Russian Health Care System Research Articles

Pharmacoeconomic rationale for switching patients with rheumatic diseases from original biologic disease-modifying antirheumatic drugs to biosimilars in context of the Russian healthcare system

Objective: to analyze the pharmacoeconomic efficiency of biosimilars in context of national healthcare system.Material and methods. Based on the developed interactive pharmacoeconomic model, we made an analysis of the impact on the budget of treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), patients with psoriatic arthritis (PsA) were analyzed separately, within the framework of the study a cost-effectiveness analysis of bDMARD and tsDMARD therapy was performed to determine the preferred alternative in RA.Results and discussion. The performed pharmacoeconomic analysis confirmed the research hypothesis on the economic feasibility of transferring patients with rheumatic diseases (RA, PsA and SpA) receiving original bDMARDs to biosimilars in the context of Russian healthcare system. According to the cost analysis, biosimilars, except for infliximab, are characterized by comparatively less cost of a treatment course than the original drugs. The results of the budget impact analysis and cost analysis prove the economic feasibility of switching patients from original bDMARDs to biosimilars. At the same time, the parameters of the current and planned distributions entered in the calculations of the analysis of the impact on the budget, indicate the need of the professional community and patients for a wider use of innovative original bDMARDs that are under patent protection. At the same time, in the context of budgetary constraints, switching to biosimilars remains perhaps the only available strategy for increasing the coverage of patients with innovative drugs. It has been established that the etanercept biosimilar (ETC) Erelzy® has the lowest cost-effectiveness value. At the same time, ETC is characterized by the highest clinical efficiency, which makes it possible to determine the specified ETC biosimilar as strictly preferable from the point of view of the cost-effectiveness analysis.Conclusion. It can be assumed that in the absence of medical contraindications, switching of RA patients to ETC from other bDMARDs will be accompanied by better control of the disease, and the presence of biosimilars of ETCs, including the drug Erelzi®, which are among bDMARDs with the lowest cost of treatment course, will save funds, that can be rerouted to extend the coverage of patients with bDMARDs or increase the proportion of innovative bDMARDs.

Special Provisions for the Medicines Registration Procedure in Response to Economic Restrictions Imposed on the Russian Federation

The economic sanctions imposed on the Russian Federation in 2022 create a potential risk of shortages or absence of a range of medicines demanded by the Russian healthcare system. The article describes the legislative measures by the Russian Government aimed at prevention of inventory shortages of medicinal products and, in particular, the special requirements to expert evaluation and registration of the medicines that could be affected by the risk. The article pays special attention to the time frames of assessment and registration procedures.

Structural changes in the Russian health care system: do they match European trends?

ВackgroundIn the last two decades, health care systems (HCS) in the European countries have faced global challenges and have undergone structural changes with the focus on early disease prevention, strengthening primary care, changing the role of hospitals, etc. Russia has inherited the Semashko model from the USSR with dominance of inpatient care, and has been looking for the ways to improve the structure of service delivery. This paper compares the complex of structural changes in the Russian and the European HCS.MethodsWe address major developments in four main areas of medical care delivery: preventive activities, primary care, inpatient care, long-term care. Our focus is on the changes in the organizational structure and activities of health care providers, and in their interaction to improve service delivery. To describe the ongoing changes, we use both qualitative characteristics and quantitative indicators. We extracted the relevant data from the national and international databases and reports and calculated secondary estimates. We also used data from our survey of physicians and interviews with top managers in medical care system.ResultsThe main trends of structural changes in Russia HCS are similar to the changes in most EU countries. The prevention and the early detection of diseases have developed intensively. The reduction in hospital bed capacity and inpatient care utilization has been accompanied by a decrease in the average length of hospital stay. Russia has followed the European trend of service delivery concentration in hospital-physician complexes, while the increase in the average size of hospitals is even more substantial. However, distinctions in health care delivery organization in Russia are still significant. Changes in primary care are much less pronounced, the system remains hospital centered. Russia lags behind the European leaders in terms of horizontal ties between providers. The reasons for inadequate structural changes are rooted in the governance of service delivery.ConclusionThe structural transformations must be intensified with the focus on strengthening primary care, further integration of care, and development of new organizational structures that mitigate the dependence on inpatient care.

