Russian Health Care System Research Articles

Awareness of the population about clinical examination and implementation of preventive screening for tumor diseases in the health care system

In the Russian healthcare system, the main method of preventive medicine is regular preventive examinations and medical examinations. Purpose. To study the population’s awareness of preventive examinations and medical examinations and participation in them; analyze methods for performing medical examinations in relation to oncological diseases (OC) and their results. Material and methods. An observational study was conducted with a survey of a random sample of the adult population of Moscow; 461 respondents aged 18–79 years took part in the survey. The main research method is personal interviewing using a unified questionnaire regarding the set of characteristics being studied. Results. In the study sample, 33.2% (95% confidence interval [CI] – 28.8–37.6) of respondents knew nothing about the purposes of medical examination or had incorrect ideas; 65.5% (95% CI – 61.07–69.9). 40.6% (95% CI – 36.03–45.07%) of respondents knew nothing about methods of preventing OH or had incorrect knowledge. Of the 4 screening tests for early diagnosis of certain most common forms of OH, only 2 tests were carried out in the majority of people undergoing clinical examination: examination by a gynecologist with a cytological examination of smears from the cervix - in 83.2% of women; mammography – in 77% of women aged 40–70 years. A stool test for occult blood was performed in only 31% of respondents aged 40–70 years; a full examination to identify visual localizations of OA was performed in 7.8%. Conclusion. Opportunities for the prevention of OH remain largely unrealized. The results of this study show that clinical examination is carried out in a small part of the population. At the same time, in persons undergoing medical examination, it is rarely performed in full.

Integration of AI-based software as a medical device into Russian healthcare system: results of 2023

Introduction. Healthcare is one of the priority sectors for the deployment of artificial intelligence (AI) technologies worldwide, including Russia. A key area of AI deployment is the integration of AI-base software as a medical device (AI SaMD) into the Unified digital systems of the healthcare sector of the Russian Federation.Aim. Research of the results of the deployment of AI SaMD in healthcare of the Russian Federation in 2023.Materials and methods. The State Register of Medical Devices and Organizations (individual entrepreneurs) engaged in the production and manufacture of medical devices was used as information about AI SaMD registered in Russia. As information on the deployment of AI SaMD, data from monitoring to the federal project “Creating a single digital system in healthcare” was used, including reports from constituent entities of the Russian Federation upon these activities. The results of the implementation of AI SaMD in Moscow were obtained according to data from the Moscow Department of Health as part of an experiment on the use of innovative technologies in the field of computer vision for the analysis of medical images.Results. As of January 1, 2024, Roszdravnadzor registered 26 AI SaMD, 77 % of them were developed by 13 Russian companies. At the end of 2023, 84 (94 %) constituent entities of the Russian Federation met the minimum established target for the purchase of AI SaMD. Within the framework of public procurement procedures provided by law, 106 government contracts were signed for the purchase and deployment of AI SaMD for a total amount of 448 million 430 thousand rubles.Conclusion. In 2023, the Russian healthcare system made a significant breakthrough in terms of the practical deployment of AI SaMD. Completed procurement and deployment projects are the basis for subsequent industry development.

Communication aspects of the development management in digital healthcare

The development of digital technologies in the Russian healthcare system implies communication processes, e.g. interaction of management structures and performers, doctor-patient communications, standards of medical care, and many others. This requires solving a number of managerial, organizational, and ethical problems. The Russian government has defined the main goals of healthcare digitalization: providing the population with medical services at a qualitatively different modern level, satisfying the modern demands of society, allowing the use of modern achievements of world and domestic medicine in the widest possible range. The authors consider the problems of digitalization of medicine, the solution of which is proposed through the optimization of communications of the professional community. The proposals have been developed based on the generalization of the results of sociological surveys of patients of Moscow dental clinics “Use of electronic medical records” (March 2022) conducted by the authors, a survey of residents of Tomsk (N = 107) and Moscow (N = 157) waiting for an appointment at city clinics (March 2022), as well as a substantive analysis of the websites of professional online communities “Analysis of the content of discussions in online communities of medical workers” (August 2018 – February 2019). A secondary analysis of data is based on the sociological studies by the Russian Public Opinion Research Center (VCIOM). Based on the results of the study, it was established that a number of problems are associated with the legal uncertainty of procedures and methods for applying digital technologies, the issue of developing communicative competencies in the professional environment remains relevant, the need for an exchange of experience in the implementation of digital technologies in the practice of doctors and administrators, professional development of personnel, and the involvement of the most active employees in the processes of designing and implementing digital technologies.

