Articles from rubric: «Financial management»
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2022 № 11 Implementation Of The Material Incentives Mechanism In A Healthcare Organization With The Use Of HIS.
The article notes the importance of the financial incentive mechanism for a healthcare organization. The mechanism should be both effective, delicate, objective, fair, transparent, stimulating professional and personal growth. The principles are proposed and the mechanism of material incentives, built at the V. A. Nasonova Research Institute of Rheumatology. The features of the implementation of the subsystem “Incentive payments” in HIS Interin PROMIS are briefly presented. In conclusion, the main results of the implementation and operation of the subsystem “Incentive payments” of HIS in the medical organization are listed.
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2022 № 4 Features of the formation of the labor rationing system in medical organizations providing primary health care
Labor rationing has a number of potential opportunities, with the competent implementation of which it is possible to solve many urgent management tasks, including stimulating employees.
The purpose of the study is to evaluate the principles of the formation of the remuneration system through the applied elements of labor rationing for various categories of medical workers providing primary health care, taking into account the specialty of the medical worker and his activities.
Materials and methods. A mechanism has been developed for the introduction of a remuneration system (an effective contract) through labor rationing in compliance with labor legislation and other regulatory documents based on the timing of the performance of the labor function (manipulation, procedure, examination, etc.), its quantitative and qualitative characteristics.
Results. During the development of the labor rationing system in the polyclinic, timekeeping tables for load accounting were developed for all departments. Based on these data, the optimal accounting unit of labor costs was established and the required number of points was determined, which guarantees the receipt of an official salary with a full worked rate of hours per month. For each employee, the form “Performance of the load per month” was filled out, where the indicators “Number of patients/days per month” and “Average load per day” were calculated. Summary evaluation data were entered into labor passports, which reflected the rate of points per day, the actual number of points scored, the difference between the actual number and the norm, the percentage of the surcharge. As an example, several developed methods are presented for the development of criteria and the establishment of additional payments to polyclinic medical workers within the framework of an effective contract.
Findings. Determining the workload of medical workers based on the study of labor processes and the cost of working time to perform various jobs, and then rationing their labor, in general, makes the requirements for the volume of work performed transparent, reasonable and understandable for the staff of medical organizations. -
2022 № 1 New classification of national public health financing systems
R e l e v a n c e : The variety of methods and approaches to the financing of medical care accumulated by the world experience determines the importance of classification. However, the existing capabilities of classification systems seem to be limited and unsuitable for practice and management decision-making.
P u r p o s e : development of a new classification of health care financing systems to improve the efficiency of managerial decisions taken when modeling long-term strategies for the development of health care in the Russian Federation.
M e t h o d s : A method was used based on a functional and structural analysis of the main links of the technological cycle of financing public (free at the place of delivery) medical care: coverage, determination of sources of revenues, their redistribution, consolidation, payment for medical care and management expenses for creating a new classification of health care financing systems.
R e s u l t s a n d c o n c l u s i o n s : A new classification has been developed and tested to analyze the national health systems of different countries and model the most relevant changes in the health financing system.
A p p l i c a t i o n o f t h e r e s u l t s : public health, public financial management, consolidation of revenues. -
2022 № 1 Assessment of economic losses due to the development of infection in the surgical intervention area
The development of infection in the field of surgical intervention is inextricably linked with financial costs and the public reputation of the institution. The medical and preventive institution needs to allocate additional funds from the hospital budget for diagnostic studies, as well as for medicines for the treatment of frolicking purulent-septic complications. As a result, medical and preventive institutions experience annual additional economic losses.
P u r p o s e of the study is to assess the economic damage caused to medical and preventive institutions due to the development of infections in the field of surgical interventions.
M a t e r i a l s a n d m e t h o d s . In the course of this study, an analysis of domestic and foreign literature sources on the issue of economic damage from purulent-septic complications in surgical practice was carried out.