Pharmacoeconomic evaluation of using enzalutamide for treatment of patients with metastatic hormone-sensitive prostate cancer

Background. The addition of enzalutamide to standard androgen deprivation therapy (ADT) significantly increases overall survival and progression-free survival in patients with metastatic hormone-sensitive prostate cancer (mHSPC) compared with ADT.Objective: to evaluate the incremental cost/effectiveness ratio (ICER) of enzalutamide use in patients with mHSPC and the ICER of enzalutamide as the first-line therapy for metastatic castration-resistant prostate cancer (mCRPC) from the Russian healthcare system perspective and to assess the contribution of enzalutamide into the reduction of mortality of mHSPC patients in the Russian Federation on the horizon until 2024.Materials and methods. Standard ADT regimens for mHSPC were used as a comparator as it is the most common treatment for mHSPC in Russia. We proposed a Markov model of mHSPC progression on enzalutamide + ADT (hereinafter enzalutamide) or ADT + 1st generation antiandrogen (hereinafter ADT) based on ENZAMET trial data. Model was used to calculate the average life-years gained (LYG) and costs of mHSPC and post-progression mCRPC treatment. Simulation period was 15 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for enzalutamide plus ADT vs ADT in the first-line therapy of mCRPC as a benchmark based on PREVAIL trial data. In both cases, the average LYG over a 15-year period was used as an efficacy criteria. To assess the contribution of the enzalutamide into the reduction of mortality rate of mHSPC patients, the potential number of patients who could be treated with enzalutamide on the horizon of 2021–2024 was taken into account.Results. According to the Markov model, the average LYG over a period of 15 years for enzalutamide was 7.59 years compared to 5.12 for ADT. The average enzalutamide therapy costs were 11,193,802 rubles per patient for 15 years, which were 8,597,131 rubles higher than when using ADT (2,596,672 rubles). ICER for enzalutamide (vs ADT) in mHSPC treatment was 3,484,362 rubles per one life-year gained. ICER for enzalutamide in the first line of mCRPC treatment (vs ADT) was 5,899,418 rubles per one life-year gained. The combination therapy with enzalutamide + ADT in Russia can be started annually by 2,410 mHSPC patients. If they all receive enzalutamide a total of 561 averted deaths among prostate cancer patients can be expected in 2021–2024.Conclusion. In the Russian healthcare system, ICER for enzalutamide in mHSPC was 3,484,362 rubles and the ICER for enzalutamide in mCRPC was 5,899,418 rubles. Enzalutamide can make a significant contribution to achieving the target cancer mortality rates by 2024.

Healthcare Development Based on Public-Private Partnership: Opportunities and Limitations

Currently, the Russian healthcare system is in critical condition. And for many years, the limited financial resources of the state have significantly aggravated this problem. Therefore, it is necessary to search for effective ways to resolve this problematic situation. One of these methods is public-private partnership (hereinafter – PPP), which ensures the attraction of private investment in the healthcare system, contributing to the provision of high-quality medical services. The purpose of the article is to study the possibilities and limitations of the development of the Russian healthcare system based on PPP. The conducted research allowed us to draw conclusions, firstly, about the significant results in the development of the Russian healthcare system achieved through the implementation of PPP projects. Secondly, about the existence of tripartite opportunities for the development of healthcare based on PPP, identified through the use of a combined approach that combines the interests of stakeholders (a stakeholder approach) and a targeted orientation towards human development (a person-centered approach). Along with this, it is emphasized that there are a number of limitations that hinder the effective implementation of these capabilities. This implies the importance of implementing a number of practical measures, in particular: the development and implementation of a federal model and uniform standards for the implementation of PPP in healthcare at the regional level; assistance from the federal budget to the regions for the implementation of capital-intensive projects in healthcare; development and application of economically sound ways to return investments by generating income from the guaranteed volume of the customer base and the tariff of compulsory medical insurance. The methodological basis of the article is the general scientific method of dialectical cognition of economic and financial phenomena in their interrelation and interdependence. The methods of analysis, synthesis, expert evaluation and others are used in the work. The materials presented in the article can be used in decision-making in the Russian healthcare system in order to ensure its sustainable development using the PPP.

Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part II

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia.

