Compulsory Medical Insurance Research Articles

Юридические противоречия применения медицинских стандартов при осуществлении медицинской деятельности

The article presents a review of regulatory legal acts and judicial practice on the application of clinical recommendations. Medical-organizational problems and legal contradictions are indicated, which can be used by medical organizations as grounds for challenging in court some provisions of their application in the implementation of their professional activities. The relevance of the study. Providing procedures and standards of medical care are the basis for the establishment of insurance support in the compulsory medical insurance system and at the same time guarantee the equal amount of medical care provided throughout the Russian Federation. Based on the procedures, standards, and from January 1, 2019, the clinical recommendations, criteria for assessing the quality of medical care are formed. In addition, since January 2025, medical organizations should proceed to the provision of medical care based on clinical recommendations. In this regard, the legal description of the ratio of the procedure for the provision of medical care, standards of medical care and clinical recommendations becomes especially relevant for both the purpose of the control and supervision functions in the field of medical services, and for specific individuals and legal entities carrying out medical activities. Relevance is also due to the fact that health protection for a single person occurs at the level of receipt of goods, works and medical services. And the safety and quality of medical services necessary to restore and maintain the patient’s health depend on corresponanse of pay services and quality of medical services. Materials and methods. Within the framework of this study, an analysis of regulatory legal acts and literary sources on the implementation of medical activities in terms of applying the procedures for the provision of medical care, standards of medical care and clinical recommendations posted in the scientific electronic library was carried out. The specified analysis was performed using the reference legal system Consultant Plus. At the same time, along with general scientific logical methods of cognition, they used formally - legal and comparative and legal research methods. The goals and objectives of the study. Conduct an analysis of the content and legal status of medical standards, determine their ratio in issues of regulating medical activities, identify existing problems in the studied sphere and, based on the data obtained, formulate proposals to harmonize the legal regulation of the standardization of the therapeutic and diagnostic process. Results and discussions. Medical activity in its main manifestations is multifaceted. Its legal regulation is also difficult, including in relation to the process of providing medical care. The normative determination of medical care is enshrined in law as a set of measures aimed at maintaining and (or) restoration of health and including the provision of medical services [Article 2 of the Law of the Russian Federation No. 323-ФЗ]. According to federal law, the organization and provision of medical care should be carried out in accordance with the procedure for the provision of medical care, on the basis of clinical recommendations and taking into account the standards of medical care [part 3 of article 2, part 1 of article 37 of the Law of the Russian Federation No. 323-ФЗ] .

Financial support for guaranteed medical care and indicators of the health capital of the Russian population

BACKGROUND: Financial support for medical care is one of the conditions for the implementation of the state’s social objectives and strategic provision of the required level of health capital for the population. Financial resources of compulsory health insurance account for more than 48% in the structure of sources of financing of guaranteed medical care. AIM: Analysis of the relationship between basic integral indicators of population health capital and the level of financial security of medical care within the framework of the compulsory health insurance program. MATERIALS AND METHODS: The study was carried out using the method of correlation and regression analysis, the method of constructing time series, comparative analysis of quantitative and qualitative indicators. RESULTS: Financial support for medical care within the framework of compulsory medical insurance in 2011-2022. was characterized by significant underfunding and a decrease in the coverage of the population with timely and high-quality medical care. Government expenditures within the framework of compulsory health insurance are determined by the dynamics of GDP per capita. The volume of expenses for the provision of guaranteed medical care does not directly determine the level of life expectancy, birth rate and disability of the population. The scale of financial support within the framework of compulsory health insurance only partially mediates the variation in such indicators of health capital as natural population growth and the level of general morbidity. CONCLUSION: The absence of a formalized positive correlation between indicators of the volume of state financial resources within the framework of compulsory medical insurance and indicators of health capital for 2011-2022, revealed in the framework of the study. can be considered as a direction for increasing the efficiency of the organizational and economic mechanism for using limited resources.

