All articles by Perkhov V. I.
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2018 № 5 About the legality of the payment for the provision of medical care in the emergency form
The journal “Health Manager” published an article by Kadyrov F. N. and Sorokina Yu. A, which contains the statement that in the emergency form of medical care can be provided at the expense of personal funds of citizens. Often the uncertainty of legal norms leads to their ambiguous understanding and creates the possibility of their various applications. However, with regard to the possibility of providing medical assistance in an emergency form for a fee, the existing legal norms clearly do not allow such a possibility. The author believes that the publication contains a wrong interpretation of the legal norms that promotes intensive commercialization of public health institutions, but does not support citizens of a special category – who are in danger and in a helpless state
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2017 № 9 About standards of medical care again: who needs them?
Recently, the standards of care are constantly subjected to criticism from clinicians, but are protected by the professionals working in the enforcement agencies, insurance medical institutions, funds of CMI. The article pro- vides additional arguments about the voluntary application of standards. These arguments will help leaders of health organizations and practitioners to understand the complex conflict
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2016 № 10 Аnalysis of the application of standards of care
The article addresses the problem of application of standards in the provision of medical care, and also when exercising control and expert activities. Set out grounds for revision of the paradigm of quality assessment of medical aid in system of obligatory medical insurance based on the comparison of the standardized and the actual performance of medical-diagnostic process.
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2015 № 9 Influence on age and gender considerations costs while providing high-aid in profile «traumatology and orthopedics»
Annotation. Relevance. One of the economic problems in health care in the shortage of funds is to find mechanisms of payment, the most adequate and reliable-specific medical care. This is especially true of the cost of such a species as a high-tech medical care. One of the most appropriate ways to pay for medical care provided in inpatient and day hospital is to pay as part of the clinical and statistical groups of diseases. When forming groups, in addition to such major criteria as the ICD-10 code or having surgery, apply additional criteria, taking into account the peculiarities of medical care to patients of different age and gender categories. Material presented in the article findings justify the need for such a differentiated approach to the formation of groups of high-tech expensive medical care
Subject of research: the group of high-tech medical care, approved by RF Government Decree of 28.11.2014 №1273 in the framework of the provision of state guarantees of free medical care to citizens for 2015 and the planning period of 2016 and 2017.
Objective: research to justify the use of a differentiated approach to the establishment of standards for the financial costs of groups of high-tech medical care, taking into account age and gender considerations. Methods of work: statistical, analytical.
Results: for the first time carried out an in-depth analysis of the cost structure of the federal health care organizations in the provision of high-tech medical care, identified factors affecting the size of the cost of medical organizations in the profile «Traumatology and orthopedics», to justify proposals to optimize the standards of financial costs on the profile «traumatology and orthopedics.»
Conclusions: the patient population, which is a high-tech medical care in the profile «Traumatology and Orthopaedics », consists mainly of older persons of working age, mainly women. The average standard of financial expenses higher in the older working age. -
2021 № 5 FROM MULTI – TO THE MONOPAYER IN THE RUSSIAN SYSTEM OF OBLIGATORY MEDICAL INSURANCE
Since January 1, 2021 amendments to the law “About Obligatory Medical Insurance in the Russian Federation” according to which medical insurance companies are excluded from the system of financing of medical care in federal clinics came into force. The logic of these changes provides creation in each territorial subject of the Russian Federation of a system of “the uniform payer” not only for federal, but also for other medical organizations that can regard as the beginning of centralization and restoration of integrity of a health care system that demands carrying out the analysis and forecasting of consequences of these innovations.
Research objective – the analysis and the forecast of consequences of the changes in the legislation on obligatory medical insurance providing creation of “the uniform payer” of the medical care provided in federal clinics.
Materials and methods. Content analysis methods, information and analytical materials of the Russian and foreign news agencies, expert estimates are used.
R e s u l t s . The federal law of December 8, 2020 № 430-FZ “About introduction of amendments to the Federal law “About Obligatory Medical Insurance in the Russian Federation” provides creation of two parallel systems of financial security of activity of the federal medical organizations – the first for directly from the compulsory health insurance Federal fund, the second – through the compulsory health insurances territorial funds and medical insurance companies. The law provided development of an order of distribution of volumes of the medical care provided at the expense of means of obligatory medical insurance in the federal medical organizations, taking into account capacities of such organizations and volumes of the provided medical care at the expense of other sources of financing. It can lead to division of the federal medical organizations into groups taking into account their dependence on treasury which force is inversely proportional to a share of paid services in revenue breakdown of these organizations.
