indicators of medical care;
· streamlining the system of financing and management of institutions and organizations in the healthcare industry.
It is assumed that medical institutions, as well as territorial compulsory health insurance funds, should become sources of primary information for the formation of elements of the System.
The information generated within the System will make it possible to solve problems of analyzing and forecasting key indicators of the development of the healthcare industry, as well as improving the quality and efficiency of providing medical services to the population. This will be achieved through automation:
· monitoring of financial flows in healthcare institutions both on the territory of the constituent entities of the Russian Federation and in the industry as a whole;
· assessing the effectiveness of human resource management in the healthcare sector;
· determining the volume and structure of medical care based on data on citizens’ requests to health care institutions;
· forecasting the need for prescription medicines citizens, including under the drug insurance program, based on data from territorial population registers;
· forecasting the costs of medical care provided under the State Guarantees Program;
· assessing the effectiveness of the activities of regional health authorities.

Implementation stages:
2009 - 2015:
· development and coordination of organizational and technical requirements for the components of the System, providing for the possibility of using unified social cards of citizens in the Russian Federation at the stage of the second stage of creating the System;
· approval of the system project for the creation of the System;
· formation of a “pilot” zone for testing standard software and hardware complexes created within the System;
· installation of standard software and hardware systems in federal, state and municipal healthcare institutions and regional centers of the “pilot” zone and connecting them to the Internet;
· creation within the System using the infrastructure of the All-Russian State information center Federal Data Center for Healthcare;
· refinement based on the results of trial operation of standard software and hardware systems installed in federal, state and municipal healthcare institutions and regional centers of the “pilot” zone;
· creation of subsystems of federal registers, registers and regulatory reference information in the field of healthcare with the possibility of access of government authorities and organizations in the field of healthcare, as well as local governments of municipalities to information contained in the federal and regional centers for data processing and analysis, including including, to subsystems of registries and registries in the healthcare sector.
2016 - 2020:
· putting the System into commercial operation;
· introduction of a unified system for identifying recipients of medical services based on the use of a citizen’s unified social card.
· creation of a system for centralized maintenance and updating of scientific reference information, including reference books, classifiers, medical and economic standards;
· creation of a unified federal system collection and storage of electronic medical records based on national standards.

Innovative development of healthcare

Lecture, abstract. Innovation and informatization of healthcare - concept and types. Classification, essence and features. 2018-2019.

Improving health financing

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Introduction

1. Main models and trends in the development of healthcare in the world

1.1 Main directions of global health care reform

1.2 Search for the optimal role of the state in the healthcare system

1.3 Reforms in the financing and insurance system

1.4 Reforms of regional health systems

1.5 Development of health services

1.6 Situation in the field of drug supply

1.7 Information and technological development of healthcare

2. Current state healthcare in the Russian Federation

2.1 Demographic situation In Russian federation

2.1.1 Health indicators and main risk factors for morbidity and mortality of the population of the Russian Federation

2.2 Implementation of the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation

2.2.1 System for organizing medical care to the population

2.3 Innovative and staffing support for healthcare development

2.4 Medicine provision for citizens on an outpatient basis

2.5 Healthcare informatization

3. Main activities for the implementation of the concept of healthcare development

3.1 Main goals, objectives and main directions of the concept of healthcare development

3.2 Formation of a healthy lifestyle

3.3 Guaranteed provision of quality medical care to the population of the Russian Federation

3.3.1 Organization and standardization of medical care

3.3.2 Providing the population with medicines on an outpatient basis

3.4 Implementation of a unified personnel policy

3.5 Innovative development of healthcare

3.6 Financial support for the provision of free medical care to citizens

3.7 Healthcare informatization

3.8 Legislative and regulatory support for the implementation of the concept

Conclusion

List of used literature

healthcare development concept

Introduction

In order to ensure sustainable socio-economic development of any country, one of the priorities of state policy should be the preservation and strengthening of public health based on the formation of a healthy lifestyle and increasing the availability and quality of medical care.

The effective functioning of the healthcare system is determined by the main system-forming factors:

Improving the organizational system to ensure the formation of a healthy lifestyle and the provision of high-quality free medical care to all citizens of the 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 institutions based on innovative approaches and the principle of standardization;

The presence of a sufficient number of trained medical personnel capable of solving the problems set before the healthcare system of the Russian Federation.

These factors are interdependent and mutually determining, and therefore modernization of healthcare requires the harmonious development of each of them and the entire system as a whole. The concept for the development of healthcare in the Russian Federation until 2020 is an analysis of the state of healthcare in the Russian Federation, as well as the main goals, objectives and ways to improve it based on the application of a systems approach.

The concept was developed in accordance with the Constitution of the Russian Federation, federal laws and other regulatory legal acts of the Russian Federation, generally accepted principles and norms of international law in the field of healthcare and taking into account domestic and foreign experience.

1 . Main models and trends in the development of healthcare in the world

1.1 The main directions of global health care reform

In 2006, healthcare spending worldwide was $3,608.7 billion. The National Research Institute of Public Health estimates that 2/3 of this amount was spent on healthcare in North America. The main trends in the development of the global healthcare system in 2007-2008 were the implementation of reforms in the field of healthcare, the development of medical services, the provision of medicines, increasing the level of technological development of healthcare, and the restoration of healthcare systems after military conflicts and natural disasters.

The results of monitoring organized by the National Research Institute of Public Health of the Russian Academy of Medical Sciences made it possible to highlight reforms among the main events of 2006 national systems health care, which are carried out in the former socialist countries (Czech Republic, Hungary, Bulgaria) and third world countries, as well as regional reforms carried out in individual states and provinces.

In general, global healthcare reform is taking place in the following areas:

searching for the optimal role of the state as a provider of medical services in the healthcare system;

reducing high costs for the health care system;

development of all types of health insurance.

1.2 Search for the optimal role of the state in the healthcare system

In 2007-2008 There was a significant decrease in the role of the state in the health care system of Bulgaria, the Czech Republic, Poland, and Hungary. This was often due to the corporatization of hospitals, which resulted in the transfer of part of public health services into private hands. Time will tell how effective and economically justified this is.

At the same time, in other countries in 2008, the role of the state in the healthcare sector was strengthened, but not at the level of supply of medical services, but at the level of increased funding. Thus, in China, India, Venezuela, and the USA, until recently, the role of the state was insignificant. For example, the Chinese state has practically not participated in the financing of its country’s healthcare since the middle of the last century. However, after the outbreak of bird flu, the Chinese Government decided to significantly increase government spending in the health care system, primarily in the rural health care system. In addition to increasing the share of government spending on rural health care to 40% of all health care spending, it is planned to create an infrastructure of low-cost hospitals that would be accessible to low-income families.

Another Asian country, India, having become disillusioned with the capabilities of the private market, has also set a course for increasing the share of the public health sector.

Venezuela, practically building socialism, is pursuing the same line in the healthcare sector. Venezuelan leader Hugo Chavez announced that the country's entire healthcare infrastructure should be state-owned, and medical workers must be exclusively in the public service. However, the policy of the country's president has not received widespread support from Venezuelan doctors, as a result of which specialists from other countries are currently being invited to the country. Thus, over the past 4 years, 12 thousand doctors from Cuba arrived in Venezuela, who were offered a salary of $500 per month and the so-called “basket of products.” Now Hugo Chavez sends his students to Cuba to study the profession of a doctor. All these measures are aimed at building a state healthcare system in the country.

The strengthening role of the state in healthcare is also observed in developed countries. Thus, the US government is actively creating a drug supply system for the population. In countries such as Sweden and Great Britain, optimization of the role of the state occurs through the implementation of public-private partnerships. In Sweden, the state engages private providers of medical care, and in the UK there is a system of granting the right to patients to be treated in private clinics if public medical institutions are not able to provide them with the necessary medical care. In this case, the state undertakes to pay all patient expenses for private medical services.

Thus, in general, the world is witnessing an increase in the role of the state in the provision of medical services - it is becoming a regulator, controller and financier of the functioning of the healthcare system.

1.3 Reforms in the financing and insurance system

When reforming the country's financing system in 2007, Germany set itself the task of reducing health care costs. A Centralized Health Fund was created in the country - an analogue of the Russian health insurance system. That's it Insurance companies make payments at uniform tariffs through this fund, while before the reform payments were made in individual companies at different tariffs. Based on a unified tariff system, it is planned to create a competitive market of insurers, which would increase the efficiency of the entire insurance system. It is expected that in the future, due to this, healthcare costs will be reduced by approximately 7-10%.

According to the National Research Institute of Public Health of the Russian Academy of Medical Sciences, a reduction in the funding gap for hospital institutions in 2007 also occurred in the UK. The health budget in this country has reached £81 billion, and of the 570 operating trusts, 37% are in financial crisis.1 Thus, in 2007-2008. year were devoted to the fight against financial crisis and deficits in medical care for the population. To achieve this, the UK government set goals to reduce staffing levels (as a result, the number of doctors' salaries decreased by 1 thousand), reduce hospitalization volumes, and close hospital wards. On this moment It is not known whether it was possible to completely eliminate the gap in healthcare financing, but according to preliminary results, this work has not yet yielded the expected result: the deficit persisted, as a natural reaction to the closure of hospitals, queues for hospitalization grew, and very tense relations arose among healthcare workers.

