Articles from rubric: «Focus of problem»
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2023 № 10 Legal regulation of test purchases in the provision of paid medical services: relevance of the issue for medical organizations.
The article presents a detailed analysis of the Federal Law of July 31, 2020 № 248-FZ “On State Control (Supervision) and Municipal Control in the Russian Federation” in the context of such a control (supervisory) event as a test purchase in the provision of paid medical services. Heads of medical organizations need to know and take into account in their activities that grounds for conducting a control purchase of paid medical services may arise, including when supervisory authorities carry out control measures without interaction with controlled persons, and as a result of a preventive visit. Legislative consolidation of test purchases as a method of control (supervision) over the provision of paid medical services requires medical organizations to ensure their constant readiness in terms of knowledge
by employees of the medical organization of the established procedure and mechanisms for its implementation. The implementation by Roszdravnadzor bodies of a test purchase within the framework of federal state control (supervision) of the quality and safety of medical activities once again confirms that the issues of providing paid medical services should be constantly in the spotlight when medical organizations conduct internal control of the quality and safety of medical activities. The authors substantiate that organizing and conducting control purchases of paid medical services is a very promising control (supervisory) measure for its active use by supervisory authorities. -
2023 № 5 New rules for the provision of paid medical services: review and evaluation of the main innovations
The article discusses the change in the regulatory framework for the provision of paid medical services in connection with the adoption of the decree of the Government of the Russian Federation, which approved new rules for the provision of paid medical services. The reason for the adoption of the new rules is analyzed, as well as the content of its individual provisions. An assessment is given of how the new legal framework for the provision of paid medical services will affect the activities of medical organizations and how they will affect the interests of patients.
Special attention is paid to the emergence of a new – remote form of contract conclusion. -
2023 № 5 Risks of advanced training of doctors in private educational institutions: causes, consequences, what to do
The article discusses in detail the reasons for the low quality of training of doctors in private educational institutions. Among them, the absence of the necessary personnel and material and technical base for training, the implementation of activities with gross violations of the law, the imperfection of legal regulation in the field of education, etc. of which today additional professional medical education programs are being implemented with gross violations of the requirements established by the legislation on education, creates significant legal risks for doctors in terms of the validity of their admission to professional activities. The article emphasizes that the low quality of medical training
provided by a significant number of private educational organizations that implement additional professional medical education programs inevitably leads to a decrease in the quality of medical care provided, which today must be considered as one of the factors that threaten the national country’s security. Measures are proposed to correct the current situation. -
2022 № 10 Categorization of the Higher Attestation Commission List and its place in the national system for evaluating the effectiveness of research and development
In 2022, Western countries imposed sanctions on the Russian scientific community, giving grounds to overestimate the paradigm of building an open global scientific system, proclaimed in Europe after the end of the Cold War. The main refrain of the new stage is the strict regulation of European values and transatlantic interests in the security of communications with Russia. The growing relationship between foreign policy and security policy marks a departure from the principles of scientific internationalism, therefore, a National System for evaluating the Effectiveness of scientific research and Development is being created in the Russian Federation. The methodology of creating
a sovereign system and the principles of forming a national “white list” of journals and/or scientific publishers, publications in which are taken into account when evaluating the activities of national organizations, collectives or individual scientists, are considered.
In order to increase the strictness of the selection of journals of the list of Higher Attestation Commission and the transparency of its replenishment procedures, the Ministry of Education and Science of Russia has developed a Methodology for ranking journals of the list of Higher Attestation Commission. Scientometric indicators are listed, on the basis of which an integral indicator of the “quality of the journal” is calculated for each scientific specialty.
