Russian Health Care System Research Articles

MOTIVATING AND STIMULATING THE WORK OF MEDICAL PROFESSIONALS: THE REALITIES AND PROBLEMS OF TODAY

The article considers and justifies the need to change the system of motivation and incentives for the work of medical workers in the Russian healthcare system in the context of new socio-economic conditions and the growth of professional risks in the medical field. The COVID-19 pandemic, which has lasted for more than a year, has exposed significant shortcomings in the system of motivation of medical workers, showing serious problems consisting in a shortage of specialists, hospital beds, medicines, and an increase in professional workload. As a result, of the analysis of statistical data and the conducted sociological survey, a system of key socio-psychological factors and motivational indicators of the work of medical workers was developed, and ways to optimize the system of their labor motivation were identified.

THE SPECIFIC WORK FOR REQUIEREMENTS FOR PHARMACEUTICAL PERSONNEL DUE TO COVID-19

COVID-19 pandemic has become a challenge for the entire healthcare system in Russia. Pharmaceutical specialists, like all medical workers, are at the forefront of the fight against the pandemic, as they are providing quality pharmaceutical care to the population. The sociological study was carried out to analyze the particular characteristics of pharmaceutical personnel during this period, as it becomes more relevant to report the new conditions of labor organisation and development of new pharmaceutical consulting standards. The study revises challenges in the provision of pharmaceutical services, assessment of preventive measures in regards to protection of the personnel from infection, as well as demand to raise awareness about COVID-19 preventive measures among the pharmacy visitors.

Problems of Realization of the Rights of Russian Men to Reproductive Health

The article presents an analysis of modern scientific literature and Russian legislation on legal regulation and the implementation of the right of men in Russia to protection of the reproductive health and specialized medical care. There were identified problems of the organization of andrological medical care for the male population in the Russian health care system, which affect the indicators of the incidence and life expectancy of men. It is proposed to improve Russian legislation regarding the training of andrologists and the organization of andrological medical care for the male population

Activities of the Federal Compulsory Health Insurance Fund as the main source of financing of the Russian Healthcare System

Activities of the Federal Compulsory Health Insurance Fund as the main source of financing of the Russian Healthcare System

Models of Physician’s Behavior in the Situation of Assignment Paid Procedures

The Russian healthcare system provides a set of free and paid diagnostic and therapeutic services. Although, when prescribing additional paid services, a specific doctor is provided with the situation of choice. The doctor is faced with a set of ethical and professional motivators, one of which is paid services as a source of additional medical income. What do doctors do in this situation, what strategies do they choose and what motivates their decision? Conducted and analyzed in-depth interviews (18 interviews, Tver, 2018) with doctors of different specialties revealed several patterns of doctor’s behavior when prescribing paid services. The data analyzed in the tactics of grounded theory allowed the author to build several models of doctor’s behavior, where such choices are associated with certain system of professional and personal values. The described models are conventionally named by author: “Making money”, “Polypragmasia”, “Collegiality”, “Man-System”, “One and a half rates”, “Out of the system”, “Avoidance”.The constructed models of behavior of doctors show that the appointment of additional optional procedures is associated not only with the doctor's desire to earn money, but also can be explained by a more complex combination of reasons, working conditions, formal and informal social norms, as well as the basic values of the doctors themselves.

Abortion and infant mortality change driven by socioeconomic conditions in Russia.

Increasing fertility and decreasing mortality are major response strategies in Russian demographic reform, which has led to significant decreases in both abortion rate (AR) and infant mortality. This study explores mechanisms influencing the socioeconomic conditions leading to abortion and infant mortality. Spatial panel economic analysis using data from the 83 regions of the country covering four time periods was applied. Every 1000 USD increase in per capita gross regional product (GRP) can lead to a decrease of the AR by 0.075, while one year life expectancy increase would lower it by 0.441. For infant mortality rate (IMR), GRP also shows a positive impact, particularly in recent years, while the population size of the region has a negative impact. Every 1000 USD increase in per capita GRP would result in a rate decrease of 0.064 in IMR, and every increase of 1000 added population would lead to an increased IMR by 2.05. The harvest effect between AR and infant mortality that was evident earlier, but not in the recent years, implies that the health care system in Russia is effective. A comprehensive improvement in wellbeing, income, etc. can contribute to mitigation of abortion and infant mortality. Theoretically, this study extends current research by comprehensively displaying the spatio-temporal patterns of abortion and infant mortality in Russia and qualifies the impact of regional socioeconomic disparities with regard to these two issues.