R e s u l t s . The damage caused by the development of infections in the area of surgical intervention is quite significant, and even the introduction of new technologies and therapies does not relieve patients from their possible appearance. The estimated costs of infection of the surgical intervention area vary depending on the region, the type of operation and the degree of infection.
Economic analysis in this case is necessary to study the activities of organizations from the point of view of evaluating their work in order to monitor and subsequently better manage the processes of supplying the institution itself with material resources, as well as the use of internal reserves and their rational use.
F i n d i n g s . The distribution of funds in medical and preventive facilities should be carried out rationally to ensure the full-fledged activity of the institution. In the absence of measures taken to prevent the development of nosocomial infections, infections of the surgical intervention area may occur after a certain period of time after the patient is discharged from the hospital, thereby contributing to the spread and contamination of healthy people, which from a socio-economic point of view is unprofitable. -
2022 № 1 Analysis of medical organization website during the Covid-19 pandemic
The Web site has become an integral part of organizations that use the power of the Internet and online communication platforms to build trust and strengthen relationships with stakeholders during and after a crisis.
The COVID‑19 pandemic is an uncertain risk factor that requires ongoing analysis of interventions in order to make effective decisions.
P u r p o s e of the study is to analyze user behavior pattern at medical organization website.
M a t e r i a l s a n d m e t h o d s . The analysis of the website of the SamSMU Clinics performed using the web-analytics tool Yandex Metrics. The measurement periods has been done between January 2020 and June 2021.
R e s u l t s . The results showed a change in visitor behavior during the pandemic in the direction of an increase in visits, a decrease in time and depth of browsing, and a change in the type of device used to access the site in favor of the smartphone. The main result was the need to make decisions to improve interaction with patients as part of the development of mobile health.
F i n d i n g s . The COVID‑19 pandemic has had an impact on medical organization digital marketing. A behavioral shift of site visitors toward increased activity in the use of electronic registration and mobile devices has been revealed. To improve interaction with the target audience, it is necessary to categorize website content into different categories: for the patient, for medical students, and for medical staff. -
2021 № 4 COST-EFFECTIVENESS ANALYSIS OF MODERN MEDICAL TECHNOLOGIES MALDI-TOF MS FOR RAPID DIAGNOSTICS OF BACTERIAL INFECTIONS
The principle of rational antibiotic therapy can only be realized in the case of accurate and rapid identification of the pathogen. The spread of antibiotic resistance limits the choice of antimicrobial drugs and worsens the clinical prognosis for patients, so new strategies are needed to improve patient outcomes. The article presents a clinical and economic analysis of innovative technologies MALDI-TOF MS for the rapid diagnosis of microorganisms. Mass spectrometric identification of bacterial pathogens helps to reduce the time required for the issuance of the results of bacteriological analysis and an economically viable technology for use in routine practice of microbiological laboratories in Russia.
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2020 № 7 Pharmacoepidemiological analysis of the safety of therapy for chronic diseases of the mental group as a tool for improving the efficiency of the public proc urement system
The material presents regional problems of drug’s treatment complication and results of pharmacoepidemiological analysis of the safety of therapy for chronic diseases of the mental group in the Pskov region. Basing on real author’s practice in pharmacovigilance centre in Pskov, it also includes analyses of main factors and key elements of pharmacovigilance activity. Proposals have been developed to optimize interchangeability in the field of public procurement, prescribing and dispensing of medicines of this group.
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2019 № 5 Providing income activities as a conscious necessary for functioning of the state (municipal) medical providers
Realization of the rights of citizens to health care and medical care free of charge, enshrined in the Constitution of the Russian Federation, carried out by state and municipal health care institutions «… at the expense of the relevant budget, insurance premiums and other income». Analysis of the dynamics of the volume of financial sources for 2014–2017 showed a significant increase in revenues of medical organizations, which are state budgetary institutions, funds from income-gener- ating activities.