Is an adolescent with chronic kidney disease ready for the transition to an adult health service: translation and adaptation of questionnaires

Introduction. The issue of the readiness of adolescents with chronic kidney disease (CKD) for the transition to the adult service in the Russian healthcare system remains unexplored. One of the reasons of this problem is the lack of Russian tools for evaluating patient transition readiness.The goal of this study is to develop Russian-language questionnaires to evaluate the readiness of adolescents for the transition to an adult health service based on the English-language originals.Materials and methods. A literature search was carried out to identify English questionnaires, as well as recommendations for their translation and adaptation. Development of the Russian versions of the questionnaires included the following major stages: preparation, two forward translations, their reconciliation, adaptation and creation of an intermediate version, back-translation into English, cognitive interviewing of the adolescents, proofreading and approval of the final version by the authors of the original English questionnaires. Cognitive interviewing was performed with 10 adolescents with CKD aged 15–17 years.Results. Four English questionnaires were identified. They were studied and comparatively analysed. Translated versions of these questionnaires into foreign languages were revealed. Two most promising questionnaires for translation into Russian were identified: UNC TRxANSITION Index and STARx. Russian versions of these questionnaires were developed based on the international recommendations. Cognitive interviewing provided additional adaptation and linguistic validation of the translated versions based on the adolescents’ opinions. UNC TRxANSITION Index is a provider-administered questionnaire and includes 32 questions. STARx is a self-report questionnaire and includes 18 questions.Conclusions. Russian versions of questionnaires for evaluating adolescents’ transition readiness are available for use by health professionals and social workers. A further study of their psychometric properties and confirmation of the validity of their results in the context of the Russian healthcare system is required.

Социальные последствия реформы здравоохранения в регионах России

The current state of the Russian health care system is a consequence of the reforms carried out in the last two decades, during which the positive characteristics of the previous system of management and financing were lost. The steady decline in the assessment of the state of health of Russians after 45 years indicates the insufficient quality and availability of the medical care, which is increasingly felt with age, due primarily to the reduction in the number of doctors and medical personnel. In the context of a prolonged decline in real incomes of the population, a very eloquent assessment of the social consequences of the reform is the growth of the private sector in the health sector. Focusing public attention on the situation with COVID-19 pushes to the background not only the assessment of the activities of the authorities in this area, but also the satisfaction of the needs for medical care of other, often seriously ill patients. A typical example of this approach is insufficient attention to the medical examination of the population. The pandemic becomes the litmus test that shows the negative consequences of the reform of the health care system:  a significant reduction in infrastructure, the outflow of qualified medical personnel from the public sector, a decrease in the availability of quality medical care, increasingly dependent on the solvency of the population, the loss of hope for the help of state medicine on the part of the vast majority of the population. It seems quite convincing to assume that the authors of the reform initially consider such a result as their goal.

Телереабилитация пациентов, перенесших инсульт: современные тенденции в системе здравоохранения России

With age, the risk of stroke increases significantly, but at the same time, there are tendencies for an increase in its prevalence in young and middle-aged people, which determines the urgency of the problem of rehabilitation treatment after stroke both in the world and in Russia. The use of digital technologies in neurorehabilitation can be very multifaceted and extensive. Telerehabilitation as an innovative direction of telemedicine is an important aspect within the framework of the national project «Healthcare» and the program «Digital Economy of the Russian Federation». P u r p o s e of the study is to analysis of the Russian experience of organizing and conducting telerehabilitation of post-stroke period in the context of the digital transformation of the healthcare system in Russia. M a t e r i a l s a n d m e t h o d s . The article used technologies for searching and selecting information using search engines (www.google.ru, www.yandex.ru), specialized and bibliographic databases (PubMed, eLIBRARY.RU), methods of analysis and synthesis, analytical data processing. R e s u l t s . The study showed that telerehabilitation has a high clinical value of adherence to the treatment of patients of post-stroke period and is not a separate type of medical activity, but an innovative therapeutic and prophylactic method that expands the possibilities of therapy and improves the process of interaction in the «doctor-patient» and «doctor-doctor» communication systems. This technology of restorative telemedicine makes it possible to increase the level of scientific knowledge, skills and abilities of healthcare organizers and medical workers in order to strengthen the national healthcare system of Russia, as well as to rationally use the scientific and practical potential of digital solutions in interdisciplinary interaction of specialists dealing with medical neurorehabilitation, significantly expanding the coverage of the population telerehabilitation services after a stroke. F i n d i n g s . Despite the positive experience of some medical organizations in Russia in the use of telerehabilitation, this direction is still in its infancy and is likely to develop in the coming years for the rehabilitation of many stroke patients, which will help healthcare organizers, doctors and patients and other interdisciplinary specialists effectively and interact seamlessly in the digital health ecosystem in the context of the development of patient-centered medicine.