Analysis of the provision of medical care using telemedicine technologies at the endocrinology research centre

In the first months after the pandemic of the COVID-19, the provision of medical care through telemedicine technologies took a leading position, in particular regarding endocrine nosologies. Meanwhile, at present, comprehensive information on telecommunications interaction between doctors of various medical organizations of the regions of the Russian Federation and employees of federal centers is insufficient, which determines the relevance of studying this topic. Analysis of the provision of medical care in remote interaction of medical workers using telemedicine technologies («doctor-doctor») between the Endocrinology Research Centre and the regions of the Russian Federation in 2019-2023. A single-center, observational, single-sample study was conducted, including completed planned and urgent telemedicine consultations in the format of «doctor-doctor « in the fields of «endocrinology» and «pedia-tric endocrinology», conducted through a telemedicine system for remote consultations at federal and regional levels between 2019 and 2023. Data on the referral rate of medical personnel from the regions of the Russian Federation to the Endocrinology Research Centre for telemedicine consultations were analyzed, including annual dynamics of treatment, frequency of referrals from each region, nosological structure of referrals, and number of patients admitted to the center based on the results of these consultations. Analysis of interdepartmental cooperation between the Endocrinology Research Centre and other federal centers was also performed. In the period from 2019-2023, 14,475 telemedicine consultations «doctor-doctor» were conducted. In 2019, medical workers from 78 regions of the Russian Federation applied to the Endocrinology Research Centre. By 2023, this figure has increased to 88 (including newly annexed territories). The Yamalo-Nenets Autonomous Okrug, Tambov Region and Astrakhan Region were the leading regions in terms of the circulation of medicines at the Endocrinology Research Centre. In the nosological structure, the largest number of consultations in adult patients were conducted for acromegaly and primary hyperparathyroidism, in children for stunting and type 1 diabetes mellitus. In the period from 2019-2023, the Endocrinology Research Centre sent a total of 300 «outgoing» requests to 17 medical organizations. Consulting with the use of telemedicine technologies has become a convenient and multifunctional way of providing medical care. Further analysis of the place of telemedicine in practical healthcare will expand its capabilities, including considering the introduction of financing by the territorial fund of compulsory medical insurance for this area of medical activity.

Work Experience of Medosmotr39 LLC in Organizing and Conducting Medical Support for the Floating Staff of the Fishing and Scientific Fleet in the Subject of the Russian Federation

There is a problem in the country of comprehensive and competent pre-voyage medical examination of seafarers. Since the implementation of Federal Law no. 326 dated 11/29/2010 On Compulsory medical insurance in the Russian Federation, the issues of compulsory medical insurance in the field of marine medicine have not been resolved. Crew members with chronic diseases are sent on the flight without prior medical examinations. There is no medical worker on the ships, a member of the crew is responsible for the medical part without a license to provide medical care, who does not have the right to provide it, which in turn led to an increase in morbidity and deaths on the voyage. There is no single standardized form of laying first-aid kits on ships, which also affects the health of the crew. This situation prompted the medical organization Medical Examinations 39 to open a Marine Medicine Department at its base, which significantly improved the situation in the region. We also propose to legislate the issue of a single form of packing first-aid kits on flights, the composition of which will depend on the time of year, natural and social conditions of the area to which the sailors will go.

Budgets of state extra-budgetary funds: legal regulation in the modern period

This article analyzes the legal features of the budgets of state extra-budgetary funds as targeted centralized funds. The legal status of state extra-budgetary funds as legal entities is characterized, and attention is paid to the issue of their organizational and legal form. It is concluded that the Social Fund of Russia, its bodies and divisions constitute a centralized system, however, the system of the Compulsory Medical Insurance Fund and territorial funds, which have significant powers, is decentralized. In addition, general issues of budgetary regulation of funds are considered: the procedure for drawing up and approving budgets, types of income and expenses that assume a targeted nature, the formation and approval of reporting documentation.

Dynamics of Dental Care for the Population of the Ryazan Region in COVID-19 Pandemic