Conclusions. Application in the system of obligatory medical insurance of the principles of “the uniform payer” of medical care is economic due to reduction of administrative expenses and elimination aspiration of commercial insurers to receiving profit. This decision also corresponds to global trends and will promote ensuring intrasystem efficiency in the industry, to development of network of the medical organizations as the “uniform organism” providing need of citizens for medical care. Division of the federal medical organizations into groups taking into account their dependence on treasury can have ambiguous consequences, including lead to strengthening of commercialization of federal clinics, many of which have legal status of autonomous budgetary institutions that causes need of creation of a system of protection of the population against catastrophic payments for medical care. -
2021 № 4 ABOUT ENSURING STABILITY OF FUNCTIONING OF HEALTH CARE IN EMERGENCY SITUATIONS
The pandemic of COVID‑19 put before society new unique, economic and ethical dilemmas as it imposed increased requirements to health care systems, both on national, and at the global level. One of these problems – ensuring stability of functioning of a health care system in emergency situations.
Research objective – the analysis of the current trends defining ability of health care to satisfy sharply increasing needs of people for medical care at emergence of emergency situation.
Materials and methods. Methods of the content analysis, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, statistical materials of the Russian Ministry of Health and Federal State Budgetary Institution TSNIIOIZ of the Russian Ministry of Health [1], a form of the state statistical observation No. 62, summary across Russia, “Data on resource providing and on delivery of health care to the population”, methods of the content analysis, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, expert estimates, analytical materials and statistical data of World Health Organization, statistical data and metadata over the countries of the Organization for Economic Cooperation and Development (OECD) and the certain countries which are not members and also the materials of monographic researches and periodicals including placed on the Internet are used.
Results. At the level of the state, resistance of a national health care system to emergency situations is defined by a condition of infrastructure of the industry, the mechanism and the amount of financing and also scales of attraction of the private medical sector to work for the benefit of society. For 2011–2019 the number of the hospitals of the state form of ownership participating in implementation of the Program was reduced from 4542 in 2011 to 2896 in 2019, or for 37%, and the number of the group hospitals participating in implementation of the Program increased almost by 1.5 times – from 163 organizations in 2011 to 235 in 2019. The number of the medical organizations of emergency medical service of the state form of ownership was reduced from 235 in 2011 to 169 in 2019, and the number of the private medical organizations of emergency medical service participating in implementation of the Program increased from only one organization in 2012 to 28 organizations in 2019. The number of the out-patient and polyclinic institutions of the state form of ownership participating in implementation of the Program was reduced since 2581 in 2011 to 1419 in 2019, or twice, and the number of private out-patient and polyclinic medical institutions increased from 485 organizations in 2012 to 2160 organizations in 2019, or by 4,5 times. At the level of the population stability of health care is affected by social and economic structure of society, ability and readiness of people to pay and be assessed with a tax for payment of medical care. At the same time, the solvency of the population of Russia remains low, and the insufficient amount of financing of health care leads to the accruing substitution guaranteed to medical
care by paid medical services.