СОСТОЯНИЕ И ПРОБЛЕМЫ ФИНАНСОВОГО ОБЕСПЕЧЕНИЯ СИСТЕМЫ ЗДРАВООХРАНЕНИЯ РФ

The current health care system in Russia has a number of unresolved problems associated with a lack of financial support for the industry, which negatively affects the effectiveness of medical activities, the quality and availability of medical services [3]. The imperfection of the model of financial support for the industry, combined with underfunding and the lack of clear control over the rationality of the use of funds, became the reasons for the existing problems - the lack of a modern material and technical base, staff shortages, accompanied by ineffective healthcare and, as a result, a decrease in public confidence in the industry. In the course of the study, the current state and problems of financial support of the health care system of the Russian Federation, associated with the socio-economic differentiation of regions of the country by the level of development, were considered, the existing trends and their causes were identified. It has been established that a steady trend towards a reduction in budgetary expenditures aimed at financing the health care sector continues today. If in 2013 the volume of funding was 1.25 trillion. rubles, then to decreased to 950.7 billion rubles. The assessment of the financing of the regions of the Russian Federation in the context of the grouping by federal districts showed a widespread reduction in budgetary spending on health care, however, to the greatest extent - in the regions of the North Caucasus Federal District and the Siberian Federal District, and to the least - in the Central Federal District and the Northwestern Federal District. This indicates that there is a direct relationship between the level of socio-economic development of a subject and the volume of budgetary spending on health care.

Cost-effectiveness study of treatment with biologic disease-modifying antirheumatic drugs in adult patients with active ankylosing spondylitis

Objective: to conduct a cost-effectiveness study of major biologic disease-modifying antirheumatic drugs (bDMARDs) used for the treatment of ankylosing spondylitis (AS) in Russian health care system with the focus on the new effective drug netakimab (NTK).Patients and methods. Based on the available meta-analysis, a Markov model for therapy was constructed using reference drugs. Then, based on the simulation results, a Cost-Effectiveness Analysis (CEA) and a Budget Impact Analysis (BIA) were carried out. The robustness of the result has been confirmed by several sensitivity analyzes.Results and discussion. NTK showed an advantage in CEA, including the cases when the direct costs of therapy were lower for the reference drug (which shows the greater efficacy of NTK). According to the BIA, the extension of NTK administration in naive patients was consistently associated with a decrease in the budgetary burden. Sensitivity analyzes confirmed the robustness of the result.Conclusion. NTK has clinical and economic advantage in the treatment of AS, it is attractive in terms of both patient's and health care benefit in general. More extensive use of NTK can save more than 5 billion RUB.

Concept of value-based healthcare

This article contains the aims and main principles of the concept of value-based healthcare (VBHC). The relevance of the implementation of this approach into the Russian healthcare system results from the fact that during the control and payment for medical care, the treatment outcomes are evaluated selectively and at separate stages. The medical care payment system considers only its volumes and not achieving the desired treatment outcome significant to a patient. A review of the world’s best practices of introducing VBHC conception and, also new medical care payment methods such as bundled payment and pay-for-performance (P4P) has been conducted. According to international experience, VBHC increases the quality of medical care and provides the optimization of costs. To implement VBHC model in the Russian Federation, it is necessary to ensure the informatization of the providing medical care, development, and improvement of medical quality control systems (development of the resulting criteria for medical care quality for all diseases), and introduction of the rating system for medical organizations. Provided these processes are ensured, further progressing to P4P is possible. Moreover, it would also be feasible to implement VBHC in other healthcare processes including procurement of drugs and medical devices, their pricing, and reimbursement.

