Russian Health Care System Research Articles

Теоретико-методологические основы компаративного анализа систем здравоохранения в мире

The article examines and examines the research of foreign specialists in the field of economics and healthcare organization, who used a comparative approach to analysis in their works. The article examines the features of the application of mechanisms and models of health management characteristic of different countries, studied the experience of the UK, USA, Sweden, Finland, Germany and Japan. The article systematizes the views of scientists on the problem of applying comparative research in the field of healthcare. The article defines generalizations that characterize almost all existing healthcare systems in the world today. Studies are shown that allow us to identify common principles of the organization of health systems in the world, but, at the same time, to identify specific regional and national conditions that become the basis of existing regional, subnational and national health systems. In Russia, at the same time, the healthcare system includes an insurance component and private medicine. The development of the modern healthcare system in Russia can be assessed as not very positive, since with a general reduction in the number of medical personnel and the number of medical institutions in the 90s, this trend is currently continuing, albeit in a more smoothed form. A common place in the development of the healthcare system remains the growth of paid medical services and the orientation of sectoral public authorities in the direction of the development of the health care market with the strengthening of the role of the private sector. The healthcare system is undergoing, on the one hand, an upswing due to the growth of investments caused by coronavirus infection (buildings and entire complexes are being built and repurposed to combat it), and, on the other hand, especially for "traditional" diseases, the trend outlined in previous years continues.

Medical personnel potential of the regional healthcare system: risks and development opportunities

The current period of development of the Russian healthcare system is characterized as a crisis, which is primarily due to the personnel imbalance. The authors, on the basis of a medical and statistical study of the staffing of medical organizations in the Saratov region, revealed the presence of structural imbalances: both between the actual population of the region and the staffing of the healthcare system with medical personnel in general, and between the indicators that characterize the staffing of organizations providing primary healthcare and specialized medical care with medical personnel. In regional healthcare, with a general shortage of medical personnel in the state health system (-986 doctors), there is a particularly pronounced shortage of polyclinic doctors (-986 doctors, mostly district pediatricians and internists), with a slight surplus of doctors in inpatient medical organizations (+91 people). The personnel shortage in the primary health care system determines a decrease in the level of its availability and quality and is a key risk factor for the reputational losses of the regional health care system.

Economic development trends and aspects of healthcare reform in Russia under COVID-2019 pandemic

The article is aimed at studying the state of the Russian economy and health care system before and after the COVID-2019 pandemic, identifying the main trends in the economy and health care, regardless of the pandemic, as well as its impact on the socioeconomic development of the country. The interrelation and mutual influence of the levels of development of the economy and health care of the country is noted. An analysis of the state of the economy and health care system in Russia for 2017–2019 is presented, problems and achievements in the pre-pandemic period are identified. The COVID-2019 pandemic is considered not only from the point of view of a medical manifestation but as a powerful trigger that provoked large-scale socioeconomic changes in the world, as a bifurcation point in world development, requiring states to objectively assess the state of the economy and healthcare, revise the current coordinate system, getting out of the state of uncertainty and choosing promising areas of socioeconomic development. A cross-country analysis of the response of various health systems to the COVID-19 pandemic has shown the advantages of countries with centralized management, health financing, and subordinate sanitary and epidemiological services. Along with the achievements of Russia in the fight against COVID-19, the existing specific problems of the domestic health care system are noted, which negatively affected the preparedness for a pandemic. Analyzed the consequences of the COVID-2019 pandemic for the socio-economic state of countries at the global level. The change in socio-economic indicators in Russia in 2020 compared to 2019 is presented as a result of the consequences of the COVID-2019 pandemic. The main results of the study are to identify the main trends in the development of the economy and the healthcare system in Russia in the context of the ongoing COVID-2019 pandemic, defining the directions of reforming the national healthcare, trajectories of increasing the level of socioeconomic development of the country

Clinical and economic aspects of the use of OneTouch glucose meters for the screening of diabetes mellitus