Modern Approaches to Integrated Assessment of Public Health in Russian Federation and the Republic of Kazakhstan

Public health management plays an important role in Russian healthcare system. However, the task is impossible without an integrated assessment. In order to understand modern approaches to integral assessment of public health as well as to develop effective methods for its determination, it is necessary to systematize the existing research data. Countries of vast geographical extent, such as Kazakhstan, are of particular interest, as their regional peculiarities do not allow to elaborate a unified approach aimed at improving public health. The purpose was to analyze the scientific research findings on integrated assessment of public health in the Russian Federation and the Republic of Kazakhstan. Material and methods. A keyword search of scientific data available in eLibrary.RU, PubMed, Google Scholar scientometric databases, subsequent study and analysis were carried out. As a result, 35 articles were included in the review for further analysis. Results. In the scientific literature, there is ambiguity in the choice of criteria for an integrated assessment of public health. The use of different approaches and public health indicators reveals the complexity and multilevel nature of the phenomenon. The revealed weight contributions of various public health indicators, as well as the change in their role in different regions, age groups and other cohort groups indicate the need to adapt unified and standardized approaches using correction factors taking into account the above factors. The existing scientific groundwork on integrated assessment of public health in Russian Federation and the Republic of Kazakhstan allows us to predict an upcoming appearance of scientific research that will contain the results of the most accurate and adequate integrated assessment of public health. Conclusion. A comprehensive assessment of public health is a complex multi-level system that should be measured by integral indicators. In this regard, in order to improve these indicators, it is necessary to clarify the criteria characterizing the high indicative value and coverage of various aspects that determine the level of public health.

Financial Risk Management in Healthcare in the Provision of High-Tech Medical Assistance for Sustainable Development: Evidence from Russia

The research determines the level of financial risk in the Russian healthcare system and identifies prospects for improving the current Russian practice of financial risk management in healthcare when providing high-tech medical care for sustainable development (using Russia as an example). The author summarizes the advanced experience of the top 20 largest healthcare organizations in Russia by revenue in 2022. Based on this experience, the author developed an SEM model of the financial risks in healthcare during the provision of high-tech medical care in Russia from a sustainable development perspective. The theoretical significance of the developed model lies in uncovering the previously unknown causal relationships between the implementation of the ICT, sustainable development support, and financial risks in healthcare. The model reveals a new market dimension of financial risks for healthcare organizations in Russia. The main conclusion is that implementing the ICT and support for sustainable development helps to reduce the financial risks in healthcare. The identified potential for reducing financial risks in providing high-tech medical care in Russia until 2026 is practically significant. This prospect can be practically applied as a roadmap for the digital modernization and sustainable development of healthcare until 2026, enhancing the state healthcare policy in Russia. The established systemic relationship between ICT implementation, sustainable development support, and financial risks in healthcare is of managerial importance because it will increase the predictability of the financial risks in the market dimension of healthcare in Russia. The newly developed approach to risk management in healthcare during the provision of high-tech medical care in Russia has expanded the instrumental framework of risk management for healthcare organizations in Russia and revealed further opportunities for improving its efficiency.

Trajectories of a doctor's professional development: a narrative interview. Part 1

BACKGROUND: Medical education is one of the most prestigious and in demand at the present stage, which, first of all, is reflected in the high competition rates for admission to a medical university. At the same time, the digital development of the Institute of Medicine determines the increasing academic load and the need to expand the range of disciplines studied at a medical university. AIM: To study of the trajectories of professional development of a young doctor in the Russian healthcare system in modern conditions. METHODS: The study of the trajectories of professional development of young doctors was carried out by the method of narrative interview (n=52) in September–December 2022 on the basis of the Institute of Social Sciences of Sechenov University. The study involved young internists (n=11), pediatricians (n=11), obstetricians and gynecologists (n=10), dentists (n=10), surgeons (n=10). RESULTS: The analysis of the array of narratives allowed us to identify three key semantic and semantic data blocks (including seven subgroups), which served as the empirical basis of the standard narrative plot: the pre-university stage ["playing the profession" (3–7 years), "premonition" of professional choice (8–11 years), professional self-determination or the formation of professional intentions (12–17 years)]; university stage [obtaining medical education as the "foundation" of professional socialization (1–2 years), determining the desired trajectory of the professional path (3–6 years)]; postgraduate stage [debut of professional activity (residency), "challenges of professional autonomy"]. CONCLUSION: The analysis of the corpus of narratives of young doctors made it possible to identify the key temporal points of the trajectory of their professional formation in the modern situation, and showed that the formation and professional self-determination of a medical specialist is determined not only by internal motivation, but also by the influence of social agents (specific for each stage), the conditions of the social and professional environment.