Цифровизация российской системы здравоохранения: перспективные направления и риски

Digital technologies are currently entering a human life and changing it drastically. Education, economy and healthcare go hand in hand with digitalization. The author of the article stresses that digital technologies spawn fear and mistrust in many people. This applies especially to digitalization of the healthcare system. To overcome the mixed feelings arising in people, we need to understand what digitalization is and review its perspectives and threats. Thus, the purpose of this paper is to consider perspective trends of digitalization of the Russian healthcare system and reveal the existing risks. The author of the article analyzes the normative legal base devoted to the development of healthcare system in Russia, examines the available articles of scientists on the subject, and analyzes the interviews undertaken by IT company representatives, which assess the use of digital technologies in medicine. Based on the performed analysis, the author underlines the following upcoming trends in healthcare digitalization: rapid data generation and processing, remote medical aid, remote enrollment in a medical institution, and easy access to an electronic medical record. The author mentions the following risks: a set of personal data, which could be stolen from digital media, mistakes existing when telehealth technologies are used, and impossibility to get access to a high-speed Internet connection in some Russian regions. According to the author, coordinated work of all actors of healthcare digitalization will allow to keep to a minimum or completely avoid the mentioned risks.

Modern Development Problems of Russian Healthcare: Part 2.

—The second part of the article (see the beginning in No. 6-2021) analyzes the negative consequences of the so-called health care optimization. It is shown that as a result of its implementation, the availability of medical care has decreased. A possible way to improve the territorial organization of medical services is considered. The effectiveness of the Russian health care system in the fight against the coronavirus pandemic was assessed.

Теоретические основы деятельности органов исполнительной власти по реформированию системы здравоохранения в Российской Федерации

The authors identified the main factors influencing the process of reforming the health care system in Russia. The purpose is to study the essence and main features of the health care system in order to analyze the activities of executive authorities to reform the health care system in the Russian Federation. The authors noted that the health care system in Russia is built according to the district principle, which involves the division of certain territories into certain medical areas. The system of governing bodies of the health care system in the Russian Federation has been studied in more detail. The main powers of executive authorities in the management and reform of the health care system are determined. It is concluded that in modern conditions the management of the health care system in the Russian Federation is carried out by various authorities in the state, both at the federal and regional levels. However, reforming the health care system and organizing the achievement of health care goals for the protection of the health of individuals is carried out only by executive authorities with their inherent structure and powers.

National healthcare system performance in- dex: methodological approaches and results for Russia

The provision of comprehensive and high-quality services is one of the most important aims of the healthcare system. This important task can be accomplished by continuously evaluating and improving the performance of the health care service. The purpose of our study is to propose and to test the methodology for evaluation the performance of the healthcare system in Russia. The methodology is based on the construction of a composite index - an integrated indicator that aggregates four main aspects of the healthcare system (accessibility, financing, responsiveness, outcome), measured by nineteen indicators. The information base of study is not only objective, but also subjective statistical data (data from special surveys). It was established that in general for the period 2000-2017 healthcare system performance improved by 8%. The aspects and indicators contributed to this process were identified. Of the four aspects, improvement has occurred in two. Of the nineteen indicators nine improved, and, accordingly, ten worsened. The main contribution to improving of the healthcare system performance was made by such aspect as “Responsiveness of the healthcare system” (+64%), followed by “Outcome of the healthcare system” (+12%). The worst situation is in the areas of “Financing of the healthcare system” (-26%) and “Accessibility of the healthcare system” (–17%). Despite the difficulties and limitations met by the authors, attempts to build composite indexes are seemed to be a promising approach for assessing the performance of the healthcare system, since they are easier to interpret; make it relatively easy to track progress over time using just one indicator, rather than multiple indicators; identify problem areas that require changes to improve performance; allow to draw public attention to industry problems; can stimulate the search for better analysis methods and statistics of better quality.

К вопросу о необходимости изучения преступности в сфере обязательного медицинского страхования

Extreme pressures on the Russian healthcare system that arose at the height of the COVID-19 make re-searchers pay attention to ways to ensure the medical industry working capacity. Financial sustainability is a re-source factor for the functioning and efficiency of healthcare. Corruption and economic crimes harm the health care system, thereby inhibiting its development and leading to financial destabilization. The purpose of study is to analyze the proposed formation and study of a special type of crime “in the field of compulsory medical insurance”. As the objectives of the undertaken research, we define the review of the social insurance model of the healthcare organization functioning in Russia, the identification of features of crimes in the field of compulsory medical insurance, the development of criminological concepts for the knowledge of crime in the field of compulsory medical insurance. The methodological basis of the study included a dialectical method, which allowed us to consider the principle of building the Russian social insurance model of the health organization and the nature of the crimes committed by medical workers in terms of their interrelation and dynamics; a classification method by which it was possible to systematize crimes in the field of compulsory health insurance; a formal legal method that allowed us to look at the phenomena under consideration from the point of view of their legal regulation. We make an attempt to detect a new group of crimes in the official statistical reporting. The work is the result of study of cases related to illegal receipt of funds by doctors and executives of medical organizations of private and state ownership. An assumption is made about the “economic” nature of crimes committed in the field of compulsory health insurance (for example, fraud). The research should be the first step towards the formation and study of a new type of crime and its indicators.

