This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessmentframework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.
The adoption of new medical technologies often generates losses in efficiency associated with the excess or insufficient acquisition of new equipment, an inappropriate choice (in terms of economic and clinical parameters) of medical equipment, and its poor use. Russia is a good example for exploring the problem of the ineffective adoption of new medical technologies due to the massive public investment in new equipment for medical institutions in 2006–2013. This study examines the procurement of new technologies in Russian hospitals to find the main causes of inefficiency. The research strategy was based on in-depth semistructured interviews with representatives of prominent actors (regional health care authorities, hospital executives, senior physicians). The main result is that inefficiencies arise from the contradiction between hospitals’ and authorities’ motivation for acquiring new technologies: hospitals tend to adopt technologies which bring benefits to their department heads and physicians and minimize maintenance and servicing costs, while the authorities’ main concern is the initial cost of the technology.
Integrated pathways are commonly seen as the way to strengthen service delivery in many countries. Russia has traditionally had a multilevel system of care that consists of facilities varying in terms of the complexity of cases treated. The attempts are currently made to strengthen this system with an emphasis on closer interaction between individual providers. The recent innovation is to establish a new intermediate level of inter-district specialty centers that serve the population of a few local areas and provide additional services. The early detection of new cases and their follow-up management have been activated as a part of a new model. It is piloted in a Russian region with the focus on the cases of benign prostate hyperplasia. The objective of the paper is to present the new model and to evaluate its first impact on urological service performance. The major findings include: 1) the growth of the new urological cases detected at the level of primary care and a gradual decline in the frequency of the most complicated and neglected cases; 2) the optimization of patients flows across the levels of service delivery – the rise in the utilization at the first levels of service delivery and the decline in the share of tertiary care; 3) the need for additional funding to treat the increased number of cases, with the first signs of slowing down this process; 4) a decrease in unit costs as the result of the changes in the structure of new cases, shifts in the utilization of care by the levels of service delivery. These trends are discussed with the focus on the identification of strengths and weaknesses of the new model, as well as the ways to ensure its sustainability. The major lesson learnt is that building a multilevel system of service delivery can be seen as the instrument of integration of care and efficiency savings for a country with limited financial resources for health. This process should go parallel with more profound changes in the health system, of which the most important is strengthening primary care, particularly coordination function of general practitioners.
Russian health care policy turns on a number of significant tensions between three vectors – all evolving at different speeds: first, the extent and nature of substantive state health care guarantees for Russian citizens; second, the extent or size of state versus non-state funding of health care; and, third, organisational challenges in the national health care system, including due to the advent of new health care technologies. Russia’s ability to negotiate these tensions will determine the future health of the country’s population.
Russia has had a high elderly share of its population like the OECD countries, but has had a more turbulent history over the past 100 years, which has caused fluctuations in the capabilities of those turning 60 (measured by education and training, income, enabling environment, medical care, and health status). This article analyses the life experiences and capabilities of five Russian birth cohorts turning 60 over the period 1990–2020. It presents relevant concepts, reviews past research, and evaluates the importance of health factors (health environment, health-related behaviours, medical care, health status) in determining the activities and contributions of older people in Russia. A Human Capabilities of the Elderly in Russia Index (HCERI) with 22 indicators is developed. Russian data are used in the calculation of the HCERI for the cohorts turning 60 in 1990, 1995, 2000, 2010 and 2020. The article then presents evaluations of the experiences and changes in capabilities for each of the five selected cohorts of the elderly in four periods of life: Childhood (1–15 years), Young Adult (16–49), Mature Adult (50–59), and Early Elderly (60–69). The implications of changes in the characteristics of the elderly for Russian government policies are discussed.
This article analyses the interrelation between human resource policies and educational policies in the system of healthcare provision to solve the problem of the structural imbalance in the supply of physicians. International experience reveals a growing emphasis on policies which help maintain the optimal structure of medical workers, i.e. the structure that corresponds to the needs of the healthcare system and society as a whole. Such policies include new regulatory and planning mechanisms for medical schools, the regulation of admission plans and the specialization structure in postgraduate medical education, specific post-education employment practices, and measures to overcome the shortage of supply of some categories of physicians and their geographic misbalance. In Russia, the structural component of human resource policies and educational policies has clearly weakened. The current regulatory and planning methods tend to reproduce the accumulated structural imbalances. Regulatory measures to improve the quality of the training of physicians are still ineffective. No prospective planning exists. Postgraduate training is poorly oriented towards the specializations currently in short supply. Medical schools are interested in training physicians capable of paying for their education and the government does not have the instruments to manipulate the structure of the student body. Recent attempts to improve the situation have not resulted in any positive outcomes yet. The decision to accredit graduates for practicing in primary care without postgraduate training will most likely deteriorate the quality of healthcare. Based on international experience, the authors suggest new regulatory mechanisms.