Conclusions. In modern Russia there was a trend of increase in number of the private medical organizations which are carrying out activity in the sphere of compulsory health insurance in a combination to decrease in number of the public medical institutions that demonstrates gradual strengthening of a role of private business in questions of providing the population with medical care. It is necessary to guarantee that financing of the private sector at the expense of treasury will be carried out not to the detriment of the state medical organizations and will not undermine the processes which began in the country on system strengthening of health care, first of all – its primary link. For this purpose it is necessary to increase significantly a share of the public expenditures by health care in gross domestic product of Russia. -
2018 № 5 The program of state guarantees as a tool for ensuring social obligations of the state in the field of health protection of citizens
The program of state guarantees of free medical care is a tactical tool to ensure the social obligations of the state in the field of public health. It is shown that the current system of state guarantees at the macrolevel provides funding for all types, forms and conditions of medical care in the full range of diseases, but free medical care is not fully provided. In the overall structure of health care spending in Russia, the share of personal funds of citizens is almost half, which is more than three times higher than in the European Union. The data presented in the article suggest that the population pays not for the possibility of obtaining medical care, but for its quality. The authors believe that it is necessary to change the relationship between the doctor and the patient, to create conditions for the traditional spiritual and intellectual development of the Russian professional medical community
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2017 № 9 Postoperative mortality in the Federal cardioke-rulechecker clinics. the Hamburg account
The article is devoted to the comparative analysis of indicators of postoperative mortality in the most frequently performed cardiac surgical procedures. Revealed extraordinary heterogeneity of hospitals for postoperative mortality when the same types of surgical interventions. This may indicate the existence of serious problems of quality of care in the individual Federal clinics. Ranking distribution of clinics by indicators of postoperative mortality are shown. The proposed methodological approach to assess the results of surgical interventions in patient groups, comparable in age, sex, diagnoses, and applied technologies
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2017 № 6 Metamorphosis standardization of medical care
The article discusses a bill regulating the development and use of clinical guidelines in public health practice. The authors believe that the bill makes clinical recommendations to the regulatory option binding standards of сare. This approach only superficially converts the ways of ensuring the quality of medical care. From the point of view of the authors of the health care system fell into the organizational trap of technological regulation of the actions of the physicians, while the traditional values of the medical profession is gradually devalued. The authors propose to reconfigure relationships in the industry, not only by importing foreign countries, but in accordance with the usual Russian professional medical community’s leadership in the field of cultural, spiritual and intellectual development
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2018 № 10 About the transparency of compulsory health insurance
The problem of insufficient information openness in the system of compulsory medical insurance in Russia is considered. The non-transparency of the procedures of planning and execution of its budget of the Federal Fund of obligatory medical insurance. Distribution of subventions is carried out by mathematical formulas, the principles of calculations are not defined, and the coefficients used - closed. Financing the high-tech health sector is becoming unregulated. The list of new expensive medical services includes operations performed in the middle of the last century. In the system of obligatory medical insurance it is necessary to provide a clear and open mechanism for the development, adoption of and implement solutions related to common health problems
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2013 № 7 Analysis of international experience of funding and managing research and development in healthcare (Federal Research Institute for Health Care Organization and Information of the Ministry of Health of Russian Federation, Moscow, Russia; Research center of neurology Russian academy of medical science, Moscow, Russia; Research-Practical Center of Medical Radiology, Moscow Department of Health care, Moscow, Russia)
Healthcare in developed countries becomes the most productive and cited field of the world science. However little is known about innovative processes in the non-market oriented areas including medicine. This article deals with funding and managing research and development in medicine in foreign countries. The authors show that innovations in healthcare are the major focus of interest of foreign governments seeking for balance between cost-containment, quality and access to health care. Healthcare innovations assessment is necessarily accompanied with the expert evaluation of efficacy and safety of health technologies delivered by designated institutions. International policy analysis confirms that the search for the most effective management in organization and funding of healthcare research is of high priority in the world.
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2020 № 7 Covid‑19 pandemic: the realized decisions and the forthcoming tasks in the sphere of public health care
The response measures taken in the Russian Federation allowed to avoid the “explosive” nature of epidemic of a
new coronavirus and also a critical overload of the health care system weakened by spontaneous “optimization”. The flash
of COVID‑19 reminds that modern society is extremely vulnerable before threats of infectious pandemics. Important not
only to support and strengthen infrastructure of the medical organizations, but also to provide the mobilization readiness
of a health care system reflecting ability of the industry effectively to react to emergency situations. -
2016 № 9 New mechanism for financing high-tech medical care in 2017: characteristics and risks
Federal hospitals will receive state funds to provide high-tech medical aid from the Federal mandatory medical insurance Fund directly, and not from the budget of its founder or of insurance companies in 2017. Thus, in relation to Federal clinics it is planned to implement the mechanism of financing expensive medical interventions, which, according to the authors, is neither the budget nor the insurance. The authors have shown that legislative innovations and their associated risks will require from the Ministry of health of Russia and the Federal mandatory medical insurance Fund serious work to ensure the necessary accessibility for citizens is costly, but most effective methods of medical care.