Diabetes is increasingly widespread in the Russian Federation. It is a severe chronic disease that both independently reduces quality of life and causes exacerbation of other pathologies. This makes evaluation of quality of diabetes management and understanding of clinical and economic properties of various technologies used to screen blood glucose levels, including portable blood glucose meters. Previously there already were clinical-economic evaluations of blood glucose meters within context of Russian Federation but they have not included modern high-precision equipment, thus ensuring attractiveness of current research effort into HTA of modern blood glucose meters that accounts for real life hospital practice. Goal. To assess the clinic-economic properties of modern blood glucose portable measurement systems of OneTouch family and the real-world practics of their use in Russian healthcare facilities. Methodology. The research was performed from the perspective of the Russian healthcare system. Target population was represented by a virtual cohort of 100 patients. Only direct costs were accounted for, specifically all costs caused by consumables involved in operating multifunctional laboratory complexes and all consumables involved in operating portable glucose meters. Employee salaries were also included (accounting for number of personnel involved in different procedures as based on a real clinical practice survey performed as part of this research). Since it is known that modern, standard-compliant portable glucose meters have an accuracy that is more than sufficient for routine screening, cost minimization analysis was used for assessment of economic effects when comparing different approaches to organizing glucose level screening. Research results. The survey during this research effort has indicated that not all medical facilities utilize “tandem usage” of multifunction laboratory complexes and portable glucose meters, however, such “tandem use” is the most widespread approach to organizing blood glucose screening. Cost minimization analysis has demonstrated that “tandem usage” is also the most economically attractive approach and results in cost savings for the medical facility. Conclusions. Current research effort which included cost analysis and cost minimization analysis has demonstrated that “tandem usage” approach which involves combined use of both multifunction laboratory complexes and portable glucose meter systems has substantial economic advantage (over 60 % for analysis with 5 year time horizon). Multiple sensitivity analyses have confirmed robustness of this result. This research further establishes the importance of communicating advantages of modern portable glucose meters to healthcare organizers since this technology is not only clinically rational but also economically optimal.

Partnership in Healthcare System Sustainability and Resilience: Russian Healthcare System Analysis

Background. In 2020 the global community faced a serious unexpected challenge COVID-19. Fighting the aggressive spread of the coronavirus required rapid reconfiguration of the Russian healthcare system, while exposing its weak spots and pressure points. Critical evaluation of the Russian healthcare systems resilience to crises offers new perspectives on the most effective management and organizational solutions for resolving this crisis. Research objective. The main goal of this study is to make a significant long-term contribution to the Russian healthcare system by developing a set of recommendations for increasing the systems sustainability and resilience to crises. Methods. For this study, specialists developed a framework that includes a set of questions in the 1) domains of governance, 2) financing, 3) workforce, 4) medicines and technology and 5) service delivery, which align closely with the well-recognised WHO health system building blocks. In each domain, a series of targeted questions concerned both sustainability and resilience. Findings. The main areas of work for increasing the Russian healthcare systems sustainability and resilience to crises include: adapting the existing legislative framework to the current crisis, and to prepare it for similar crises in the future; increasing healthcare funding; improving the image of the medical profession; promoting healthcare digitalization; reducing the pressure on the inpatient and emergency care services by strengthening preventive and rehabilitative care services. Conclusion. The synthesis and analysis of materials relevant to understanding the impact of the coronavirus pandemic on the Russian healthcare system, supplemented by expert assessments and examples drawn from practice, allowed the authors to compile a list of recommendations for ensuring the healthcare systems sustainability and resilience to future crises. This list offers potential for healthcare industry development.

Development of Telemedicine in Russia: A Consumer View

Introduction: One of the most significant trends in the global and Russian healthcare system is its digitalization. The COVID-19 pandemic has only given more importance and accelerated this process. The worldwide demand for telemedicine services has grown considerably. Yet, among Russian citizens e-health is not very popular. Besides, the use of telehealth gives rise to controversial issues as to the boundaries of its application. Objective: To analyze the attitude of various socio-demographic groups of Russian people to telemedicine and perspectives on its use. Methods: The article is based on the results of a sociological study aimed to establish the attitude of citizens to telemedicine. In order to obtain empirical information, an all-Russian sociological survey of the population representing various socio-demographic groups was carried out in April 2021. The survey method was a formalized personal interview at the place of residence of the respondents. Results: The study showed that few respondents had ever made use of telemedicine opportunities so far. At the same time, the low level of e-health use was accompanied by a very restrained attitude of the respondents to practicing it in the future. Conclusion: According to the data obtained, having a higher level of education allows citizens to integrate much more easily into innovative projects, including those in the digital space. Personal experience of using digital (e-health) technologies determines a more loyal attitude and greater interest of consumers to its potential use. The attractiveness of telemedicine opportunities is mostly attributed to complicated formal administrative procedures of obtaining medical certificates, referrals, and sick leaves offline. However, Russians are still wary of the possibilities of having the first consultation or monitoring their well-being and condition during the online treatment process. The majority of the respondents did not accept the diagnosis and the choice of treatment by means of telecommunications