The lists of peer-reviewed scientific journals are presented, in which the main scientific results of dissertations for the degree of candidate of science, for the degree of doctor of science, should be published, classified as K1, K2 and K3 in the scientific specialty 14.02.03 – Public health and healthcare (medical sciences). -
2022 № 8 Professional standards: the role and importance in ensuring the quality and safety of medical activities, the main tasks
The article deals into detail with the application of professional standards in the activities of medical organizations and in the training of medical personnel. The authors substantiate that the application of professional standards in the regulation of labor relations of medical workers, as well as in the development and implementation of both professional educational programs and additional professional programs is an essential tool for ensuring the quality and safety of medical activities. The main tasks facing today in the field of the application of professional standards, the implementation of which will contribute to improving the quality and safety of medical activities, are identified: the creation of legal mechanisms for the effective application of professional standards by educational organizations; ensuring continuity in the application of professional standards between the training of medical personnel and the regulation of labor relations in the process of medical activity; the need to constantly maintain professional standards up to date
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2022 № 3 Control (Supervision) without interaction with a controlled person, as a new form of control over the provision of paid medical services: what the heads of medical organizations need to know
Currently, Roszdravnadzor and Rospotrebnadzor in the established areas of state control (supervision) over the provision of paid medical services are entitled to exercise control (supervision) without interaction with a controlled person, in which the following are carried out: monitoring compliance with mandatory requirements and on-site follow-up. Due to the fact that control (supervisory) measures without interaction with the controlled person are implemented without prior notification of the controlled persons, the conduct of these measures by the supervisory authorities is likely to entail an increase in the number of unscheduled inspections of medical organizations, including
control procurement. The emergence of a new type of control (supervisory) measures without interaction with a controlled person is one of the significant factors that increase the responsibility of medical organizations in terms of compliance with the requirements established by law for the procedure and conditions for the provision of paid medical services. -
2022 № 2 Advanced training of doctors: the main tasks today and what to do
The article presents and analyzes the main challenges that directly affect today both the qualifications of doctors and the work on the implementation of professional development programs. The author attributed the following to such challenges: the pandemic of coronavirus infection; the implementation of advanced training programs for doctors with the exclusive or preferential use of distance educational technologies; a decrease in the quality of implementation of advanced training programs for doctors; long breaks in the professional activities of doctors in the main specialty; periodic accreditation of doctors. The article proposes to focus on the development of exemplary professional development programs for doctors, taking into account the requirements of professional standards. It is necessary to ensure that the programs for improving the qualifications of doctors who develop and implement educational organizations strictly comply with the sample programs.
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2021 № 8 Study of quality of life related to health in patients with COVID19 on the first day of admission to hospital
The COVID‑19 pandemic has resulted in exceptional social disruption and consequent changes in quality of life. Assessment of the health-related quality of life in patients infected with the SARS-CoV‑2 (2019-nCoV) virus in a covid hospital is an urgent public health issue that affects the organization of medical care processes and the planning of rehabilitation programs.
Purpose of the study is to determine the level of health-related quality of life in patients with COVID‑19 on the first day of inpatient treatment for comparison with pre-pandemic norms and planning targeted rehabilitation programs.
Materials and methods. A study of the quality of life was carried out using the EuroQol EQ‑5D‑5L questionnaire assessing the Index EQ and EQ VAS indicators. Using the method of simple random sampling, the data of patients were collected for three sets having following features: “Both sexes”, “Men”, “Women”. The analysis was carried out using descriptive statistics methods.
Results. The indicators of health-related quality of life in patients with COVID‑19 on the first day after admission are lower than the pre-pandemic population norms for Moscow residents according to Index EQ by 20%, according to EQ VAS by 29%, on average. Women have more health limitations than men in all EQ‑5D‑5L domains, which is proportionally lower than population norms. In 3,7% of patients on admission to the hospital, the type of quality of life corresponded to “a condition worse than death”, which was practically not observed in the pre-pandemic period in Moscow residents. The greatest losses are observed in the “Self-Care” and “Mobility” domains, both for men and women. On admission to the hospital, no differences were found in the pre-pandemic and pandemic levels of health limitations in the “Anxiety/Depression” domain.
Conclusions. The results of the study can be used by specialists from various branches to plan clinical, service, educational, economic, and other public health programs related to the rehabilitation of patients who have had COVID‑19. And it also represents an indispensable additional material for further sociological and clinical research. -
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. -
2020 № 6 What checks are cancelled and which are retained for medical organizations of the country in terms of the situation with coronavirus infection
The article contains a detailed analysis of the legal acts issued in April 2020 in connection with coronavirus infection and regulating the issues of state control (supervision) in relation to medical organizations until the end of 2020. In the publication, the authors present the main control and Supervisory measures that will be carried out in medical orga- nizations during 2020. A number of issues related to the legal regulation of control and Supervisory activities that require clarification are identified. In terms of the quality and safety of medical activities, the attention of medical organizations is drawn to the expediency of ensuring their own maximum readiness for various scenarios of carrying out certain control and Supervisory measures established before the end of 2020.