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2016 № 1 Organisation and outcomes of monitoring medical-economical factors of high-technology medical aid
This article explores individual organisational-methodological approaches to constructing monitoring informational systems of high technology medical aid. Authors conclude that there is a necessity to create unique monitoring systems and databases, formed by personified audit of the most significant signs of surveillance subject. Article’s materials can be used while modelling information systems for practical implementation of high medical technology in circumstances of one stream financing.
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2019 № 8 Evaluation of the effectiveness of health care in the constituent entities of the Russian Federation using the Bloomberg methodology
A point assessment of healthcare systems efficiency of the regions of the Russian Federation is conducted on the
basis of methodological approaches of Bloomberg international rating agency using Minmax method, according to which the higher life expectancy is, the more efficient healthcare system is. The highest score according to the assessment result was given to Tyumen oblast with life expectancy of 72,1 years and minimal healthcare expenditures both per capita and in share of gross regional product. The leaders in the size of state expenditures on healthcare per capita are Magadan and Sakhalin oblasts, Kamchatka krai, the Republic of Sakha (Yakutia), accordingly reaching 80th, 77th, 78th and 72nd position on the rating. The city of Moscow reached 6th place, while surpassing the city of St. Petersburg by 19 positions, mostly because of higher life expectancy. The study showed that the variability of life expectancy in the context of the regions of the Russian Federation is about 15 times less than the indicators of health expenditure. The authors argue that since the health care system in Russia is predominantly state-owned, any estimates of economic efficiency are conditional, since only a competitive economy can be effective. -
2015 № 9 Provision of medical aid within a medical approbation
Currently there are developed legal and methodological principals for medical aid provision within a clinical approbation of prevention methods, diagnostics, treatment and rehabillitation. Despite the imperfections of the developed system, it allows to eccelerate the process of implimenting new medical technologies into the health care system, having simultaneously provided financial support to federal clinics, experiencing serious economical burdens due to budget cuts for the most common types of medical care in circumstances of economical instability. The article analyses the issues and provides recommendations for improving organizational mechanisms of clinical approbation.
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2020 № 1 Planning the subject of dissertations in the specialty «public health and healthcare»: problems and solutions
Over the last 20 years, the professional values of applicants for a degree in the specialty «Public health and health care» have shifted from health issues to disease issues, which does not meet the needs of modern society. There is a disappearance from the considered discipline, the ancestor of which is the medical police, of knowledge and competencies necessary for the successful implementation of management activities for the implementation of one of the most important social functions of the state-the prevention of threats to public health and safety. It is necessary to clarify the essence of the basic concept of the scientific specialty “Public health and healthcare”, as well as to improve the planning procedures of dissertation research.
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2016 № 2 Structure and challenges of the medical division of the new programme of fundamental scientific research of state science academies
The article considers the questions of planning and financing the scientific-research activity in the field of medical science, realized at the cost of the state budget. Authors demonstrate that disintegration of scientific processes leads to a decrease of intensity of scientific search and implementation of achievements in medical sciences in the health care practice. Authors conclude that it is necessary to increase the effectiveness of the management of scientific research and more clearly define the priorities of the medical sciences development.
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2018 № 7 Strategies and conditions for provision of state guarantees for free medical assistance
Guarantees of free medical care are important constitutional guarantees that provide material benefits and the most specific type of public debt to the citizen. It is shown that in modern Russia, implemented a version of the strategy of providing state guarantees of free medical care, based on a combination of resource reduction and attempts to improve the efficiency of their use. There is no paradigm of transformation and development of the industry, which has a strategic focus and covers all levels and components of the national health system. The authors believe that due to the traditional conservatism of the health care system, it is difficult, but possible, to solve this problem by the internal forces of the industry. To do this, it is necessary to create conditions in which the circle of strategic decision-makers in health care will be separated from the circle of persons developing and implementing tactical tools.
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2017 № 10 Performance of the hospitals neurosurgical profile in subjects of the Russian Federation
The main indicators of resource provision (number of beds, medical personnel) and in the performance of neurosurgical hospitals in the constituent entities of the Russian Federation for three years (2014–2016) are ana¬lyzed. The substantial variation in resource provision of certain regions of the country medical care of neurosurgical profile, a variety of indicators of total and postoperative mortality are shown. The authors emphasize the need for the restoration of health-organizational unity in the industry, enhancing coordination of regional and Federal medical organizations not only in the field neurosurgery but other high-tech areas of scientific and clinical activities