Similar processes are taking place in France - the country has entered into a struggle with a shortage of funding for hospital institutions. Health care financial management was transferred to the private sector, and hospital managers began budgeting on an income-expenditure basis based on new rules. In addition, it was forbidden to carry forward spending deficits to the next year, with responsibility for the deficit being placed on the hospitals themselves, which, among other things. We were forced to look for new ways of self-financing. The preliminary results of this reform showed that many medical institutions were able to equalize their income and expenses, while at the same time the volume of required medical care increased.

Another significant event in 2006 was the launch of a large rural insurance program in China. According to this program, by 2010 the entire rural population of the country, which is about 900 million inhabitants, of which 700 million are below the poverty line, will be provided with health insurance policies. The Chinese Government proposes the so-called cooperative insurance, under which 1.5 dollars for medical services is paid by the resident, and 5 dollars by the state. Thus, 65% of guaranteed medical care will be paid for by the Chinese Government, the remaining 35% - by the population of the country.

1.4 Reforms of regional health systems

Reforms regional system healthcare in 2008 took place in the following regions: Quebec (Canada), New Wales (Australia), Michigan, California (USA), Shanghai (China), Astana (Kazakhstan).

A private-public partnership introduced in the Canadian province of Quebec implies that if a public hospital can provide the required service only after six months, then for more timely care the patient can turn to a private medical institution, the services of which will be paid for by the regional government.

In New Wales, Australia, a program was carried out to restructure state health authorities: the number of medical institutions in the region was reduced, the number of managers' salaries was reduced, and management costs were also reduced. The states of California and Michigan provided coverage to residents who previously did not have health insurance.

In Shanghai, China, 600 hospitals have been built, of which 200 hospitals are either already managed by foreign capital or have foreign shareholders. An interesting program for building clusters of modern medical care has been launched in Astana (Kazakhstan) - Construction has begun on approximately 10 medical institutions of all main profiles. It is important to note that foreigners will be involved in managing clusters in two ways: either through capital investment or through management companies.

1. 5 Development of medical services

In 2008, according to the National Research Institute of Public Health of the Russian Academy of Medical Sciences, the development of medical services in the field of human organ transplantation was observed in global health. In organizing transplantation activities, much attention was paid to providing a guarantee of the safety of donor organs and tissues, legalizing the system of trade in human organs, developing the direction of production of artificial organs, as well as medical tourism.

Based on the information obtained in the study1, it was estimated that the average waiting time for organs in Europe is now approaching three years. By 2010, waiting times will increase to 10 years, indicating a trend toward increasing shortages of organs for transplantation at the global level and increasing patient waiting lists. Thus, in the USA in 2008, the waiting list for a kidney transplant reached 95 thousand people. In 2007, Israel performed 260 organ transplants per day, compared with only 73 in the United States, highlighting the uneven distribution of transplant opportunities around the world.

The year 2008 was marked by the emergence of new types of medical care. Thus, in the UK, day health centers were opened for passengers traveling to work or home, which caused widespread approval from the citizens of this country. And US residents had the opportunity to use the services of medical centers in stores across the country.

1. 6 The situation in the field of drug supply

The state of the global drug supply system in 2006 was determined by the level of availability of drugs, the development of trends in reducing the cost of drugs and the reduction in the number of counterfeit drugs.

On January 1, 2008, the United States began modernizing drug coverage under the Medicare program. According to this program, over the next 10 years, the Government of the country will allocate funds in the amount of $678 billion, while the approximate cost of one prescription will be $5. In Germany, since the beginning of 2007, the cost of medicines has been reduced by exempting people who want to buy less expensive medicines from paying sales tax.

According to the National Research Institute of Public Health, it was found that in 2008, 50% of all counterfeit drugs, which make up 10% of the global drug market, were purchased via the Internet, 30% in African countries, 20% in the CIS countries.

1.7 Information and technological development of healthcare

In 2008, the health service of the Spanish Barcelona signed a 4-year contract worth 20 million euros with the IBM Corporation to implement a project to transform and modernize medical information systems in eight hospitals in Catalonia. The goal of the project is to simplify the work of both ordinary employees and health service managers, organizing a range of services for patients by reducing the number of bureaucratic procedures. As a result, doctors will be able to serve patients faster and make diagnoses more accurately.

In Finland, since April 2008, there has been a virtual maternity hospital, in which expectant mothers can familiarize themselves with the medical recommendations of doctors in detail. This Internet- the project opens the doors of the maternity hospital of the Kuopio University Hospital, Eastern Finland to site visitors, providing the opportunity for future mothers and their families not only to get acquainted with the work of the maternity hospital, but also to receive answers to specific questions that arise while expecting a child. Especially for this, doctors have provided text, photo, and video information.

2 . The current state of healthcare in the Russian Federation

2. 1 Demographic situation in the Russian Federation

The demographic situation in the Russian Federation still remains unfavorable. The population decline that began in 1992 continues. However, the rate of population decline has decreased significantly in recent years - from 700 thousand people annually in the period 2000-2005 to 213 thousand people in 2007. For 10 months of 2008, the rate of natural population decline was 2.7 per 1000 population, while for the corresponding period in 2007 it was 3.4.

As of October 1, 2008, the permanent population of the Russian Federation was 141.9 million people, which is 116.6 thousand people less than on the corresponding date in 2007.

The slowdown in population decline is mainly due to an increase in the birth rate and a decrease in mortality. In 2007, 1,602 thousand children were born, which is 8.3% more than in 2006. The increase in the birth rate over 10 months of 2008 amounted to 7.7%. The mortality rate (per 1000 population) decreased in 2007 compared to 2006 by 3.3%. For 10 months of 2008, the mortality rate compared to the corresponding period previous year has not increased.

The maternal mortality rate per 100,000 live births in 2007 decreased by 7.2% compared to 2006. Infant mortality per 1,000 live births in 2007 decreased by 7.8% compared to 2006. Over 10 months of 2008. compared to the corresponding period in 2007. infant mortality decreased by 8.3% and amounted to 8.8 per 1000 live births.

In 2007, life expectancy increased to 67.65 years. However, life expectancy in Russia remains low - 6.5 years less than in the "new" EU countries (European countries that joined the EU after May 2004), and 12.5 years less than in the "old" EU countries. " EU countries (European countries that were part of the EU before May 2004). Life expectancy is the most accurate measure of the mortality rate and serves as a recognized indicator of the quality of life and health of the population.

Its importance depends significantly on the amount of government spending allocated to medical care and health care in general, as well as on the effectiveness of the policy cash income population, the development of the system of sanitary and epidemiological welfare, the level of preventive activity of the population.

The modern history of the Russian Federation convincingly shows that a decrease in state support for healthcare and a deterioration in the quality of life of the population lead to a significant decrease in average life expectancy.

The increase in life expectancy in 2005-2007 is largely due to an increase in spending on medical care from 2.6% of GDP in 2005 to 2.9% of GDP in 2007, and spending on health care in general - from 3.2% GDP in 2005 to 3.5% of GDP in 2007.

Overall mortality rate, i.e. the number of deaths from all causes per 1000 people in 2007 was 14.7 (in 2005 - 16.1, in 2006 - 15.2), which reflects a certain positive trend. But, nevertheless, the mortality rate remains 1.3 times higher than in the “new” EU countries, and 1.5 times higher than in the “old” EU countries. The main cause of mortality is diseases of the circulatory system, from which about 1.2 million people died in 2007 (56.6% of deaths). 13.8% died from neoplasms, 11.9% from external causes. Indicators of maternal and infant mortality exceed similar indicators in developed countries by 1.5 - 2.0 times.

Fig.1 Causes of mortality in Russia, 2008

In the Russian Federation, mortality rates from circulatory diseases (in 2008 - 829 cases per 100 thousand people, in 2006 - 865, in 2005 - 908) are among the highest in the world. The corresponding figures in other countries were in 2005: in the “old” EU countries - 214, in the “new” EU countries - 493, in the USA - 315. At the same time, the share of mortality from strokes in Russia is almost half (46%) in mortality from diseases of the circulatory system. For 10 months of 2008, mortality from cancer was 203.9 per 100 thousand people (2007 - 202.3, 2006 - 200.9; 2005 - 201.2). The mortality rate of the Russian population aged 0-64 years from cancer is 30% higher than in the “old” EU countries and is on the same level as the “new” EU countries. Oncological diseases in Russia are characterized by a high proportion of deaths during the first year after diagnosis: for example, the percentage of deaths from lung cancer is 56, from stomach cancer - 55. This indicates a late detection of these diseases. Men of working age die from cancer almost 2 times more often than women, but the incidence among women is higher.