INTRODUCTION: Identification of morbidity (based on requests) and the population’s need for dental care optimizes the planning and distribution of compulsory health insurance (CHI) funds between medical organizations at the regional level. However, due to a decrease in the population’s demand for medical care in the context of the new coronavirus infection (Corona Virus Disease 2019, COVID-19), the dynamics of the provision of dental care and the structure of dental morbidity taken into account in the compulsory medical insurance system, have changed. AIM: To study the structure and dynamics of the provision of dental care in the period 2018–2021 (pre-pandemic and COVID-19 pandemic period) based on the volume of dental care paid for in the compulsory medical insurance system provided to citizens of the Ryazan region (RR). MATERIALS AND METHODS: The analysis was carried out on the basis of registers of bills accepted for payment submitted by medical organizations, taking into account the results of control and expert measures. All completed cases of treatment of insured persons with dental diseases in medical organizations of the Ryazan Region for 2018–2021 were selected for study according to territorial compulsory medical insurance programs. RESULTS: In the structure of outpatient primary health care in 2021, cases of its provision in the ‘Dentistry’ profile amounted to 7.40 ± 0.10%, taking 3rd place; the total number of cases of providing medical care to patients with this pathology decreased by 5.60% compared to 2018. Despite the reduction in the volume of primary dental care, the volume of dental examinations of the population of the RR increased by 30.46%. There was also a 34.08% reduction in completed cases of treatment of chronic periodontitis (p 0.02). For the 2018–2021 period 73,049 medical and economic examinations (MEE) and 1,626 examinations of medical care quality (EMCQ) were carried out, and 1,966 violations were identified (1,316 based on the results of the MEE and 650 based on the results of the EMСQ). The vast majority of these concerned non-compliance with standards of care and clinical guidelines. CONCLUSION: The results of the study indicate a reduction in the number of cases of insured persons seeking medical care for dental diseases during the COVID-19 pandemic. Owing to the approval of Order No. 231n of the Ministry of Health of Russia of March 19, 2021, obliging medical insurance organizations to carry out control and expert measures in each medical organization in a certain amount of dental care cases accepted for payment, the number of examinations has increased, and, as a result, the identification of violations in the provision of dental care.

Реализация принципов обязательного медицинского страхования в контексте финансового обеспечения предоставления бесплатной медицинской помощи: тенденции судебной практики

At present, free medical care in Russia is provided mainly at the expense of compulsory medical insurance. This system is implemented in accordance with the principles enshrined in legislation. The degree to which they are observed in the framework of free medical care makes it possible to determine the effectiveness of the realisation of the right of citizens to health care and medical assistance. The article considers cases of judicial practice in disputes involving medical organisations regarding the financial provision of their activities in the context of compliance with the principles of compulsory medical insurance. Trends in court practice related to the refusal to pay medical organisations for excessive amounts of medical care provided at the expense of compulsory health insurance funds and the recognition of actions involving medicines as inappropriate expenditure of compulsory health insurance funds have been identified.

The comparative analysis of health care systems based on rating definition.

The article describes system of compulsory medical insurance and voluntary medical insurance in the Kyrgyz Republic nowadays. The becoming of medical insurance as system of access for citizens to preferential medical services and medications is considered. The State Guarantees Program offers equal conditions for entire population to access free medical services and particular medications, especially for certain category of citizens with chronic, age-related or individual physical characteristics.

Evaluation of hospitalized morbidity in children of the first month of life in a multidisciplinary children hospital of the megalopolis

Objective: evaluation of factors affecting hospitalization of children of the first month of life in a multi-disciplinary children's hospital in a metropolitan area. Material and methods. Using the continuous method, data from 267 children in the first month of life in St. Petersburg was copied from the Ariadna medical information system. Re-sults. In 2020-2022 the majority of children were treated through compulsory medical insurance (89.5-93.2%). During the year of the COVID-19 pandemic, 66.7% of patients were admitted as emergencies. More than half of the children were admitted through internal routing. In 2022, the highest hospitalization rate was in patients with certain conditions arising in the perinatal period (452.6%o) and congenital malformations (242.1%o), and the longest average duration of treatment was observed in patients with factors influencing health status population and visits to health care institutions (24.5±7.5 days), respiratory diseases (22.5±21.5 days). Most children were discharged with improvement. Conclusion. The hospitalized morbidity of children in the neonatal period is influenced by a significant number of factors, among the main ones being the location of the medical organization, the presence of a perinatal center in its structure and the COVID-19 pandemic.