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2020 № 6 Application of the method of analysis of “oriented trees with assessments” to identify regional features of forming the pathology of dairy teeth in children
In order to identify regional features of the sequence of lesions of primary teeth in children, the data of the medical in- formation system of a children’s hospital using the method of “oriented trees with estimates” were used. The data of 3,405 children under the age of 6 years who contacted a dentist about diseases of deciduous teeth during 2015–2018 were analyzed. They had 17,462 appeals. It was found that in 516 children the first diseased milk tooth was 51, with an average age of 2.72 years. The second is either 61 (237 patients, with an average age of 2.91 years), or 52 (224 patients, with an average age of 2.58 years). In 113 patients, a sequence of newly diagnosed affected primary teeth 51–52–61 was observed. Only one tooth was observed in 59.9% of patients, in 13.1% of two and in 27% of three or more teeth. It is calculated that if premolar is the first diseased milk tooth, then with a probability of 0.619 the next will be the same as the premolar. Application of the method made it possible to es- tablish regional features of the sequence of lesions of primary teeth in children and to develop approaches to individual prevention.
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2020 № 6 Pregnant technologies in primary health care in rural doctor’s ambulatory
The priority state project currently being implemented, “Creating a New Model of a Medical Organization Providing Primary Health Care,” is especially relevant for implementation in hard-to-reach areas. Since rural health care is character- ized by a shortage of personnel, a weak medical and diagnostic base, low material and technical equipment, a low level of development of information technologies, and a large territorial extent. Objective: to evaluate the effectiveness of the implementation of lean manufacturing technologies with the participation of nursing specialists in the work of a medical out- patient clinic. Materials and methods. To determine the directions for the implementation of lean manufacturing methods, a questionnaire was conducted among patients (n = 232). Mapping and visualization, as well as timing of the processes before and after the introduction of organizational measures in two areas of the medical ambulance clinic “Reception of healthy children” and “Reception of patients with acute disease and with exacerbation of chronic.” Results and discussions. In order to eliminate (minimize) the revealed losses, re-planning of the premises was carried out, the functions were redistributed and the working hours of the medical staff were structured, templates-forms of documentation were developed. Conclusion and conclusions. The introduction of organizational measures allowed us to significantly reduce the waiting time for admission of a healthy child on the day of the disease without additional financial costs, as well as to increase patient satisfaction.
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2020 № 5 Is a medical organization required to provide medical documents of a deceased patient for review at the request of his / her spouse or close relatives
The article presents a detailed analysis of the legal situation related to issues of medical confidentiality after the death of a patient. The publication brought to the attention of the medical organizations, now in accordance with the Decision of the constitutional Court of the Russian Federation of January 13, 2020, № 1-P the denial of a spouse (wife), close relatives of a deceased patient access to his medical records may be considered valid only if during the life of the patient expressed prohibition on disclosure of information constituting a medical secret.
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2020 № 4 Risks that need to be taken into account in the implementation of a new model of a medical organization providing primary health care help
The article analyzes documents (guidelines, drafts of Federal legal acts) that present issues related to criteria and the introduction of a new model of a medical organization that provides primary health care. As a result, it was noted that the analyzed documents lack clear characteristics of the new model, the principles of its organization and functioning, and there is no clear description of the content and structure of the new model. The article draws attention to the fact that the financial and economic justification of the draft Law on the implementation of the new model does not contain any information about the financial and human resources required for the implementation of the new model. The authors emphasize that one of the main criteria for allowing medical organizations to implement the new model should be at least
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2020 № 3 Collection of statistical data characterizing the quality and safety of medical activities and their analysis by order of the ministry of health of the Russian Federation № 381 of 07.06.2019: what andd how a medical organization should collect and analyze
In the article, the authors pay attention to the fact that in accordance with the Requirements for the organization and conduct of internal control of the quality and safety of medical activities, approved by the order of the Ministry of health of the Russian Federation from 07.06.2019, № 381n, medical organizations must ensure the collection of statistical data characterizing the quality and safety of medical activities, and their analysis. The authors show that, on the one hand, this work includes the collection and analysis of primary statistical data, traditionally carried out by medical organizations within the framework of Federal statistical observation, at the same time, on the other hand, now medical organizations must collect and analyze indicators that characterize the implementation of the tasks set by the Requirements. The publication presents and justifies a specific list of these indicators.