The article describes the main financial sources that a medical organization – a state (municipal) institution may have for providing medical care, as well as for implementing the Program of state guarantees of free medical care to citizens. The rationale for the insufficiency of public funds to ensure the necessary level of wages for medical workers is given on the example of comparing tariffs of the compulsory health insurance system and prices (tariffs) of private medical organizations in the city of Moscow.
The regulatory and legislative conditions for obtaining funds from various financial sources by a public institution are con- sidered, the relevance of developing measures to attract additional financial sources, which include revenues from providing paid medical services to the population, including through voluntary medical insurance, is justified. -
2019 № 1 Methodology for estimating the costs of identifying, diagnosing and treating tuberculosis with multiple and extensive drug resistance
Estimating the cost of treating patients with extensive drug-resistant Mycobacterium tuberculosis is useful both in planning financial resources for anti-tuberculosis activities and in determining the economic burden of this phenomenon. The article proposed the author’s methodology for estimating the costs of identifying, diagnosing and treating tuberculosis with multiple and extensive drug resistance, calculated estimates of the cost of combating the general drug resistance of mycobacteria tuberculosis.
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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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2016 № 9 Payment arrangements for interrupted case of medical care, including ultrashort course, in the system of compulsory medical insurance
Annotation. According to the draft program of state guarantees of free medical care to citizens in the years 2017–2019, when paying for medical care provided in a hospital, as well as in the provision of medical rehabilitation services in specialized medical institutions (structural units) in the compulsory medical insurance system, used payment method for interrupted, including ultrashort, the case of medical care. Issues correct compensation for the medical organization with ultrashort or interrupt the event is dedicated to the treatment of the material costs.
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2016 № 9 Рayment of primary health care on per capita financing
Examines conditions and problems of translation of health care organizations on a per capita principle of financing. The material is based on the experience of the constituent entities of the Russian Federation, a long-time practicing activities in terms of per capita funding. Recommendations for minimization of financial risks of healthcare organizations.
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2016 № 6 To a question of outsourcing of motor transportation service in an emergency medical service
The analysis of a condition of vehicle fleet of an emergency medical service in the Russian Federation testifying to need of updating about a half of cars is presented in article. One of problem solutions – outsourcing of transport service of an emergency medical service which is already successfully applied in a number of regions of the country is considered.
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2016 № 5 Overview of the implementation of a policy to provide neurosurgery medical care for adult population in Ryasan region
The quality and accessibility of medical care affect improving health, social and economic efficiency and directly dependent on the optimal organization of medical care on the basis of developed and approved procedures of medical care. The number of beds and neuro-surgical profile doctors-neuro-surgeons in the Ryazan region, are lower than the national average. In General, in the Ryazan region observed the procedure of rendering of medical aid to adult population the profile of «neurosurgery». To improve the quality and efficiency of neurosurgical care is necessary to conduct a number of organizational measures.
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2016 № 2 Staff time specialist doctors for the provision of medical care in the outpatient setting
In order to implement the Decree of the President of the Russian Federation dated May 7, 2012 № 598 «On improvement of state policy in the sphere of public health» and in accordance with the Action Plan of the Ministry of Health Labor norms in health care, approved by the Interagency Working Group on the organization of rationing of work, the development of professional standards and skill levels in the health sector conducted observed for 2 working weeks of the working process of two specialists: cardiologist, endocrinologist and dentist-therapist in 20 pilot areas of the country. Data analysis observation revealed the need for regulations to establish standards load specialists providing outpatient care to the population due to an increase in the time to visit a patient.
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2016 № 2 The economical effectiveness of actions preventing the expansion of incidents of substance and alcohol abuse
The analysis of economical effectiveness of preventative measures against substance and alcohol abuse in the Kostromskaya region between 2008–2012 years showed a presence of significant losses for the region’s economy, prompted by the population’s morbidity for drug and alcohol abuse among the young and employable population. There was noted a low level of financial provision of regional target-oriented programmes and a deficit in current financing of narcology service, what in turn makes the medical aid considerably less accessible. The level of achieved indicators for evaluating the effectiveness of the narcology service’s activity demonstrated that there is a significant retardment among the regions, included in the process of realization of the concept for modernizing the narcology service of the Russian Federation.