ПОКАЗАТЕЛИ СТОМАТОЛОГИЧЕСКОГО ЗДОРОВЬЯ НАСЕЛЕНИЯ САМАРСКОЙ ОБЛАСТИ, ОБРАТИВШИХСЯ В СТОМАТОЛОГИЧЕСКИЕ ПОЛИКЛИНИКИ ЗА ПЕРИОД 2020-2022ГГ. ДЛЯ ПЛАНОВОЙ САНАЦИИ ПОЛОСТИ РТА

Dental health is an important part of a person's overall health, providing a certain level of quality of life. Dental health depends on three main parameters: social, biological and medical, just like health in general. We examined 100 people (59 men and 41 women) of various age groups (group 1 - 35-44 years 11%, group 2 - 45-59 years 34%, group 3 - 60-74 years 38%, group 4 - 75 years and older 17%). Age groups are identified according to WHO criteria. The number of remaining teeth in the oral cavity per person examined, the structure of the CP, the number of cervical defects of non-carious origin (CD), and the number of teeth with pathological abrasion were determined. Hygiene status was analyzed using the Green-Vermilion index. Periodontal condition - according to the CPITN index. The chewing function of natural intact teeth was also assessed and taken as a total of 100%. The results of the study showed that the number of preserved teeth per examinee ranged from 3 to 28, median – 21.0, lower quartile – 17.0, upper quartile -24.0, which corresponds to the minimum number of preserved natural teeth in the oral cavity necessary to maintain optimal functional activity of the dental system according to WHO criteria (20 teeth). The structure of the cpu is dominated by extracted teeth. Cervical non-carious defects (CD) and pathological abrasion (PA) are approximately equally common among applicants. In the structure of periodontal morbidity according to the CPITN median 2 index, forms with code 2 are common. Loss of dental function (LDF) from 0 to 100%, median 50.0, chewing function index (MIF) from 0 to 100%, median 50.0. These data indicate that chewing efficiency is only half preserved in the majority of patients. Thus, the dental health indicators of the population of the Samara region applying for routine dental sanitation within the framework of compulsory medical insurance are at the lower level of the standards recommended by WHO. No statistically significant differences were found between the comparison groups by gender. Significant differences are determined only by age, by the number of remaining teeth, by the need for tooth extraction, and by loss of chewing function. These problems intensify with age. All patients need correction and training in oral hygiene.

Influence of medical and social factors on patients’ satisfaction at the center for reproduction and family planning with medical care

BACKGROUND: The constant increase in the number of commercial medical organisations providing medical care using assisted reproductive technology (ART) and compulsory medical insurance funds necessitates the need to control the quality of medical services in this area. An important tool for this control is conducting sociological surveys of women undergoing infertility treatment using in vitro fertilisation (IVF) both in paid and free forms.
 MATERIALS AND METHODS: Using a random sampling method, an anonymous survey was conducted on 398 patients of the Center for Reproduction and Family Planning in St. Petersburg, which provided medical care for infertility treatment using ART both at the expense of compulsory medical insurance and in paid form. The significance of differences in indicators was assessed using Student’s t-test for quantitative indicators. The significance of differences between qualitative characteristics was checked using contingency tables and Pearson’s chi-square test (χ2). Differences were considered significant at р 0.05.
 RESULTS: Despite the high level of patient satisfaction with the provision of medical care using ART, 9.0% of women were partially or completely dissatisfied. Compulsory medical insurance funds were paid for infertility treatment using IVF for 12.1% of patients. The majority of patients paid for medical care themselves (87.9%), of which 13.1% of women believed that the cost of medical services in the center was excessive (χ2=29.08; р=0.000), and 10.9% thought that the cost does not correspond to the level of medical services provided (χ2=25.74; р=0.000). There was no significant influence of age (χ2=4.78; р=0.311), place of residence (χ2=1.79; р=0.409), presence of children (χ2=2.21; р=0.331), employment (χ2=2.91; р=0.233) and forms of payment for treatment (χ2=4.69; р=0.096) on the distribution of patients according to the degree of satisfaction with medical care. At the same time, it was determined that marital status (χ2=6.88; р=0.032) and income level (χ2=60.01; р=0.000) are factors that influence the degree of satisfaction of women with infertility treatment using ART.
 CONCLUSION: Many medical and social factors have been identified to significantly affect satisfaction with medical care, such as the patient’s marital status and income level. Simultaneously, the economic form of payment for treatment did not have a significant effect on the degree of satisfaction.