Evaluation of the reference value of the incremental parameter "cost-effectiveness" for Russian healthcare system

Introduction. Presently, the willingness-to-pay threshold (cost-effectiveness threshold, incremental cost-effectiveness ratio) is used as one of the decision-making criteria for reimbursement in some foreign countries with a developed system of healthcare technologies evaluation (HTE). However, in Russia, the willingness-to-pay threshold (WPT) is undetermined, which complicates the evaluation of clinical-economical effectiveness of medical technologies, including medicines. Aim . The study aimed to calculate WPT for the Russian healthcare system using the available foreign experience. Materials and Methods . WPT was calculated with the following methods: the method proposed by the WHO, hemodialysis cost-effectiveness standard, case-based reasoning (CBR), and the evaluation of the shadow cost of the budget. Results . WPT was calculated for the Russian healthcare system using four different methods of calculation. According to the method proposed by the WHO, WPT was 2,235,201.60 Rub for DALY in the RF; according to the hemodialysis cost-effectiveness standard, it was 1,748,623.36 Rub for QALY; according to the method of the evaluation of the shadow cost of the budget, it was 313,878.21 Rub for DALY and 365,060.31 Rub for QALY; and according to the method of the case-based reasoning, it was 7,494,944.00 Rub for QALY. Conclusion . The study results showed that the optimal WPT values for the Russian healthcare system were those obtained by the method of the WHO (2,235,201.60 Rub). The authors propose to use this value as one of the decision-making criteria for the reimbursement of medical technologies, including medicinal drugs.

Efficacy and safety of biologics for the treatment of ankylosing spondylitis: systematic literature review and network meta-analysis of treatments registered in the Russian Federation

The aim of the study was to evaluate the comparative efficacy and safety of biologics registered and reimbursed in the Russian healthcare system for the treatment of adult patients with active ankylosing spondylitis. Material and methods . We performed a systematic literature review of randomized controlled trials in PubMed, Embase, and eLIBRARY.RU databases. 17 articles reporting results from 16 trials were selected for qualitative and quantitative analysis. The main efficacy criteria were ASAS 20/40 over 12-16 weeks of therapy, additional criteria were BASDAI 50, changes from baseline in BASDAI and BASFI indexes. Safety criteria were determined based on the incidence of adverse events; we also analysed the proportion of patients suffering from at least one serious adverse event. Biologics were ranked based on the SUCRA values. Results. Subgroup analysis showed no statistically significant differences between IL-17 and TNF-a inhibitors, but the IL-17 inhibitor class had a higher SUCRA values. For the combination of all analyzed efficacy outcomes, netakimab, infliximab, and ixekizumab hold the first three ranks. The safety profiles of biologics included in the review were comparable with each other. Conclusion . The results of this review are intended to help healthcare professionals make decisions about optimal therapy for adult patients with active ankylosing spondylitis.

Healthcare financing in Russia: mechanism and assessment of regional budget opportunities

In the difficult economic conditions in Russia, caused, as in the all countries, by the consequences of the coronavirus pandemic, the search for additional government revenues is becoming especially relevant. All possibilities of cutting budget expenditures are being considered, including the optimization of the number of civil servants. The deputies of the State Duma of the Russia over the past month have been actively discussing the effectiveness of the functioning of state extra-budgetary funds and expressing ideas about the abolition of the Pension Fund of Russia and others, with the simultaneous return of functions back to the federal budget. It is important to reasonably assess the effectiveness of the financial mechanism of each extra-budgetary fund in Russia, including the Federal and Territorial Compulsory Medical Insurance Funds. To this end, it is necessary to comprehensively consider the mechanism of financing health care in the country within the framework of the current budget-insurance model. This article reveals the features of the financial mechanism in the healthcare sector in Russia, primarily in terms of methods for the formation of financial resources. In general, the Russian health care system is financed by the country’s budgets, Compulsory Medical Insurance Funds, voluntary medical insurance and paid medical services. In accordance with this, the budget, insurance and market methods for the formation of financial resources in health care are identified. The article describes each method; the effectiveness of the current financial mechanism was assessed and recommendations for its improvement were proposed.