In Russia, for 10 months of 2008, mortality from external causes was 166.0 cases per 100 thousand people (in 2007 - 174.8, 2006 - 198.5 cases, in 2005 - 220.7) , which is 4.6 times higher than the indicators of the “old” EU countries (36.3 cases per 100 thousand population) and 2.6 times higher than the indicators of the “new” EU countries (65 cases per 100 thousand people; 2005, the Russian Federation ranks ranks first in the world in terms of road accidents, which are often caused by drunk drivers.Mortality from all types of transport accidents (mainly road traffic accidents) is 27.4 per 100 thousand population (in 2007 - 27.7, 2006 g. - 26.8, in 2005 - 28.1), which is almost 3.3 times higher than in the “old” EU countries (8.4) and 2.2 times higher than in the “new” "EU countries (12.6). In 2007, there were 23,851 road accidents involving children (in 2005 - 25,489, in 2006 - 24,930), 1,116 children died (in 2005 - 1,341, in 2006 - 1,276). At the same time It must be taken into account that the number of cars per capita in Russia is more than two times less than in EU countries.

2. 1.1 Health indicators and main risk factors for morbidity and mortality of the population of the Russian Federation

Over the past 16 years, the morbidity rate of the population of the Russian Federation has been constantly growing, which is associated, on the one hand, with the growing proportion of the elderly population and with more effective detection of diseases using new diagnostic methods, and on the other hand, with the ineffectiveness of the disease prevention and prevention system. In 1990, 158.3 million cases of morbidity in the population were identified, in 2006 - 216.2 million cases, that is, the increase in incidence was 36% (and in terms of 100 thousand population, the incidence was 41.8% ).

The most important indicator of the effectiveness of healthcare in any country is the average life expectancy of people suffering from chronic diseases. In Russia it is 12 years, and in EU countries it is 18-20 years.

Disability in the Russian Federation from 1990 to 2006. does not decrease, including among people of working age, whose share in the total number of persons recognized as disabled for the first time is at least 40%.

In Russia, there are four main risk factors: high blood pressure, high cholesterol, tobacco smoking and excessive alcohol consumption, which contribute 87.5% to overall mortality and 58.5% to disability years. At the same time, alcohol abuse ranks first in terms of its impact on the number of years of life with loss of ability to work (16.5%). According to expert estimates, relative indicators have changed little over the past 6 years.

220 thousand people die annually from diseases associated with tobacco smoking, while 40% of the mortality rate among men from diseases of the circulatory system is associated with smoking. It is noted that a higher mortality rate among male smokers leads to a 1.5-fold decrease in their share among men over 55 years of age.

2.2 Implementation of the Program of State Guarantees for Providing Free Medical Care to Citizens of the Russian Federation

The legislation of the Russian Federation establishes the insurance principle of financing medical care. In 1993, in addition to the budgetary healthcare system, a compulsory health insurance (CHI) system was created, as a result, a budgetary insurance model for financing the state healthcare system emerged in Russia.

Since 1998, the Government of the Russian Federation has annually adopted a program of state guarantees for the provision of free medical care to citizens of the Russian Federation, provided at the expense of the budgetary system of the Russian Federation.

Since 2005, the Government of the Russian Federation has annually approved standards for the financial provision of medical care per capita (per capita financial standards). It is necessary to note the constant decline in the share of compulsory medical insurance in the financial support of the state guarantee program, while insurance of the non-working population was carried out in the absence of uniform principles for the formation of insurance payments, and the remaining sources of formation of the compulsory medical insurance system were of a tax rather than insurance nature. This happened due to an increase in budget funding within the framework of a priority national project in the healthcare sector.

An analysis of the financial indicators of the implementation of territorial state guarantee programs in 2007 made it possible to establish their deficit in 60 constituent entities of the Russian Federation, which amounted to 65.4 billion rubles.

The most deficient in 2007 were territorial programs in the constituent entities of the Southern Federal District: Ingushetia (56.4%), Dagestan (51.1%), Chechen (36.1%), Kabardino-Balkarian (36.6%) republics and Stavropol region. It should also be noted that in addition to the shortage of territorial state guarantee programs, there is also a significant differentiation in their provision among the constituent entities of the Russian Federation, which leads to differences in the availability and quality of medical care provided.

The main problems of implementing state guarantees of providing free medical care to citizens of the Russian Federation in the Russian Federation are:

1. insufficient financial support for the rights of citizens of the Russian Federation to free medical care, strong differentiation among the constituent entities of the Russian Federation in terms of the implementation of territorial programs of state guarantees of free medical care;

2. fragmentation of sources of financing of medical care, which does not allow the full implementation of the compulsory health insurance system.

2. 2.1 System of organizing medical care to the population

From the first half of the twentieth century to the present, Russia has been implementing a two-level principle of building a system of medical care for the population, represented by self-sufficient and poorly integrated structures: outpatient, emergency and inpatient.

Currently, medical care is provided to the population of the Russian Federation in 9,620 healthcare institutions, including 5,285 hospitals, 1,152 dispensaries, 2,350 independent outpatient clinics, and 833 independent dental clinics.

Primary health care is a set of medical, social, sanitary and hygienic measures that provide health improvement, prevention of non-communicable and infectious diseases, treatment and rehabilitation of the population. Primary health care represents the first stage of the continuous process of protecting public health, which dictates the need for it to be as close as possible to the place where people live and work. The main principle of its organization is territorial and local. Services providing primary health care remain functionally overloaded and ineffective. It's connected with:

Inadequately high population size assigned to 1 outpatient site (nominally in large cities - 1800-2500 people per 1 site, in fact - up to 4000 people), which transforms the functions of a doctor into the functions of an operator for issuing prescriptions for drugs within the framework of the additional drug supply program ;

Expanded scope of medical work for acute pathology. Lack of interaction and continuity in work individual divisions primary health care, which leads to insufficient efficiency of its work as a whole.

Imperfections in the work of outpatient health care, in particular, the lack of a patronage system and ineffective monitoring of patients with chronic pathologies, have led to the fact that emergency medical care is the most common type of out-of-hospital medical care for the population of the country, taking on some of the functions of outpatient clinics. link The following factors hinder the effective use of NSR capabilities:

1. The provision of timely medical care in municipal areas occurs not according to the principle of the closest team, but according to the principle of territorial affiliation.

2. Significant differences in the financial support of emergency services lead to the inability to create a unified electronic dispatch service and equip emergency vehicles with a satellite navigation system, as well as to weakening control over technical condition equipment supplied for operation.

3. There is an insufficient staffing of EMS teams with qualified personnel, including specialists who have undergone timely retraining, due to the imperfection of the personnel training system for the EMS service at both senior and middle levels. Draws Special attention the fact of a reduction in the number of specialized teams and the outflow of experienced medical personnel.

4. There is often inappropriate use of emergency medical services teams (for transporting planned patients).

Thus, the low efficiency of the preventive work of primary health care, the lack of a system of outpatient follow-up care and patronage, as well as the imperfect organization of emergency medical care have led to the fact that hospital care acts as the main level in the public health system. The introduction of hospital-substituting technologies into the activities of outpatient clinics made it possible from 2006 to 2007 to increase the number of places in day hospitals by 9% (from 187.7 thousand in 2006 to 206.2 thousand in 2007. ), the provision of places in day hospitals - by 4.3% (from 13.9 to 14.5 per 10 thousand population, respectively) and the level of hospitalization in day hospitals - by 5.5% (from 3.6 to 3.8 per 100 people of the population, respectively; for comparison: in 2003 - 2.6).

Today there is no coherent system of restorative treatment and rehabilitation in the country. In many cases, the patient is discharged from the hospital “under the supervision of a local doctor,” which in reality means “under his own supervision.” At the outpatient clinic level, the patronage service is poorly developed, the “hospital at home” system has not been developed, continuity in treatment between the hospital and the clinic is often not ensured, and rehabilitation measures are not available to patients.

Thus, the existing needs of a significant part of the population of the Russian Federation for restorative treatment and rehabilitation are also not met.

2. 3 Innovative and staffing support for healthcare development

The level of development of medical science determines the prospects for improving the entire healthcare system. The current state of medical science in the Russian Federation is characterized by blurred priorities, low innovative potential, poor communication with government customers, and a weak system for introducing scientific results into practical healthcare. The development of modern scientific research in the field of medicine is possible only under the condition of an integrated approach based on the involvement of developments in fundamental biomedical, natural and exact sciences, as well as new technological solutions.

In 2007, the healthcare system employed 616.4 thousand doctors and 1,349.3 thousand paramedical personnel (in 2004 - 607.1 thousand and 1,367.6 thousand; in 2006 - 607.7 thousand . and 1,351.2 thousand, respectively). The provision of doctors per 10 thousand population was 43.3 (2004 - 42.4; 2006 - 43.0), nursing staff - 94.9 (2004 - 95.6; 2006 - 95.0 ). The ratio of doctors and nursing staff is 1: 2.2.

Despite the fact that there are more doctors per capita in the Russian Federation than, on average, in developed countries, the quality of medical care and health indicators in our country are significantly worse, which indicates the low efficiency of the domestic medical care system, insufficient qualifications of doctors and their weak motivation for professional improvement.