Medical professional liability insuarance

The aim of the study is to form an integrated approach to understanding the context and legal necessity of medical professional liability insurance.
 The methodological basis of the study is a set of scientific techniques and methods of scientific knowledge, including dialectical, historical-legal, logical-legal, system-structural, method of forecasting and comparative jurisprudence. Dialectical method has provided opportunities to analyze scientific positions regarding the content and development of medical professional liability insurance. Historical-legal method helps to study the genesis of the development of insurance in specific historical and legal situations, the development of theoretical scientific thought and legislation. The method of comparative law is used to study the legislative and regulatory acts of Ukraine and other countries in the world as well as to clarify the advantages and disadvantages of the mechanism of legal regulation the insurance of medical professional liability in various countries in the world. Systemic and structural methods have helped to clarify the content of the contracts connected with this kind of insurance. Formal-logical method has allowed analyzing the provisions of the legislation of Ukraine in the sphere of this type of insurance.
 Results. This study contains a comprehensive scientific analysis of modern problems of medical professional liability insurance. The elements of the medical professional liability insurance contract are defined, namely: subject matter, insured, beneficiary, insurance risk, insurance event, conditionals of insurance compensation payment. It is stipulated that medical professional liability insurance contract shall have separate grounds for refusal to pay insurance compensation, inherent only to this type of insurance. It is shown that this type of insurance helps to manage the risks in medical practice activities. The concept of this type of insurance has been researched. The conditions to terminate the medical professional liability insurance have been identified.
 Conclusions. Having considered the issues of medical professional liability insurance and examined the conditions of the medical professional liability insurance contract, it has been made a conclusion that it is necessary to introduce this type of insurance as mandatory for healthcare institutions and private practitioners. It has been proposed to introduce compulsory medical professional liability insurance by approving necessary alterations the valid legislation.

Затраты средств обязательного медицинского страхования на лечение пациентов ХОБЛ в некоторых субъектах Российской Федерации.

Modern treatment of patients with chronic obstructive pulmonary disease is highly effective and leads not only to a decrease in the frequency of exacerbations, but also to a decrease in mortality and an increase in the life expectancy of patients and requires daily lifelong medication on an outpatient basis. At the same time, the costs of the compulsory medical insurance system for the treatment of patients with COPD are unknown, this was the goal of this work. We analyzed the volume of medical care for patients diagnosed with COPD in round-the-clock and day hospitals, in outpatient care, as well as emergency medical care in 2019–2022 in some regions of the Russian Federation, as well as the amount of money spent on paying for this medical care. We found that subjects differed greatly both in the proportion of COPD patients treated in 24-hour and day hospitals, as well as in the frequency of emergency medical calls and the frequency of requests for medical care in outpatient settings. In some regions of the Russian Federation that we analyzed, in some years, almost a third of patients with COPD were treated in a hospital or day hospital, and the average frequency of hospitalizations exceeded one, i. e. some patients were hospitalized at least twice within one year, and the frequency of emergency medical calls exceeded 2 times per year. This is likely due to ineffective treatment of patients in outpatient settings.In the absence of access to preferential drug coverage for these patients, it is necessary to develop and implement mechanisms for preferential drug provision for patients with COPD.

Economic efficiency of information management technology for the quality of dispensary observation in patients with coronary artery disease of the last access

Purpose. To economically substantiate the developed technology of information management of the quality of dispensary observation of patients with coronary heart disease using dynamic monitoring and evaluation of digital personalized data on the provided medical care.
 Materials and methods. To improve the efficiency of dispensary observation for angina pectoris, since 2018, the regional health care system of the Orenburg region has been implementing a technology for managing the quality of dispensary observation based on the analysis of big data on medical services and information integration “emergency medical care (EMC), hospital — Territorial Compulsory Medical Insurance Fund + Medical information-analytical center — polyclinic”. To assess the effectiveness of this technology in a group of angina pectoris patients with dispensary observation in the amount of 13,208 patients, we compared the results for 2017 and 2019. 
 the total cost of treatment per year in the polyclinic, EMC, and hospital, economic losses from deaths and financial costs per unit of efficiency. Angina pectoris patients without a myocardial infarction during the observed period of time was taken as a unit of effectiveness. The data were processed using linear statistics and parametric comparison methods. The Statistica 10 software package was used.
 Results. Financial costs for the treatment of angina pectoris for 2017 and 2019 did not differ significantly from each other. The economic losses from premature death have been almost the same over the years. At the same time, the financial costs per unit of efficiency in angina pectoris patients in 2019 accounted for only 76% of the same indicator for 2017, the difference in this indicator was significant.
 Limitations. To assess the effectiveness of information management technology, we analyzed the clinical and economic results of dispensary follow-up for two years in 13,208 patients with angina pectoris, which is a sufficient reference sample.
 Conclusion. The technology of information management of the quality of dispensary observation in coronary artery disease is cost-effective, manifested by a significant reduction in financial costs per unit of efficiency. The analysis of large databases of electronic data on medical services is a tool for economic evaluation of the effectiveness of healthcare management technologies.