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2020 № 2 Phenomena of formation and functioning of modern managers in russian healthcare
The article considers a number of phenomena that determine the features of the formation of the professional trajectory of modern managers in health care. The analysis of factors that determine the appointment of managers to positions, as well as environmental, market, personal, educational, political and other factors that accompany the activities of management personnel in health care is presented.
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2020 № 1 Is the medical organization obliged to ask the patient for an identity document when applying for paid medical services?
The article shows and proves that when a patient applies for paid medical services, a medical organization is obliged to ask him for an identity document. First of all, this is enshrined in the requirements for the maintenance of accounting and reporting documentation established by the legislation of the Russian Federation. At the same time, the authors emphasize that even if the patient does not have an identity document, the refusal to conclude a contract for the provision of paid medical services is unacceptable. The issue of presentation of an identity document by a patient when applying for the provision of paid medical services became particularly relevant after the introduction of such a control tool as the control purchase of paid medical services.
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2019 № 10 Requirements to internal control of quality and safety of medical activity according to the Оrder of Ministry of health of the Russian Federation of 07.06.2019 № 381n: how to ensure coordination of work of system on internal control and the medical commission
In the article the authors emphasize the importance of the Requirements for the organization and conduct of internal control of quality and safety of medical activities, approved by the order of the Ministry of health of the Russian Federation of 07.06.2009 № 381n, in terms of ensuring continuity between the content of internal control of quality and safety of medical activities, on the one hand, and the directions of state and departmental control of quality and safety of medical activities, on the other hand. The publication details and substantiates the mechanisms of interaction on internal control between the Commission (service) on internal control and the medical Commission of the medical organization.
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2019 № 10 Patient-centeredness in the provision of medical services to the population as a value and principle of activity
The article correlates the principles of patient-orientation (PO) and patient-centeredness (PC) in the provision of medical care, gives a normative basis for the implementation of these principles, defines the characteristics of a value-oriented healthcare, presents the features of the implementation of the patient-centered principle in the provision of paid medical services.
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2019 № 10 Medication and medical product procurement regulations in a multidisciplinary healthcare institution
Relevance. The process of organization of medication and medical product supply in conditions of the day hospital and inpatient care, that are part of the health insurance system, is assigned to the authority of the Ministry of Health of the constituent territory of the Russian Federation. However, the need to determine the quotas for medications and medical products from other sources of funding (federal budget, extrabudgetary activity) falls within the competence of a healthcare institution.
Aim. To propose tools and regulations that allow to plan volume and range of medications and medical products for health¬care institutions that provide medical services, both through compulsory medical insurance and on an extrabudgetary basis.
Materials and methods. The materials studied were the legislative and regulatory framework governing the medication supply of healthcare institutions of the Russian Federation and the Krasnoyarsk Territory; internal regulations of the FSFI FSRCC under the FMBA of Russia, a healthcare institution subordinate to the Federal Medical-Biological Agency. Mathe¬matical, analytical and descriptive methods were used in this work.
Results and discussion. Particular problems in determination of the volume and range of medications for the institutions providing medical services on an off-budget basis are associated with the impossibility of accurate planning concerning medication type and volume. The FSRCC uses a retrospective analysis of requests for each type and number of medical services using a technical medical service worksheet. Application of the designed and approved procurement regulations allows to plan future expenses the most optimal way for the uninterrupted high-quality routine medical care provision not only at the expense of compulsory medical insurance but also as a part of extrabudgetary activity.
Conclusions. The proposed algorithm for work with the regulations is recommended for the use in multidisciplinary health-care institutions in order to optimize procurement activity. -
2019 № 10 Perinatal monitoring system in Krasnoyarsk region
Successful functioning of information software systems that provide automation of monitoring of pregnant women at the regional level is possible only if there is, as well as continuous improvement of the organizational system. The lack of a well-established organizational system does not allow to use the capabilities of these complexes and often leads to their asynchronous work.
The aim of the study was to form a scheme of perinatal care in the Krasnoyarsk region using the perinatal monitoring system and its evaluation using the methodology of system analysis. Data on 122 250 cases of pregnancy in the period from 2014 to 2017, the degree of risk of women, as well as the outcomes of these cases of pregnancy were used to analyze the work of perinatal monitoring of the Krasnoyarsk territory. All pregnancy outcomes were divided into 2 groups: cases of pregnancy with adverse outcomes and favorable outcomes.