2. 4 Medicine provision for citizens on an outpatient basis

Currently in the Russian Federation there are three models for providing citizens with medicines: additional medicine provision for privileged categories of citizens as part of the set of social services provided for by Federal Law No. 178-FZ of July 17, 1999 “On State Social Assistance” and medicine provision for certain groups population free of charge or at a discount on doctor's prescriptions in accordance with Decree of the Government of the Russian Federation of July 30, 1994 No. 890, as well as providing expensive medicines to patients with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, myeloid leukemia, multiple sclerosis, as well as after transplantation organs and tissues. From 2005 to 2007, procurement was carried out Federal Fund compulsory medical insurance at the expense of funds transferred from the federal budget, in 2008 - by state authorities of the constituent entities of the Russian Federation at the expense of subventions transferred to the territorial funds of compulsory medical insurance, and in 2009 will be transferred by subventions from the federal budget to the budgets of the constituent entities of the Russian Federation

In 2005, 50.8 billion rubles were planned for additional drug provision; actual expenses amounted to 48.3 billion rubles. In 2006, there was a legislative refusal of a significant part of beneficiaries from receiving a set of social services, and only citizens who needed to regularly take medications remained in the system of additional drug provision. In 2007, the number of citizens who retained the right to additional drug provision practically did not change, funds were planned in the amount of 34.9 billion rubles, but expenses decreased by 30 percent and amounted to 50.7 billion rubles. In 2008, the planned expenses for the implementation of the rights of citizens of preferential categories to additional drug provision amounted to 30.1 billion rubles. In addition, in 2008, an additional 10 billion rubles were allocated to the constituent entities of the Russian Federation for the implementation of certain powers in the field of drug provision.

In general, the existing system of preferential provision of medicines to citizens on an outpatient basis is subject to change for the following reasons:

The system does not allow for effective planning and control of the level of costs - the per capita standard for DLO is not based on an analysis of needs, but is formed on the basis of an established monthly cash payment;

The DLO model using procurement procedures for government needs does not guarantee uninterrupted service of preferential prescriptions of the appropriate assortment;

The main limiting mechanism is the restrictive list, but its formation is not based on an analysis of clinical and economic effectiveness;

There are no participants who are economically motivated to spend budget funds efficiently.

2. 5 Informatization of healthcare

In the Russian Federation, the development and implementation of healthcare informatization programs has been ongoing since 1992. To date, the country has created elements of information and communication infrastructure for the needs of medicine, and has begun the use and dissemination of modern information and communication technologies in the healthcare sector. Medical information and analytical centers, automated information systems of compulsory health insurance funds and medical insurance organizations have been created in the constituent entities of the Russian Federation.

At the same time, the developed information systems, as a rule, are narrowly focused, focused on providing specific functions and tasks. The lack of a unified approach to their development during operation has led to serious problems. As a result, existing information systems represent a complex of disparate automated workstations, rather than a unified information environment.

The level of equipment of the healthcare system with modern information and communication technologies is extremely heterogeneous, and is mainly limited to the use of several computers as autonomous automated workstations. To date, a unified approach to organizing the development, implementation and use of information and communication technologies in medical institutions and organizations has not been formed. As a result, the ability to integrate existing software solutions is very limited.

Thus, the current level of informatization of the healthcare system does not allow quickly solving issues of planning and management of the industry to achieve existing targets.

Currently, many countries have begun to implement a program to create a unified information space in the areas of health and social development.

For example, in the UK, the NHS Connecting for Health program is being implemented with a total investment until 2014 of about 25 billion US dollars with a population of approximately 60.5 million people. Similar programs are being implemented in all countries of the Organization for Economic Cooperation and Development (30 countries).

In Europe, in addition to national programs, a unified European Union e-health program is being implemented. Primary tasks: standardization, ensuring insurance coverage regardless of location, processing medical information about the patient using information technology (sometimes the term telemedicine is used to describe the last task, but it does not fully reflect the essence of these processes).

The volume of EU investments within the framework of the pan-European e-health program (excluding similar national programs) has already amounted to about? 317 million.

A unified health information system is being created in Canada. Priority areas of work: Electronic health passport, infrastructure, telemedicine, creation of national registers, reference books and classifiers, systems for diagnostic visualization and storage of graphic information. The program budget for the period until 2009 is $1.3 billion with a population of about 39 million people.

A similar comprehensive program is being implemented in the United States. According to this program, it is planned to create a segment of an information system in the field of healthcare within the framework of Electronic Government. Total eHealth investment needs for the next decade: estimated at $21.6-$43.2 billion. The priority areas of work for the current period are: electronic health passport (EHR), national information infrastructure for health, regional health information centers (RHIOs), electronic health data exchange.

According to expert estimates, the full-scale implementation of information technologies in medicine in the United States could lead to savings of up to $77 billion. Similar studies in Germany estimate cost savings from switching to eHealth at up to 30% of existing costs. In particular, the introduction of electronic prescription technology provides savings of about?200,000,000 per year, reducing costs associated with choosing the wrong treatment method, unnecessary procedures and medications will save about?500 million annually, identifying and preventing insurance fraud will amount to about?1 billion per year. year with a population of about 83 million people.

3. Key activities to implement the healthcare development concept

3. 1 Main goals, objectives and main directions of the concept of healthcare development

the main objective modernization of Russian healthcare - increasing the availability and quality of medical care for the general population based on increasing the efficiency of resource use and reviving the preventive focus in healthcare.

The modern concept of modernizing the healthcare system involves systematically directing efforts and resources towards financial, economic and regulatory support for the process of healthcare restructuring in order to increase accessibility and guarantee the provision of free medical care to the population based on the priority development of primary health care, prevention, and strengthening of security services motherhood, paternity and childhood, improving the training and retraining of specialists in accordance with the needs of the industry, improving the drug supply to citizens, and developing medical science.

All this pursues one strategic goal - improving the health status of the country's population.

The goals of healthcare development are:

Stopping the population decline in the Russian Federation by 2011 and increasing the population to 145 million people by 2020;

Increasing life expectancy of the population to 75 years;

Reducing the overall mortality rate to 10 (that is, 1.5 times compared to 2007);

Reducing the infant mortality rate to 7.5 per 1000 live births (20% compared to 2007);

Reducing the maternal mortality rate per 100,000 live births to 18.6 (15.7% compared to 2007);

Formation of a healthy lifestyle of the population, including reducing the prevalence of tobacco use to 25% and reducing alcohol consumption to 9 liters per year per capita;

Improving the quality and accessibility of medical care guaranteed to the population of the Russian Federation.

The objectives of healthcare development are:

Creating conditions, opportunities and motivation for the population of the Russian Federation to lead a healthy lifestyle;

Transition to a modern system of organizing medical care;

Specification of state guarantees for the provision of free medical care to citizens;

Creation of an effective model for managing financial resources of the state guarantee program;

Improving the provision of medicines to citizens on an outpatient basis within the framework of the compulsory health insurance system;

Improving the qualifications of medical workers and creating a system of motivating them to perform quality work;

Development of medical science and innovation in healthcare;

Informatization of healthcare.

3. 2 Formation of a healthy lifestyle

Preserving and strengthening the health of the population of the Russian Federation is possible only if health is prioritized in the system of social and spiritual values ​​of Russian society by creating economic and sociocultural motivation for the population to be healthy and providing the state with legal, economic, organizational and infrastructural conditions for leading a healthy lifestyle.

To create a healthy lifestyle, it is necessary to introduce a system of state and public measures to:

1) improvement of medical and hygienic education and upbringing of the population, especially children, adolescents, and young people, through the media and the mandatory implementation of relevant educational programs in preschool, secondary and higher education institutions.

2) creation of an effective system of measures to combat bad habits (alcohol abuse, tobacco smoking, drug addiction, etc.), including education and informing the population about the consequences of tobacco use and alcohol abuse, promoting the reduction of tobacco and alcohol consumption,

3) creating a system for motivating citizens to lead a healthy lifestyle and participate in preventive measures, primarily through the popularization of a way of life and lifestyle that contributes to the preservation and strengthening of the health of citizens of the Russian Federation, the formation of a fashion for health especially among the younger generation, the introduction of a medical care system healthy and practically healthy citizens; conducting awareness-raising work about the importance and necessity of regular prevention and medical examination of citizens;

4) creating a system for motivating employers to participate in protecting the health of employees by establishing benefits on insurance premiums for compulsory medical and social insurance, stimulating working teams to lead a healthy lifestyle;

5) prevention of risk factors for non-communicable diseases (blood pressure, poor nutrition, physical inactivity, etc.);

6) creation of a system for motivating heads of school education institutions to participate in health protection and the formation of a healthy lifestyle for schoolchildren.

Activities aimed at developing a healthy lifestyle among citizens of the Russian Federation will be carried out in two stages.

At the first stage (2009 - 2015), a health assessment system will be developed, basic indicative indicators will be determined, such as public health potential and a healthy lifestyle index. Their stabilization is also ensured through a gradual increase in the volume of funding for specific activities, including those aimed, taking into account the level of prevalence of bad habits in the country, at reducing the consumption of tobacco and alcohol, and at providing medical and preventive care to the population based on developed methods and standards, taking into account risk groups and stages of implementation of individual medical and preventive technologies (first “pilot” regions, then replication throughout the entire territory of the Russian Federation).

At the second stage (2016 - 2020), it is planned to reach the necessary, in terms of efficiency, volume of activities to gradually increase (in relation to the basic indicators established at the first stage) the public health potential by 10% and the healthy lifestyle index by 25 %. At the same time, the prevalence of tobacco use and the volume of alcohol consumption (in terms of pure alcohol) in the country over the entire period should decrease by 2 times.