PP219 Combining Healthcare Solutions For Cataract Surgery. An Incremental Benefit Analysis From The Perspective Of The Russian Healthcare System

IntroductionRising health expenditures lead to increasing budgetary pressures, which often manifest in budget managers seeking more for the same resources or trying to maintain the status quo with less. Consequently, enablers that drive efficiencies throughout the entire care pathway have come under increasing focus. This is particularly true in the operating room (OR) setting where considerations around operational efficiency, clinical excellence, and patient-centered care pose challenging questions. While a comprehensive solution set should be formulated, small parts of the solution can be applied now to prime systems for easy integration into future solutions. The objective of this analysis was to estimate the impact of combining custom healthcare solutions for cataract surgery from the perspective of a Russian hospital.MethodsA decision-analytic model was developed to assess the aggregated impact of combining the following products or services for cataract surgery: an intraocular lens delivery-system; process-redesign; a phacoemulsification machine; and a phaco tip. The model and underlying assumptions were validated by clinical experts. OR time-savings was chosen as the variable of efficiency underpinning the analysis. Inputs were estimated from the literature, expert opinion, and the local cost databases. Two scenarios were defined that reflected technologies commonly used in surgical practice. The model scenarios assumed that a hospital performs 2,000 cataract procedures per year, with 100 percent adoption and equal acquisition costs.ResultsChoosing a combination of healthcare solutions for cataract surgery was associated with an incremental benefit of RUB5,935,982 per year (EUR71,364) and generated an OR time saving of approximately 237 cataract procedures.ConclusionsThis analysis highlighted that, compared with treating technologies on an individual level, combining healthcare solutions commonly used for cataract surgery has the potential to drive efficiencies and cost savings for hospitals and to reduce surgical wait lists.

Cervical cancer in the Russian Federation and the risks of vaginal fistula

This review aims to provide up-to-date information on the factors associated with an increased risk of vaginal fistula in women with cervical cancer, as well as on methods of their prevention and treatment. It includes data on various types of vaginal fistulas in cervical cancer patients and risk factors for their development, according to foreign and Russian research articles published over the last 20 years. Cervical cancer is one of the most challenging oncological diseases in the Russian Federation, because it is detected at stage III–IV in more than 30 % of women. Such a high incidence of cervical cancer and the need for radiotherapy determine high risk of fistulas, which significantly impairs the quality of life. Thus, identification of factors associated with vaginal fistulas, as well as methods of their prevention and treatment remains a highly relevant task for the Russian healthcare system.

Emigration of Russian doctors abroad: reasons and potential of reemigration

The article presents the results of an empirical study. The aim of the study is to identify the real factors of the emigration of Russian doctors abroad in the period from 2013 to 2019. The theoretical part of the study was built within the framework of a sociological approach. The theory of “attraction and pushing” by Everett Lee was taken as a basis. In the course of the study, 10 in-depth interviews were conducted with Russian doctors who at the time of the study were permanently living and working abroad. The uniqueness of the results of this study lies in the fact that the empirical object of the study is not doctors who want to go abroad, but doctors who have already moved and at the time of the study are permanently residing abroad. In each interview, questions were asked on the following topics: reasons for moving from Russia, how was the decision-making process to move, how the respondent chose a country for a new place of residence, what were the costs of moving, the respondent’s attitude to the Russian healthcare system, the question of returning to Russia.The article is divided into two parts. The first part provides a detailed analysis of the research results with quotes from respondents. The second part describes 4 groups of identified factors of emigration of Russian doctors: pull factors abroad in general, pull factors in the healthcare system abroad, push factors in Russia as a whole, push factors in the healthcare system in Russia. According to the results of the study, it was revealed that the push factors of the emigration of Russian doctors abroad over the attractive ones. Extremely low return migration attitudes have been identified. Also, no significant impact of socio-political and natural-climatic factors of pushing out on the process of emigration of Russian doctors was revealed.