Despite the rather long-term work of perinatal monitoring in the Krasnoyarsk region, the analysis of the existing system revealed a number of significant shortcomings that limit its effectiveness, functioning and management of this system. The lack of management of women’s consultations as the level of management of the system of perinatal care in the Krasnoyarsk region, the imperfection of the system of assessing the degree of perinatal risk, the lack of information in the existing reporting forms and information on the outcomes of completed pregnancy cases in the database of the system were noted as shortcomings.
Identification of the presented shortcomings allowed to form the offers allowing to increase efficiency, to expand opportunities, and also to create tools of management of routing of pregnant women in system of perinatal monitoring. -
2019 № 7 To the 10th anniversary of the health centers
The article analyzes the main performance indicators of health centers for the period 2014–2018. Shows the coverage of comprehensive surveys in health centers per 10000 population; distribution of citizens recognized as healthy and with risk factors; presents indicators characterizing preventive work with the surveyed citizens. In the context of Federal districts and subjects of the Russian Federation, indicators for the last two years – 2017 and 2018 were analyzed. According to the provided results, conclusions are drawn about the absence of significant positive dynamics of the indicators characterizing the activities of health centers over the past 5 years. Thus essential divergences of indicators at the level of Federal districts and subjects of the Russian Federation are revealed. Analysis of indicators of activities of health centers indicates the lack of a unified organizational methodology of their activities. Improvement of organizational processes in health centers should go in parallel with the improvement of accounting and reporting documentation, these processes should be inextricably linked and aimed at solving the strategic problem – ensuring the quality of preventive work with the population, including the formation of management decisions based on them.
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2019 № 6 Control purchase when providing paid medical services: what medical organizations must know
The article deals with changes in legislation relating to the test purchase in order to verify compliance with the medical organization of the order and conditions of paid medical services. It is emphasized that control purchases in the provision of paid medical services is now one of the areas of state control of quality and safety of medical activity. The authors present the characteristics of the control purchase in conjunction with other forms and methods of control, including unscheduled inspections and control without interaction with legal entities, individual entrepreneurs. It is noted that the control purchase in the provision of paid medical services can be used by the relevant Supervisory authorities not only in the implementation of state quality control and safety of medical activities, but also in the implementation of supervision in the field of consumer protection, as well as in the implementation of the Federal state sanitary and epidemiological surveillance.
Keywords: control purchase, paid medical services, medical organization, control without interaction with legal entities, unscheduled on-site inspections, quality control and safety of medical activities, separate types of state control (surveillance)
… Р. 6-10
Abstract. The article deals with changes in legislation relating to the test purchase in order to verify compliance with the medical organization of the order and conditions of paid medical services. It is emphasized that control purchases in the provision of paid medical services is now one of the areas of state control of quality and safety of medical activity. The authors present the characteristics of the control purchase in conjunction with other forms and methods of control, including unscheduled inspections and control without interaction with legal entities, individual entrepreneurs. It is noted that the control purchase in the provision of paid medical services can be used by the relevant Supervisory authorities not only in the implementation of state quality control and safety of medical activities, but also in the implementation of supervision in the field of consumer protection, as well as in the implementation of the Federal state sanitary and epidemiological surveillance. -
2019 № 4 Amendments to the Federal law “On the basics of public health in the Russian Federation” on matters of clinical guidelines: what to do and what to expect medical organizations
The article deals with an analysis of certain provisions of the legislation on health care in connection with the changes made to the Federal law “on the basics of public health in the Russian Federation” on clinical guidelines.” In the context of the adopted changes, the authors consistently and clearly justify the obligation of medical organizations to comply with both the standards of medical care and the current clinical recommendations (treatment protocols). The sig- nificantly increased role of criteria for assessing the quality of medical care, approved by the Ministry of health of Russia, is emphasized and justified.
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2018 № 9 Does the right health professional to work as a chief physician or his deputy?