At the same time, from 2009 to 2012, financial support for activities to promote a healthy lifestyle will be the priority national project “Health”, which will provide 3.8 billion rubles.

Reducing risks to public health should be carried out on the basis of preventing and eliminating the harmful effects of human environmental factors (biological, chemical, physical and social) on the population. Ensuring healthy, safe nutrition for the population of all age groups is an important direction in creating a healthy lifestyle among the population of the Russian Federation, which involves optimizing the diet and nature of nutrition, as well as education and training of various groups of the population on healthy nutrition, including with the participation of scientific and medical centers dealing with nutrition issues.

Another important area is measures to increase physical activity, which is the most important condition for maintaining the health of citizens.

3. 3 Guaranteed provision of quality medical care to the population of the Russian Federation

High-quality medical care is based on the use of modern technologies for organizing and providing diagnostic, therapeutic, rehabilitation and preventive services, the effectiveness and safety of which (for specific diseases or pathological conditions) has been confirmed in accordance with the principles of evidence-based medicine.

Guaranteed provision of quality medical care to every citizen of the Russian Federation must be ensured by the following measures:

1. specification of state guarantees for the provision of free medical care;

2. standardization of medical care;

3. organization of medical care;

4. provision of medicines to citizens on an outpatient basis;

5. implementation of a unified personnel policy;

6. innovative development of healthcare;

7. modernization of the system of financial support for the provision of medical care;

8. healthcare informatization.

State guarantees for the provision of free medical care to citizens of the Russian Federation must be defined by law, including:

Sources of financial support for state guarantees of providing free medical care to citizens of the Russian Federation;

The scope of state guarantees for the provision of free medical care to citizens of the Russian Federation in terms of the types, procedure and conditions for the provision of medical care;

The procedure for assessing the effectiveness of the implementation of state guarantees of free medical care;

Responsibility for failure to comply with state guarantees of free medical care;

The procedure for developing regulations that specify the scope of state guarantees of free medical care established by the legislation of the Russian Federation.

In accordance with the provisions of the legislation of the Russian Federation, the Government of the Russian Federation must adopt a State Guarantee Program for three years, containing:

The minimum per capita standard for financial support of state guarantees for the provision of free medical care;

Standards of financial costs per unit of volume of medical care;

Per capita standards for the volume of medical care by type;

Minimum values ​​of criteria for assessing the quality and accessibility of medical care.

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Based on an analysis of the situation in the country, V.V. Putin, as president and then prime minister, signed two fundamental documents:

• About approval of the Concept demographic policy Russian

• The concept of long-term socio-economic development of the Russian

Federations for the period until 2020 . (Order of the Government of the Russian Federation No. 1662-r dated November 17, 2008).

All calculations of the “Concept for the development of healthcare until 2020” were calculated based on the parameters by which the concept of long-term socio-economic development of the Russian Federation until 2020 was calculated, because these are interrelated documents.

Goals of the Healthcare Development Concept

1. Exceeding healthcare financing by 5% of GDP by 2020.

2. Stopping population decline by 2011 and increasing the population to 145 million people by 2020.

3. Increasing life expectancy of the population to 75 years.

4. Reducing the overall mortality rate to 10 (the overall mortality rate is the number of deaths from all causes per 1000 people per year).

5. Formation of a healthy lifestyle of the population, including reducing the prevalence of tobacco use to 25% and reducing alcohol consumption to 9 liters per year per capita.

6. The main goal is to provide the population with free, state-guaranteed, high-quality medical care.

Objectives of the Healthcare Development Concept

The semantic part of the Concept contains two large sections. The first section is preserving the health of the population based on the formation of a healthy lifestyle. The second is to guarantee the provision of quality medical care to the population, and for this it is necessary:

• Creating conditions, opportunities and motivation of the population to conduct

healthy lifestyle.

• Improving the system of organizing medical care.
• Specification of state guarantees of providing citizens with free

medical care.

• Creating an effective financial resource management model

government guarantee programs.

• Improving drug provision for citizens in outpatient settings

within the framework of the compulsory health insurance (CHI) system.

• Improving the qualifications of medical workers and creating a system

motivating them to do quality work.

• Development of medical science.
• Informatization of healthcare.

All activities aimed at implementing the concept will be carried out in several stages - testing in “pilot” regions (2010-2015) and subsequent replication throughout the country (2016-2020) reaching the necessary, from an efficiency point of view, volumes of activities for achieving target values.

In our country, healthcare has always been financed on a residual basis, but 10 years ago at the highest political level it was announced that public health is one of the priorities of state policy.

And it is very good that this understanding does not disappear from the platform of state priorities. As Ms. Gro Harlem Bruntland, who served as WHO Director-General from 1998 to 2003, said, “...the real ministers of health are the president and the prime minister...”

Current state of healthcare in the Russian FederationDemographic situation

At the end of the last century in countries former USSR There was a decline in the birth rate and an increase in mortality. This demographic phenomenon was called the “Russian Cross” (or “Slavic Cross”).

The population decline that began in the 1990s continues, but its pace has slowed significantly. The slowdown in population decline is mainly due to an increase in the birth rate and a decrease in mortality.

Measures were taken to stimulate the birth rate:

• One-time benefit at the birth of a child (RUB 10,988.85)
• The birth certificate (introduced in 2006) secured the right

patients to choose from a antenatal clinic and a maternity hospital. And institutions providing assistance to expectant mothers began to receive additional payment from the state for each pregnant woman registered with them (an attempt to financially interest doctors and create a competitive environment).

• Certificate for maternal capital(from January 1, 2011 – RUB 365,698.4),

which can be used to improve living conditions, educate children, or form the funded part of a woman’s labor pension.

• Help for childless couples - in vitro fertilization included

included in the list of types of high-tech medical care and is carried out at the expense of the federal budget in 11 federal medical institutions.

• Crisis centers where psychologists convince women to give up

intentions to have an abortion.

The main causes of mortality in our country are diseases of the circulatory system (56.6% of deaths), neoplasms (13.8%), injuries and poisoning (11.9%).

Mortality from circulatory diseases is one of the highest in the world. Moreover, the share of mortality from strokes in Russia is almost half (46%) of mortality from diseases of the circulatory system, which indicates the poor quality of treatment for arterial hypertension (both on the part of patients and doctors). According to World Bank The loss of GDP in the Russian Federation is about $30 billion due to premature death from heart attacks and strokes.

Cancer diseases in Russia are characterized by a high proportion of deaths during the first year after diagnosis. This indicates late diagnosis of these diseases. Men of working age die from cancer almost 2 times more often than women, although the incidence among women is higher.

External causes of death have a significant impact on the formation of mortality rates in working age. Mortality from external causes is overwhelmingly associated with excessive consumption of strong alcoholic beverages. Our country ranks first in the world in terms of road accidents, which are often caused by drunk drivers. It should be taken into account that the number of cars per capita in Russia is two times less than in the countries of the European Union (EU).

The morbidity rate of the population is constantly growing, which is associated, on the one hand, with the growing proportion of the elderly population and with more effective diagnosis of diseases, on the other hand, with the ineffectiveness of the disease prevention and prevention system.

It is believed that the level of population health depends on the percentage allocated for healthcare from domestic gross product(GDP). However, research recent years also show an inverse relationship. WHO mathematical calculations indicate that improvements in health status make an adequate contribution to the increase economic potential countries. For example, in Russia, on average, up to 10 working days per worker are lost due to illness, which amounts to losses of about 1.4% of GDP per year.

The most important indicator of the effectiveness of healthcare in any country is the average life expectancy of people suffering from chronic diseases. In Russia it is 12 years, and in EU countries it is 18-20 years.

Another important indicator of the quality of life and health of the population is the life expectancy indicator. In 2006, life expectancy began to increase. However, it is 12.5 years less than in the “old” (joined the EU before 2004) EU countries.

A key role in the low life expectancy of the population is played by the high mortality rate of people of working age, mainly men. During the lifetime of 1 woman, 2.7 men die between the ages of 15 and 60 years.

Our country is characterized by the phenomenon of excess mortality among men, which consists in the fact that the life expectancy of the male population throughout the post-war period was 10 years less than that of women, and in the last two decades this difference has generally frozen at around 13-13.5 years. This is an unprecedented phenomenon. That is, it has no analogues in any country in the developed world. The average man does not live to retirement age.

Formation of a healthy lifestyle

For the first time in the history of not only the Russian Federation, but also the Soviet Union, the state undertakes to promote a healthy lifestyle among the population and actively allocates funds for this.

Maintaining and strengthening health is possible only if the following conditions are met:

• formation of the priority of health in the value system of society,
• creating motivation among the population to be healthy,
• provision by the state of legal, economic, organizational and infrastructural conditions for leading a healthy lifestyle.

The main directions of the program are as follows:

1. Improving medical and hygienic education and training

• Education of the population through the media.
• Introduction of educational programs in educational institutions.
• Training in hygienic skills to comply with work and rest regimes,

diet and structure of nutrition and other norms of behavior that support health.

• Conducting awareness-raising work about the importance and necessity of regular

medical examination of citizens, timely seeking medical help.