Modern Development Problems of Russian Healthcare (Part 1).

—The paper (part 1) analyzes the dynamics of indicators characterizing the state of health of the Russian population. A comparative analysis of the development of healthcare in Russia and other countries is carried out. The conclusion is confirmed that the main problem in the development of Russian healthcare is the insufficient volume of public funding. The drawbacks and limited potential of the adopted funding model are assessed. A possible way to increase public funding is proposed. It is shown that the availability of medical care is reduced as a result of the so-called optimization of healthcare. A possible way to improve the territorial organization of medical services is considered. The effectiveness of the Russian healthcare system in the fight against the coronavirus pandemic is assessed.

The financial mechanisms in health care system and medical services

The article considers financial mechanisms applied in provision of medical services in the Russian health care system. The data concerning the structure of state financing and personal expenses of Russian citizens in health care system is presented. The financial resources in the Russian health care system are formed on the basis of mixed model consisting of personal funds of citizens (private sources of financing) and public funds allocated by budget system to implement the program of state guarantees of free medical care to citizens. Nowadays, the citizens have an opportunity to pay the cost of medical services directly when applying to medical organizations and through medical insurance organization, purchasing voluntary medical insurance policy and visiting medical organizations when insurance case occurred. The key goal of financial policy in concerning health care is the implementation of directions contributing to increase of financial sources in the system of medical services provision, population health support and improving efficiency of financial mechanisms application. The effectiveness of use of financial resources in health care determines the efficiency of impact of financial policy on national economy.

The image of the Russian health care in information field during second wave of COVID-19

The article presents the results of restudy of the Russian health care information field, carried out during the second wave of COVID-19 in the mass media database "Medialogia" and in the search engine "Yandex" from October 1, 2020 to January 31, 2021. The comparative analysis of the results of the study with previous measurements taken from December 1, 2019 to May 15, 2020 was implemented. The results of the study are a portion of panel study of the Russian health care system image and can be used hereinafter by interested structures with the view of its adjustment.

The economic analysis of provision of medical services via medical insurance in Russia

The article demonstrates that the restrictions introduced during the coronavirus pandemic affected the dynamics of mutual settlements between the territorial funds of the mandatory medical insurance (MMI, TFMMI). According to the results of the first nine months of 2020, medical institutions of a number of subjects were not able to earn even a half of the amount of sum that was presented for payment in 2019 on medical care support of patients from other regions. It was established that besides such relevant features of the Russian health care system as large territory, fragmentation of population, necessity to maintain a number of state medical institutions, there is also a number of factors that during the pandemic were most aggravated in those "weak" places in the MMI system that have been stagnating for a long time. Among them, insufficiently large listing of medical services covered by MMI, inability to provide medical services to all those in need due to shortage of equipment, working areas, qualified care, etc. It is noted that among the general trends of MMI, the Russian medical insurance system (not only that it is not a classical one), especially during the pandemic, is broken out of social insurance: two funds, structures, costs of informatization, etc. However, in Russia, even in such conditions, health care is funded through the MMI system up to 50%. The pandemic demonstrated that no private sector, no paid services, no commercial insurance companies can cover the whole spectrum of health care complicities during the pandemic crisis. Namely, the MMI system bore the brunt of the survival of medicine during the pandemic. It is concluded that namely the need in medical institutions with sufficient reserve of bed fund with MMI services can input into development of necessary stable basis for survival in difficult conditions of pandemic crisis. The proposal of the Audit Chamber of the Russian Federation of further reforming of the mandatory medical insurance system is considered reasonable and logical especially in difficult situation of struggle against COVID-19. The article also presents data concerning the state of MMI in 2020, at the height of the pandemic crisis in the regions of the Russian Federation.