On the 80th Anniversary of the N.A. Semashko National Research Institute of Public Health

The article explores the history of the N. A. Semashko National Research Institute of Public Health by examining archival materials and scientific publications from the Institute's staff. It highlights the key achievements of the Institute over its 80-year existence, showcasing its significant impact on both scientific advancements and the healthcare system in Russia.

Analysis of the demand for medical services using digital programs in the Russian healthcare system: an overview of trends

The research conducted in this article has determined that among Russians, preference for private medical services, including through online technologies, is given for the following reasons: the speed of service provision - 45.1%; lack of queues (44%); quality of medical procedure (39.8%); ease of making an appointment (32.1%); high professional level of the doctor (24.4%). Given the fact that the cost of medical services at a personal appointment is increasing, it is safe to say that the types and forms of services in the format of remote medical care will certainly increase in number and may become the most important trend in 2024 and subsequent years. An important factor in the availability and satisfaction of medical services, and hence its demand, is the use of digital technologies and the direction of development of programs using artificial intelligence in medicine. The article provides an overview of the artificial intelligence resources used and implemented in medicine and healthcare in Russia, and the prospects for their development in the short term.

The impact of digital technologies on labor organization in health care scope

Enhancement of the health care system in Russia continues to be one of key directions of National development. In conditions of deficiency of personnel, systemic changes are needed to transit to qualitatively new level. The application of digital platforms permits to resolve a number of issues related to accessibility and quality of medical services. The paper characterizes current state of health care digitization and level of competitiveness of medical institutions. On the basis of analysis of corporate culture of medical institutions, conclusions are made that it contributes to successful implementation of unified medical information system and development of best corporate standards and traditions.

The comparative analysis of health care systems based on rating definition

The comparative analysis of effectiveness and efficiency of health care systems functioning causes a number of difficulties due to different indicators applied in countries as assessment tools, different data collection mechanisms and differences in nature and dimension of determining indicators. To ensure comparability of absolute values of various indicators and possibility to compare activities of single medical organizations and effectiveness of health care system of both various Subjects of the Russian Federation and health care system as a whole, it is possible to apply different rating techniques. The article presents comprehensive comparative analysis of activities of health care systems based on construction of rating using integral indicators of public health: indicators of key functioning of health systems (financial support and infrastructure development), total mortality from non-communicable diseases, probability of dying at the age of 30 to 70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases, universal health coverage index, life expectancy (at birth and at the age of 60). The comprehensive comparative analysis of results permitted to to conclude that the greatest financial costs for health care and best level of infrastructural support (beds and medical personnel) in countries with health insurance system. At that, according to ranking results and all selected integral public health indicators, health insurance system took the first place.

Creation of Remote Monitoring Centers for Patients with Spinal Cord Injury Based on the Principles of Value-Oriented Rehabilitation Model: Relevance and Organization Principles

Due to the widespread introduction into the practice of Russian healthcare of the International Classification of Functioning, Disability and Health (ICF), the development of digital medicine requires the reorganization of rehabilitation care in the Russian healthcare system. Special attention is paid to the models of 5P medicine and trinitarianism. In this regard, it seems relevant to form the basic principles of building a remote monitoring center model for patients with spinal cord injury. To this end, the authors conducted a search for publications in the PubMed databases, e-Library (the rubricator of clinical recommendations and regulatory legal acts), as well as additional sources in the reference lists. As a result, 86 publications and literature sources were identified, analyzed and systematized, 25 of which are included in this review. The following research methods were used: analytical method, data copying, SWOT analysis. As a result, from the perspective of a value-oriented model of rehabilitation, 5P medicine, and trinitarianism, the need for creating regional remote monitoring centers for patients with spinal cord injury to provide them with the necessary assistance, as well as other patients traveling in wheelchairs, was justified. The principles are substantiated, as well as the possibilities and threats of the formation of regional remote monitoring centers are shown. In conclusion, it is emphasized that the creation of such centers for remote monitoring of low-mobility patients based on ICF in Russia will contribute to optimizing resources, optimal routing and accessibility of medical rehabilitation care.