2. Creation of an effective system of measures to combat bad habits

• Health education and public awareness of the consequences

tobacco use and alcohol abuse.

• In 2001, Federal Law No. 87 “On Restricting Tobacco Smoking” was adopted - assistance

reducing the consumption of tobacco and alcohol (places and hours of sale, age, price measures), protecting non-smokers from exposure to tobacco smoke, limiting the consumption of alcohol in public places.

• In 2010, the provisions of the technical regulations on the new

in the form of warning labels on tobacco packages. The main warning label “Smoking kills” occupies at least 30% of the area of ​​the larger side of the consumer packaging (previously only 4%), for another warning label - at least 50% on the other larger side of the pack.

3. Providing a healthy diet

In 2010 the following were approved:

• "Doctrine of food security of the Russian Federation."
• “Fundamentals of the state policy of the Russian Federation in the field

healthy nutrition of the population for the period until 2020" (Order of the Government of the Russian Federation dated October 25, 2010 No. 1873-r).

• Order of the Ministry of Health and Social Development of the Russian Federation dated

4. Development of mass physical education and sports

5. Reducing the risk of exposure to adverse external factors

• Sanitary and epidemiological surveillance of habitat and conditions

Attention will continue to be paid to controlled infections, whose prevalence directly depends on vaccine prevention, improvement and implementation of the National Preventive Vaccination Calendar and the Preventive Vaccination Calendar for epidemic indications, as well as the prevention, diagnosis and treatment of HIV infection and viral hepatitis B and C.

6. Changing the regulatory framework to create a system for motivating employers to participate in protecting the health of workers.

7. Creation of a system for motivating citizens to maintain a healthy lifestyle and participate in preventive measures:

• Popularization of the way of life and lifestyle that contributes to the preservation and

strengthening health, creating a fashion for health, especially among the younger generation.

Suffice it to recall various television projects (for example, Dancing on Ice, Dancing with the Stars), in which famous people prove that anyone can learn to control their body. An example of a healthy lifestyle is also shown by the top officials of the state (Medvedev, Putin). The introduction of a system of medical care for healthy and practically healthy citizens is unique - the creation of Health Centers in Russia (order of the Ministry of Health and Social Development of the Russian Federation No. 597n dated 08/19/2009). The centers are equipped with Health Express complexes for screening assessment of health and body reserves. The patient receives specific recommendations on predisposition to certain diseases with the formation of an individual preventive program.

8. Mass prevention of risk factors for non-communicable diseases

We are talking primarily about cardiovascular diseases and cancer, which occupy the first places in the mortality structure.

• Implementation of primary outpatient clinics in institutions

level of automated risk assessment of vascular diseases (1st place in mortality, 2nd in morbidity) and primary prevention of stroke and myocardial infarction. A patient's SCORE score (sex, age, smoking, blood pressure, cholesterol) predicts the risk of death over the next 10 years.

• Introduction of total cancer screening (2nd place in

mortality, 15th in morbidity). A fibrinogen test can be used as a simple laboratory screening method. Fibrinogen is reduced: cancer of the prostate, pancreas, lung. Fibrinogen is increased: stomach, breast, kidney cancer.

Availability and quality of medical care

Of particular importance in the Concept is the section on guaranteed provision of quality medical care to the population. 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, block

legislative and legal support).

• availability of medical personnel in sufficient numbers and properly

prepared to solve the challenges facing healthcare.

Improving the organizational system

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 patients. 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.

First contact doctor- This is a local therapist (pediatrician). 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, but it turned out that it was too early to write off the polyclinic:

• At the current level of development of medicine, a general practitioner cannot

To 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

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 of a 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 this system is expected to be developed.

The emergency assistance scheme is also organized differently abroad. In the event of an emergency illness or injury, the patient calls a single emergency number (911 for the USA or 112 for Europe) and a team of paramedics (delivery service) takes him to the emergency department without any further assistance. 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, where a course of intensive treatment is carried out for 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 in the required quantity.

The second very important block is the phasing of medical care according to Ok. At the same time, ensuring continuity between different stages is an important condition for 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 allow monthly assessment of the effectiveness of medical personnel, depending on the completeness and correctness of implementation, 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 areas: reducing the number of attached adults

population from 1700-2500 people to 1.2-1.5 thousand people per 1 site (becomes possible when the personnel shortage is eliminated).

• Creating comfortable conditions for a doctor to work - increasing the standard

the allocated time per adult patient is up to 20 minutes.

• Reducing the workload by transferring the number to nursing staff

activities: first aid for acute pathology, dispensary observation of patients with chronic pathology, etc.

• Retrofitting primary care with hospital-replacing technologies -

development of systems of “hospitals at home” and active patronage.

• Transition to other performance targets with an emphasis on

preventive activities.

Level 2. Inpatient care

• The main point is the intensification of the work of the bed. This will be possible with

On the one hand, if hospital-replacing technologies are introduced into primary care, and a network of departments for after-care and rehabilitation is also deployed. 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 major regional centers coordinating the entire

the scope of preventive, diagnostic and therapeutic measures for socially significant medical problems.

• Improving target performance indicators for inpatient facilities

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. Instead of a two-tier one, a three-tier health care system is being created: primary health care, inpatient care and a rehabilitation treatment service.

• Creation and expansion of a network of institutions (departments) of rehabilitation

treatment (aftercare), rehabilitation, medical care by repurposing some of the operating hospitals and sanatorium-resort institutions.

• Setting performance targets that reflect quality

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 have achieved good development by 2014-2015.

The essence of the project: an organizational structure is being created that combines a hospital admissions department and an 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 ambulance and emergency 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", departments of rehabilitation treatment and rehabilitation, hospice) and the implementation of active or passive patronage.

Affordable and high-quality medical care is not possible without resources, including three supporting infrastructure blocks:

1. economic block (how much medical care should cost and how

spend money);

2. information block (electronic health care);

3. block of legislative and legal support for the Concept.

Economic bloc, where the determining factor is bottom channel financing. Any service costs money. In Soviet times, the state paid for medical care. In 1993, in addition to the budgetary health care system, a compulsory health insurance system was created, as a result, a unique budgetary and insurance model for financing the state health care system has developed in Russia. The number of sources from which healthcare began to receive money has increased (multi-channel financing).

As part of the Healthcare Development Concept, from January 1, 2012, a transition to predominantly single-channel financing of medical care was carried out - through the system of compulsory health insurance, which is regulated by Federal Law No. 326 of November 29, 2010 “On compulsory health insurance in the Russian Federation.” The following steps have been taken for single-channel financing:

• Transition from the system of unified social tax to insurance premiums. Insurance principles formation of payments in terms of establishing

various kinds of incentive regimes, for example, towards a healthy lifestyle, are much closer to insurance than to taxation. Employers' insurance contributions are set at 5.1% of the wage fund, while a limit is set for the annual wage fund, beyond which no insurance premiums are paid.

• Transition to unified methods of establishing payments for non-working

population(previously, the decision to establish payments for the non-working population always lay with the constituent entity of the Russian Federation itself, but regions preferred to allocate less (that is, declare a deficit) in order to receive subsidies from the federal budget).

State guarantees

Since 1998, the Government of the Russian Federation has annually adopted a program of state guarantees for the provision of free medical care to citizens of the Russian Federation, which is provided at the expense of the budgetary system of the Russian Federation and funds from the compulsory medical insurance system. There were two big problems:

• Underfunding, both from the budget and financial

provision of compulsory medical insurance programs. The employer, who paid for the workers, paid from the white salary; regions that paid for non-working people deliberately underestimated payments in order to create a deficit and receive subsidies from the center.

• There is a big difference among the constituent entities of the Russian Federation in terms of

implementation of territorial programs of state guarantees of free medical care.

For example, the standard for financial provision of medical care per 1 resident in Ingushetia is about 2.5 thousand rubles, and in Chukotka Autonomous Okrug it reaches 30 thousand rubles. It is clear that this is a very significant limitation in the availability of medical care. Thus, in 58 regions the per capita tariff for providing the state guarantee program is lower than the average established for the Russian Federation.

To remedy the situation it is proposed:

• To specify the system of formation of state guarantees,

to legislate “who pays for whom and how much”, to introduce criteria and procedures for assessing effectiveness and, most importantly, to establish liability for failure to fulfill state guarantees of free medical care.

• The financial security standard adopted by the Government should be

provided throughout the Russian Federation. This is the most important innovation. That is, the minimum must be ensured throughout the Russian Federation. At the same time, the per capita standard, which is established by the Government, must be calculated taking into account the standards of medical care. This is the basic minimum package of government guarantees.

• Also, for the first time, a Federal financial fund, which

specifically designed to equalize financial situations between regions (federal surcharge to deficit regions).

• You will have to pay extra for treatment that goes beyond the scope of government guarantees.

citizens. But now it’s at the box office, and quite officially. For this purpose, new organizational and legal forms of medical organizations (autonomous organizations) have been introduced.

These innovations both in the press and in the speech of the General Director

WHO are noted as best practices in the world. The Americans became so interested that they themselves translated our Concept and used some of the provisions for their health care reform plans.