К вопросу о развитии частной медицины в условиях ограничений и новых рисков

This article deals with issues that are directly related to the regulatory legal regulation of the health care system in the Russian Federation. The paper analyzes the norms regulating both the provision of medical services itself and the developing activities of entrepreneurs in the field of providing medical services on a paid basis. Today, the state's policy is aimed at forming a healthy lifestyle of civil society, at making them aware of the value of life and health. in the context of the emergence of new risks and, in this regard, the introduction of new restrictions in the life of society. In this light, the development of private medical practice already has a very different meaning. The fear of people when contacting doctors in state polyclinics, the need for a long time to stay in queues for tests, leads to the desire of people to increasingly turn to private clinics, in which the appointment is made by appointment at a certain set time, and tests can be passed not according to the strictly limited two hours in state medical institutions, but choose a more suitable and convenient time. Problems of providing medical services and medical care were analyzed during data collection through interviews and interviews with patients of polyclinics and ordinary citizens who want to express their opinions. The analysis of the legislation that changed in late 2020 - early 2021 brought some information on positive and not quite innovations that are already in effect on the territory of the state. The paper analyzes the regulatory legal acts that allow the state institution of the Russian healthcare system to provide medical services on a paid basis. The problems that require legislative regulation for the foundations of the activities of private medical institutions for the provision of medical care, medical services and counseling of citizens who have applied to them are considered. The results of the study show that it is possible to make certain changes in the activities of the health care system of the Russian Federation by organizing co-financing of patients from insurance organizations, associated with the use of a progressive taxation scale, as well as the obligation of private clinics to provide certain types of services, for example, counseling, in the direction issued by a state medical institution in the absence of a narrow specialist. Consequently, the development of domestic health care, taking into account a fairly wide range of services provided under compulsory health insurance policies, can be assessed positively. To regulate the activities and development of private business in the organization and operation of medical institutions, it is necessary to introduce rules that allow you to control the tariffs for services and assistance provided, contracts and agreements offered to those who apply, as well as to introduce a system of expert assessments to facilitate the resolution of disputes arising on the work of medical institutions on a commercial basis.

ОЦЕНКА ВОЗДЕЙСТВИЯ ЭПИДЕМИИ КОРОНАВИРУСА НА ЭКОНОМИЧЕСКИЕ ПОКАЗАТЕЛИ РАБОТЫ РОССИЙСКИХ ФАРМАЦЕВТИЧЕСКИХ ПРЕДПРИЯТИЙ

In the context of the COVID-19 virus global pandemic the Russian healthcare system faced important challenges. On the one hand, it is required to provide the population with all the necessary medicines, and, on the other, to support domestic pharmaceutical manufacturers in conditions when foreign manufacturers occupy a priority position in the market in value terms. Thereby hospitals and other medical and preventive institutions sharply increased procurement by tenders from Russian manufacturers since, as a rule, those infected with coronavirus were sent to hospitals. The sharp increase in morbidity and the “waves” of the pandemic created an additional burden on both the hospital system and the medicines manufacturers’ capacity, as a result of which medicines sales increased significantly, and with them, the companies’ revenue and profits. The article gives a general description of the Russian pharmaceutical mar- ket in 2020 and 2021, emphasizing its attractiveness to manufacturers, high competition level and growth prospects. Using the example of the 20 largest Russian pharmaceutical companies it shows the revenue and profit dynamics in 2020 compared to 2019. It was also noted that the demand and, as a result, sales of “anti-covid” medicines changed over 2020 and the 1st half of 2021 along a trajectory sim- ilar to the trajectory of the number of people infected with “waves” in May and October 2020, and then by July 2021. Therefore, it was hypothesized that there would be a correlation between the cases’ number and medicines’ sales of certain therapeutic groups. By “anti-covid” drugs are meant antibacterial, antiviral drugs and immunostimulants. Hence it is possible to build a regres- sion model with the help of which to predict the change in medicines’ sales depending on the epidemiological situation. According to the results of the study, it was revealed that about 50% of sales changes are explained by the morbidity dynamics in Russia. The remai-ning 50% of the changes can be explained by the fact that the considered thera- peutic groups of medicines are used to treat not only the COVID-19 virus, but also other respiratory diseases. The author draws conclusions about the main trends of the new era in the pharmaceutical industry.