Pharmacoeconomic aspects of the therapy for moderate and severe psoriatic arthritis

Objective: to perform cost-effectiveness analysis of the treatment for adult patients with psoriatic arthritis (PsA) with a Russian interleukin- 17А inhibitor netakimab in comparison with other biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) and to evaluate the influence of the inclusion of netakimab in the therapy for PsA on the budget of the Russian healthcare system.Material and methods. The evaluation of cost-effectiveness was performed from the position of the Russian healthcare system for patients with moderate and severe PsA. The evaluation was performed based on the results of the network meta-analysis of the randomized clinical studies. The criterion of clinical effectiveness included the changes in the condition of the joints by the criteria of the American College of Rheumatology (ACR20, ACR50, and ACR70) and changes in skin symptoms by the index of the prevalence and severity of psoriasis (PASI 75 and PASI 90) with a recalculation into quality-adjusted life-year (QALY). The time horizon of the cost-effectiveness analysis was 2 years. The calculation was based on the registered prices and VAT. If there was an original drug and a biosimilar registered on the pharmaceutical market, the calculation was based on the median of the registered prices. The budget impact analysis of the influence of netakimab inclusion in the therapy for patients with PsA was performed considering the structure of the prescription of bDMARDs and tsDMARDs that was determined in the pharmaco-epidemiological study conducted in the Russian Federation in 2020. The analysis was performed for patients that received medication by the scheme of reimbursement. The time horizon of the study was 3 years old.Results. In the base-case analysis, the cost-effectiveness ratio for netakimab was 1.210 mln rub/QALY (by 66.2–88.5% lower than in cases when comparison drugs were used). The budget impact analysis showed that the inclusion of netakimab in the therapy for PsA could reduce the costs by 376.60 mln rub (21.1%). Considering budget saving, the number of additional patients that can be treated will increase by 26.7% within 3 years.Conclusion. Netakimab is characterized by higher cost-effectiveness in comparison with other bDMARDs (adalimumab, golimumab, guselkumab, ixekizumab, infliximab, secukinumab, ustekinumab, certolizumab pegol, etanercept) and tsDMARDs (apremilast, tofacitinib) prescribed in the Russian Federation for patients with PsA. The inclusion of netakimab in the therapy for PsA will reduce the financial burden on the healthcare system.

Financial Risk Protection and Unmet Healthcare Need in Russia.

Achieving universal health coverage (UHC) includes financial risk protection. To date, catastrophic healthcare expenditure (CHE), the impoverishing effect of out-of-pocket (OOP) healthcare payments, and unmet healthcare need are the most widely used indicators for assessing the financial risk protection of a healthcare system. This study aimed to estimate the Russian healthcare system's financial risk protection by focusing on CHE, OOP and unmet healthcare need. The study used eight waves of the Russia Longitudinal Monitoring Survey (RLMS) (2010-2017) to analyze the financial risk protection of the Russian healthcare system. Commonly used indicators - CHE, both incidence and intensity, the impoverishing effect of CHE and unmet need -were used. We found low incidence and intensity of CHE in the Russian Federation. Our results are robust to various definitions of CHE (eg, as a share of total household expenditure or total household income). Furthermore, the impoverishing effect of OOP healthcare payments remains limited, despite the most recent economic slowdown (2014- 2016). This could be explained by a noticeable reduction in CHE during the crisis years, as postponing healthcare was adopted as a coping mechanism, particularly among households heavily affected by the crisis. As stressed by the UHC framework, our findings suggest that CHE only partly captures inefficiencies and inequities in coverage, because one tenth of households forwent medical care for medicines and certain services. As spending on medicines and dental care are the main drivers of CHE, policy interventions should focus on extending coverage for pharmaceutical and dental care and target financial barriers to seeking care, particularly for the poor and vulnerable.

The prospective directions of development of entrepreneurship in health care of the Russian Federation

The analysis of international data established that the national indicator of population health quality in the Russian Federation is significantly lower than in the EU, the USA and Canada. In this regard, the urgency of enhancement of state policy concerning updating and promoting development of national health care system,involving available resources of the public and private health sectors is obvious. The development of entrepreneurship in health care should be considered as a mean of improving social and economic efficiency of health care system in Russia. The purpose of study was to analyze perspective directions of development of entrepreneurial initiatives in national health care. On the basis of analysis of corresponding normative legal acts and publications, it is demonstrated that in national health care system prerequisites are establishing to implement new opportunities for patient-oriented entrepreneurial activities associated with development of digital technologies, e-Health, new forms of public-private partnership focused primarily on prevention and rehabilitation of patients.