Standardization of medical care

Of course, the key to quality medical care is its unification on the basis of uniform procedures and standards for the provision of medical care throughout the country. Mandatory execution and uniform content guarantees affordable, high-quality medical care in the country. Currently, 1041 standards and 44 procedures for the provision of medical care have been developed and adopted.

Procedure for providing medical care represents organizational requirements. For example, how should a medical facility, office or ambulance be equipped; how many people should work in a particular department, what is the workload; what should be the sequence of treatment and diagnostic measures, where and when to transfer the patient, etc.

Standard of care includes the necessary medical procedures, the use of specific medications, the possibility of surgical intervention and other treatment methods, etc. Standards are created on the basis of methodological recommendations (guidelines, manuals), which are developed by international/domestic professional communities (associations) and contain information on the prevention, diagnosis, and treatment of specific diseases and syndromes.

Standards and Procedures are the foundation of the State Guarantees Program. On the basis of these documents, a list of vital medicines is created, which does not live separately from these documents, it is formed from them.

In addition, standards and procedures allow the quality of medical care to be assessed for each completed case. On this basis, a system of ranked remuneration for medical personnel is being developed.

Thus, medical standards themselves, not being financial documents, acquire an economic component and become medical and economic standards.

Informatization

Today, patient information can be entered once and stored throughout life, used repeatedly, and transmitted over any distance. Moreover, two types of information can be stored: “biological” and “non-biological” (bed days, treatment costs, etc.).

Modern medical information technologies can:

• Have a significant impact on improving quality and accessibility

medical services to the population (for example, making an appointment via the Internet, receiving test results, on-line consultations, etc.).

• Increase the efficiency of planning and managing system resources

healthcare.

• Save costs. According to expert estimates, the transition to

e-health leads to cost savings of up to 30% of existing costs. For example, through the introduction of electronic prescription technology (reducing costs associated with choosing the wrong treatment method), identifying and preventing insurance fraud.

Many countries have begun implementing programs to create a unified information space in the areas of health and social development. Russia lags behind in this direction, despite the fact that the development and implementation of informatization programs for domestic healthcare have been ongoing since 1992.

Currently the following problems exist:

• Uneven level of equipment. Most often these are several autonomous

(not connected into a single network) automated workstations.

• Lack of unification leads to the lack of a single information

space (electronic data exchange between offices, departments, institutions, regions is difficult).

The concept outlines two interrelated directions for the development of informatization. The first is the formation of unified reference information databases. And the second block is a block of personalized accounting of medical care consumers, which is needed for planning the volume of care, collecting better statistics and reporting.

For these purposes, a state information system for personalized accounting of medical care should be created, which will provide operational accounting of medical care, health care institutions and medical personnel and create a reliable basis for solving key problems of industry management. It is assumed that medical institutions, as well as territorial compulsory health insurance funds, should become sources of primary information for the formation of elements of the System.

By 2016-2020 the following should be implemented:

• Entering the state information system into the industrial

exploitation.

• Implementation of a unified system for identifying recipients of medical services

based on the use of a citizen’s unified social card.

• Creation of a system of centralized management and updating of scientific

reference information, including reference books, classifiers, medical and economic standards.

• Creation of a unified federal system for collecting and storing electronic

medical histories based on national standards.

Legal support

Outside the legal framework, not a single Concept can be implemented.

The regulatory framework of the Concept provides for both the improvement of existing legislation and the publication of new laws. Thus, it is planned to develop a Federal Law “On State Guarantees of Providing Free Medical Care to Citizens.” The current legislation does not provide a clear distinction between the procedure for citizens receiving free medical care and paid medical services, and does not contain provisions governing pricing issues for medical services provided to citizens for a fee. Therefore, this bill is of paramount nature, because aimed at the implementation of Art. 41 of the Constitution of the Russian Federation and must determine the procedure, conditions and standard for the volume of providing citizens with free medical care, and the procedure for financial support.

the federal law No. 326-FZ “On Compulsory Health Insurance in the Russian Federation” was adopted on November 29, 2010, and came into force on January 1, 2011. This is the main

Goals and priority areas for the development of healthcare in the Russian Federation in the medium term (2018-2020)

WHO has determined that the main goal of creating and developing healthcare systems is to improve the health of the population. In the Russian Federation, thanks to targeted measures taken in the industry from 2005 to 2012, some improvement in population health indicators was achieved. But in many of these indicators, Russia continues to lag significantly behind developed countries. Namely. The mortality rate of the population from preventable causes in the Russian Federation is almost 2 times higher than in the EU countries on average, and life expectancy (LE) is 8 years lower.

The main goal of significantly improving the health of the population of the Russian Federation through the modernization of healthcare is set in the decrees of the President of the Russian Federation of May 7, 2012: “On improving state policy in the field of healthcare” (No. 598) and “On measures to implement the demographic policy of the Russian Federation” (No. 606) . These documents plan that by 2018, the life expectancy of Russian citizens should increase from 70.3 to 74 years, and the population should increase from 143 to 145 million people.

However, there are still serious problems in the Russian healthcare system that will hinder the achievement of the above goals. The most important of them:

• * shortage of medical personnel (especially pronounced in primary health care and in rural areas) and disproportions in their structure;
• * low qualifications of medical personnel, which is associated with problems in basic medical education, lack of continuity of postgraduate education and insufficient implementation of modern educational technologies:
• * insufficient volumes of medical care provided under the state guarantee program, including poor supply of medicines to the population and low volumes of high-tech medical care;
• * inconsistency of the system of organizing medical care with modern technologies for its provision;
• * lack of a healthcare development strategy, responsibility and accountability of managers at all levels for achieving results according to established indicators.

It should be noted that in order to improve the situation in healthcare, the Russian Ministry of Health developed the State Program “Health Development until 2020” (Order of the Government of the Russian Federation dated December 24, 2012 No. 2511-r). Order of the Government of the Russian Federation dated November 17, 2008 No. 1662-r (as amended on August 8, 2009) “On the Concept of long-term socio-economic development of the Russian Federation for the period until 2020.” This program contains provisions important for the development of the industry, including: early detection of diseases and development of primary health care; eliminating the shortage of medical personnel and improving their qualifications; development of medical rehabilitation and sanatorium-resort treatment; introduction of innovative treatment methods. The Program focuses on improving the health of the population as a whole, disease prevention and the health of children and adolescents. However, the Program does not reflect all areas of healthcare development.

The main risk in implementing the Program is the lack of sufficient funding from state (public) sources. Thus, federal budget expenditures on healthcare from 2012 to 2015 are reduced by 1.7 times, the budgets of most constituent entities of the Russian Federation are in deficit (according to the Accounts Chamber of the Russian Federation, 60% of them have a high state debt, with whom they will not be able to pay).

A further increase in the rates of insurance premiums for compulsory medical insurance is extremely undesirable due to the increased tax burden on the wage fund. especially for small and medium businesses. Paid services to the population of the Russian Federation also cannot become a source of additional income for the health care system, since today the share of the population’s expenses on health care exceeds that in OECD countries (33 and 27% of total expenses, respectively).

All this dictates the need to develop and quickly approve a healthcare development strategy for the medium term (2018-2020) with justification for appropriate funding from public funds. This strategy should highlight priority areas and define tasks covering the full range of measures to protect the health of citizens. Implementation mechanisms and indicators for monitoring have been developed. And most importantly, the volumes and sources of additional healthcare financing have been determined.

When developing a strategy, in addition to solving internal problems of the industry, it will be necessary to take into account external demographic, socio-economic and technological challenges. Among them are demographic ones - high mortality from non-communicable diseases, a reduction in the number of working-age citizens by 1 million annually, an increase in the proportion of the elderly population to 26% and a reduction in the number of women of childbearing age by 22%. Taking into account these challenges, the healthcare development strategy should focus on preserving and strengthening the health of citizens of working age, women of childbearing age and children, increasing the volume of medical and social assistance to older citizens. age group and children.

It is also necessary to take into account serious economic challenges - the increasing gap in the income of different groups of the population and the need to extend the retirement age by at least 5 years (which can only be realized if the life expectancy of men is extended by 5 years, in which case they will live to 65 years already almost 60% men); and social challenges - increasing poverty as a result of the impact of a possible global economic crisis and budget cuts, etc. Socio-economic challenges confirm the need to increase the volume of free medical care for the population at the expense of public funds.

The main technological challenge to healthcare will be the rapid development of information electronic technologies. This should be used in medical education, data collection and analysis in healthcare. organizing medical care for patients.

To achieve the target indicators of public health and based on the need for a speedy solution to the problems existing in the healthcare system, as well as taking into account the tasks set in the Presidential Decrees of May 7, 2012 and the Program “Health Development until 2020”, the editorial board of the National Guidelines proposes the following goals and priority directions for the development of healthcare in the Russian Federation in the medium term.