The article provides a detailed legal analysis of the formulation of one of the most important licensing requirements for the presence of a certificate(s) of the head (Deputy head) of a medical organization. The authors provide an unambiguous interpretation of this license requirement, which is that the presence of a certificate of a specialist in the specialty “health care organization and public health”, in the presence of the necessary length of service, gives the doctor the right to fill the position of the head (Deputy head) of a medical organization, regardless of the presence or absence of a certificate of a specialist in any other specialty
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2018 № 8 Duties of the doctors and the quality control and safety of medical activity: what to consider in a medical organization
The article deals with the issues of registration and content of duties of a doctor in connection with the implementation of the state control of quality and safety of medical activities on checklists (lists of control issues). The authors pay attention to the direct requirement of the legislation in the field of health care, concerning the obligatory presence of job descriptions of doctors, as well as justify in detail where and how the medical organization should be prescribed job duties and duties of a doctor. The article shows that in the duties of a doctor it is necessary to document the provisions on compliance with the requirements for ensuring the quality and safety of medical activity.
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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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2018 № 5 Checklists of healthcare quality control and safety of medical activity: new challenges of medical organizations
The article substantiates the necessity of analysis and careful study by medical organizations Of checklists (lists of control issues), approved by the order of Roszdravnadzor of December 20, 2017 № 10450. To this end, the authors propose to identify in the test sheets four conditional groups of control issues that have certain features that need to be considered by medical organizations. The article contains a reasonable conclusion that the analysis and careful study of the test sheets should be pre-determined by medical organizations as a mandatory component of internal quality control and safety of medical activities, ensuring its real continuity with the state control of quality and safety of medical activities
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2018 № 4 The role and importance of criteria for evaluating the quality of medical care, approved by order of ministry of health of Russia from 10.05.2017 n203n for healthcare organizations working in the mandatory health insurance system
The article analyzes the regulatory framework governing the quality control of medical care in the system of mandatory health insurance (MHI) and the application of criteria for assessing the quality of medical care in a medical organization. It is noted that the criteria for assessing the quality of medical care are an integral tool for ensuring and controlling the quality of medical care for all medical organizations without exception, including those operating in the MHI system. The authors explain and emphasize that the legislation on compulsory medical insur¬ance in no way limits the use of these criteria medical organizations working in MHI. At the same time application of the specified criteria allows to prevent or reduce number of defects of medical care / violations at rendering medical care, and also number of defects of registration of primary medical documentation
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2018 № 3 Influence of doctors’ patient-orientation on patient involvement in treatment
In the article it is shown that nowadays in the public health care of different countries researches of patient-orientation are actively conducted. At the same time patient-orientation as a characteristic of the patient’s communication with the doctor is considered the basis of the patient-doctor relationship. All this corresponds with the feasibility of forming in the domestic health care model of 4P medicine, already repeatedly voiced in recent years on various medical forums. The authors carried out an assessment of the patient-oriented corporate culture of the medical organization. For this purpose, two types of questionnaires were developed and analyzed: “Involvement of health workers” and “Patients’ involvement in treatment”. It has been established that the level of the doctor’s involve- ment in achieving the strategic goals of the medical organization directly affects the level of intention of patients to fulfill doctors’ recommendations. The range of this influence is 43.3% on average
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2018 № 1 Development of a new model of health care: a conceptual approach and pilot implementation
This paper presents an extended understanding of preventive healthcare model as a set of measures ad¬dressing risk factors (primary prevention), early detection of diseases (secondary prevention) and prevention of their complications (tertiary prevention). Four principles of service delivery are formulated to ensure the transition from a primarily curative to a predominantly preventive model, including strengthening the responsibility of citizens for the prevention of diseases, enhancing the role of primary care, overcoming physicians' interest in the volumes of care, as well as quality control based on the indicators of complications and neglected cases. The paper presents these principles pilot implementation in the reorganization of urological care in Voronezh oblast (Russia). Activities for early detection of diseases, strengthening the role of primary care providers, building interregional urological centers have significantly reduced the proportion of complicated cases, changed the structure of medical care towards the low-cost activities and eventually provided substantial clinical and economic benefits
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2017 № 10 Criteria for assessing the quality of health care: what to consider and how to ensure compliance in a healthcare organization
The issue deals with the organization of work on the application of criteria to assess the quality of care in a medical organization. The authors pay attention to a number of characteristics that must be taken into account specified criteria, including note that work on their application not only largely concerned, but also overlap with the functions of the medical Commission of the medical organization. The article shows that the use in a medical organization criteria for evaluating the quality of medical care is one of the tools that ensures the continuity of inter¬nal control of the quality and safety of medical activities with the departmental and state control of the quality and security of medical activity
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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 № 9 Credit for accreditation of the specialist: some results of the «credit fever» in the russian health system
The authors indicate that the main reason is over the past two years, the health system of Russia «credit fever» (the desire of doctors to earn credits and points for the upcoming accreditation) is the commercial interest of those who sell doctors credits for participation in conferences and seminars. The article noted that the process of providing doctors with credits was the most ambitious business project in the Russian healthcare system over the past 25 years. Getting doctors of points, credits, hours, credit units for participation in workshops and conferences on a commercial basis is unacceptable as this scheme does not increase the professional level of doctors, constrains and limits of their professional interests, undermines the state system of additional professional education of doctors, limits the availability of doctors to free conferences and seminars
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2017 № 8 Standards of medical care: whether they are mandatory for compliance with medical organizations?