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2016 № 1 On particular issues of defining the demand for hospital beds (according to data from Samara region)
The task to define the real demand for hospital beds has become one of the most relevant ones in the recent times. There are suggested several options to estimate demand, out which the most attractive are those based on the audits of the population’s morbidity.
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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. -
2015 № 9 Financial cost estimate of the laboratory tests performance in the samples with hemolysis
Two different ways of hemolysis evaluation in blood serum were analyzed for better effectiveness as a most frequent mistake in pre-analytical phase. Automatic measurement of hemolysis index (HI) was proved to be of the highest effectiveness as an economical as well as a patient safety matters.
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2015 № 8 On certain questions relating to interterritorial accounting in the system of compulsory medical insurance
Issues of interterritorial accounting for provided care to citizens registered with a compulsory medical insurance plan yet outside of the insurance territory is relevant and needs further and deeper analysis. It is safe to conclude that insurance medical organizations should participate in interritorial accounting process along with conducting control check of volumes and conditions at which medical care is provided and completing a medical aid quality check.
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2015 № 7 Regulations of working time nurses in general practice in urban polyclinics
Annotation. The article presents the form of the work of nurses in General practice (IUCN) to complete the transition of the city clinic in General medical practice. Given the results of the research work on the standardization work of the IUCN in the new environment with the release of an independent nursing admission.
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2015 № 6 Improving system specialized medical care in acute coronary syndromes: experience at the level of the Russian Federation, outstanding issues
A review is presented of the Kemerovo regional experience improving specialized medical care in acute coronary syndrome. Marked the problematic issues in the health care in acute coronary syndrome in modern conditions (late hospitalization, poor interaction of medical organizations). To improve the social and economic efficiency of medical care is necessary to strengthen the preventive orientation in the activities of the primary health care, to create organizational, economic conditions compliance with the order of care in hospitals, to carry out external control of health care health insurance organizations, to provide a system of care in acute coronary syndrome information and statistical tools.
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2015 № 5 Direct costs calculator as a tool for economic justification of health care expenditures for patients with castration-refractory prostate cancer
The article describes a tool to calculate the direct medical costs of treating patients with castrationre fractory prostate cancer. This tool will allow to assess cost of medical procedures and to justify treatment choice.
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2015 № 5 On the issue of statutory normatives of rehabilitation centers for children with congenital heart disorders
To date the statutory normatives of rehabilitation centers and rehabilitation departments for children with congenital heart disorders are not approved, methodological recommendations on this issue are missing. There has been undertaken a review of specific normative-legal acts as well as theoretical findings from the literature related to development and approval of statutory normatives for healthcare and regulations on provision of medical aid to the population. There has been presented an organizational-statutory structure of a rehabilitation center for children with congenital heart disorders. The purpose of this article is to make a defense case for optimal statutory normatives of a children's rehabilitation center for children with congenital heart disorders.
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2015 № 4 High-tech medical care in the system of compulsory health insurance
Health care reform had an impact on the such expensive type of medical services as a high-tech medical care. Since in 2015, as planned new federal legislation, went into the system of compulsory health insurance. Answer to the question, what is the purpose of the transfer of high-tech health care insurance rails, whether all the volume of this type of medical care today is subordinate stringent requirements of the compulsory health insurance, and what kind of the medical organization involved in providing this type of care, to what extent and for the what funds are reimbursed which health organizations can get the volume of the entire high-tech medical care, dedicated to this material.