Radiation accidents in X-ray and radionuclide diagnostics and therapy: comparison of Russian and international approaches to the terminology and classification

Introduction of new methods of nuclear medicine, X-ray diagnostics and therapy using medical sources of ionizing radiation inevitably leads to an increase in the number and types of accidents (abnormal situations). In international practice in recent years, special attention has been paid to the prevention of radiation accidents and incidents from medical exposure. The main focus is put on accidental exposure (overexposure) of patients in X-ray and radionuclide diagnostics and therapy. These approaches are implemented in Russian regulatory and methodological documents in a limited and formal way. The main attention is paid to large-scale technogenic radiation accidents, and accidents (abnormal situations) from medical irradiation are undeservedly ignored. The aim of the work was to analyze the terminology and classification of radiation accidents and incidents from medical exposure in the Russian Federation and foreign countries to develop proposals to improve approaches to their classification within the framework of revision of existing regulatory and methodological documents. The results of the work indicate that it is necessary to actualize Russian approaches to the definition and classification of radiation accidents in medicine considering the specifics of medical exposure. For this purpose, it is advisable to introduce different levels of accidents (abnormal situations), differing from each other by the scale of impact and consequences for patients, workers and public. Considering the absence of elaborated scenarios of accidents (abnormal situations) in Russian regulatory and methodological documents, such gradation can be borrowed from international regulatory documents provided that it is adapted to the specifics and realities of the Russian health care system

Current issues of increasing the availability of innovative therapy for the treatment of patients with non-small cell lung cancer within the Russian healthcare system

The advisory board was held to discuss he current situation with diagnosis and treatment of advanced non — small cell lung cancer with a mutation in the MET gene (aNSCLC with METex14). Lung cancer takes a leading place in the structure of oncological diseases in Russia. The frequency of molecular abnormalities in the MET gene patients with advanced lung cancer is 3%, the NGS method is the most effective in identifying this alteration.The effectiveness of capmatinib, a MET tyrosine kinase inhibitor was confirmed in the GEOMETRY mono-1 registry trial: the objective response rate in the patients with aNSCLC with METex14 who had previously received 1–2 lines of therapy was 41%, among those who had not previously received treatment — 68%. Median duration of response was 9.7 month in previously treated patients with aNSCLC with METex14 and 12.6 months in the treatment — naïve patients with aNSCLC with METex14. Intracranial response was observed in 54% of cases among patients with aNSCLC with METex14. In addition, the efficacy of capmatinib was confirmed when it is administered to the patients with aNSCLC with METex14 in real-world clinical practice. Other therapeutic options (immune-oncology therapy, chemotherapy) are less effective in case of this disease variant.Based on the data on effectiveness and tolerability of capmatinib, the expert group made a decision to recommend inclusion of capmatinib in the Russian Clinical Guidelines for the treatment of lung cancer and into the Essential Drug list.

Rethinking Performance-based Budgeting: The Case of the Russian Healthcare System

Aiming to enhance efficiency, performance, and accountability in the management of the public sector, performance-based budgeting (PBB) has gained prominence worldwide. The present study addresses the challenges of implementing and managing PBB in the Russian public sector, with a particular focus on the Orel region's long-term targeted healthcare programs. Drawing on case study analysis and empirical evidence, the study identifies specific challenges hindering effective PBB implementation, including effectiveness issues, revenue generation concerns, and passive actors with limited knowledge and skills. The study sheds light on the complexities and tensions arising from a top-down approach to PBB implementation and offers insights into prioritizing expenditures amid economic and geopolitical factors in emerging market economies like Russia.