Methodological approaches to assessing the effectiveness of financial and economic activities of a healthcare institution

The article reveals a set of issues related to the development of methodological and information support for evaluating the effectiveness of financial and economic activities of healthcare institutions. A critical analysis of existing approaches presented in regulatory and recommendation documents of various legal status, as well as a review of publications by Russian and foreign authors showed that for use in management practice, existing developments need to be improved, adapted to the socio-economic conditions of health care institutions, whose management needs an objective assessment not only of the medical component, but also an analysis the efficiency of using the entire range of resources generated within the framework of the state task, the sources of which are funds from the federal and regional budgets, the compulsory medical insurance fund and income from the provision of paid services. The directions of developing a system of evaluation indicators of effectiveness and efficiency, improving the information base for their analysis, control and forecasting are proposed.

Формирование бюджета территориального фонда обяза-тельного медицинского страхования (на примере Тверского ФОМС)

The problem of effective and rational budget formation of state off-budget funds is becoming more and more urgent today. The processes of budget formation of the off-budget funds are studied to ensure income growth, optimize expenses, and to increase their efficiency and transparency. Territorial compulsory medical insurance funds (TCMIF) are created by the executive authorities of all subjects of the Russian Federation. The purpose of territorial funds is to implement state policy in the field of medical insurance on the territories of the subjects of the Russian Federation. The purpose of the analysis of the process of forming TCMIF budget of Tver region is to assess the possibilities of the fund to implement the state policy in the field of compulsory medical insurance (CMI) in Tver region. The analysis of TCMIF budget formation of Tver region in 2021-2023 made it possible to make a conclusion that the available financial resources of the fund allowed to finance medical care provided to the population by medical organizations of Tver region, to cover the expenses of medical organizations of Tver region with the CMI funds and to pay for medical care by insurance medical organizations timely and in full volume.

Анализ причин летальных исходов хронической обструктивной болезни легких в Санкт-Петербурге

Background: mortality from chronic obstructive pulmonary disease (COPD) is increasing worldwide. The prognosis of a COPD patient's life largely depends on the presence of concomitant conditions, primarily diseases of the cardiovascular system. Aim: to analyze the fatal outcomes of COPD in 2022–2024 in St. Petersburg. Materials and Methods: statistical data on mortality from COPD in St. Petersburg for 2022–2024 were studied. Besides, 159 medical records and protocols of pathoanatomical autopsies of patients hospitalized with COPD who died in 2023 were analyzed. Results: in 2022 in St. Petersburg, COPD caused the fatal outcome of 165 people (0.27% of the total urban mortality structure), in 2023 — 252 (0.44%), in January and February 2024 — 78 (0.63%). During the same period, chronic coronary artery disease (CCAD) became more commonly mentioned as a concomitant disease in deceased patients with COPD: in 2022, 44.8% of patients, in 2023 — in 62.3%, in January and February 2024 — in 74.4%. Based on the analysis of medical records of 159 deceased patients, an expert group determined that in 53 cases, COPD either was not the cause of death, which occurred due to cardiovascular or oncological diseases, or was not confirmed upon expert evaluation. In 56 patients, the role of the respiratory disease was deemed primary, while in 50 cases, the severity of COPD and concurrent pathologies were comparable, preventing the experts from reaching a definitive conclusion regarding the cause of death. Overdiagnosis of COPD as the cause of death could be facilitated by the fact that the rate of payment for hospitalization under compulsory health insurance (CHI) for patients with COPD was higher than for patients with CCAD. Conclusions: in a significant part of the reviewed cases, COPD was not the main cause of death or its diagnosis was not justified. One of the conditions for improving the correctness of the disease diagnosis and the causes of fatal outcomes may be the pricing policy improvement of the CHI, which would make the estimation of the main diagnosis independent of economic factors. KEYWORDS: COPD, mortality from COPD, concomitant diseases in patients with COPD, mortality from chronic coronary heart disease, overdiagnosis of COPD, compulsory medical insurance. FOR CITATION: Titova O.N., Kuzubova N.A., Kozyrev A.G., Dvorakovskaya I.V., Chermenskii A.G. Analysis of the fatal outcomes due to chronic obstructive pulmonary disease in St. Petersburg. Russian Medical Inquiry. 2024;8(8):447–452 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-8-1.