СМЕРТНОСТЬ В ПЕРИОД ПАНДЕМИИ COVID-19 И НАПРАВЛЕНИЯ СНИЖЕНИЯ РИСКА: ПРЕДВАРИТЕЛЬНЫЕ ИТОГИ 2020 Г

The mortality indicators of the world's population in 2019 and 2020 are analyzed. Despite the approximate character and inaccuracy of the available information for 2020, the analysis allows to present the overall picture and preliminarily estimate the demographic losses from the COVID-19 pandemic. In addition, the problems that have been identified in national health systems during the fight against coronavirus infection are considered. The experience gained serves as a basis for proposals for improving the healthcare system in Russia.

Готовность к переходу во взрослую службу здравоохранения подростков с хронической болезнью почек: описательный обзор международной литературы

The organization of a successful transition of adolescents with chronic diseases from pediatric to adult healthcare services is an important marker of healthcare quality. Despite the existence of both theoretical and empirical knowledge on this subject, there are still many issues that require further investigation. An evaluation of readiness to transition to adult healthcare services is one such issue. We conducted a narrative review in order to summarize the available data. We selected 43 articles that discuss the definition and meaning of the concept of “readiness” and/or methods and tools for assessing transition readiness in patients with chronic kidney disease (CKD). We found that experts have been studying the transition readiness of adolescents with CKD for more than 30 years. So far, there is no generally accepted definition of this concept. We have identified the following categories of indicators for evaluating adolescents’ transition readiness: clinical, physiological, psychological, social, and cognitive. Seven readiness evaluation tools were also identified, four of which were quantitative (UNC TRxANSITION Scale, RTQ, TRAQ, STARx), i.e. they determined readiness scores; three were qualitative (ON TRAC, Ready Steady Go, Got Transition) and were mainly used to facilitate structured conversations with patients. Further studies are needed to analyze this problem, particularly in the Russian healthcare system. These studies should focus on the development of special criteria of transition readiness and elaborate upon the subsequent integration of this methodology into routine clinical practice. It is important for timely modification of patient management tactics, the prevention of CKD progression, and the improvement of patients’ quality of life. Key words: transition readiness, readiness assessment, transition from pediatric to adult healthcare, adolescents, chronic kidney disease

Антибиотикопрофилактика острого послеоперационного эндофтальмита

This paper reviews current aspects of antibacterial prophylaxis of acute endophthalmitis, a dangerous complication of cataract surgery. The lack of a common standard for preventing phaco infectious complications, a growing number of resistant bacterial strains, and legal aspects of the lack of some antibiotic formulations and routes of their administration with established efficacy in Russia account for the importance of this issue. The authors provide a list of primary causative agents of endophthalmitis and specify their antimicrobial susceptibility, highlight the importance of using antiseptics to prevent endophthalmitis, and describe in detail routes of administration of antibiotics, including conventional ones (subconjunctival injections, topical use) and whose actively promoted (intracameral, transzonular). In conclusion, the authors suggested a rational antimicrobial preventive algorithm for endophthalmitis after phaco based on the analysis of recent Russian and foreign published data and adapted to the Russian health care system. Keywords: phacoemulsification, endophthalmitis, antiseptic, antibiotic, prophylaxis, antibacterial resistance, fluoroquinolones, aminoglycosides, povidone-iodine, intracameral administration. For citation: Nikolaenko V.P., Belov D.F. Antibiotic prophylaxis of acute postoperative endophthalmitis. Russian Journal of Clinical Ophthalmology. 2021;21(4):220–226 (in Russ.). DOI: 10.32364/2311-7729-2021-21-4-220-226.