Assessment of quality of life in patients after surgery for pancreatic and periampullary malignancies. Systematic review

Aim. To analyze the current methods of life quality assessment in patients undergoing surgical treatment for pancreatic and periampullary cancer, to study the influence of surgical treatment and postoperative complications on the quality of life. Materials and methods. The study involves a systematic review of the literature available in MEDLINE, Embase and e-Library electronic databases for 2015–2022. The methodology of the systematic review is reflected in the study protocol, designed according to PRISMA guidelines. Results. The systematic review embraces 26 studies including 4937 patients met the inclusion criteria. The present study examines design and objectives, survey forms, methods of surgical interventions and drug treatment, survey frequency and data collection methodology, risk of systematic error, etc. Conclusion. When choosing a survey form, most authors favored EORTC QLQ-C30 and EORTC QLQ-PAN26. Even the most complex surgeries such as pancreaticoduodenal resection and pancreatectomy can provide a satisfactory quality of life. Many current studies appear methodologically-challenged thereby increasing the risk of systematic error and reducing the reliability of the data. The quality of life of patients in this category is to be further investigated, the optimal principles and methodology of such studies are to be standardized, in particular, in Russian healthcare system.

Attitude towards the risk-based approach implementation into the russian healthcare system among employees of medical organizations

Aim of the study was to develop recommendations for improving procedures and unifying the content of risk management of the healthcare system to preserve public health based on an analysis of the opinions of doctors, organizers and experts of the healthcare system. Material and methods. As part of a quantitative online survey conducted from September to December, 2022, 104 respondents working in the healthcare system of the Russian Federation were interviewed. Additionally, 6 in-depth interviews were conducted with the organizers and experts of the healthcare sector as part of a qualitative sociological study. Desk research included analysis of scientific literature, and the regulatory framework related to the introduction of a risk-based approach to healthcare. Results and discussion. The article presents an analysis the perception of risks in healthcare by doctors, organizers and experts at the level of a medical organization, of the healthcare system and of public health (macro level), with the identification and classification of the main risk groups, on the basis of which risk-management’ measures can be built. The results of the study testify to the insufficiently deep introduction of risk management into the management system of medical organizations. The half of the respondents noted the low and extremely low level of risk management principles’ usage in their own organizations (50 % of respondents) and in Russian medical organizations in general (58.6 % of respondents). At the same time, from a third to a half of the participants found that it was difficult to answer about risk management implementation in their organizations, due to the lack of a unified methodology, imperfection of standards and quality control system of this set of measures, lack of specialists who could manage risks, lack of educational activities. To introduce a systematic approach to the unification of risk management processes, it is necessary to develop and approve the methodology of best practices, as well as take care of the training of specialists. Conclusions. In order to implement a systematic approach to the unification of risk management processes, it is necessary to develop and approve a methodology of best practices, as well as to take care of the training of specialists. It is imperative that hospital managers and staff focus on improving the organizational culture of patient safety management as the basis for their mission to preserve public health. It is necessary to continue further research in this direction in order to develop a strategy for countering risks at the level of public health as a medical and social resource of society.

ПЕРСПЕКТИВЫ РАЗВИТИЯ РЫНКА ПРОФЕССИОНАЛЬНОГО ОБОРУДОВА-НИЯ В УСЛОВИЯХ ТРАНСФОРМАЦИИ СФЕРЫ МЕДИЦИНСКИХ УСЛУГ В РФ

The Russian public MD&D market dynamics is described based on state tender analytics for a period of 2019–2023. The negative trend in both value and units is revealed. Local MD&D players accelerated growth is stipulated leverage on J.Gans and H.Stern strategic tool while considering current geo-political, economic reality, Russian healthcare system challenges and the its prioritized pillars outlined in Government De-cree No. 2161 of 11/29/2022.

Present Strategy and Tactics of Antibacterial Therapy for Hospital Infections: Lessons Learned from the COVID-19 Pandemic

