Strengthening providers integration to improve health indicators is an important direction of healthcare development. Comparison of the 2012 survey and 2020 survey suggests some improvements in interaction between district physicians and outpatient specialists, however its level is hardly adequate. Interaction between district physicians and emergency care providers in polyclinics has improved. Interaction between polyclinic and hospital physicians before and after hospital admission is very limited and has deteriorated over the period under study. The level of outpatient physicians’ awareness of emergency calls and hospital admissions of their patients is low. Interaction between polyclinics and hospitals on the one hand, and rehabilitation units and social care providers on the other hand, is also low. Information on the location and volumes of care provided to patients is still inaccessible for most physicians. This limits continuity of care. The study shows that the Russian healthcare system remains fragmental. This is the result of low priority of integrative activities, as well as low involvement of health managers in these activities.
In Russia disputes on the need to abandon Compulsory Health Insurance (CHI) and return to the tax-based financing are yet to subside. At present, after the statement of the President of the Russian Federation V. Putin about the possibility to establish a state health care corporation, discussions on the issue have only escalated.
Purpose. To conduct a comparative assessment of the public health financing model impact on the access and structural characteristics of health care delivery in the developed countries.
Material and methods. Assessment of the potential impact of public funding models on the health system performance is carried out by analyzing variations in the main indicators of financial access, health care uptake and health status of the population, achieved in the developed countries with different health financing models.
Results. Health care expenditures in countries with CHI are higher than in countries with the tax-based financing model. In countries with CHI the share of administrative expenses is slightly higher than in countries with the tax-based financing system. The share of spending on preventive care is slightly higher in countries with the tax-based financing system. There is a slightly lower level of outpatient and inpatient care uptake in countries with the tax-based financing system compared to countries with CHI. The premature mortality rate in countries with CHI is slightly lower than in countries with the tax-based system.
Conclusion. The obtained data indicate that there are no significant differences in the access and structural characteristics of medical care in the health care system of the developed countries with different financing models. The main difference remains the level of health expenditures. In countries with CHI, the level of health expenditures is higher than in countries with the tax-based financing, which is largely due to the existence of a separate source of funding. The level of administrative costs in countries with CHI is also higher than in countries with the tax-based system.
Aim. To systemize and summarize approaches and methods used in international practice to estimate the need for health financing; to highlight the most important factors dictating the need for additional funding.
The obtained assessments of the state benefits from the rational and effective organization of care for patients with type 2 diabetes that makes it possible to achieve the target indicators of disease management. Moreover, it indicates that additional investments in improving the process of providing medical care can pay off many times by reducing the level of development of adverse events among patients with type 2 diabetes.
Throughout the world in 2020 the Covid-19 pandemic caused widespread infections, realignments of medical priorities, pervasive shortages and rationing of medical care, increases in the hidden components of morbidity icebergs, and substantial mortality. It also caused two types of international disequilibrium: ‘excess supply’ in the macroeconomic sphere generated by lockdowns and ‘excess demand (shortage)’ in critical product markets (e.g., personal protective equipment). Although the simultaneous and global nature of these phenomena and problems in 2020 were unusual, many of them have been evident in national medical systems over the past decade. The key questions addressed in this article are: (1) What are the relationships between economic systems, government priorities, shortages in health services, and compensatory policies? and (2) How did resource constraints, priority shifts, shortages, bottlenecks in production, and rationing during 2000–2019 influence the initial conditions of medical systems in the UK and Russia in 2020 when confronting Covid-19 epidemics?
The paper presents the results of a study of changes in the salary schemes and working conditions of medical staff, their labor motivation and the compliance of these changes with the objectives of the so-called “effective”, performance-based, contract being introduced. The data from a set of surveys of employees at public medical facilities in 2009–2018 served as the empirical base of the study. It is shown that the introduction of the effective contract had changed the role of factors determining the salary of medical workers. Whereas earlier qualification had been the leading factor, afterwards it was the volume and quality of the work performed as well as the outcomes of a given medical institution or unit. Most doctors had increased the amount of work they do, and the secondary employment of medical staff had slightly been reduced. Survey data indicate quite a stable hierarchy of labor motives among medical workers, the leading ones being earning money, professional interest in work, and altruism. In 2018, the role of the guaranteed employment motive was elevated. Among the positive changes are an increase in the satisfaction of medical workers with the salary, conditions for advanced training, and rules of remuneration. The identified outcomes are generally consistent with the objectives of introducing the effective contract, and they allow one to argue that the new salary scheme has had a positive impact on the labor motivation of medical staff. However, the conclusion of an effective contract was noted by only half of respondents. For the rest, it all boiled down to an increase in salary. These results indicate serious failures in the administration of this reform.
The aim of the study is to define the reference points for determining the state health financing based on set goals.
The simple idea of rationing appears unacceptable both for the relatively poor “socialist” health care in Russia and for the most expensive USA health care. In Russia the idea of rationing is unacceptable, because the Constitution promises free and unlimited medical care. Therefore, discussion is blocked from the top. In the USA the idea is unacceptable, because citizens are understood as having the right to free choice of legal access to any care, without intervention of a ‘death jury’. We analyse the similarities and differences in the arguments rejecting explicit rationing in health care in the USA and Russia. We describe the legal framework in Russia related to rationing, and theresults of a qualitativestudy of the understanding of the concept of rationing by Russian doctors and of the practices in Russian health care organizations to limit the use of expensive diagnostic and treatment options. While the Russian Constitution promises free medical care, unlimited, legally there are limits imposed by the quota of specific treatments, limited access to care abroad, and problematic access to drugs not included on the essential drug list for inpatient care. Explicit rationing is not rejected by society or by the medical profession. In medical organizations the more explicit techniques are a second opinion by a committee (physicians’ commission), especially in the case of prescription of drugs and diagnostic tests. Physicians tend to behave as medical professionals do: provide more care to people in greater need.
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.