Pathways for the Development of Workforce Capacity of Paramedical Personnel in the System of Modern Russian Health Care System (Based on Materials from the Volga Federal District)

Pathways for the Development of Workforce Capacity of Paramedical Personnel in the System of Modern Russian Health Care System (Based on Materials from the Volga Federal District)

Mortality as a social problem: 2001–2017

The article presents a sociological analysis of the mortality rate of the population of post-Soviet Russia. The socio-demographic characteristics of respondents who passed away due to diseases of the circulatory system, respiratory system, cancer, suicide, homicide, external causes and due to the old age are analyzed. Statistical data of Rosstat (2018) and sociological databases of RLMS-HSE (2001–2017) are used as an empirical basis, the results of the analysis are consistent. In the conditions of Russia's depopulation, not only the health of an individual is important, but also the health of the nation as a whole. As the analysis reveals, only 5% of the population of modern Russia die of old age, while 95% of deaths are a consequence of social factors. In the opinion of the author the reasons for this situation are the optimization of the Russian health care system, the "modernization" of the economy, a dangerous ecological situation, degradation of the institutions of family and marriage, of the educational institutions, unemployment, low incomes of the population, etc. The article analyses the social factors affecting the causes of death of men and women, socio-demographic portraits of the deceased are given. The author demonstrates the unfolding demographic catastrophe of modern Russia - a decrease in the birth rate and an increase in mortality, that will inevitably be followed by an economic collapse and social chaos. The analyzed problem is not unique and characteristic only for Russia. This catastrophe looms over the countries of Eastern Europe and the Baltic states. The data from the Russia Longitudinal Monitoring Survey by the National Research University Higher School of Economics and Demoscope LLC with the participation of the Population Center of the University of North Carolina (Chapel Hill) and the Institute of Sociology of the Federal Research Sociological Center of the Russian Academy of Sciences (Moscow) was used as an empirical sociological basis for the study.

Public policy and resort industry

For the past three centuries, sanatorium treatment has been an integral part of the Russian health care system. Wise use of natural resources can significantly reduce the morbidity rate, prevent many diseases, and effectively treat chronic illness. In Russia, after the reforms of the 1990s, the health resort complex was not able to immediately enter the market of services, which led to a reduction of personnel, obsolescence of material and technical base. However, nowadays, the situation is changing radically. At the moment, the state has already solved the problems of the transition period but has faced other challenges in the field of health protection of the nation. The author concludes that special attention should be paid to the further development of the industry aimed at recovering the most valuable resource – a person.

The effectiveness of the Russian healthcare system during the COVID-19 epidemic: public opinion

<h3></h3> Проанализирована актуальная проблема доступности и качества оказания медицинской помощи в России населению в период эпидемии COVID-19. На основе изучения мнения населения в ходе исследования, проведенного в 2020 г., сделан вывод о том, что деятельность системы российского здравоохранения в период эпидемии COVID-19 в целом можно считать удовлетворительной: большая часть населения Российской Федерации была удовлетворена лечением во всех типах медицинских организаций. Таким образом, российская система здравоохранения показала свою способность эффективно и оперативно реагировать на экстренную ситуацию, мобилизовать кадры, лечебные и материально-технические ресурсы для оказания населению своевременной и качественной медицинской помощи.

Russian legal experience in using information technologies in diagnostics of reflux esophagitis

This publication focuses on a theoretical investigation of the issues of Russian experience in the application of digital technologies in the provision of medical care in the diagnosis of oesophageal hernia complicated by reflux esophagitis. The relevance of the research lies not only in the increasing number of patients diagnosed with reflux esophagitis, but also in the current digital paradigm of the entire Russian healthcare system. Despite domestic legislative attempts to legally regulate the use of digital technologies in health care through the regulatory introduction of telemedicine technology, as is most common, certain issues in the use of this digital "platform" in health care remain unresolved. The methodological basis of this study is the methods of comparative analysis, system-structural analysis and synthesis. The author has assessed the possibility of using telemedicine technologies in the context of the doctor-patient relationship, implemented in a remote format, when diagnosing a patient, including from the position of significant territorial remoteness of the patient. There is a focus on the need for a more specific legal regulation in terms of legally establishing the definition for guaranteeing the security of personal data received by participants in the consultation, processed by them when applying telemedicine technologies.