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2015 № 3 Regarding certain issues on payment for medical aid with the usage of clinical-static groups in the system of mandatory medical insurance
Russian Ministry of Health Care and Federal Fund of Mandatory Medical Insurance system completed an important project on implementing paid medical services, delivered in conditions of in-patient facilities, on the basis of for medclinic-static groups. It is necessary to continue the work on enhancing the proposed system with consideration of raised issues and proposals, coming from the regions.
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2015 № 2 On certain issues occurring in medical insurance organizations functioning in the mandatory medical insurance system
Modernization of mandatory medical insurance system should imply a broader usage of reserves from medical insurance organizations (MIO). These reserves are interlinked with changes in the legislation, regulating the responsibilities and obligations of insured citizens, commitment of MIO in covering expenses for medical aid, provided outside of the region, the order of utilizing assets of MIO.
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2015 № 1 Characteristics of financing the joint practice: Case study of Samara region
There was conducted an analysis of general practioner's average wages level, working in an outpatientambulatory unit in Samara region in the first quarter of 2013 and 2014 years in order to compare them with per capita financing normative and shares of external services. It was demonstrated that outpatient-ambulatory practitioner's wage does not depend on the per capita normative while optimizing the level of external services. There has been emphasized the importance of advancing efficient contract as a main tool for stimulating enhancement of labour quality and increasing its renumeration level in the health care system.
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2015 № 1 Prospects of applying public-private partnerships mechanisms to improve rehabilitation care for patients with congenital heart disease
The analysis of the application possibilities of public-private partnership in the creation of infrastructural base for medical rehabilitation of patients after surgical treatment of congenital heart defects. Described the main normative legal acts regulating the medical rehabilitation and public-private partnership in Russia. Offered some new ways of solving problems of public-private partnership in the system of national health care. The essence of the proposed solutions is the ability to attract pension funds as investors for infrastructure development of new rehabilitation centers for children with congenital heart disease. The author's opinion is not unconditional. In this paper an attempt is made one more look at the possibility of using public-private partnerships in health care.
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2014 № 10 When fund holding is essential (Samara State Medical University, Samara, Russia; Ryazan State I.V. Pavlov Medical University, Ryazan, Russia).
Annotation. In recent time, there has been actively discussed the efficiency of various payment methods for medical care within the system of mandatory medical insurance, however, more attention is dedicated to implementation of fund holding elements. This method along with its beneficial sides, represents a lot of risks, which complicates it's widespread usage. However, there are situations, when fund holding might neutralize the problems, which a rise while managing work in hospital organizations.
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2014 № 7 Tarrification of workers in a medical institution (Municipal hospital № 4 Ulianovsk, Russia)
Annotation. The article endeavours to give a definition to the term of tarrification of employees, clarify the order of creating tarrification commission and forming tarrification list. There is presented a list of questions, studied by commission. There are reviewed criteria when classifying worker's professions and titles are refered to professional qualification groups.
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2014 № 3 Input normal of execution of state (municipal) assignment as an instrument of financial effectiveness rise (Krasnoyarsk City Administration, Russia).
In the corresponding budget of the Russian Federation budget system there provided appropriation for execution of the assignment. The appropriation are allocated to institution as a subsidy for compensation of normative inputs connected with providing of state (municipal) services (caring out work) and maintenance of property. To determine proper value of subsidy for the fiscal year in turn it is necessary to rate the normals. In the article there considered the methods for determination of normative inputs of providing of state (municipal) services (caring out work) and normative inputs of property maintenance, there given practical examples.
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2014 № 2 Input normal of execution of state (municipal) assignment as an instrument of financial effectiveness rise (Krasnoyarsk City Administration, Russia).
In the corresponding budget of the Russian Federation budget system there provided appropriation for execution of the assignment. The appropriation are allocated to institution as a subsidy for compensation of normative inputs connected with providing of state (municipal) services (caring out work) and maintenance of property. To determine proper value of subsidy for the fiscal year in turn it is necessary to rate the normals. In the article there considered the methods for determination of normative inputs of providing of state (municipal) services (caring out work) and normative inputs of property maintenance, there given practical examples.