КАДРОВЫЙ ПОТЕНЦИАЛ СИСТЕМЫ ЗДРАВООХРАНЕНИЯ РФ: ВОПРОСЫ ФОРМИРОВАНИЯ И ТЕНДЕНЦИИ РАЗВИТИЯ

The problems of staffing the Russian healthcare system, the impact of the general level of financing, the wage reform, and the level of professional training on the employment dynamics of doctors, mid-level and junior healthcare personnel are considered. The purpose of the paper is to identify the main trends in the field of staffing in the industry and to assess the degree of influence on healthcare workers of factors related to the size of government spending and the effectiveness of the remuneration system. The study was conducted using methods of statistical and content analysis of regulatory documents, scientific literature and Internet sources. The novelty of the study consists in observing the cyclical nature of employment in the healthcare sector in the period 1990-2020, which had peaks of employment growth during periods of increased labor costs and peaks of decline during periods of economic crises. According to the results of the study, the influence of employment conditions and the amount of government spending on changes in the level of employment in healthcare has been established. Conclusions are drawn about the relevance of salary increases and standardization of incentive payments and allowances to healthcare workers, the transition to direct budget financing of the industry. In practice, the obtained research results can be used to improve the system of remuneration and management of human resources in healthcare in the context of the current needs of society.

ТЕНДЕНЦИИ РАЗВИТИЯ ЗДРАВООХРАНЕНИЯ РОССИИ

The article examines the indicators of the Russian healthcare system for the period 2005–2020. The purpose of the article is to identify trends in the development of the Russian healthcare system. In the course of the study, methods of analysis, comparison, regression, and correlation were used. Trends in a number of indicators of the Russian healthcare system have been identified: the share of government spending in GDP, provision of medical organizations and hospital beds, the number of medical personnel, etc. The conclusion is made about the need to change the trends in the development of the Russian healthcare system.

Russian healthcare system digitalization: Opportunities and contradictions

The article is devoted to the opportunities and key contradictions of the Russian state healthcare system digitalization project implementation. The authors analyze various aspects of the system digitalization algorithms in light of the federal project “Creation of the Single Digital Circuit in Healthcare based on the Unified State Health Information System”. The aim of the article was to identify problems within goal-setting, documentation development, and practical implementation of the healthcare system digitalization project, as well as to come up with proposals for eliminating these issues. The analysis showed the inefficiency of the expensive healthcare system digitalization project, which has both objective and subjective reasons for its low effectiveness. The authors come to the conclusion that it is necessary to eliminate a number of contradictions and barriers in the framework of the project implementation in order to increase the efficiency of both the healthcare system itself and the high budget federal project of the economy digitalization as a whole. The practical significance of the article consists in the applicability of proposed approach to making the necessary amendments to the current federal project documentation, which will ensure a focus on real needs within the framework of the initiative implementation. The work may be of interest to civil servants, initiators of projects on the healthcare system digital transformation, governmental bodies, healthcare organizations managers, students, and practitioners.

Raising the level of the regional healthcare development

The article is devoted to the consideration of the possibilities of change management in the regional health care system. The research methodology includes the provisions of theories of change management, innovation management, concepts of organizational development, strategic management. The author's approach to managing changes in the Russian healthcare system at the regional level was developed using a systemic, multilevel, integrative, interdisciplinary approach, methods of comparative, factor analysis, instrumental methods of statistics. The study revealed shortcomings of the management systems in the healthcare during the pandemic. Proposed current approaches to change management, author's approach to their assessment in regional health care. The studies carried out show the high potential of the Russian medical science, the sanitary and epidemiological service, the rapid adaptation of the healthcare system in the face of the challenges associated with the pandemic. Along with the success of the Russian healthcare, serious problems have been identified in the management of the industry, including due to insufficient resource provision. A conclusion is made about the possibilities of increasing the level of development of the regional healthcare as a result changes in the industry through integration of medical science and practical healthcare, active implementation of innovations, digitalization, public-private partnership tools that contribute to preservation of the human potential and strengthening the socio-demographic, economic security of the region.