Protecting of medical workers from attack: problems of constitutional provision

The article is devoted to the study of the problem of ensuring the protection of medical workers from the encroachments of patients and their relatives in the Russian health care system, the study of the level of awareness of physicians about the mechanism for protecting their rights in case of conflict situations when providing medical care to patients. As a result of the conducted research, the authors come to the conclusion that it is necessary to improve the legal literacy of physicians, provide the necessary level of material and technical support for medical workers with modern means of self-defence, and improve the legal regulation of the safety of medical activities. The proposed measures will increase the effectiveness of the implementation of the protection of the rights of medical workers and will become a means of preventing encroachments on them in the health care system. Fostering a respectful attitude of patients to medical professionals, increasing the prestige of the profession in society is an important component of preventing attacks on health workers.

The state of transformations in the healthcare system of the Russian Federation

The study is devoted to the analysis of the implemented measures in relation to the healthcare sector in the Russian Federation, which are designed to improve the standard of living of citizens. In particular, the state program of the Russian Federation «Development of Healthcare» is considered. The paper analyzes the quantitative statistical indicators that most representatively reflect the results achieved at the present stage. The aim of the work is also to identify how the Russian healthcare system is currently being transformed and what prospects are provided by the state. The purpose of the study: To analyze the process of implementation of state programs in the field of healthcare in terms of quantitative and qualitative characteristics of their implementation. Materials, methods and conditions of research. The materials of the implementation of the state program «Development of Healthcare», the national project «Healthcare», the statistical yearbooks of the Federal State Statistics Service for 2018–2020, as well as statistical information from the databases of Rosgosstat of the Russian Federation were studied. Objectives of the study: to analyze and evaluate the state of ongoing transformations in the Russian healthcare system, by identifying the main directions of development, as well as analyzing relevant statistical data. Research perspective. At present, the problem of health development is more urgent than ever, and the problem is becoming particularly acute, against the background of the spread of the COVID-19 virus pandemic. For rapid response and elimination of hotbeds of infection, it is necessary to provide the population with sufficient basic parameters for providing medical services. Therefore, it is important to analyze how effective the actions of the state are to increase the ratio of the number of doctors to the number of the population. At the same time, it is necessary to consider the opportunities for motivating employees in this field, which are currently created.

Personnel development potential of the regional health system represented by health care organizers: based on the results of an expert focus group study

The article analyzed personnel crisis problem in the modern healthcare system in Russia on the basis of the results of a focus group study. Accordingly, the formation and severity of the crisis at both regional and national healthcare system are influenced by the migration of medical personnel (from one regional center to another, other Russian regions, and overseas), disproportion in the number of doctors of some clinical specialties (such as dentists and dermatovenerologists) over the actual staffing needs of a regional health center, and shortage of middle and junior medical personnel in regional medical organizations that leads to an increase in the burden on doctors, and existing discrepancies between the requirements of the labor market in terms of work experience among young specialists and its actual absence among graduates of medical universities.

DEVELOPMENT OF THE HEALTHCARE SYSTEM BASED ON THE CLUSTER APPROACH

The study substantiates the possibility of the cluster approach for the development of the healthcare system in Russia. The analysis of foreign experience in the functioning of medical clusters made it possible to identify factors that contribute to their successful development. Based on the assessment of the domestic practice of creating clusters in the healthcare sector, their typification was carried out with the identification of groups of high-tech clusters of biomedical technologies and innovations, medical clusters of drug provision and specialized equipment, clusters of medical services, internships and transfer of medical innovations. The grouping of clusters in the healthcare sector operating in the Russian Federation according to the proposed types showed that there are practically no clusters of medical services that are able to bring the quality of medical care to the population to a higher level in the country. The article identifies the problems that prevent the formation of clusters of medical services on the territory of the regions. To solve these problems, an approach was proposed to create a medical technology park on the basis of public-private partnership, which will serve as the basis for a cluster of medical services and built its structural and functional model.