Analysis of Medical and Preventive Services of a City Clinic

Preserving public health and reducing morbidity are the most important socio-economic tasks facing healthcare.Purpose of the study: to conduct an analysis of the medical and preventive services of the City clinic No.10 in Astana.Methods. In this study, in order to analyze medical and preventive services, statistical data was studied, data extracted from the accounting and reporting documentation of the City clinic No.10 in Astana. We also analyzed reports on preventive examinations and screening studies, studied demographic indicators, morbidity rates, staffing, etc.Results. The number of the population served in the medical organization increased by 2.6% compared to 2021 and by 3% compared to 2020. The share of all visits for 2022 under the guaranteed volume of medical care package and the compulsory medical insurance package was distributed almost equally, with a 2% advantage in favor of the guaranteed volume of medical care, 61% and 39%, respectively. The main reason (68%) of all visits was due to morbidity, then the reason for the visit was preventive services, there were also home visits and visits for the purpose of medical examination and others. It should be noted that compared to 2021, visits in 2022 increased by 42.27% and the number of visits doubled compared to 2020.Having analyzed the morbidity data, it was revealed that a significant part of the diseases (31.7%) were diseases of the respiratory system, then diseases of the heart and circulatory system, 6.17% hypertension, 7% diseases of the digestive system, and at the end there were diseases of the bones. -muscular system and anemia.Conclusions. Having studied the data and performance indicators of the City clinic No.10 in Astana, we came to the conclusion that the number of the population served in the medical organization is increasing, which accordingly leads to an increase in attendance. The morbidity rate of the population attached to this organization remains high, especially the morbidity of the respiratory system and, of course, diseases of the circulatory system, as in the whole country

ENDOSCOPIC TREATMENT FOR EARLY COLORECTAL CANCER

Relevance: In recent years, significant breakthroughs have occurred in the endoscopic treatment of cancerous and precancerous lesions of the gastrointestinal tract. Endoscopic mucosal resection (EMR) is a simple and effective method of treating most benign gastrointestinal tract lesions. However, with the introduction of endoscopic submucosal dissection (ESD) and full-thickness endoscopic resection (EFTR), the volume of lesions subject to endoscopic treatment has significantly expanded even in the colon. Currently, these methods are regularly used not only for the treatment of benign tumors but also for complex resection of early stages of colorectal cancer. For the first time in Kazakhstan, the presented article analyzed the cases of endoscopic removal of epithelial formations of the large intestine performed at an oncological clinic from 2020 to 2023.
 The aim was to evaluate the use of endoscopic treatment of early colorectal cancer.
 Methods: The article presents a retrospective analysis of 68 cases of endoscopic removal of epithelial formations of the colon performed from 2020 to 2023 at the Center of Expert Endoscopy and Interventional Radiology of the National Scientific Cancer Center (Astana, Kazakhstan).
 Results: In 2020-2023, 68 endoscopic extractions of colon tumors were performed, including 25 outpatient and 43 inpatient manipulations. Out of 43 inpatient cases, endoscopic dissection in the submucosal layer was performed in 9 cases, and endoscopic mucosal resection of tumors of the large intestine was performed in 34 cases. Morphologically, we found hyperplastic polyps in 11 cases, lipomas in 2 cases, tubulovillous adenomas with mild dysplasia – 43 cases, tubulovillous adenomas with severe dysplasia – 11 cases, carcinoma in situ – 3 cases, and adenocarcinoma with invasion – 3 cases.
 Conclusion: When detecting benign neoplasms with dysplasia and early colorectal cancer, minimally invasive technologies (EMR, ESD, EFTR) should be the first preferred treatment method and only if they cannot be performed and there is a high risk of invasion into the underlying layers, and therefore, if endoscopic treatment is not radical, clinicians should choose surgical radical treatment. Patients should be informed about the availability of the latest methods of local treatment in the Republic through the financing of the Compulsory Medical Insurance Fund (CMIF).

Providing “over-volume” medical care within the framework of compulsory medical insurance: penalties or criminal liability

Providing “over-volume” medical care within the framework of compulsory medical insurance: penalties or criminal liability