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2013 № 10 The payment method for the finished case of the disease treatment according to the rates of complex medical services including the correction factor to the fund of labour payment (Krai governmentowned publicly funded health care institution «Clinical Hospital of Vladivostok № 2», Vladivostok, Russia)
Annotation: On the basis of factor-analysis model is considered a method of labour payment in Primorsky Krai`s hospitals. In the applied method of payment for the finished case of the disease treatment was determined a problem preventing for health insurance portability and health care quality. It was shown that the case price for the disease treatment by applying the correction factor depends not only from the approved rates but also of the structure and volume of medical care.
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2013 № 10 Economic loss from premature rural mortality (Federal State Budget Institution of Science Institute of Agrarian Problems of the Russian Academy of Sciences, Saratov, Russia)
The objective of the study was to make an economic assessment of the social-demographic loss caused by premature rural mortality. For that purpose the following tasks were planned to be fulfilled: choice of methods for calculating the economic damage from rural mortality; determination of indicators that adequately reflect the economic damage from rural mortality; development of a database on the basis of the indicators presented in Rosstat's official statements; calculation of monetary evaluation of key parameters; determination of the total economic damage. Experimental calculations were performed using different techniques. The study was financially supported by RFBR (project № 12-06-00012).
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2013 № 6 The experience of territorial health insurance fund in solution of certain issues connected with monitoring of target spending of funds by medical organizations (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
Annotation: The article is devoted to consideration of problems controlling the use of funds of mandatory health insurance in medical organizations. At the present time due to «the provision of control the use of funds of mandatory health insurance by medical organizations» was put into practice, there are preconditions to increase the efficiency of inspection in medical organizations. On the other hand, it’s necessary to define the policy, based on using legal documents that available for medical organizations and for professionals, who implements monitoring activities. All labor costs are the main component of funds that are expended for Medicare payment. In this article were considered particular questions about infringements in the use of funds of mandatory health insurance when salary payments are implemented.
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2013 № 5 Regarding the problem of fund's spending effectiveness in the system of mandatory medical insurance (Samara State Medical University, Samara, Russia; Territorial Fund of Mandatory Medical Insurance System of Ryazan region, Ryazan, Russia).
Annotation: Effective spending of funds for mandatory medical insurance system depends on many factors. In this article there is considered a dependency of economic effectiveness from management of medical aid. There are presented examples of when errors in managing medical aid result into serious economic losses.
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2013 № 5 Business planning in commercial medical organization's practice (Baykal State University of Economics and Law; JSC "Doctor Bermental"; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
The article is dedicated to the business planning technology as an instrument for management of a medical organization. Also there is analysis of the structure and function of a business plan. The article contains an example of the business plan's financial section of a commercial medical organization.
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2013 № 3 Classification of the financial violations connected with the direction of the medical personnel for participation in work of the draft commissions (Saratov state Socio-Economic University, Saratov, Russia)
This article is prepared on the basis of the analysis of laws and other regulations of the Russian Federation and results of the control events held in military commissariats, and intended for employees of accounts department of medical institutions and military commissariats. Systematization of standard financial violations and shortcomings will allow to define the most characteristic violations when carrying out military-medical examination and to organize precautionary work with development of concrete recommendations about strengthening of the financial and budgetary discipline.
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2013 № 1 Regarding several methodological approaches to pricing and payment process for medical services in regional system of Mandatory Medical Insurance (Samara State Medical University, Samara, Russia; TFOMS of Ryazan region, Ryazan, Russia)
Reforming the system of mandatory insurance coverage in Russia is impossible without integration of progressive directions in defining tariffs for medical services and their approaches. It is proposed to process payment for stationary aid according to formed clinic-statistic groups depending on the stage of medical care and outpatient care — with the help of combined method, consisting of capita funding and payment coverage of visits and particular medical services.