In the Federal legislation of public health has stated that «medical care is organized and is … on the basis of standards of medical care…». The phrase «on the basis of standards of medical care» is interpreted differently in medical institutions, in connection with which the question often arises: «do I have to perform the standards of care, or they are Advisory in nature?». In the article the authors substantiate and prove that is currently approved in the prescribed manner the standards of care mandatory for medical organizations and doctors
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2017 № 7 The duty of medical organizations inform about the doctors: what is informing and how to organize it
The article deals with the responsibility of medical organizations to provide information on doctors, their level of education and qualifications. Presented and substantiated list of specific information about doctors who have to post every medical organization on the official site in a network “the Internet”, as well as on the stands. The authors demonstrated that even if the doctor your consent to the placing of personal data (information about the doctor), which in accordance with legislation, obliged to submit medical organization, the placement of these data on its official site in a network “the Internet”, as well as on the stands should be continued. Stressed that the problem of placing medical organizations and maintaining up to date information about doctors, including their level of education and qualification, necessary water supply amount, and in strict accordance with the established requirements is one of the most important ways of ensuring and monitoring the quality and safety of medical activity
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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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2017 № 5 A new control tool in healthcare: a control without interacting with legal entities and individual entrepreneurs
The article deal with the emergence of a new monitoring tool in the health sector – organization and conduct of control measures without the cooperation of legal entities and individual entrepreneurs. The authors note that the legislation of the Russian Federation contains a significant amount of the requirements for medical organizations
to embed and provide information. Thus compliance with these requirements will be validated by the Supervisory authorities by carrying out control activities without interaction with legal entities, individual entrepreneurs. All this increases the responsibility of medical organizations and confronts them with new challenges when conducting internal monitoring the quality and safety of medical activity. -
2017 № 3 Issue of evaluation of the doctor’s report for accreditation
The article deal with the questions of information security, related to the assessment of the report of the doctor in the procedure of accreditation of specialist. The authors note that current Regulation of the accreditation of professionals do not transparent that information about the professional achievements should reflect the doctor in the report which he submits to the accreditation Commission. With the exception of information about the development of professional development programmes is not established, and criteria of doctor’s report of the accreditation Commission. All this makes the assessment of the report of the doctor not transparent within the accreditation of a specialist and requires the necessary correction.
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2017 № 2 New tasks and directions of work of the medical commision in the system of providing and controlling the quality and safety of medical activities
The article deals with the reasons of insufficiently work of medical commissions of medical organizations. It was noted that today the medical Commission, continuing to be the third level of quality control of medical care in medical organization, often is the third level of quality control and safety of medical activities. In the publication of the proposals to improve the efficiency of the medical Commission, including revealed the contents of its work in accordance with the objectives and functions set by law, which often remain outside the purview of heads of medical organizations.
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2016 № 10 Accreditation specialist: myths, realities, risks, proposals
The article analyzes into detail the situation related to the newly introduced procedure of accreditation experts, caused by the professional community a set of questions. The authors show convincingly that doctors do not need to be mandatory to get collecting credits in order to in the future be accredited. In the publication are listed and thoroughly analysed risks relevant to the requirements for the procedure of accreditation of specialist. One of the risks named a possible limitation of the availability for doctors free conferences and seminars. The article contains a large block of proposals concerning the accreditation of specialist, including the formation of the system of continuous medical education.
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2016 № 6 About the national healthcare system
The reasons to of establish a national health system are given in the article. A number of problems existing in public health are mentioned there, one of the problem is the absence of equal participation of private healthcare settings in the programs of government guarantees. The advantages of the using the resources of private health care settings on a national wide scale are presented as the example of a health system of «Russian Railways».