Basic goals:

• 1. Increase the proportion of the population satisfied with the quality and availability of medical care by 2 times (from 34 to 70%).
• 2. Achieve an improvement in the health of the population (increase life expectancy by 5.3 years (from 70.3 to 75.6 years); reduce the overall mortality rate by 19% - from 13.5 to 11.0 cases per 1 thousand population: reduce by 33% the mortality rate of men of working age - from 10.0 to 6.7 cases per 1 thousand men; to reduce the share of citizens of working age among the total number of those recognized as disabled for the first time from 47 to 35%.
• 3. To create a healthy lifestyle among citizens of the Russian Federation (reduce the proportion of daily smoking adults from 40 to 25%; reduce alcohol consumption by 33% - from 15 to 10 liters per year in terms of pure alcohol per capita over 15 years old, etc. .d.).
• 4. Promote an increase in the birth rate and improve the health of children (increase by 20% the number of children born to one woman from 1.5 to 1.75; reduce infant mortality by 22% - from 8.8 to 6.4 cases in children under 1 year of age per 1 thousand live births; reduce the proportion of children born sick or ill during the neonatal period - from 40 to 30% of the total number of live births: reduce child mortality (from birth to 5 years) by 25% - from 10.2 to 7.6 cases per 1 thousand live births, reduce the number of abortions by 30% (from 73.7 to 57 cases per 100 births), reduce maternal mortality by 6% - from 16.5 to 15.5 cases per 100 thousand live births.
• 5. Increase the availability of medical care (reduce the waiting time for a doctor’s appointment at the clinic to 20 minutes, consultations with medical specialists at the clinic (in case of a non-acute illness) - to 3 days; reduce the arrival time of emergency medical teams in urban conditions to less than 20 minutes; reduce waiting time for planned operations is up to 1 month, high-tech medical interventions - up to 2 months.

Priority directions:

• 1. Increase in volumes government funding healthcare by 1.5 times (from 2 to 3 trillion rubles in 2011 prices) or up to 6% of GDP, as is happening today in all developed countries. Without increasing healthcare funding, solving other problems will be impossible. This will require identifying additional sources of healthcare financing.
• 2. Ensuring the optimal number and structure of medical personnel. To do this, along with the increase in wages for medical personnel provided for in the decree of the President of the Russian Federation (doctors - 2 times in relation to the average wage in the regional economy, paramedical personnel - at the level of the average wage in the economy), it is necessary to provide additional measures.
• 3. Improving the qualifications of medical personnel. To implement this direction, it will be necessary to significantly improve the quality of basic medical education, for which to increase the salaries of teaching staff by at least 2.5-3 times; implement modern technologies advanced training of doctors, including the development of a system of continuous medical education (CME).
• 4. Increasing the volume and quality of free drug provision (FM) to the population in outpatient settings at the expense of state (public) sources. These volumes must be gradually increased by at least 5 times - to the level of 1% of GDP, i.e. to the level of the “new” EU countries today (or from 132 billion rubles to 600 billion rubles per year in 2012 prices). To implement state programs for drug provision of the population, it is necessary to formulate unified approaches - a single the legislative framework, a unified list of medicinal products (MD), the consolidation of all existing government medicinal products programs into one, a unified information system in medical organizations. It is also necessary at the federal level to organize a strict system of control over the implementation of LO in the constituent entities of the Russian Federation.
• 5. Ensuring accessibility of primary health care with the preservation and development of the system of organizing medical care that existed in the Soviet Union, namely: preventive focus, territorial principle of population attachment, coordination and integration of medical care for patients by primary care physician (including referral systems to other levels provision of medical care), maintaining clinics and separate provision of medical care to adults and children.
• 6. Reorganization of medical care in inpatient settings, distinguishing its three levels (for the provision of specialized, specialized high-tech and innovative medical care); restructuring of the bed capacity - division of the bed capacity into beds for emergency and intensive treatment and into rehabilitation and aftercare beds.
• 7. Development of a medical care quality management system. To achieve this, it is necessary to develop a national policy for the management of ILC. Create special departments for managing the quality of medical care in health care authorities at all levels, introduce a system of mandatory accreditation of medical organizations (based on ISO and international system accreditation of medical organizations), as well as unified methods for assessing the quality of medical care by developing indicators of the quality and safety of medical care (target values ​​​​of these indicators must be set for each level of healthcare management in accordance with best performance in the constituent entities of the Russian Federation and abroad).
• 8. Improving management efficiency, including improving the legislative and regulatory framework for healthcare. This will require the development of a healthcare development strategy, increased responsibility and accountability of managers at all levels for achieving results and efficient use of resources, as well as continuous training of management personnel. It is also necessary to introduce such elements of market relations as competition between doctors and medical organizations based on the quality of medical care, ratings of medical institutions, and payment for results.
• 9. Creating conditions for citizens of the Russian Federation to lead a healthy lifestyle (in solving this problem, the Ministry of Health of Russia acts as the initiator and coordinator of programs).

An increase in government funding for healthcare and the successful implementation of the above priority areas will make it possible to increase the life expectancy of Russian citizens to 75-76 years by 2018. Moreover, increasing the availability of free medical care for the majority of the population in conditions of serious stratification of the country's population by income level will play an important role in achieving social and political stability in the country.

The State Program of the Russian Federation “Health Development” (hereinafter referred to as the State Program) was approved by Decree of the Government of the Russian Federation dated December 26, 2017 No. 1640 “On approval of the state program of the Russian Federation “Health Development”.

Decree of the Government of the Russian Federation dated March 29, 2019 No. 380 “On Amendments to the State Program of the Russian Federation “Health Development” approved changes to the State Program concerning the adjustment of goals, the composition of co-executors and participants, the structure and timing of the implementation of the pilot State Program, the rules for provision and distribution subsidies from the federal budget to the budgets of constituent entities of the Russian Federation.

The state program was developed in accordance with the Rules for the development, implementation and evaluation of the effectiveness of individual state programs of the Russian Federation, approved by Decree of the Government of the Russian Federation of October 12, 2017 No. 1242 “On the development, implementation and evaluation of the effectiveness of individual state programs of the Russian Federation.”

The state program was prepared taking into account the provisions:

• Messages of the President of the Russian Federation to the Federal Assembly of the Russian Federation dated March 1, 2018; dated February 20, 2019;
• Decree of the President of the Russian Federation of May 7, 2018 No. 204
  “On the national goals and strategic objectives of the development of the Russian Federation
  for the period until 2024";
• The main directions of activity of the Government of the Russian Federation for the period until 2024, approved by the Chairman of the Government of the Russian Federation D.A. Medvedev September 29, 2018 No. 8028p-P13;
• Guidelines for the development of national projects (programs) approved by the Chairman of the Government of the Russian Federation D.A. Medvedev June 4, 2018 No. 4072p-P6;
• Regulations on the organization of project activities in the Government of the Russian Federation, approved by Government Decree
  Russian Federation dated October 31, 2018 No. 1288;

• strategic planning documents of the Russian Federation
  in the healthcare sector;
• decisions (instructions) of the President of the Russian Federation
  and the Government of the Russian Federation; and etc.

Taking into account Decree of the President of the Russian Federation dated May 7, 2018 No. 204 “On national goals and strategic objectives of the development of the Russian Federation for the period until 2024” (hereinafter referred to as Decree No. 204), the goals of the State Program were adjusted.

Goals of the State Program:

1) reducing the mortality rate of the working-age population by 2024
up to 350 cases per 100 thousand population;

2) reducing mortality from diseases of the circulatory system to 450 cases per 100 thousand population by 2024;

3) reduction by 2024 in mortality from neoplasms, including
from malignant, up to 185 cases per 100 thousand population;

4) reducing infant mortality to 4.5 cases per 1 thousand live births by 2024.

The values ​​of target indicators by year of implementation are indicated
in the State Program passport.

The deadline for the implementation of the State Program has been changed from 2025
for 2024 in accordance with the completion date of the national project “Healthcare”. This change was approved by Order of the Government of the Russian Federation dated October 13, 2018 No. 2211-r “On Amendments to the List of State Programs of the Russian Federation.”

The design part of the pilot State program includes the national project “Healthcare” (hereinafter referred to as the National Project).

The National Project reflects in the form of structural elements
8 federal projects:

“Development of the primary health care system”;

“Combating Cardiovascular Diseases”;

“Fighting cancer”;

“Development of children's healthcare, including the creation of a modern infrastructure for providing medical care to children”

“Providing medical organizations of the healthcare system with qualified personnel”;

“Development of a network of national medical research centers
and implementation of innovative medical technologies";

“Creation of a unified digital circuit in healthcare based on the unified state health information system (USISZ)”;

“Development of export of medical services”;

Passports of federal projects were approved by the minutes of the meeting of the project committee for the national project “Healthcare”
dated December 14, 2018 No. 3.

In addition, the structure of the project part of the State Program includes 2 federal projects implemented within the framework of the national project “Demography”:

“Strengthening public health”;

"Older generation".

The process part of the State Program includes 24 departmental target programs (DTPs), developed on the basis of individual events.

Development and approval of VDC projects was carried out in accordance with
with the Regulations on the development, approval and implementation of departmental
target programs approved by Decree of the Government of the Russian Federation dated April 19, 2005 No. 239 (as amended on February 23, 2018 No. 196).

The State Program includes in the form of annexes the Rules for the distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation, as well as summary information on the rapid development of priority territories of the Russian Federation. The list of priority territories is brought into compliance with paragraph 1 of the Decree of the President of the Russian Federation of November 3, 2018 No. 632 “On amendments to the list federal districts, approved by Decree of the President of the Russian Federation of May 13, 2000 No. 849.”