A significant increase in sales of antibacterial drugs in pharmacies and their purchases by medical institutions of the Russian Healthcare System was observed against the background of the past pandemic of a novel coronavirus infection in Russia. Microbiological monitoring that was carried out at City Clinical Hospital No. 67 named after. L. A. Vorokhobov (Moscow) in 2020–2021, revealed a pressing problem — primarily gram-negative bacteria, with a predominance of multidrug-resistant (MDR) strains, were isolated from patients with healthcare-associated infections (HAIs). As shown by pharmacoeconomic studies conducted by the authors, the cost of one course of targeted antibacterial therapy for HAI in this case could increase by 6–12 times compared to a similar course of therapy in the absence of both MDR strains and XDR strains of hospital pathogens. In order to achieve a reduction in the cost of antibacterial therapy developed and used by the authors, in addition to the development of effective antibacterial therapy regimens for HAIs caused by MDR/XDR pathogens, another study was carried out as a continuation of the work on creating and improving biotherapy regimens for HAIs, namely the development of personalized phage therapy regimens for patients with hospital-acquired pneumonia caused by MDR bacterial strains. Based on the data obtained, the concept of a personalized approach to phage therapy of various nosological forms of HAIs caused by hospital-acquired MDR pathogens in patients of a multidisciplinary hospital was proposed and tested. As a result of this approach, the effectiveness of phage therapy for various nosological forms of HAIs caused by MDR and XDR strains of hospital pathogens in City Clinical Hospital No. 67 named after. L. A. Vorokhobov increased by 30%, and the effectiveness of the initial antibiotic regimen was 70%. The economic effect of the combination of antibiotic therapy and phage therapy («booster therapy») amounted to 3,000,000 rubles, compared with the use of antibiotics alone in the treatment of patients with HAIs caused by MDR/XDR strains of hospital pathogens.

Features of the Worldview of Pediatric Palliative Care Physicians: an Interpretative Phenomenological Analysis

Pediatric palliative care is a multidisciplinary branch of medicine and health care that includes both biomedical techniques of patient care and social and psychological practices. At the same time, its goal differs from that of curative approaches in medicine and is predominantly to alleviate patients’ suffering. We used the qualitative method of Interpretative Phenomenological Analysis (IPA), which allows us to uncover the «inside», emotional and existentially significant dimensions of respondents’ personal and intersubjective experiences. This method provides an «insider» perspective of the community under study. The article presents the results of IP. interviews with nine doctors of pediatric palliative care working in the Russian health care system and taking specialized advanced training courses. The goals of the study were to identify the most subjectively significant factors for physicians of palliative care for children, influencing the ethical and communicative aspects of interaction with patients and their parents, and to identify the most important problems and issues of concern to specialists, with an emphasis on worldview. Semi-structured interviews were conducted using a specially designed questionnaire and mainly addressed the topics and issues of worldview of palliative care physicians (including the role of faith and religion) in the context of communication with patients and their parents. As a result, it was found that doctors typically assess their work as a vocation (in a number of cases — with explicitly religious attribution), and this is used by part of the respondents as a justification of their activities in front of a critically minded environment. A common view of a hospice is that of a place that needs to be comfortable, home-like. Subjectively, the majority of respondents evaluate themselves as Orthodox Christians, but emphasize the «non-fanatical» nature of their faith. At the same time, respondents note the significant influence of parental religiosity on communication patterns and acceptance of inevitable disease outcomes. Most respondents noted a high need for a spiritual counsellor in the hospice. Respondents do not necessarily insist that the counsellor be a priest, but his or her figure in the physicians’ descriptions has distinct confessional features.

Empirical Testing of Grossman’s the Demand for Health Model: The Case of Russia

Healthcare services constitute one of the most important markets as they are used by all people regardless of age, wealth, and worldview. In order to effectively manage both private and public healthcare systems and to expand the scope of services provided in a timely manner, it is necessary to understand the nature of the demand for health, depending on the development of society and individuals. This paper is devoted to the empirical testing of one of the most influential models of health economics – Michael Grossman’s model of health demand – by means of econometrical modelling. We used data from RLMS HSE (Russia Longitudinal Monitoring Survey of HSE) for 2019 and 2020. The paper tested the hypotheses that educational level positively affects the demand for health, that women invest in their health more responsibly than men, that the “age”- “demand for health” link has non-linear character, and the rate of health amortization is not constant during the life of an individual. We concluded that health demonstrates the features of both consumption and investment good. It was also found that income affects the demand for health just within the consumption interpretation of this construct, not within the investment one. The study showed that people with a low income tend to consume medical services more actively by spending more time in hospitals. It can be assumed that demand for medical services will increase during the economic crisis, job cuts, inflation, and a drop in real incomes of the population. The results of the study may help to predict the demand and consumption of medical services and to facilitate decision-making in Russia's healthcare system in the future.